Treatment Patterns and Outcomes in Patients with Esophageal Cancer: An Analysis of a Multidisciplinary Tumor Board Database.

BACKGROUND: Multidisciplinary management strategies are standard in esophageal cancer. Based on a multidisciplinary tumor board (MTB) database in a high-volume center, we aimed to evaluate real-world treatment patterns and patient outcomes in patients with esophageal cancer. In addition, we determined the impact of MTB discussions on patient prognosis. METHODS: Patients diagnosed with esophageal cancer between 2010 and 2019 were retrospectively reviewed. The pattern of treatment modalities and overall survival (OS) of patients with limited, locally advanced, and advanced/metastatic disease were reported. RESULTS: Data from 1132 patients, including 247 patients with limited esophageal cancer, 606 patients with locally advanced esophageal cancer, and 279 patients with advanced/metastatic esophageal cancer were included. Upfront surgery was the most common (56.3%) treatment modality for patients with limited esophageal cancer, while treatment for locally advanced esophageal cancer included upfront surgery (19.1%), neoadjuvant chemoradiotherapy (44.9%), and definitive chemoradiotherapy (36.0%); however, 27.9% of patients undergoing neoadjuvant chemoradiotherapy did not receive planned esophagectomy. Definitive chemoradiotherapy was mainly used for patients with locally advanced and advanced/metastatic disease, but had an incompletion rate of 22.0% and 33.7%, respectively. Regarding survival, the 5-year OS rates were 56.4%, 26.3%, and 5.1% in patients with limited, locally advanced, and advanced/metastatic disease, respectively. Additionally, patients whose clinical management was discussed in the MTB had a significantly better 5-year OS rate than the other patients (27.3% vs. 20.5%, p < 0.001). CONCLUSIONS: We report the real-world data of treatment patterns and patient outcomes in patients with esophageal cancer with respect to multidisciplinary management, and demonstrate the positive impact of MTB discussions on patient prognosis.

Schottky-type GaN-based UV photodetector with atomic-layer-deposited TiN thin film as electrodes.

In this work, a GaN-based UV photodetector with an asymmetric electrode structure was fabricated by atomic layer deposition (ALD) of TiN layers. The thickness of the TiN can be monitored in situ by a quartz crystal microbalance (QCM) and precisely controlled through the modulation of deposition cycles. During the ALD process, periodic variation in the QCM frequency was observed and correlated to the physical adsorption, chemical bonding, and the excessive precursor exhaust, which included tetrakis(dimethylamino)titanium (TDMAT) and N sources. The asymmetric TiN/GaN/TiN photodetector showed excellent photosensing performance, with a UV-visible rejection ratio of 173, a responsivity of 4.25 A/W, a detectivity of 1.1×1013 Jones, and fast response speeds (a rise time of 69 µs and a decay time of 560 µs). Moreover, the device exhibits high stability, with an attenuation of only approximately 0.5% after 360 nm light irradiation for 157 min. This result indicates the potential of TiN as a transparent contact electrode for GaN-based optoelectronic devices.

Genuine Pores in a Stable Zinc Phosphite for High H2 Adsorption and CO2 Capture.

Invited for the cover of this issue are Chih-Min Wang and co-workers at Academia Sinica of Taiwan and National Taiwan Ocean University. The image depicts an unusual organic-inorganic hybrid zinc phosphite with interesting structural features and gas adsorption properties. Read the full text of the article at 10.1002/chem.202200732.

Genuine Pores in a Stable Zinc Phosphite for High H2 Adsorption and CO2 Capture.

An uncommon example of stable mixed-ligand zinc phosphite with genuine pores has been synthesized by using zinc metal, inorganic phosphite acid, thio-functionalized O-donor (2,5-thiophenedicarboxylate, TPDC), and tetradentate N-donor [1,2,4,5-tetrakis(imidazol-1-ylmethyl)benzene, TIMB] units assembled into one crystalline structure according to a hydro(solvo)thermal method. This is a very rare case of a metal phosphite incorporating both N- and O-donor ligands. The tetradentate TIMB linker bound to zinc atoms of the isolated zincophosphite hexamers to form a 3D open-framework structure by crosslinking structural components of 1D chains and 2D layers. Here, the TPDC ligand acts as a monodentate binding model to functionalize its porous structure with the uncoordinated S atom and COO- group. Interestingly, this compound demonstrates the highest H2 storage capacity among organic-inorganic hybrid metal phosphates (and phosphites), and a good CO2 capture at 298 K compared with the majority of crystalline materials. The possible adsorption sites and selectivity for CO2 over H2 , N2 , and CO at 298 K were calculated by using density functional theory (DFT), the ideal adsorption solution theory (IAST), and fitting experimental pure-component adsorption data.

Probing Interactions between Metal-Organic Frameworks and Freestanding Enzymes in a Hollow Structure.

It has been reported that the biological functions of enzymes could be altered when they are encapsulated in metal-organic frameworks (MOFs) due to the interactions between them. Herein, we probed the interactions of catalase in solid and hollow ZIF-8 microcrystals. The solid sample with confined catalase is prepared through a reported method, and the hollow sample is generated by hollowing the MOF crystals, sealing freestanding enzymes in the central cavities of hollow ZIF-8. During the hollowing process, the samples were monitored by small-angle X-ray scattering (SAXS) spectroscopy, electron microscopy, powder X-ray diffraction (PXRD), and nitrogen sorption. The interfacial interactions of the two samples were studied by infrared (IR) and fluorescence spectroscopy. IR study shows that freestanding catalase has less chemical interaction with ZIF-8 than confined catalase, and a fluorescence study indicates that the freestanding catalase has lower structural confinement. We have then carried out the hydrogen peroxide degradation activities of catalase at different stages and revealed that the freestanding catalase in hollow ZIF-8 has higher activity.

Stabilizing DNAzymes through Encapsulation in a Metal-Organic Framework.

DNAzymes are a promising class of bioinspired catalyst; however, their structural instability limits their potential. Herein, a method to stabilize DNAzymes by encapsulating them in a metal-organic framework (MOF) host is reported. This biomimetic mineralization process makes DNAzymes active under a wider range of conditions. The concept is demonstrated by encapsulating hemin-G-quadruplex (Hemin-G4) into zeolitic imidazolate framework-90 (ZIF-90), which indeed increases the DNAzyme's structural stability. The stabilized DNAzymes show activities in the presence of Exonuclease I, organic solvents, or high temperature. Owing to its elevated stability and heterogeneous nature, it is possible to perform catalysis under continuous-flow conditions, and the DNAzyme can be reactivated in situ by introducing K+ . Moreover, it is found that the encapsulated DNAzyme maintains its high enantiomer selectivity, demonstrated by the sulfoxidation of thioanisole to (S)-methyl phenyl sulfoxide. This concept of stabilizing DNAzymes expands their potential application in chemical industry.

Structural Distortion of Molybdenum-Doped Manganese Oxide Octahedral Molecular Sieves for Enhanced Catalytic Performance.

Due to the excellent catalytic performance of manganese oxide (K-OMS-2) in a wide range of applications, incorporation of various dopants has been commonly applied for K-OMS-2 to acquire additional functionality or activities. However, the understanding of its substitution mechanism with respect to the catalytic performance of doped K-OMS-2 materials remains unclear. Here we present the structural distortion (from tetragonal to monoclinic cell) and morphological evolution in K-OMS-2 materials by doping hexavalent molybdenum. With a Mo-to-Mn ratio of 1:20 (R-1:20) in the preparation, the resultant monoclinic K-OMS-2 shows a small equidimensional particle size (∼15 nm), a high surface area of 213 m(2) g(-1), and greatly improved catalytic activity toward CO oxidation with lower onset temperatures (40 °C) than that of pristine K-OMS-2 (above 130 °C). HR-TEM analyses reveal direct evidence of structural distortion on the cross-section of 2 × 2 tunnels with the absence of 4-fold rotation symmetry expected for a tetragonal cell, which are indexed using a monoclinic cell. Our results suggest that substitution of Mo(6+) for Mn(3+) (rather than Mn(4+)) coupled with the vacancy generation results in a distorted structure and unique morphology. The weakened Mn-O bonds and Mn vacancies associated with the structural distortion may be mainly responsible for the enhanced catalytic activity of monoclinic K-OMS-2 instead of dopant species.

Gemcitabine plus cisplatin for patients with recurrent or metastatic nasopharyngeal carcinoma in Taiwan: a multicenter prospective Phase II trial.

OBJECTIVE: This multicenter Phase II trial evaluated the toxicity/efficacy of gemcitabine plus cisplatin as first-line chemotherapy in patients with recurrent/metastatic nasopharyngeal carcinoma. METHODS: Gemcitabine 1250 mg/m(2) on Days 1 and 8 and cisplatin 75 mg/m(2) on Day 1 were administered at a 3-week interval. The primary endpoint was the response rate. Secondary endpoints included progression-free survival, overall survival, response duration and safety. RESULTS: Fifty-two patients were recruited between 2004 and 2008. The response rate was 51.9% (complete remission rate, 9.6%) in the intent-to-treat group. The median progression-free and overall survivals were 9.8 and 14.6 months, respectively. The major Grade III/IV adverse event was leucopenia (61.6%). The mean number of cycles was 6.63 ± 0.40. The regimen was well-tolerated, although one treatment-related death occurred after severe sepsis from aspiration pneumonia. CONCLUSIONS: Gemcitabine plus cisplatin is an effective, well-tolerated regimen as a first-line treatment for recurrent/metastatic nasopharyngeal carcinoma.

Structure-property relationship of bifunctional MnO2 nanostructures: highly efficient, ultra-stable electrochemical water oxidation and oxygen reduction reaction catalysts identified in alkaline media.

Manganese oxides of various structures (α-, ß-, and δ-MnO2 and amorphous) were synthesized by facile methods. The electrocatalytic properties of these materials were systematically investigated for catalyzing both oxygen evolution reaction (OER) and oxygen reduction reaction (ORR) in alkaline media. Extensive characterization was correlated with the activity study by investigating the crystal structures (XRD, HRTEM), morphologies (SEM), porosities (BET), surfaces (XPS, O2-TPD/MS), and electrochemical properties (Tafel analysis, Koutechy-Levich plots, and constant-current electrolysis). These combined results show that the electrocatalytic activities are strongly dependent on the crystallographic structures, and follow an order of α-MnO2 > AMO > ß-MnO2 > δ-MnO2. Both OER studies and ORR studies reveal similar structure-determined activity trends in alkaline media. In the OER studies, α-MnO2 displays an overpotential of 490 mV compared to 380 mV shown by an Ir/C catalyst in reaching 10 mA cm(-2). Meanwhile, α-MnO2 also exhibits stability for 3 h when supplying a constant current density of 5 mA cm(-2). This was further improved by adding Ni(2+) dopants (ca. 8 h). The superior OER activity was attributed to several factors, including abundant di-µ-oxo bridges existing in α-MnO2 as the protonation sites, analogous to the OEC in PS-II of the natural water oxidation system; the mixed valencies (AOS = 3.7); and the lowest charge transfer resistances (91.8 Ω, η = 430 mV) as revealed from in situ electrochemical impedance spectroscopy (EIS). In the ORR studies, when reaching 3 mA cm(-2), α-MnO2 shows 760 mV close to 860 mV for the best ORR catalyst (20% Pt/C). The outstanding ORR activity was due to the strongest O2 adsorption capability of α-MnO2 suggested by temperature-programmed desorption. As a result, this discovery of the structure-related electrocatalytic activities could provide guidance in the further development of easily prepared, scalable, and low-cost catalysts based on metal oxides and their derivatives.

MS-20, a chemotherapeutical adjuvant, reduces chemo-associated fatigue and appetite loss in cancer patients.

A small pilot study of the fermented soybean extract MicrSoy-20(MS-20) demonstrated its ability to restore chemotherapy-induced immunosuppression and improve quality of life (QoL). This randomized, cross-over, comparative trial was conducted to confirm the effects of MS-20 on QoL and to understand its underlying mechanism when used in conjunction with chemotherapy. One hundred forty-three patients undergoing cancer chemotherapy were randomly assigned to 2 groups. Group 1 was administered MS-20 for 1 wk followed by 3 wk of concomitant MS-20 plus chemotherapy. Group 2 was administered chemotherapy for 3 wk. QoL was assessed by the EORTC/QLQ-C30 questionnaire and visual analogue scales (VAS). Changes in immunological parameters and antioxidant profiles were also examined. Significant increases were observed in EORTC/QLQ-C30 scores for physical (4.45, P = 0.023) and social (3.99, P = 0.023) functioning in Group 1 patients compared to Group 2 patients. VAS scores for fatigue and appetite loss significantly improved with MS-20 treatment (P < 0.001). Group 1 patients exhibited smaller decreases in peripheral blood mononuclear cells compared to Group 2 patients (P = 0.026). Other immunological parameters, antioxidant, and safety profiles were not significantly different between treatment groups. Addition of MS-20 as an adjuvant to chemotherapy can be effective in improving QoL for cancer patients.

One-step hydrothermal synthesis of manganese-containing MFI-type zeolite, Mn-ZSM-5, characterization, and catalytic oxidation of hydrocarbons.

Manganese-containing MFI-type Mn-ZSM-5 zeolite was synthesized by a facile one-step hydrothermal method using tetrapropylammonium hydroxide (TPAOH) and manganese(III)-acetylacetonate as organic template and manganese salts, respectively. A highly crystalline MFI zeolite structure was formed under pH = 11 in 2 days, without the need for additional alkali metal cations. Direct evidence of the incorporation of Mn in the zeolite framework sites was observed by performing structure parameter refinements, supported by data collected from other characterization techniques such as IR, Raman, UV-vis, TGA, N2-adsorption, SEM, TEM, EDAX, and XPS. UV-vis spectra from the unique optical properties of Mn-ZSM-5 show two absorption peaks at 250 and 500 nm. The absorption varies in different atmospheres accompanied by a color change of the materials due to oxygen evolution. Raman spectra show a significant and gradual red shift from 383 cm(-1) to 372 cm(-1) when the doping amount of Mn is increased from 0 to 2 wt %. This suggests a weakened zeolite structural unit induced by the Mn substitution. The catalytic activity was studied in both gas-phase benzyl alcohol oxidation and toluene oxidation reactions with remarkable oxidative activity presented for the first time. These reactions result in a 55% yield of benzaldehyde, and 65% total conversion of toluene to carbon dioxide for the 2% Mn-ZSM-5. Temperature programmed reduction (TPR) using CO in He demonstrates two reduction peaks: one between 300 and 500 °C and the other between 500 and 800 °C. The first reduction peak, due to manganese-activated oxidation sites shifted from higher temperature to lower temperature, and the peak intensity of CO2 rises when the dopant amount increases. For the first time, calculated photophysical properties of a model Mn(O-SiH3)4(-) compound, an Mn-embedded zeolite cluster, and model Mn oxides help to explain and interpret the diffuse reflectance spectroscopy of Mn-ZSM-5 zeolites.

"Spongy skin" as a robust strategy to deliver 4-octyl itaconate for conducting dual-regulation against in-stent restenosis.

The valid management of inflammation and precise inhibition of smooth muscle cells (SMCs) is regarded as a promising strategy for regulating vascular responses after stent implantation, yet posing huge challenges to current coating constructions. Herein, we proposed a spongy cardiovascular stent for the protective delivery of 4-octyl itaconate (OI) based on a "spongy skin" approach, and revealed the dual-regulation effects of OI for improving vascular remolding. We first constructed a "spongy skin" onto poly-l-lactic acid (PLLA) substrates, and realized the protective loading of OI with the highest dosage of 47.9 µg/cm2. Then, we verified the remarkable inflammation mediation of OI, and surprisingly revealed that the OI incorporation specifically inhibited SMC proliferation and phenotype switching, which contributed to the competitive growth of endothelial cells (EC/SMC ratio âˆ¼ 5.1). We further demonstrated that OI at a concentration of 25 µg/mL showed significant suppression of the TGF-ß/Smad pathway of SMCs, leading to the promotion of contractile phenotype and reduction of extracellular matrix. In vivo evaluation indicated that the successful delivery of OI fulfilled the inflammation regulation and SMCs inhibition, therefore suppressing the in-stent restenosis. This "spongy skin" based OI eluting system may serve as a new strategy for improving vascular remolding, and provides a potential concept for the treatment of cardiovascular diseases.

Thieno[3,4-b]thiophene-based organic dyes for dye-sensitized solar cells.

New dipolar sensitizers containing an ethyl thieno[3,4-b]thiophene-2-carboxylate (ETTC) entity in the conjugated spacer have been synthesized in two isomeric forms. These compounds were used as the sensitizers of n-type dye-sensitized solar cells (DSSCs). The best conversion efficiency (5.31%) reaches approximately 70% of the N719-based (7.41%) DSSC fabricated and measured under similar conditions. The ETTC-containing compounds exhibit a bathochromic shift of the absorption compared to their thiophene congeners due to the quinoid effect, however, charge-trapping at the ester group of ETTC was found to jeopardize the electron injection and lower the cell efficiency. Charge trapping is alleviated as the ester group of ETTC is replaced with a hydrogen atom, as evidenced from the theoretical computation.

The substrate stiffness at physiological range significantly modulates vascular cell behavior.

Changes in the stiffness of the cellular microenvironment are involved in many pathological processes of blood vessels. Substrate stiffness has been shown to have extensive effects on vascular endothelial cells (VECs) and vascular smooth muscle cells (VSMCs). However, the material stiffness of most previously reported in-vitro models is ranging from ~100 kPa to the magnitude of MPa, which does not match the mechanical properties of natural vascular tissue (10-100 kPa). Herein, we constructed hydrogel substrates with the stiffness of 18-86 kPa to explore the effect of physiological stiffness on vascular cells. Our findings show that, with the increase of stiffness at the physiological range, the cell adhesion and proliferation behaviors of VECs and VSMCs are significantly enhanced. On the soft substrate, VECs express more nitric oxide (NO), and VSMCs tend to maintain a healthy contraction phenotype. More importantly, we find that the number of differentially expressed genes in cells cultured between 18 kPa and 86 kPa substrates (560 in VECs, 243 in VSMCs) is significantly higher than that between 86 kPa and 333 kPa (137 in VECs, 172 in VSMCs), indicating that a small increase in stiffness within the physiological range have a higher impact on vascular cell behaviors. Overall, our results expanded the exploration of how stiffness affects the behavior of vascular cells at the physiological range.

Bioinspired NO release coating enhances endothelial cells and inhibits smooth muscle cells.

Thrombus and restenosis after stent implantation are the major complications because traditional drugs such as rapamycin delay the process of endothelialization. Nitric oxide (NO) is mainly produced by endothelial nitric oxide synthase (eNOS) on the membrane of endothelial cells (ECs) in the cardiovascular system and plays an important role in vasomotor function. It strongly inhibits the proliferation of smooth muscle cells (SMCs) and ameliorates endothelial function when ECs get hurt. Inspired by this, introducing NO to traditional stent coating may alleviate endothelial insufficiency caused by rapamycin. Here, we introduced SNAP as the NO donor, mimicking how NO affects in vivo, into rapamycin coating to alleviate endothelial damage while inhibiting SMC proliferation. Through wicking effects, SNAP was absorbed into a hierarchical coating that had an upper porous layer and a dense polymer layer with rapamycin at the bottom. Cells were cultured on the coatings, and it was observed that the injured ECs were restored while the growth of SMCs further diminished. Genome analysis was conducted to further clarify possible signaling pathways: the effect of cell growth attenuated by NO may cause by affecting cell cycle and enhancing inflammation. These findings supported the idea that introducing NO to traditional drug-eluting stents alleviates incomplete endothelialization and further inhibits the stenosis caused by the proliferation of SMCs.

Direct observation of Au/Ga2O3 peapodded nanowires and their plasmonic behaviors.

Gold-peapodded Ga(2)O(3) nanowires were fabricated successfully in a well-controlled manner by thermal annealing of core-shell gold-Ga(2)O(3) nanowires. During the heating process, the core gold nanowires were broken up into chains of nanoparticles at sufficiently high temperature by the mechanism of Rayleigh instability. In addition, the size, shape, and interspacing between the particles can be manipulated by varying the annealing time and/or the forming gas. The plasmonic behaviors of these nanostructures are investigated by optical spectroscopy. A single nanowire optical device was designed, and its photonic characteristics were investigated. A remarkably high on/off photocurrent ratio in response to a 532 nm Nd:YAG laser light was found. As the size of the particle (pea) increases, the corresponding spectra are red-shifted. In addition, morphological changes of the peas lead to a distinct spectral response. The results may usher in the diverse applications in optoelectronics and biosensing devices with peapod nanostructures.

Enhanced Production of Formic Acid in Electrochemical CO2 Reduction over Pd-Doped BiOCl Nanosheets.

Bismuth oxyhalides (BiOX, X = F, Cl, Br, I) are emerging energy materials because of their remarkable catalytic activity. The BiOX compounds usually have a tetragonal type crystal structure with unique layered morphology consisting of [X-Bi-O-Bi-X] sheets. Although the BiOX nanosheets exposed with {001} facets perform superior photoactivity, there is lack of understanding about their capability in the electrochemical CO2 reduction reaction (CO2RR). Herein, we adopt wet-chemical syntheses to make 2D BiOCl and Pd-doped BiOCl nanosheets for CO2RR. In the results, formic acid is the only one kind of product converted from CO2 along with H2 gas from water reduction over both BiOCl and Pd-doped BiOCl nanosheets. By thorough analyses with ex situ and in situ spectroscopy, the results reflect that (1) metallic Bi0 atoms generated by the applied negative potentials serve as the catalytic sites for the hydrogen evolution reaction (HER) and CO2RR and (2) the existence of doped Pd ions in the BiOCl structure reduces the barrier of charge transfer over the nanosheets, which enhances HER and CO2RR activities. We believe that the observations are important references for making catalysts toward CO2RR performance.

miR-22 eluting cardiovascular stent based on a self-healable spongy coating inhibits in-stent restenosis.

The in-stent restenosis (IRS) after the percutaneous coronary intervention contributes to the major treatment failure of stent implantation. MicroRNAs have been revealed as powerful gene medicine to regulate endothelial cells (EC) and smooth muscle cells (SMC) in response to vascular injury, providing a promising therapeutic candidate to inhibit IRS. However, the controllable loading and eluting of hydrophilic bioactive microRNAs pose a challenge to current lipophilic stent coatings. Here, we developed a microRNA eluting cardiovascular stent via the self-healing encapsulation process based on an amphipathic poly(ε-caprolactone)-poly(ethylene glycol)-poly(ε-caprolactone) (PCL-PEG-PCL, PCEC) triblock copolymer spongy network. The miR-22 was used as a model microRNA to regulate SMC. The dynamic porous coating realized the uniform and controllable loading of miR-22, reaching the highest dosage of 133 pmol cm-2. We demonstrated that the sustained release of miR-22 dramatically enhanced the contractile phenotype of SMC without interfering with the proliferation of EC, thus leading to the EC dominating growth at an EC/SMC ratio of 5.4. More importantly, the PCEC@miR-22 coated stents showed reduced inflammation, low switching of SMC phenotype, and low secretion of extracellular matrix, which significantly inhibited IRS. This work provides a simple and robust coating platform for the delivery of microRNAs on cardiovascular stent, which may extend to other combination medical devices, and facilitate practical application of bioactive agents in clinics.

Tailoring Heterogeneous Catalysts at the Atomic Level: In Memoriam, Prof. Chia-Kuang (Frank) Tsung.

Professor Chia-Kuang (Frank) Tsung made his scientific impact primarily through the atomic-level design of nanoscale materials for application in heterogeneous catalysis. He approached this challenge from two directions: above and below the material surface. Below the surface, Prof. Tsung synthesized finely controlled nanoparticles, primarily of noble metals and metal oxides, tailoring their composition and surface structure for efficient catalysis. Above the surface, he was among the first to leverage the tunability and stability of metal-organic frameworks (MOFs) to improve heterogeneous, molecular, and biocatalysts. This article, written by his former students, seeks first to commemorate Prof. Tsung's scientific accomplishments in three parts: (1) rationally designing nanocrystal surfaces to promote catalytic activity; (2) encapsulating nanocrystals in MOFs to improve catalyst selectivity; and (3) tuning the host-guest interaction between MOFs and guest molecules to inhibit catalyst degradation. The subsequent discussion focuses on building on the foundation laid by Prof. Tsung and on his considerable influence on his former group members and collaborators, both inside and outside of the lab.

Betel-Nut Chewing Increases Difficulty in Tracheal Intubation.

BACKGROUND: Betel-nut chewing (BC) causes oral submucous fibrosis (OSF), and this leads to difficult tracheal intubation (DI). Unanticipated DI was reported in chewers with apparently normal preoperative airway evaluations (PAEs). This analysis aims to investigate whether BC is an independent risk on DI besides the common DI risk prediction factors. METHODS: After the approval of Institutional Review Board and the written informed consent were obtained, 2,682 patients were enrolled in a cohort. PAEs, intubation difficulty scale (IDS), intubation time, and perceived DI were recorded prospectively. All 805 male patients received classical intubation, 307 with BC and 498 without BC were analyzed. Data were analyzed by Student's t-test and chi-square test. Stepwise logistic regression was performed to identify BC effects on IDS adjusting for related factors with WEKA (Waikato Environment for Knowledge Analysis; Machine Learning Group at the University of Waikato, Hamilton, New Zealand). RESULTS: Fewer BC patients were Cormack-Lehane (CL) grade I (38.9% vs. 47.6%) or IDS degree 〞Easy〞 (24.8% vs. 33.5%). Compared with IDS degree 〞Easy〞, patients in the BC group had a significantly higher odds ratio (OR) for 〞Slight + Moderate-Major〞 degree than in the non-BC group (adjusted OR, 1.75; 95% CI, 1.15-2.68). Compared with CL grade I, patients with BC was an independent risk for II (adjusted OR, 1.53; 95% CI, 1.02-2.32) and IV (adjusted OR, 3.25; 95% CI 1.01-10.49). Otherwise, patient's age ≥ 46 and the presence of teeth were also significant risk factors for IDS degree 〞Slight + Moderate-Major〞. CONCLUSION: BC increased not only the tracheal intubation difficulty in patients with apparent OSF but also in patients with PAEs. BC is an independent risk factor besides the commonly used DI prediction factors. We suggest physicians operating on BC patients to be better prepared for DI.