Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy.

BACKGROUND: We aimed to estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU). METHODS: Overall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage. RESULTS: LND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively (P <  0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P <  0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P <  0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P <  0.05). CONCLUSIONS: The beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was evident in pT3/4 patients. LND can be considered for pT3 and pT4, for pT1/2 remains to be seen, both of which will be verified by further prospective studies.

Facile and efficient transformation of thiols to disulfides via a radical pathway with N-anomeric amide.

Radical coupling of thiols is an attractive route for the synthesis of disulfides, but this approach should be promoted by strong oxidants and/or metal salts in combination with additives, which limits its substrate scope and application. In this work, the N-anomeric amide was first found to be able to realize the conversion of thiols to sulfur radicals with high efficiency in the absence of an oxidant or any additives for the synthesis of symmetrical disulfides. The protocol features mild reaction conditions, good functional group tolerance, and moderate to excellent yields.

Nutritional status and its relationship with blood pressure among children and adolescents in South China.

The present study measures the nutritional status and the blood pressure to assess their relationship in a group of children and adolescents in the Hainan province, China. A total of 5,456 students aged 7 to 18 years were recruited from 10 public schools in Hainan province of South China during the period March 2009 to December 2009. Height, weight, systolic blood pressure, and diastolic blood pressure were measured by health-care professionals. Body mass index (BMI) was calculated and used to define thinness, overweight, and obesity according to the existing standards. Prevalence of thinness, overweight, obesity, pre-hypertension, and hypertension was computed, and logistical regression model was used to examine the association of BMI with elevated blood pressure. A high prevalence of thinness was observed in male and female children and adolescents (34.0% and 34.3%, respectively). The percentage of overweight and obesity was 2.7% and 1.3%, respectively. Pre-hypertension and hypertension were detected in 3.9% and 3.3% children and adolescents, respectively. Multivariate logistical regression analysis showed that obesity was positively associated with both pre-hypertension and hypertension, with adjusted odds ratio of 1.44 (95% confidence interval (CI) = 1.08-1.92, P = 0.014) and 2.00 (95%CI = 1.53-2.60, P < 0.001) compared to normal weight students. Overweight was also associated with pre-hypertension and hypertension. However, no significant association between thinness and pre-hypertension and hypertension was found. In conclusion, this study showed that thinness, especially mild thinness, was a major public health problem among children and adolescents in Hainan province of South China. Overweight and obesity were strongly associated with pre-hypertension and hypertension among studied students.

Diversity Evolutionary Policy Deep Reinforcement Learning.

The reinforcement learning algorithms based on policy gradient may fall into local optimal due to gradient disappearance during the update process, which in turn affects the exploration ability of the reinforcement learning agent. In order to solve the above problem, in this paper, the cross-entropy method (CEM) in evolution policy, maximum mean difference (MMD), and twin delayed deep deterministic policy gradient algorithm (TD3) are combined to propose a diversity evolutionary policy deep reinforcement learning (DEPRL) algorithm. By using the maximum mean discrepancy as a measure of the distance between different policies, some of the policies in the population maximize the distance between them and the previous generation of policies while maximizing the cumulative return during the gradient update. Furthermore, combining the cumulative returns and the distance between policies as the fitness of the population encourages more diversity in the offspring policies, which in turn can reduce the risk of falling into local optimal due to the disappearance of the gradient. The results in the MuJoCo test environment show that DEPRL has achieved excellent performance on continuous control tasks; especially in the Ant-v2 environment, the return of DEPRL ultimately achieved a nearly 20% improvement compared to TD3.

Perioperative Chemotherapy on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma Undergoing Nephroureterectomy: A Population-Based Study.

Objectives: To estimate the stage-specific impact of perioperative chemotherapy on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU). Methods: Overall, 7,278 UTUC patients treated with NU from 2004 to 2015 were identified within the SEER database. Kaplan-Meier plots were used to elucidate overall survival (OS) and cancer-specific survival (CSS) rates. Multivariable Cox regression analyses were used to test the impact of chemotherapy on survival rates, after stratifying according to pathological stage. Results: Chemotherapy was performed in 17.3% of patients and in 5.7, 11.5, 25.4, and 51.3% of patients with, respectively, pT1, pT2, pT3, and pT4 disease (P < 0.001). In multivariable analyses, perioperative chemotherapy was associated with a lower OS in pT2 patients and a lower CSS in pT1 disease (both P < 0.05), while predisposed to a higher OS in pT3 and pT4 patients (both P < 0.01). Moreover, perioperative chemotherapy was prone to a higher OS or CSS in pN+ disease compared to no chemotherapy (both P < 0.01). Conclusion: Perioperative chemotherapy was more frequently performed in locally advanced UTUC patients. The beneficial effect of chemotherapy on OS was evident in pT3/pT4 and pN+ patients. In addition, a clear CSS benefit was observed in patients who received chemotherapy for pN+ UTUC, while perioperative chemotherapy may reduce CSS for pT1 and OS for pT2 patients following NU.

Formability of ABX3 (X = F, Cl, Br, I) halide perovskites.

In this study a total of 186 complex halide systems were collected; the formabilities of ABX3 (X = F, Cl, Br and I) halide perovskites were investigated using the empirical structure map, which was constructed by Goldschmidt's tolerance factor and the octahedral factor. A model for halide perovskite formability was built up. In this model obtained, for all 186 complex halides systems, only one system (CsF-MnF2) without perovskite structure and six systems (RbF-PbF2, CsF-BeF2, KCl-FeCl2, TlI-MnI2, RbI-SnI2, TlI-PbI2) with perovskite structure were wrongly classified, so its predicting accuracy reaches 96%. It is also indicated that both the tolerance factor and the octahedral factor are a necessary but not sufficient condition for ABX3 halide perovskite formability, and a lowest limit of the octahedral factor exists for halide perovskite formation. This result is consistent with our previous report for ABO3 oxide perovskite, and may be helpful to design novel halide materials with the perovskite structure.

Pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition grafts for cancer: a meta-analysis.

The use of interposition grafts for portal-superior mesenteric vein (PV-SMV) reconstruction during pancreatoduodenectomy (PD) with venous resection (VR) for localized periampullary tumors is a controversial topic. The present meta-analysis aimed to evaluate the perioperative and long-term outcomes in patients who received interposition grafts for PV-SMV reconstruction after PD with VR. The correlative databases were systematically searched to identify relevant trials comparing vein grafts versus no vein grafts during PD with VR. 14 studies including 257 patients with vein grafts and 570 patients without vein grafts were extracted. The meta-analysis indicated no difference in perioperative morbidity, mortality, or thrombosis between the two groups, but the vein graft group was associated with a significantly increased venous thrombosis rate (≥ 6 months) (odds ratio [OR] = 2.75; 95% confidence interval [CI], 1.32-5.73; P = .007). The autologous vein group subgroup analysis also revealed a significantly increased vein thrombosis rate (OR = 3.13; 95% CI, 1.45-6.76; P = .004) between the two groups. Meanwhile, the prosthetic vein group subgroup analysis indicated no difference. Additionally, the oncological value of vein grafts during PD for pancreatic cancer survival was analyzed and revealed no difference in 1-year, 3-year, or 5-year survival between the two groups. Using interposition grafts for PV-SMV reconstruction is safe and effective, and has perioperative outcomes and long-term survival rates compared to those with no vein grafts during PD with VR. However, the lower long-term vein patency rate in patients with vein grafts indicate that interposition grafts may be more likely to lose function.

Selective fluorescent sensing of α-amanitin in serum using carbon quantum dots-embedded specificity determinant imprinted polymers.

α-amanitin could make patients die of acute liver failure within a short time if suitable treatment is not provided in a timely fashion. This paper demonstrates a new strategy for direct detection of α-amanitin in serum using carbon quantum dots-embedded specificity determinant imprinted polymers. According to the structure of α-amanitin, we selected a proper moiety of α-amanitin as specificity determinant to synthesize template to prepare the MIPs. The computer simulation was used to screen out acidic methacrylic acid (MAA) and basic 4-vinyl pyridine (4-Vpy) together as functional monomers, and the experiments further proved that synergistic interaction of MAA and 4-Vpy was beneficial to enhance the recognition capability of MIPs for α-amanitin. Moreover, the fluorescence intensity showed good linear correlations with the concentration of α-amanitin from 0.05 to 4.0µgmL(-1). The detection limit for α-amanitin was 15ngmL(-1). The nanoparticles were employed to directly detect α-amanitin in serum without any pretreatment with recoveries of 97.8-100.9%.