Fabrication and characterization of smart titanium alloy bolt based on high-frequency piezoelectric thin-film.

We reported here on the fabrication and characterization of a smart titanium alloy bolt based on a high-frequency piezoelectric thin-film sensor. The thin-film sensor was directly deposited on a titanium alloy bolt head with radio frequency magnetron sputtering and characterized by a scanning electron microscope and an atomic force microscope. The ultrasonic characteristics of the smart bolt, which include a pure and broad frequency spectrum peaked at 14.81 MHz, high measurement accuracy below 3%, and high repeatability free from some interference from bolt detection position change, were fully characterized. No obvious frequency shift was observed with the increase in axial preload. Based on the mono-wave method [TOF (time of flight) of longitudinal mode wave], TOF change increased linearly with preload force in the range of 0-20 kN. With the increase in temperature from 22 to 150 °C, the TOF linearly increases while the longitudinal wave velocity linearly decreases. The results indicate the prepared smart titanium alloy bolt is suitable as a smart aviation and automotive fastener.

Surgery combined with antibiotics for thoracic vertebral Escherichia coli infection after acupuncture: A case report.

BACKGROUND: Acupuncture is relatively popular worldwide, but an unregulated operation can easily lead to infections. The purpose of this report was to analyze a clinical case of surgery combined with the use of antibiotics for the treatment of thoracic vertebral infection by Escherichia coli (E. coli) after acupuncture. CASE SUMMARY: A 63-year-old male was diagnosed with E. coli infection in the thoracic vertebra after acupuncture. His fever and pain did not improve after treatment with broad-spectrum antibiotics for 10 d. Thus, debridement of the infected area and biopsy were decided. The final pathology confirmed the diagnosis of vertebral infection by E. coli. The patient underwent anterior and posterior thoracic vertebral debridement and internal fixation surgery combined with the use of sensitive antibiotics. He had no fever or backache 3 mo postoperatively. CONCLUSION: In this report, we first considered antibiotic treatment for the patient with septic spinal infection, but the effect was not obvious. Interventional surgery was combined with the use of sensitive antibiotics to relieve backache, and good clinical results were achieved. Furthermore, acupuncture practitioners should pay attention to hygienic measures.

Evaluation of Axial Preload in Different-Frequency Smart Bolts by Laser Ultrasound.

We report here on a laser ultrasonic system to indirectly evaluate the preload force of different-frequency piezoelectric bolts. This newly developed system enables us to achieve the goal of non-contact excitation and synchronously collects the laser-induced ultrasonic signal by the combination of a smart piezoelectric sensor and a magnetically mounted transducer connector. A numerical model based on the finite element method (FEM) was developed to simulate the propagation and displacement distribution of laser-generated ultrasonic waves along the axial direction. The measured A-scan waveform basically coincided with the counterpart obtained from a theoretical simulation, confirming the effectiveness of the proposed system to measure a bolt. By comparison, a laser spot diameter of 6 mm was the optimal beam diameter for the excitation of the ultrasonic wave in the bolt. The linear relationship between time of flight (TOF) of the ultrasonic longitudinal wave and bolt torque was almost independent from the center frequency of the smart bolt. By contrast, a piezoelectric patch centered at 5 MHz was more suitable as an ultrasonic sensor in terms of the nonlinear effects component suppression and linear fitting degree between TOF and torque. The results indicate that the proposed system based on a surface-mounted piezoelectric sensor is a promising system for evaluating the axial preload change of connector and fastener and is an additional potential laser ultrasonic system for nondestructive tests.

Quantifying the shape effect of plasmonic gold nanoparticles on photoacoustic conversion efficiency.

Gold nanoparticles with strong localized plasmonic effects have found wide applications in photoacoustic imaging, which are ascribed to their unique microscopic mechanism of converting photons to ultrasound. In this report, we quantitatively model the time-resolved temperature field, thermal expansion, and pressure distribution based on the finite element analysis method, and two-dimensional gold nanoparticles spanning from the triangle, square, pentagon, and hexagon to the circle have been systematically studied. Results show that the shape of gold nanoparticles has a nontrivial effect on photoacoustic conversion efficiency, and the square-shaped gold structure exhibits the best performance. Our findings could shed light on the shape design of high-performance photoacoustic agents in the future.

TRIM36 inhibits tumorigenesis through the Wnt/ß-catenin pathway and promotes caspase-dependent apoptosis in hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and has an extremely poor prognosis. We aimed to determine the latent relationships between TRIM36 regulation of apoptosis and the Wnt/ß-catenin pathway in HCC. METHODS: Immunohistochemistry and western blotting were used to characterize the aberrant expression of TRIM36 in HCC and adjacent tissues. Clinical information was analyzed using Kaplan-Meier and Cox methods. RNA-seq of potential targets was conducted to detect the regulation of TRIM36. Apoptosis assays and cellular proliferation, invasion and migration were conducted in a loss- and gain-of-function manner in cultured cells to determine the biological functions of TRIM36. A rescue experiment was conducted to confirm the role of Wnt/ß-catenin signaling in TRIM36 regulation. Finally, in vivo experiments were conducted using cell line-derived xenografts in nude mice to validate the central role of TRIM36 in HCC. RESULTS: TRIM36 expression was significantly downregulated in HCC tissues compared to adjacent non-tumor tissues. TRIM36 repressed the proliferation, migration, and invasion of Huh7 and HCCLM3 cells, whereas it stimulated apoptosis. Wnt/ß-catenin signaling was inhibited by TRIM36, and rescue experiments highlighted its importance in HCC proliferation, migration, and invasion. In vivo experiments further confirmed the effects of sh-TRIM36 on HCC tumorigenesis, inhibition of apoptosis, and promotion of Wnt/ß-catenin signaling. CONCLUSION: Our study is the first to indicate that TRIM36 acts as a tumor suppressor in HCC. TRIM36 activates apoptosis and inhibits cellular proliferation, invasion, and migration via the Wnt/ß-catenin pathway, which may serve as an important biomarker and promising therapeutic target for HCC.

Clinical outcomes of retrievable inferior vena cava filters for venous thromboembolic diseases.

Aim: To identify literature evidence assessing retrievable inferior vena cava filter (rIVCF) for venous thromboembolic diseases. Methods: A systematic literature search was conducted to identify relevant references from the mainstay English and Chinese bibliographic databases (search period: January 2003 to October 2019). Results: 80 original studies with 11,413 patients were included in this review. The success rates of deploying the six types of rIVCFs ranged from 98.4 to 100.0%. Denali had the highest retrieval success rate (95.4-97.6%). The incidence rates of fracture and perforation associated with retrieving the six rIVCFs were less than 2%. Conclusion: The approved rIVCF had comparable clinical profiles, except that Denali was easier to be retrieved than other rIVCF.

Economic impact of powered stapler in video-assisted thoracic surgery lobectomy for lung Cancer in a Chinese tertiary hospital: a cost-minimization analysis.

BACKGROUND: To assess the economic impact of powered stapler use in video-assisted thoracic surgery (VATS) lobectomy for lung cancer in a Chinese tertiary care hospital. METHODS: This study identified 388 patients who received VATS lobectomy using the ECHELON powered stapler (n = 296) or the ECHELON manual stapler (n = 92) for lung cancer in a Chinese tertiary hospital. Multiple generalized linear regression analyses were conducted using data on hospital costs and patient characteristics to develop predictive equations for hospital costs in a cost-minimization analysis (CMA) model comparing hospital costs associated with the ECHELON powered stapler and the ECHELON manual stapler. CMA model was used to conduct scenario analysis to compare the ECHELON powered stapler with another manual stapler (Victor Medical). RESULTS: The multiple generalized linear regression analyses identified that using the ECHELON powered stapler in VATS lobectomy for lung cancer was associated with significantly lower drug costs than using the ECHELON manual stapler (coefficient - 0.256, 95% confidence interval: - 0.375 to - 0.139). The CMA model estimated that the ECHELON powered stapler could save hospital costs by ¥1653 when compared with the ECHELON manual stapler (¥65,531 vs. ¥67,184). The use of the ECHELON powered stapler also saved hospital costs by ¥4411 when compared with the Victor Medical manual stapler (¥65,531 vs. ¥69,942) in the scenario analysis. CONCLUSIONS: Compared to the two manual staplers used for VATS lobectomy for lung cancer in a Chinese tertiary hospital, the ECHELON powered stapler had 100% probability to save total hospital costs under present prices of the three staplers according to the CMA.

Ultrasonic Measurement of Axial Preload in High-Frequency Nickel-Based Superalloy Smart Bolt.

A high-frequency, piezoelectric thin-film sensor was successfully deposited on a nickel-based superalloy bolt by radio frequency magnetron sputtering to develop a smart, nickel-based superalloy bolt. Ultrasonic response characterization, high accuracy, and repeatability of ultrasonic measurement of axial preload in nickel-based superalloy smart bolts are reported here and were fully demonstrated. The axial preload in the nickel-based superalloy smart bolt was directly measured by the bi-wave method (TOF ratio between transverse and longitudinal-mode waves) without using the traditional integration of a longitudinal and shear transducer. A model concerning the bolt before and after tensioning was established to demonstrate the propagation and displacement distribution of the ultrasonic waves inside a nickel-based superalloy smart bolt. The measured A-scan signal presented significantly favorable features including a mixture of transverse and longitudinal mode waves, a pure and broad frequency spectrum which peaked at 17.14 MHz, and high measurement accuracy below 3% for tension of 4 kN-20 kN. For the temporal ultrasonic signal, the measurement envelopes were narrower than for the counterpart of the simulation, justifying the 'filtration' advantage of the high-frequency sensor. Both the TOF change of the single longitudinal-mode wave and the TOF ratio between transverse- and longitudinal-mode waves increased linearly with preload force in the range of 0 kN to 20 kN. Compared with the commercial piezoelectric probe, the proposed probe, based on the combination of a high-frequency, piezoelectric thin-film sensor and a magnetically mounted transducer connector, exhibited high tolerance to temperatures as high as 320 °C and high repeatability free from some interference factors such as bolt detection position change and couplant layer thickness. The results indicate that this system is a promising axial preload measurement system for high-temperature fasteners and connectors, and the proposed sensor is a practical, high-frequency ultrasonic sensor for non-destructive testing.

Characteristic flavor formation of thermally processed N-(1-deoxy-α-d-ribulos-1-yl)-glycine: Decisive role of additional amino acids and promotional effect of glyoxal.

The role of amino acids and α-dicarbonyls in the flavor formation of Amadori rearrangement product (ARP) during thermal processing was investigated. Comparisons of the volatile compounds and their concentrations when N-(1-deoxy-α-d-ribulos-1-yl)-glycine reacted with different amino acids or glyoxal (GO) at 100 °C were executed. Additional amino acids, such as glycine (Gly), in ARP models contributed to the diversity of furanoids by the chain elongation of the derived formaldehyde. Whereas the monoanion of additional glutamic acid acted as nucleophile, favored 2-ethyl-3,5-dimethylpyrazine and 2,5-dimethylpyrazine formation; the nonionized amino group of additional lysine were involved in α-dicarbonyls formation, causing pyrazine and methylpyrazine accumulation in the ARP model. Moreover, the high dosage and pH stabilization of additional GO probably promoted the ARP degradation and deoxyosones retro-aldol cleavage, resulting in methylpyrazine rather than furanoids formation. The present work provided the guidance for the controlled flavor formation of ARP in industrial application.

Clinical outcomes of powered and manual staplers in video-assisted thoracic surgery lobectomy for lung cancer.

Methods: This retrospective cohort study identified patients who underwent video-assisted thoracic surgery (VATS) lobectomy for lung cancer from January 2016 to December 2018 in a Chinese tertiary general hospital. The electronic hospital medical records associated with the VATS lobectomy for lung cancer were the data sources. Results: Based on the analysis of 433 patients with the utilization of staplers in their VATS lobectomy for lung cancer, using powered stapler was associated with significantly shorter operation time and postsurgery hospital stay length than using the manual stapler in the multivariable generalized linear regression analyses with the adjustment of patient characteristics. However, no other significant differences were observed for other clinical outcomes between the two staplers.

Adducts Derived from (-)-Epigallocatechin Gallate-Amadori Rearrangement Products in Aqueous Reaction Systems: Characterization, Formation, and Thermolysis.

The interaction mechanism of (-)-epigallocatechin gallate (EGCG) with Amadori compound (Amadori rearrangement product, ARP) in xylose-alanine model reaction systems was investigated. The adducts between ARP and EGCG were identified as two ARP-EGCG isomers, two ARP-EGCG-H2O isomers, and multiple ARP-deoxypentosone (DP)-EGCG isomers. The structure of an isolated and purified ARP-EGCG adduct was analyzed by means of Fourier transform infrared spectroscopy, ultraviolet-visible spectroscopy, liquid chromatography-time-of-flight (TOF)-mass spectrometry (LC-TOF-MS), and nuclear magnetic resonance (NMR). Using the two-dimensional NMR analyses, the structure of ARP-EGCG adducts was clarified to consist of a covalent linkage between the C12 position of the ARP and the C8 position of the A-ring of EGCG, presumably generated by the nucleophilic nature of the EGCG or aromatic substitution reactions. The results showed that slightly alkaline pH and higher temperature could facilitate this reaction. Additionally, the thermal stability of ARP-EGCG and its degradation products revealed that the decomposition pathways of this adduct altered the classic decomposition pathway of ARP, resulting in a lower browning rate and blocking the subsequent Maillard reaction.

Ginsenoside Rg5 overcomes chemotherapeutic multidrug resistance mediated by ABCB1 transporter: in vitro and in vivo study.

BACKGROUND: Multidrug resistance (MDR) to chemotherapy drugs remains a major challenge in clinical cancer treatment. Here we investigated whether and how ginsenoside Rg5 overcomes the MDR mediated by ABCB1 transporter in vitro and in vivo. METHODS: Cytotoxicity and colon formation as well as the intracellular accumulation of ABCB1 substrates were carried out in MDR cancer cells A2780/T and A549/T for evaluating the reversal effects of Rg5. The expressions of ABCB1 and Nrf2/AKT pathway were determined by Western blotting. An A549/T cell xenograft model was established to investigate the MDR reversal activity of Rg5 in vivo. RESULTS: Rg5 significantly reversed ABCB1-mediated MDR by increasing the intracellular accumulation of ABCB1 substrates without altering protein expression of ABCB1. Moreover, Rg5 activated ABCB1 ATPase and reduced verapamil-stimulated ATPase activity, suggesting a high affinity of Rg5 to ABCB1 binding site which was further demonstrated by molecular docking analysis. In addition, co-treatment of Rg5 and docetaxel (TXT) suppressed the expression of Nrf2 and phosphorylation of AKT, indicating that sensitizing effect of Rg5 associated with AKT/Nrf2 pathway. In nude mice bearing A549/T tumor, Rg5 and TXT treatment significantly suppressed the growth of drug-resistant tumors without increase in toxicity when compared to TXT given alone at same dose. CONCLUSION: Therefore, combination therapy of Rg5 and chemotherapy drugs is a strategy for the adjuvant chemotherapy, which encourages further pharmacokinetic and clinical studies.

How were situations of preventive and curative care expenditure for AIDS and medical burden of patients? Research based on "System of Health Accounts 2011".

BACKGROUND: The problem of AIDS response has not only involved public health, but also had a great impact on the family burden.The objective of this study was to estimate the preventive and curative care expenditure(PCE)for AIDS of Hunan Province in 2017 based on System of Health Accounts 2011(SHA2011)by quantity,financing scheme,health provider,health function,and to analyses the factors affecting patients' medical burden. METHODS: Through stratified multi-stage sampling method, 1336 institutions were surveyed to obtain AIDS prevention and control data, and the official data collected from Health Statistical Yearbook, Health Financial Annual Reports and Government Input Monitoring System were used to estimate the AIDS PCE based on SHA2011. Univariate analyses and ordered logistic regression were used to evaluate the factors affecting the medical burden of AIDS patients. RESULTS: The AIDS PCE of Hunan Province in 2017 was 266.67 million, mainly flowed to hospitals and disease prevention and control institutions. The proportions of curative care expenditure(CCE) and prevention expenditure were 51.39 and 48.61% respectively. Prevention expenditure were mainly used for traditional prevention methods. All prevention expenditure and 88.52% of CCE were borne by public financing scheme. Family health expenditure accounted for 11.12% of CCE, but there were still some people with heavy burden of treatment. Non insurance, co-infection and length of stay are risk factors to the total hospitalization expenses(Totalexp)and the out-of-pocket payments(OOPs)(all p < 0.05,OR > 1). Taking the age group under 30 as the reference, the partial regression coefficient of the age group over 60 was statistically significant (OR (Totalexp) = 1.809, OR (OOPs) = 0.30). CONCLUSION: The financing structure of the PCE for AIDS in Hunan Province was relatively stable and the flow of institutions was reasonable. The functional flow of expenditure embodied the principle of "prevention first". China should incorporate oral PrEP into the national guidelines as soon as possible to improve the allocation efficiency of AIDS prevention resources. Meantime, several measures should be taken to reduce the medical burden of AIDS patients, including expanding the scope of government assistance, adjusting insurance compensation measures, increasing the rate of patients participating in insurance,encouraging commercial insurance to join the AIDS insurance system,and controlling length of stay in hospital.

Formation kinetics of Maillard reaction intermediates from glycine-ribose system and improving Amadori rearrangement product through controlled thermal reaction and vacuum dehydration.

Amadori rearrangement product (ARP) is an ideal flavor precursor. The formation kinetics of ARP from glycine-ribose system, 3-deoxyribosone (3-DR) and 1-deoxyribosone (1-DR) were evaluated, and then controlled thermal reaction (CTR) coupled with vacuum dehydration was proposed to improve the ARP yield. As key factors controlling the formation of byproducts, CTR temperature and time were optimized as 100 °C, 60 min based on the formation kinetics of the ARP and deoxyribosones. Vacuum dehydration was further used to increase the ARP yield from 0.77% to 64.50%, which was improved by 82.8 times, while 3-DR and 1-DR yield increased only by 1.5 and 3.7 times, respectively. The formation of ARP was the dominant reaction during vacuum dehydration. Under optimal conditions, CTR coupled with vacuum dehydration was an effective method to control byproducts formation and improve the ARP yield simultaneously. This method may offer a potential application in flavor enhancement of light-color food.

Aqueous Preparation of Maillard Reaction Intermediate from Glutathione and Xylose and its Volatile Formation During Thermal Treatment.

Maillard reaction intermediate (MGX) generated from glutathione and xylose in aqueous medium was prepared via the Maillard reaction performed under a two-stage temperature increase process. The purified MGX was identified by Fourier-transform infrared spectroscopy, mass spectrometry, and nuclear magnetic resonance as N-(1-deoxy-d-xylulos-1-yl)-glutathione (Amadori compound, C15 H25 O10 N3 S) with five main isomers. The method of Maillard reaction performed under a two-stage temperature increase process was further verified by high-performance liquid chromatography. The optimal reaction time and temperature for the preparation of MGX was determined as 60 min at 90 °C. The yield of MGX was increased from 8.60% to 55.52% through thermal reaction coupled with vacuum dehydration. In addition, rapid and more Maillard-type volatile compounds were formed in MGX during thermal treatment than that in Maillard reaction products or glutathione-xylose mixture. Beside, MGX possessed more pleasing meat-like volatile profile compared with the Amadori compound of glutamic acid-xylose (AAX), cysteine-xylose (ACX), and glycine-xylose (AGX). Therefore, it suggested that the MGX had the potential to achieve a better flavor formation during thermal treatment. PRACTICAL APPLICATION: Maillard reaction intermediates, such as Amadori or Heyns rearrangement products (ARP or HRP), are important flavor precursors, which possess stable physicochemical properties, but tend to degrade into flavor compounds at high temperatures. Maillard reaction intermediate from glutathione and xylose acts as primary flavor enhancers to complete Maillard reaction to produce flavors in the subsequent thermal processing, which can significantly improve and stabilize the flavor quality of the meaty food, and deserves a very broad application prospects. The new developed method will be a significant theoretical basis on research preparation and properties of Maillard reaction intermediates in complex food systems.

Research on Current Curative Expenditure among Lung Cancer Patients Based on the "System of Health Accounts 2011": Insights into Influencing Factors.

PURPOSE: To investigate the total current curative expenditure (CCE) of lung cancer in Hunan Province, China under the framework of the System of Health Accounts 2011 (SHA 2011) and explore the effect of insurance status, surgery and length of stay on the hospitalization expenses of patients with lung cancer. METHODS: Through multistage stratified cluster random sampling, a total of 46,214 patients with lung cancer were enrolled from 1,072 medical institutions in Hunan Province in 2016. Under the SHA 2011 framework, the lung cancer CCE was analyzed. The relationships between hospitalization expenditure and the following factors (surgery, type of hospital, insurance status, length of stay, institution level, age and sex) were analyzed using Spearman's correlation analyses, and how these factors influenced hospital expenditure was explored through multiple stepwise regression analysis and structural equation modelling. RESULTS: The CCE for lung cancer patients was 8063.75 million CNY. In total, 96.03% of the CCE for lung cancer occurred in hospitals and 58.88% of the expenditure flowed to general hospitals. The highest expenditures were incurred in the group aged 55-74 y, which accounted for 61.58% of the CCE. Drugs accounted for the greatest share expenditure to lung cancer patients at 34.31% of the CCE. Surgery, insurance status, institution level, sex and hospital type explained 57.5% of the variance in hospital expenses. The hospitalization expenses were related to surgery, insurance status, institution level and sex (rs = 0.033-0.688, p < 0.001). Surgery, insurance status and length of stay had direct effects on hospitalization expenses. Length of stay mediated the relationship between surgery and hospitalization expenses for lung cancer patients. Surgery mediated the relationship between insurance status and hospitalization expenses. All of these variables can explain 45% of the variance in hospitalization expenses. CONCLUSIONS: The CCE of lung cancer is extremely high. The problems related to treatment efficiency and equity are serious for lung cancer patients in China. It is essential to expand health insurance coverage and reduce the curative expenditure of lung cancer.

Timely Addition of Glutathione for Its Interaction with Deoxypentosone To Inhibit the Aqueous Maillard Reaction and Browning of Glycylglycine-Arabinose System.

The inhibitory effects of glutathione (GSH) and oxiglutathione (GSSG) on Maillard browning were compared, and it was clarified that free sulfhydryl was the key substance for the inhibition. The Amadori rearrangement product (ARP) derived from glycylglycine (Gly-Gly) and arabinose (Ara) was prepared by aqueous Maillard reaction, and LC-MS/MS was used to investigate the reaction products of GSH and purified ARP. Reaction between GSH and deoxypentosone (DP) was found to alter the pathway of aqueous Maillard reaction, which reduced the production of glyoxal, methylglyoxal, and furfural and thereby inhibited the formation of melanoidins. To determine the optimal conditions for browning inhibition, a stepwise increase of temperature was used to prepare Maillard reaction products (MRPs). The results showed that the optimum browning inhibitory effect was obtained by adding GSH after Gly-Gly and Ara heating at 80 °C for 60 min.

Perioperative outcomes and hospital costs associated with flowable gelatin hemostatic matrix for lumbar surgeries in real world hospital setting.

Background: Efficient hemostasis during lumbar surgery (LS) is associated with better perioperative outcomes. Flowable gelatin hemostatic matrix (FGHM) is a new type of absorbable hemostatic agent, which is effective to control bleeding during spinal surgery. This study aimed to assess the impact of FGHM on perioperative outcomes and hospital costs associated with LS. Methods: This study retrospectively analyzed medical and billing records of patients who underwent LS for spinal degenerative disease in a Chinese tertiary care hospital from 2014 to 2016. The identified patients were further stratified into a FGHM group (n = 108) (using the combination of FGHM and gelatin sponge) and a historical control group (using oxidized cellulose and/or collagen, n = 82) for the adjusted comparisons of the perioperative outcomes using a propensity score matching method. Multiple generalized linear regression was conducted to assess the impact of using FGHM on total hospitalization costs. Results: Comparisons of 64 propensity score matched pairs showed a significantly lower blood transfusion rate (34.4% vs 64.1%, p = 0.005), lower blood transfusion volume (182.7 ± 312.4 vs 301.3 ± 281.0 mL, p = 0.045), reduced post-surgery drainage tube placement rate (82.8% vs 93.8%, p = 0.046), and shorter post-operative days on antibiotics (6.0 ± 2.6 vs 7.1 ± 2.4 days, p = 0.010) in the FGHM group. Although with a relatively high acquisition price, the use of FGHM for hemostasis in LS did not increase the total hospitalization costs (coefficient = -0.001, p = 0.972). Conclusions: The use of FGHM in LS improved perioperative outcomes related to hemostatic effects without increasing overall hospital costs in a real-world hospital setting.

Local environment in biopsy better predict the pathological response to neoadjuvant chemoradiotherapy in rectal cancer.

Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is the standard treatment for locally advanced rectal cancer. Here, we analyzed the impact of local and systemic environments on the tumor response to preoperative chemoradiotherapy in rectal cancer. We recruited 141 patients with rectal cancer treated with nCRT. We evaluated the local tumor environment, including tumor-infiltrating lymphocytes (TILs), intratumor budding (ITB), and the systemic inflammatory environment, including the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) level. Our finding revealed that tumor regression was significantly associated with the density of CD8+ TILs in the intraepithelial, the presence of ITB, the combination of NLR and CRP (NLR-CRP) value, and the combination of CD8+ intraepithelial TIL (iTIL) density and ITB presence. Moreover, multivariate analysis showed that only the combination of CD8+ iTILs and ITB was an independent predictive factor for the pathological response to nCRT in rectal cancer. Our finding demonstrate that the local tumor environment was a better predictor of the tumor response than the systemic environment and thus provided new insight into screening for patients who are more likely to benefit from cancer treatment.

Cost-effectiveness of standard utilization of zoledronic acid for bone metastases from advanced lung cancer in China.

Aim: To assess the cost-effectiveness of standard utilization of zoledronic acid (ZA) relative to real-world utilization of ZA for bone metastasis (BM) in Chinese patients with advanced lung cancer. Materials & methods: A decision analytic model was constructed to simulate health benefits and medical costs associated with standard and real-world utilization of ZA for BM in Chinese patients with advanced lung cancer. Results: Compared with real-world utilization of ZA, standard utilization of ZA reduced cumulative risk of skeletal-related events (45.7 vs 63.6%), increased quality-adjusted life years (0.673 vs 0.626 QALY) and saved cumulated medical costs (¥343,163 vs ¥376,943). Conclusion: Standard utilization of ZA dominated real-world utilization of ZA for BM in Chinese patients with advanced lung cancer from cost-effectiveness perspective.