Development of a continuum manipulator with variable bending length and piecewise stiffness for transoral laryngeal surgery.

PURPOSE: Continuum manipulators (CMs) show great potential in transoral laryngeal surgery due to their flexibility. However, CMs for transoral surgery face several issues: large size, which reduces practicality; intersegment coupling, which causes undesired deflection; and a lack of versatility that limits their applicability across different patient groups. METHODS: This work combines a rod-driven proximal segment and a cable-driven distal segment to achieve piecewise stiffness, alleviating the issue of intersegment coupling. A rigid constraint tube is integrated into the proximal segment to diversify its bending behavior. Preliminary experiments are conducted to validate the design concept. RESULTS: The proposed CM has an overall diameter of only 6.5 mm. The proximal segment can achieve a 90° bending with various curvatures. At the working configuration, the coupling error between the proximal segment and the distal segment is less than 1 mm. The effectiveness of the proposed CM is successfully validated using a human model. CONCLUSION: The proposed continuum manipulator possesses the desirable characteristics of small size, low coupling, and high versatility, indicating its great potentialities for the diagnosis and treatment of laryngeal lesion.

Design and navigation method of a soft robot for single-port transvesical radical prostatectomy.

PURPOSE: Currently, the rigid instruments used for laparoscopic radical resection of prostate cancer not only have the risk of damage to tissues, blood vessels, and nerves, but their limited freedom will also cause surgical blind areas. Soft robots are expected to solve these issues due to inherent flexibility, compliance, and safe interaction with tissues and organs. In addition, to achieve high surgical accuracy and provide precise guidance for surgeons, the navigation method should be studied for the soft robot. METHODS: A soft robot system for single-port transvesical radical prostatectomy (STRP) is developed, and a navigation method combining fiber Bragg gratings and electromagnetic tracking is proposed for the soft robot. To validate the soft robot design and the effectiveness of the navigation method, different groups of experiments are conducted. RESULTS: The proposed navigation method can achieve accurate location and shape sensing of the soft manipulator. The experiments show that the maximum tip sensing error is 2.691 mm, which is 5.38 % of the robot length for static configurations, and that the average tip sensing error is 1.966 mm, which corresponds to 3.93 % of the robot length for dynamic scenarios. Additionally, phantom tests demonstrate that the designed soft robot can enter the prostate through navigation guidance in a master-slave control mode and cover the entire prostate space. CONCLUSIONS: The designed soft robot system, due to its soft structure, good flexibility, and accurate navigation, is expected to improve surgical safety and precision, thereby exhibiting significant potential for STRP.

Improved precise guidewire delivery of a cardiovascular interventional surgery robot based on admittance control.

PURPOSE: The development of cardiovascular interventional surgery robots can realize master-slave interventional operations, which will effectively solve the problem of surgeons being injured by X-ray radiation. The delivery accuracy and safety of interventional instruments such as guidewire are the most important issues in the development of robotic systems. Most of the current control methods are position control or force feedback control, which cannot take into account delivery accuracy and safety. METHODS: A cardiovascular interventional surgery robotic system integrated force sensors is developed. A novel force/position controller, which includes a radial basis function neural networks-based inner loop position controller and a force-based admittance outer loop controller, is proposed. Furthermore, a series of simulations and vascular model experiments are carried out to demonstrate the feasibility and accuracy of the proposed controller. RESULTS: The designed cardiovascular interventional robot is flexible to enter the target vessel branch. Experimental results indicate that the proposed controller can effectively improve the delivery accuracy of the guidewire and reduce the contact force with the vessel wall. CONCLUSIONS: The proposed controller based on radial basis function neural network and admittance control is effective in improving delivery accuracy and reducing contact force. The algorithm needs to be further validated in vivo experiments.

Perturbing BEAMs: EEG adversarial attack to deep learning models for epilepsy diagnosing.

Deep learning models have been widely used in electroencephalogram (EEG) analysis and obtained excellent performance. But the adversarial attack and defense for them should be thoroughly studied before putting them into safety-sensitive use. This work exposes an important safety issue in deep-learning-based brain disease diagnostic systems by examining the vulnerability of deep learning models for diagnosing epilepsy with brain electrical activity mappings (BEAMs) to white-box attacks. It proposes two methods, Gradient Perturbations of BEAMs (GPBEAM), and Gradient Perturbations of BEAMs with Differential Evolution (GPBEAM-DE), which generate EEG adversarial samples, for the first time by perturbing BEAMs densely and sparsely respectively, and find that these BEAMs-based adversarial samples can easily mislead deep learning models. The experiments use the EEG data from CHB-MIT dataset and two types of victim models each of which has four different deep neural network (DNN) architectures. It is shown that: (1) these BEAM-based adversarial samples produced by the proposed methods in this paper are aggressive to BEAM-related victim models which use BEAMs as the input to internal DNN architectures, but unaggressive to EEG-related victim models which have raw EEG as the input to internal DNN architectures, with the top success rate of attacking BEAM-related models up to 0.8 while the top success rate of attacking EEG-related models only 0.01; (2) GPBEAM-DE outperforms GPBEAM when they are attacking the same victim model under a same distortion constraint, with the top attack success rate 0.8 for the former and 0.59 for the latter; (3) a simple modification to the GPBEAM/GPBEAM-DE will make it have aggressiveness to both BEAMs-related and EEG-related models (with top attack success rate 0.8 and 0.64), and this capacity enhancement is done without any cost of distortion increment. The goal of this study is not to attack any of EEG medical diagnostic systems, but to raise concerns about the safety of deep learning models and hope to lead to a safer design.

Learning-Based Multimodal Information Fusion and Behavior Recognition of Vascular Interventionists' Operating Skills.

The operating skills of vascular interventionists have an important impact on the effect of surgery. However, current research on behavior recognition and skills learning of interventionists' operating skills is limited. In this study, an innovative deep learning-based multimodal information fusion architecture is proposed for recognizing and analyzing eight common operating behaviors of interventionists. An experimental platform integrating four modal sensors is used to collect multimodal data from interventionists. The ANOVA and Manner-Whitney tests is used for relevance analysis of the data. The analysis results demonstrate that there is almost no significant difference ( p <0.001) between the actions related to the unimodal data, which cannot be used for accurate behavior recognition. Therefore, a study of the fusion architecture based on the existing machine learning classifier and the proposed deep learning fusion architecture is carried out. The research findings indicate that the proposed deep learning-based fusion architecture achieves an impressive overall accuracy of 98.5%, surpassing both the machine learning classifier (93.51%) and the unimodal data (90.05%). The deep learning-based multimodal information fusion architecture proves the feasibility of behavior recognition and skills learning of interventionist's operating skills. Furthermore, the application of deep learning-based multimodal fusion technology of surgeon's operating skills will help to improve the autonomy and intelligence of surgical robotic systems.

Continuum robots for endoscopic sinus surgery: Recent advances, challenges, and prospects.

PURPOSE: Endoscopic sinus surgery (ESS) has been recognized as an effective treatment modality for paranasal sinus diseases. Over the past decade, continuum robots (CRs) for ESS have been studied, but there are still some challenges. This paper presents a review on the scientific studies of CRs for ESS. METHODS: Based on the analysis of the anatomical structure of the paranasal sinus, the requirements of CRs for ESS are discussed. Recent studies on rigid robots, handheld flexible robots, and CRs for ESS are presented. Surgical path planning, navigation, and control are also included. RESULTS: Concentric tube CRs and cable-driven CRs have great potential for applications in ESS. The CRs incorporated with multiple replaceable arms with different functions are preferable in ESS. CONCLUSION: Further study on navigation and control is required to improve the performance of CRs for ESS.

Design and path tracking control of a continuum robot for maxillary sinus surgery.

PURPOSE: Continuum robots (CRs) have been developed for maxillary sinus surgery (MSS) in recent years. However, due to the anatomically curved and narrow pathway of the maxillary sinus and the deformable characteristics of the CR, it is still a challenge to accurately approach the target in the sinus. Thus, the CR-assisted MSS demands further research, whether in robotic system design or in reliable motion control. METHODS: A continuum robotic system integrated with essential instruments and sensors for MSS is developed, and the path tracking control of the designed CR is studied. The differential kinematic model of the CR is constructed. By analyzing the potential problem of the traditional Jacobian-based control, an iterative Jacobian transpose-based closed-loop control method is proposed to improve the path tracking performance. To validate the design of the CR and the effectiveness of the proposed control scheme, different groups of experiments are performed. RESULTS: With the proposed method, the path tracking performance of the CR is improved. Compared with the open-loop Jacobian transpose-based control method, the path tracking error of the proposed method is much less. The maxillary sinus phantom tests are conducted to verify the reachability of the designed CR. Given the reference path from the nostril to the target in the maxillary sinus phantom, experiments show a mean error of 0.96 mm. CONCLUSIONS: The designed CR is slender, flexible, and able to smoothly approach the target in a tortuous and constrained environment without colliding with or damaging the surrounding tissue. The designed continuum robotic system and the proposed iterative Jacobian transpose-based closed-loop control strategy have great potential for MSS. The limitations of the proposed method are also discussed.

Recent trends in the incidence and survival of stage I liver cancer: a surveillance, epidemiology, and end results analysis.

BACKGROUND: Improvements in screening and imaging technologies and treatment of liver disease have influenced the trend in diagnosis for stage I liver cancer. In this article, recent trends in age, incidence, tumour size, and survival of different stages of liver cancer are analysed. METHODS: Surveillance, Epidemiology, and end results data from the National Cancer Institute were used to analyse trends in age-adjusted incidence rate, mean tumour size at diagnosis, age at diagnosis, and 5-year survival probability for stage I liver cancer. RESULTS: Stage I cases of liver cancer increased most tremendously over the study period, with a greater increase from 2004 to 2012 following a smaller increase from 2012 to 2015. Moreover, the mean age of stage I liver cancer increased by 1.72 years from 2004 to 2015. The 5-year-overall survival for stage I liver cases worsened from 97.9% to 83.7% from 2004 to 2011, whereas the 10-year survival probability for stage I cases worsened from 97.3% in 2004 to 79.6% in 2006. Comparing with higher stage cases, stage I liver cancer were more likely to be females, be married, live in metro areas, receive chemotherapy, and carry medical insurance. CONCLUSIONS: The incidence of stage I liver cancer has increased over the study period, with an increase in age of diagnosis, decrease in tumour size, and generally stable overall survival rate with slight decrease. These trends emphasized the importance of early detection of liver cancer and regular screening and better treatment for high-risk populations.RESEARCH HIGHLIGHTSImprovements in screening and imaging technologies and treatment of liver disease have influenced the trend in diagnosis for liver cancer.Stage I cases of liver cancer increased most tremendously over the study period, with a greater increase from 2004 to 2012 following a smaller increase from 2012 to 2015.These trends emphasized the importance of early detection of liver cancer and regular screening and better treatment for high-risk populations.

MiR-448 suppresses cell proliferation and glycolysis of hepatocellular carcinoma through inhibiting IGF-1R expression.

Background: Microribonucleic acids (miRNAs) have been shown to play important roles in hepatocellular carcinoma (HCC) progression. MiR-448 has frequently been shown to be a tumor suppressor, and is abnormally expressed in HCC tumor tissues. However, little is known about the role of miR-448 in HCC development. In this article, the regulatory role of miR-448 on insulin-like growth factor 1 receptor (IGF-1R) in modulating hepatoma cell viability and glycolysis was investigated. Methods: The expression of miR-448 profiles in clinical tumor tissues and cell lines was examined using quantitative real-time polymerase chain reaction (qRT-PCR). HepG2 and Huh7 cells were transfected with miR-448 mimics, inhibitors, and scramble sequences. Cell viability and apoptosis were determined by a Cell Counting Kit-8 assay and a flow cytometry analysis. IGF-1R, a potential target of miR-448, was selected following a bioinformatic analysis, and the regulatory effects of miR-448 on IGF-1R expression was confirmed by luciferase reporter assay, qRT-PCR, and western blot. Glucose uptake, lactate production, and adenosine triphosphate (ATP) generation were detected by corresponding kits. Results: Decreased miR-448 expression was observed in both HCC patients' tumor tissues and hepatoma cells in vitro. The overexpression of miR-448 in HepG2 and Huh7 cells decreased cell viability and increased apoptosis. Additionally, the overexpression of miR-448 or the knockdown of IGF-1R lowered the level of glucose uptake, lactate production, and ATP generation, while the knockdown of miR-448 increased glycolysis. Further, aberrantly expressed miR-448 downregulated IGF-1R levels, while the inhibition of miR-448 resulted in the upregulation of IGF-1R in both HepG2 and Huh7 cells. In addition, miR-448 interacted with the wild-type 3'untranslated regions (3'UTRs) of IGF-1R, but had no effect on the mutant 3'UTRs. The expression of IGF-1R was increased in HCC patients' tumor tissues and serum, and was inversely correlated with miR-448 expression. Conclusions: The increased expression of miR-448 appears to downregulate the expression of IGF-1R by interacting with the 3'UTR in HCC progression. These findings highlight its role as a potential target for HCC therapy.

Development and validation of a two-segment continuum robot for maxillary sinus surgery.

BACKGROUND: Existing rigid instruments have difficulties in backward inspection and operation. Moreover, the pathway to the maxillary sinus is curved and narrow, resulting in complex and repetitive manual operations. There is a necessity to develop a retro-flexing robot and achieve path-following motion. METHODS: A continuum robotic system is developed for maxillary sinus surgery (MSS). And the system adopts an anatomical constraint-based optimization of the follow-the-leader strategy to generate a safe control scheme along a given path. RESULTS: The accuracy of the system is evaluated, and the task of reaching deep-seated targets is performed in a constrained anatomical space. The simulations and experiments of the path-following motion have validated the feasibility of the proposed method. Furthermore, a preliminary porcine study is performed to assess the capability of instruments. CONCLUSIONS: The developed continuum robotic system can meet the requirements of MSS.

The power and the promise of circRNAs for cancer precision medicine with functional diagnostics and prognostic prediction.

Circular RNA (circRNA) is a large class of covalently closed circRNA. As a member of competitive endogenous RNA, it participates in the regulation of circRNA-miRNA-mRNA network and plays an important role in the regulation of physiology and pathology. CircRNA is produced by the reverse splicing of exon, intron or both, forming exon or intron circRNA. Studies have shown that circRNA is a ubiquitous molecule, which exceeds the linear mRNA distributed in human cells. Because of its covalent closed-loop structure, circRNA is resistant to RNase R, which is more stable than linear mRNA; circRNA is highly conserved in different species. It was found that circRNA competitively adsorbs miRNA, as a miRNA sponge, to involve in the expression regulation of a variety of genes and plays an important role in tumor development, invasion, metastasis and other processes. These molecules offer new potential opportunities for therapeutic intervention and serve as biomarkers for diagnosis. In this paper, the origin, characteristics and functions of circRNA and its role in tumor development, invasion and metastasis, diagnosis and prognosis are reviewed.

Factors affecting simultaneous nitrification and denitrification (SND) in a moving bed sequencing batch reactor (MBSBR) system as revealed by microbial community structures.

The effects of biological factors including dissolved oxygen (DO), pH, carbon/nitrogen (C/N) and hydraulic retention times (HRT) on the performance of simultaneous nitrification and denitrification (SND) in a moving bed sequencing batch reactor (MBSBR) were investigated. A low DO was found to be advantageous to the SND in that nitrification was not inhibited, while pH and C/N ratio were shown to have positive effects on SND, and HRT needed to be controlled in a suitable range. A desirable SND efficiency was obtained at a DO of 2.5 mg L-1, pH of approximately 8.0, C/N ratio of 10 and HRT of 10 h in the MBSBR. High-throughput sequencing analysis showed that different operating conditions impacted microbial communities, resulting in different nitrogen removal mechanisms. Autotrophic and heterotrophic nitrification together contributed to the good nitrification performance, while denitrification was conducted by combined anoxic and aerobic processes. Furthermore, the results of principal component analyses (PCA) and the abundance of the predominant nitrification and denitrification genera both showed that DO and HRT might be regarded as the dominant variable factors influencing community structure analysis during SND, while the linear discriminant analysis (LDA) effect size (LEfSe) algorithm showed differences in abundance among the biofilm microbial communities with different DO. Overall, the results of this study improve our understanding of the bacterial community structure with different operating conditions in MBSBRs.

Research progress and application prospect of anaerobic biological phosphorus removal.

Anaerobic biological phosphorus removal has proposed a new direction for the removal of phosphorus from wastewater, and the discovery of phosphate reduction makes people have a more comprehensive understanding of microbial phosphorus cycling. Here, from the perspective of thermodynamics, the bioreduction reaction of phosphate was analyzed and its mechanism was discussed. The research progress of phosphate reduction and the application prospects of anaerobic biological phosphorus removal from wastewater were introduced, pointing out the situation and guiding the further research in this field.

Overexpression of NEK3 is associated with poor prognosis in patients with gastric cancer.

The NIMA-related kinase 3 (NEK3) plays an important role in cell migration, cell proliferation, and cell viability. Recently, NEK3 was reported to enhance the malignancy of breast cancer. However, its role in gastric cancer has not been completely characterized. In this study, we explored the prognostic significance of NEK3 in human gastric cancer. Reverse transcription-polymerase chain reaction and western blot were performed to detect the NEK3 mRNA and protein expression in 6 paired fresh human gastric cancer tissues and surrounding normal tissues. NEK3 levels in gastric cancer and its adjacent normal samples of 168 cases were detected by immunohistochemistry, and the relationships between the NEK3 level and various clinicopathological features were analyzed. NEK3 mRNA and protein were significantly overexpressed in gastric cancer tissues, compared with adjacent normal tissues. Immunohistochemistry staining assay showed the percentage of high NEK3 expression in gastric cancer samples was higher than that in adjacent normal samples. NEK3 overexpression was significantly correlated with pT stage, pathologic TNM stage, lymph node metastasis, and poor prognosis of gastric cancer. Cox multivariate regression analyses suggested that NEK3 was an independent prognostic factor for survival of patients with gastric cancer. The data demonstrate that NEK3 is overexpressed in gastric cancer, which promotes the malignancy of gastric cancer. NEK3 may be as a prognostic biomarker and a potential therapeutic target for gastric cancer.

MicroRNA-100 suppresses human gastric cancer cell proliferation by targeting CXCR7.

microRNAs (miRs) are a class of small non-coding RNAs that have been demonstrated to have a crucial role in tumorigenesis of human cancers, including gastric cancer (GC). Previous results have established that miR-100 participated in the development of GC; however, the underlying mechanism remains largely unknown. The preesent study utilized reverse transcription-quantitative polymerase chain reaction to analyze the expression of miR-100 in GC tissues and adjacent normal tissues. The present results indicated that the expression of miR-100 was downregulated in GC tissues when compared to the adjacent normal tissues. Furthermore, low miR-100 expression was observed to be associated with lymph node metastasis, tumor diameter and tumor stage. In addition, Kaplan-Meier analysis revealed that patients with low miR-100 expression tended to have a shorter overall survival. The miR-100 was further identified as an independent prognostic factor for overall survival. Notably, the levels of chemokine (CXC motif) receptor 7 (CXCR7) were inversely correlated with miR-100 in GC cell lines. Furthermore, miR-100 overexpression or CXCR7 depletion decreased in vitro GC cell proliferation. Bioinformatics analysis indicated that miR-100 may bind to the 3'-untranslated region of CXCR7 to prevent the initiation of protein translation. Thus, miR-100 may function as a tumor suppressor in GC, partly by regulating the expression of CXCR7, and the regulation of miR-100 expression may be a potential strategy for the treatment of GC patients.

The effect of dissolved oxygen concentration (DO) on oxygen diffusion and bacterial community structure in moving bed sequencing batch reactor (MBSBR).

The effect of dissolved oxygen concentration (DO) on simultaneous nitrification and denitrification was studied in a moving bed sequencing batch reactor (MBSBR) by microelectrode measurements and by real-time PCR. In this system, the biofilm grew on polyurethane foam carriers used to treat municipal sewage at five DO concentrations (1.5, 2.5, 3.5, 4.5 and 5.5 mg/L). The results indicated that the MBSBR exhibited good removal of chemical oxygen demand (92.43%) and nitrogen (83.73%) when DO concentration was 2.5 mg/L. Increasing the oxygen concentration in the reactor was inhibitory to denitrification. Microelectrode measurements showed that the thickness of oxygen penetration increased from 1.2 to 2.6 mm when the DO concentration (from 1.5 mg/L to 5.5 mg/L) in the system increased. Oxygen diffusion was not significantly limited by the boundary layer surrounding the carrier and had the largest slope when DO concentration was 2.5 mg/L. The real-time PCR analysis indicated that the amount of the ammonia-oxidizing bacteria and nitrite-oxidizing bacteria increased slowly as DO concentration increased. The proportions of ammonia-oxidizing bacteria and nitrite-oxidizing bacteria, as a percentage of the total bacteria, were low with average values of 0.063% and 0.67%, respectively. When the DO concentration was 2.5 mg/L, oxygen diffusion was optimal and ensured the optimal bacterial community structure and activity; under these conditions, the MBSBR was efficient for total inorganic nitrogen removal. Changing the DO concentration could alter the aerobic zone and the bacterial community structure in the biofilm, directly influencing the simultaneous nitrification and denitrification activity in MBSBRs.

Expression of GRP78 predicts taxane-based therapeutic resistance and recurrence of human gastric cancer.

Cancer cells adapt to chronic stress in the tumor microenvironment by inducing the expression of glucose-regulated protein 78 (GRP78), a major endoplasmic reticulum chaperone with Ca(2+)-binding and antiapoptotic properties. The effect in and potential role of its expression in progression of and prognosis for gastric cancer (GC) are unclear. In the present study, we investigated the clinical value of GRP78 expression in judgment of the severity of and prognosis for GC in a retrospective cohort study of 160 patients who underwent D2 radical gastrectomy and adjuvant chemotherapy. GRP78 expression was detected using immunohistochemistry. The relationships of GRP78 expression with age, sex, differentiation, invasion depth, disease stage, lymph node metastasis, and time to recurrence (TTR) were analyzed. The GRP78 expression was higher in tumors from patients with deep tumor infiltration, with poor differentiation, at late disease stages, and with lymph node metastasis than that in tumors from patients without. Also, GRP78 positivity was associated with short TTR (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.07-4.85; P=0.041). Subgroup analysis revealed that the HR in the GRP78-high group increased significantly in patients who did not receive taxane-containing regimens (HR, 2.21; 95% CI, 1.23-7.36; P=0.038). In contrast, in the patients who received taxane-based chemotherapy, the association between GRP78 positivity and increased risk of recurrence was not statistically significant (HR, 1.16; 95% CI, 0.81-2.98; P=0.111). In the patients with GRP78 expression, those who underwent taxane-containing chemotherapy had longer median TTRs than did those who did not undergo this treatment (P=0.017). Downregulation of GRP78 expression markedly inhibited proliferation of the GC cells at the G1 phase, whereas GRP78 overexpression promoted cell-cycle progression. These findings suggest that GRP78 overexpression promotes GC cells proliferation and is an independent indicator of poor prognosis for GC.

[GRP78 expression in gastric cancer and its clinical significance].

OBJECTIVE: To investigate the clinical value of the expression of glucose regulated protein 78 (GRP78) for assessment of severity, chemoresistance and prognosis in patients with gastric adenocarcinoma ( GC) . METHODS: A cohort of 237 patients with gastric cancer was included in this study. 160 patients of them were treated by D2 radical gastrectomy and adjuvant chemotherapy. The GRP78 expression was detected by immunohistochemistry and 80 patients of them were tested in vitro for cancer chemosensitivity by ATP-tumor chemosensitivity assay (ATP-TCA). In addition, the relationships were analyzed between GRP78 and age, gender, tumor differentiation, invasion, disease stage, lymph node metastasis and chemoresistance as well as disease-free survival (DFS). RESULTS: The positive rate of GRP78 expression in the gastric adenocarcinoma was 68.8% before the initiation of chemotherapy. The positive GRP78 expression was significantly correlated with tumor invasion depth, poor differentiation, TNM stages, and lymph node metastasis (all P < 0.05), not correlated with gender and age, and high GRP78 expression was associated with the chemoresistance of the gastric cancer cells to chemotherapeutic agents. Negative GRP78 expression was associated with higher sensitivity to both drugs and regimens. The DFS of GRP78-positive group and GRP78-negative group was (53.6 ± 0.9) months and (38.3 ± 0.8) months, respectively (P = 0.041). Interestingly, subgroup analysis revealed that the DFS in GRP78-negative and-positive patients treated with taxane-containing chemotherapy was (58.6 ± 2.6) months and (49.1 ± 2.7) months, respectively, but the difference was statistically not significant (P = 0.111). In contrast, in the subset of GRP78-negative and- positive patients treated with taxane-containing regimens, the DFS was (45.5 ± 1.9) months and (35.1 ± 2.2) months, respectively, showing a significant difference (P = 0.038). In the group of patients with positive GRP78 expression, the patients treated with taxane-containing chemotherapy had a longer DFS [(49.1 ± 2.7) months] than those without that treatment [(35.1 ± 2.2) months], showing a significant difference (P = 0.017). Univariate analysis revealed that DFS was correlated with histological grade, GRP78 expression and lymph node metastasis (all P < 0.05). Multivariate analysis showed that GRP78 expression and TNM staging were independent influencing factors for gastric cancer (both P < 0.05). CONCLUSIONS: The results of our study suggest that GRP78 may be a novel biomarker for assessment of malignant degree and prediction of chemoresistance in gastric cancer, and may be helpful to chemotherapy planning and prognosis prediction in patients with gastric cancer.