The significance of time interval between perioperative SOX/XELOX chemotherapy and clinical decision model in gastric cancer.

Introduction: To investigate the influences of time interval between multimodality therapies on survival for locally advanced gastric cancer (LAGC) patients, 627 patients were included in a retrospective study, and 350 who received neoadjuvant chemotherapy (NACT) based on SOX (S-1 plus Oxaliplatin)/XELOX (Capecitabine plus Oxaliplatin) treatment, radical surgery, and adjuvant chemotherapy (AC) from 2005.01 to 2018.06 were eligible for analyses. Methods: Three factors were used to assess influences, including time interval from NACT accomplishment to AC initiation (PECTI), time to surgery after NACT accomplishment (TTS), and time to adjuvant chemotherapy after surgery (TAC). Results: Concerning PECTIs, 99 (28.29%) experienced it within 9 weeks, 188 (53.71%) within 9-13 weeks, 63 (18.00%) over 13 weeks. Patients' 5-year overall survival (OS) significantly decreased as trichotomous PECTI increased (78.6% vs 66.7% vs 55.7%, P = .02). Analogously, there was a significant decrease for dichotomous TTS (within vs over 5 weeks) in OS (P = .03) and progression free survival (PFS) (P = .01) but not for dichotomous TAC (within vs over 6 weeks) in OS and PFS (P = .40). Through multivariate Cox analyses, patients with PECTI over 13 weeks had significantly worse OS (P = .03) and PFS (P = .02). Furthermore, extended TTS had significantly worse OS and PFS but insignificantly worse OS and PFS than extended TAC. Therefore, gastric patients receiving perioperative SOX/XELOX chemotherapy and surgery with extended PECTI over 9 weeks or TTS over 5 weeks would have a negative correlation with PFS and OS, and worse when PECTI over 13 weeks. Nomograms (including PECTI, ypT, ypN, Area Under Curve (AUC) = 0.81) could predict patient survival probability and guide intervention with net benefit. Discussion: In control of PECTI, TTS could be extended appropriately, and shortened TAC might make a remedy, and delayed TAC might be allowed when TTS was shortened.

Health economic evaluation of patients with sepsis after gastrointestinal tumor surgery-a cost consequences analysis in China.

BACKGROUND: The purpose of this study was to evaluate the health economics of patients with sepsis after gastrointestinal tumor operation in ICU. METHODS: This case-control study used 1:1 propensity-score (PS) matched method and patients were matched according to tumor type, age and gender. The study group was composed of 181 patients with sepsis after operation of gastrointestinal tumor in ICU, while the control group was composed of 181 patients without sepsis after operation of gastrointestinal tumor. The medical expenses and length of stay in the hospital of these patients were analyzed. RESULTS: The median of the total hospitalization cost for the study group was $26,038, which was 1.7 times of the control group (P<0.001). The costs of drugs, laboratory test, examination, treatment, operation, anesthesia, materials, ward and other costs in the study group were higher than those in the control group (P<0.001). The median length of stay in the hospital in the study group was 26 days, which were 12 days longer than that of the control group (P<0.001). However, there was no significant difference in daily average cost between the two groups (P=0.103). CONCLUSIONS: In ICU, patients with sepsis after operation of gastrointestinal tumor increased the cost of hospitalization and prolonged the length of stay in the hospital than those without sepsis.

Assessment for prognostic value of differentially expressed genes in immune microenvironment of clear cell renal cell carcinoma.

Tumor-infiltrating immune cells have been recognized to be associated with prognosis and response to immunotherapy; however, genes related to immune microenvironment of clear cell renal cell carcinoma (ccRCC) remains unclear. To better understand the effects of genes involved in immune and stromal cells on prognosis, we used Cancer Genome Atlas Kidney Renal Clear Cell Carcinoma (TCGA-KIRC), DAVID database and ESTMATE algorithm, and divided the patients into low and high groups according to immune (median: 1038.45) and stromal scores (median: 667.945), respectively. We found the immune scores were significantly correlated with clinicopathological parameters and overall survival (OS). Based on immune scores, 890 DEGs were significantly associated with OS among the 1433 up-regulated genes. Based on top 10 DEGs (IL10RA, FCER1G, SASH3, TIGIT, RHOH, IL12RB1, AIF1, LPXN, LAPTM5 and SP140), cases with number of up-regulated genes ≥ 5 were associated poor OS (P = 0.002). In addition, the mean differences of percentages of CD8 T cells (11.32%), CD4 memory resting T cells (-4.52%) and mast resting cells (-3.55%) between low and high immune scores were the most significant. Thus, combination of these genes might use to predict the efficacy of immunotherapy. Further analyses of these genes were warrant to explore their potential association with the prognosis of ccRCC.

Assessment of programmed cell death ligand-1 expression with multiple immunohistochemistry antibody clones in non-small cell lung cancer.

BACKGROUND: Programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) have been identified as novel targets for immunotherapy, with PD-L1 as a potential predictive biomarker. However, a specific antibody for PD-L1 expression is an immediate requirement. Meanwhile, the clinicopathological identification of patients with positive PD-L1 remains unclear. METHODS: The present study adopted three anti-PD-L1 IHC antibodies, SP142, SP263, and UMAB228 to test PD-L1 expression in 84 non-small cell lung cancer (NSCLC) specimens. The concordance among antibodies was examined by analytical comparison, and the association between PD-L1 expression and clinicopathological factors was assessed. RESULTS: The samples from 41 (48.8%), 51 (60.7%), and 50 (59.5%) patients were detected as PD-L1 positive evaluated by antibody SP142, SP263, and UMAB228, respectively. The kappa coefficient was 0.53, 0.58, and 0.46 for SP263 vs. SP142, SP263 vs. UMAB228, and SP142 vs. UMAB228, respectively. On the other hand, the univariate analysis of consensus cases indicated that the PD-L1 expression was significantly correlated with tobacco use (χ2=4.25, P=0.04). CONCLUSIONS: The analytical comparison showed moderate concordance between SP142, SP263 and UMAB228, whereas SP263 exhibited higher overall positive rate. Moreover, PD-L1 positive rate was significantly higher in patients with smoking history, which might help in identifying patients who would benefit from PD-1/PD-L1 checkpoint inhibitors.

Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography.

OBJECTIVE: The present study aimed to evaluate left ventricular (LV) systolic function in patients with iron deficiency anemia (IDA) by 3 dimensional speckle-tracking echocardiography (3DSTE). METHODS: Participants were grouped by hemoglobin (Hb) levels in order to study the effect of anemia on cardiac function. Group A included 40 healthy volunteers. Eighty-three patients who were diagnosed with IDA were divided into 2 groups according to the Hb level. Group B (Hb 9 g/dL) included 44 patients, while group C (Hb 6-9 g/dL) included 39 patients. Left ventricular end-diastolic volume (LVEDV), left ventricular endsystolic volume (LVESV), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF) were calculated by real-time 3-dimensional echocardiography (RT3D). Left ventricular global longitudinal strain (GLS), global area strain (GAS), global radial strain (GRS), and global circumferential strain (GCS) were obtained by 3DSTE. RESULTS: LVMI, LVEDV and LVESV of group C increased and GCS, GRS, GLS, and GAS of group C decreased compared with those of groups A and B (all p<0.05). GAS and GLS decreased significantly compared with other parameters (both p<0.01). CONCLUSION: LV remodeling and LV systolic dysfunction occurred in patients when the hemoglobin level was in the range of 6-9 g/dL. 3DSTE can evaluate LV systolic function in patients with IDA, and GAS and GLS are more sensitive than other parameters.

Assessment of left ventricular function in chronic alcoholics by real-time three-dimensional echocardiography.

Chronic alcohol consumption may lead to progressive cardiac dysfunction. The aim of this study was to evaluate the feasibility of using real-time 3-dimensional echocardiography (3DE) on assessing left ventricular (LV) function in chronic alcoholics.We classified 92 male alcoholics into mild, moderate, and severe groups; 30 age-matched controls were also recruited. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), LV mass (LVM), LV mass index (LVMI), and systolic dyssynchrony index (SDI) were measured by 3DE and 2-dimensional echocardiography (2DE).Compared to the control group, LV volume and mass were higher in the moderate and severe alcoholic groups (P < 0.05). The severe alcoholic (symptomatic) group demonstrated decreased LVEF and increased SDI (detected by 3DE) (P < 0.05).Real-time 3DE can detect the increases of LV volumes and mass in asymptomatic alcoholics, and the changes of LVEF and systolic synchrony index in symptomatic alcoholics.

[Distribution Characteristics of Heavy Metals in Environmental Samples Around Electroplating Factories and the Health Risk Assessment].

This study aimed to investigate the pollution degree and human health risk of heavy metals in soil and air samples around electroplating factories. Soil, air and waste gas samples were collected to measure 8 heavy metals (As, Cd, Cr, Cu, Hg, Ni, Pb and Zn) in two electroplating factories, located in Baiyun district of Guangzhou city. Geoaccumulation index and USEPA Risk Assessment Guidance for Superfund (RAGS) were respectively carried out. Results showed that concentrations of Hg and Pb in waste gas and Cr in air samples were higher than limits of the corresponding quality standards, and concentrations of Cd, Hg and Zn in soil samples reached the moderate pollution level. The HQ and HI of exposure by heavy metals in air and soil samples were both lower than 1, indicating that there was no non-carcinogen risk. CRAs and CRCr in soil samples were beyond the maximum acceptable level of carcinogen risk (10(-4)), and the contribution rate of CRCr to TCR was over 81%. CRCr, CRNi and TCR in air samples were in range of 10(-6) - 10(-4), indicating there was possibly carcinogen risk but was acceptable risk. CR values for children were higher than adults in soils, but were higher for adults in air samples. Correlation analysis revealed that concentrations of heavy metals in soils were significantly correlated with these in waste gas samples, and PCA data showed pollution sources of Cd, Hg and Zn in soils were different from other metals.