Investigation of the non-small cell lung cancer patients with bronchus involvements: A population-based study.

BACKGROUND: We aimed to explore the prognostic differences among T1-4N0-2M0 non-small cell lung cancer (NSCLC) patients with bronchus involvements and to validate the T category of these patients in an external cohort. METHODS: Univariable and multivariable Cox analysis was performed to determine the prognostic factors. Kaplan-Meier method with a log-rank test was used to compare overall survival differences between groups. Propensity score matching method was used to minimize the bias caused by the imbalanced covariates between groups. RESULTS: A total of 169 390 eligible T1-4N0-2M0 NSCLC cases were included. There were 2354, 3367, 1638, 75, 87 585, 42 056, 19 246, and 13 069 cases in the group of superficial tumors of any size with invasive component limited to bronchial wall (T1-bronchus), tumors involving main stem bronchus ≥2 cm from carina (T2-main bronchus [≥2 cm]), tumors involving main stem bronchus <2 cm from carina (T2-main bronchus [<2 cm]), tumors with carina invasion (T4-carina), T1, T2, T3, and T4, respectively. Multivariable Cox analysis indicated that T1-bronchus patients had the best prognosis; T2-main bronchus (≥2 cm) and T2-main bronchus (<2 cm) patients had similar prognosis both in the entire cohort and in several subgroups. Survival curves showed that T1-bronchus and T1 patients had similar survival rates; the survivals of T2-main bronchus patients regardless of the distance from carina were comparable to those of T2 patients, and the survivals of T4-carina patients were also similar to those of T4 patients. CONCLUSIONS: Our results validated and supported the current T category for the patients with bronchus involvements, which might provide certain reference value for the revisions of T category in the next version of the tumor-node-metastasis stage classification.

A new classification of periampullary diverticulum: cannulation of papilla on the inner margins of the diverticulum (Type IIa) is more challenging.

BACKGROUND: Periampullary diverticulum (PAD) may make the performance of endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis more difficult and may increase complication rates. The present study evaluated the effects of PAD on first-time ERCP in patients with choledocholithiasis. METHODS: Outcomes were compared in patients with and without PAD and in those with four types of PAD: papilla located completely inside the diverticulum (type I), papilla located in the inner (type II a) and outer (type II b) margins of the diverticulum; and papilla located outside the diverticulum (type III). Parameters compared included cannulation time and rates of difficult cannulation, post-ERCP pancreatitis (PEP) and perforation. RESULTS: The median cannulation times in patients with types I, II a, II b, III PAD and in those without PAD were 2.0 min, 5.0 min, 0.67 min, 3.5 min, and 3.5 min, respectively, with difficult cannulation rates in these groups of 7.4%, 31.4%, 8.3%, 18.9%, and 23.2%, respectively. The rates of PEP in patients with and without PAD were 5.3% and 5.1%, respectively. Four patients with and one without PAD experienced perforation. CONCLUSIONS: The division of PAD into four types may be more appropriate than the traditional division into three types. Cannulation of type I and II b PAD was easier than cannulation of patients without PAD, whereas cannulation of type II a PAD was more challenging. PAD may not increase the rates of PEP.

High-precision single-axis rotation measurement method of multi-rudders based on monocular vision.

To evaluate the assembly accuracy of rudders during the production of aerospace vehicles, a measurement method based on monocular vision is proposed in this paper. Compared with existing methods that adopt cooperative targets pasted manually, the proposed method avoids pasting cooperative targets on the surface of rudders and calibrating the original position of rudders in advance. First, we use two known position markers on the surface of the vehicle and multiple feature points of the rudder to solve the relative pose between the camera and the rudder by employing the PnP algorithm. Then, we measure the rotation angle by converting the change of the camera's pose to the rotation angle of the rudder. Finally, a tailored error compensation model is introduced into the proposed method to increase the accuracy of the measurement. Experiment results show that the average measurement absolute error of the proposed method is less than 0.08° overall, which is remarkably superior to existing methods and satisfies the requirement of practical industrial production.

[Pathogen Distribution,Imaging Characteristics,and Establishment and Verification of Risk Prediction Model of Pulmonary Infection with Multi-drug Resistant Organism in Patients with Severe Craniocerebral Injury].

Objective To investigate the pathogen distribution,imaging characteristics,and risk factors of pulmonary infection with multi-drug resistant organism (MDRO) in patients with severe craniocerebral injury,and establish and verify the risk prediction model. Methods A total of 230 patients with severe craniocerebral injury complicated with pulmonary infection were collected retrospectively.According to the 7∶3 ratio,they were randomly assigned into a modeling group (161 patients) and a validation group (69 patients).The risk factors of MDRO pulmonary infection were predicted with the data of the modeling group for the establishment of the risk prediction model.The data of the validation group was used to validate the performance of the model. Results Among the 230 patients,68 patients developed MDRO pulmonary infection.The isolated drug-resistant bacteria mainly included multi-drug resistant Acinetobacter baumannii,multi-drug resistant Klebsiella pneumoniae,multi-drug resistant Pseudomonas aeruginosa,and methicillin-resistant Staphylococcus aureus,which accounted for 45.21%,23.29%,16.44%,and 15.07%,respectively.The imaging characteristics included pleural effusion,lung consolidation,and ground-glass shadow,which accounted for 72.06%,63.24%,and 45.59%,respectively.Multivariate Logistic regression analysis showed that the independent risk factors for MDRO pulmonary infection included age ≥60 years (P=0.003),history of diabetes (P=0.021),history of chronic obstructive pulmonary disease (P=0.038),mechanical ventilation ≥7 d (P=0.001),transfer from other hospitals (P=0.008),and coma (P=0.002).A risk scoring model was established with the ß value (rounded to the nearest integer) corresponding to each index in the regression equation.Specifically,the ß values of age ≥60 years,history of diabetes,history of chronic obstructive pulmonary disease,mechanical ventilation ≥7 d,transfer from other hospitals,and coma were 1,1,1,2,2,and 1,respectively (value ≥4 indicated a high-risk population).The areas under the receiver operating characteristic curve of the modeling group and validation group were 0.845 and 0.809,respectively. Conclusions Multi-drug resistant Acinetobacter baumannii is the most common pathogen of MDRO pulmonary infection in patients with severe craniocerebral injury.Pleural effusion,lung consolidation,and ground-glass shadow were the most common imaging characteristics.The established risk model has high discriminant validity in both the modeling group and the validation group.

Hybrid operation for arteriovenous malformations with associated multiple intracranial aneurysms and subarachnoid hemorrhage: Case report.

RATIONALE: The hybrid surgical concept for the treatment of brain arteriovenous malformations (AVMs) with associated intracranial aneurysms (IAs) is still not widely practiced. Concomitant occurrence of AVMs with IAs is common. Subarachnoid hemorrhage (SAH) as a result of AVM or IA rupture is often associated with these dual pathological phenomena. We present a case of concomitant occurrence of AVMs and IAs that was successfully treated using the hybrid operation concept. PATIENT CONCERNS: A 62-year-old man presented with sudden onset of severe headache, dizziness, nausea, and vomiting for 4 hours. DIAGNOSIS: Computed tomography revealed SAH and a hematoma in the right frontal lobe. A computed tomographic angiogram also revealed a right frontal AVM with 3 IAs. INTERVENTIONS: We used a hybrid operating room to successfully treat both AVMs and IAs. OUTCOMES: Two years of follow-up showed that the patients were well and performed their daily duties. LESSONS: The hybrid operating room is an innovative, safe, and effective method for the treatment of AVMs with associated IAs, particularly high-grade AVMs and IAs with hemorrhage or SAH. Patients with concomitant AVMs and IAs have the highest chance of hemorrhage compared with those with AVM or IAs alone.

Comparative Efficacy of Robot-Assisted and Laparoscopic Distal Pancreatectomy: A Single-Center Comparative Study.

BACKGROUND: Laparoscopic distal pancreatectomy (LDP) has become a routine procedure in pancreatic surgery. Although robotic distal pancreatectomy (RDP) has not been popularized yet, it has shown new advantages in some aspects, and exploring its learning curve is of great significance for guiding clinical practice. METHODS: 149 patients who received RDP and LDP in our surgical team were enrolled in this retrospective study. Patients were divided into two groups including LDP group and RDP group. The perioperative outcomes, histopathologic results, long-term postoperative complications, and economic cost were collected and compared between the two groups. The cumulative summation (CUSUM) analysis was used to explore the learning curve of RDP. RESULTS: The hospital stay, postoperative first exhaust time, and first feeding time in the RDP group were better than those in the LDP group (P < 0.05). The rate of spleen preservation in patients with benign and low-grade tumors in the RDP group was significantly higher than that of the LDP group (P=0.002), though the cost of operation and hospitalization was significantly higher (P < 0.001). The learning curve of RDP in our center declined significantly with completing 32 cases. The average operation time, the hospital stay, and the time of gastrointestinal recovery were shorter after the learning curve node than before. CONCLUSION: RDP provides better postoperative recovery and is not difficult to replicate, but the high cost was still a major disadvantage of RDP.

Development of a Gene Risk Signature for Patients of Pancreatic Cancer.

BACKGROUND: Pancreatic cancer is a highly malignant solid tumor with a high lethality rate, but there is a lack of clinical biomarkers that can assess patient prognosis to optimize treatment. METHODS: Gene-expression datasets of pancreatic cancer tissues and normal pancreatic tissues were obtained from the GEO database, and differentially expressed genes analysis and WGCNA analysis were performed after merging and normalizing the datasets. Univariate Cox regression analysis and Lasso Cox regression analysis were used to screen the prognosis-related genes in the modules with the strongest association with pancreatic cancer and construct risk signatures. The performance of the risk signature was subsequently validated by Kaplan-Meier curves, receiver operating characteristic (ROC), and univariate and multivariate Cox analyses. RESULT: A three-gene risk signature containing CDKN2A, BRCA1, and UBL3 was established. Based on KM curves, ROC curves, and univariate and multivariate Cox regression analyses in the TRAIN cohort and TEST cohort, it was suggested that the three-gene risk signature had better performance in predicting overall survival. CONCLUSION: This study identifies a three-gene risk signature, constructs a nomogram that can be used to predict pancreatic cancer prognosis, and identifies pathways that may be associated with pancreatic cancer prognosis.

Constrained Multiobjective Optimization Algorithm Based on Immune System Model.

An immune optimization algorithm, based on the model of biological immune system, is proposed to solve multiobjective optimization problems with multimodal nonlinear constraints. First, the initial population is divided into feasible nondominated population and infeasible/dominated population. The feasible nondominated individuals focus on exploring the nondominated front through clone and hypermutation based on a proposed affinity design approach, while the infeasible/dominated individuals are exploited and improved via the simulated binary crossover and polynomial mutation operations. And then, to accelerate the convergence of the proposed algorithm, a transformation technique is applied to the combined population of the above two offspring populations. Finally, a crowded-comparison strategy is used to create the next generation population. In numerical experiments, a series of benchmark constrained multiobjective optimization problems are considered to evaluate the performance of the proposed algorithm and it is also compared to several state-of-art algorithms in terms of the inverted generational distance and hypervolume indicators. The results indicate that the new method achieves competitive performance and even statistically significant better results than previous algorithms do on most of the benchmark suite.

Safflower polysaccharide inhibits the proliferation and metastasis of MCF-7 breast cancer cell.

Breast cancer accounts for 22.9% of all types of cancer in females worldwide. Safflower polysaccharide (SPS) is an active fraction purified from safflower petals (Carthamus tinctorius L). The present study investigated the effects of safflower polysaccharide on the proliferation and metastasis of breast cancer cells. Cell viability was analyzed using an MTT assay following treatment of the MCF­7 cells with increasing concentrations of SPS. The results demonstrated that the SPS compound significantly inhibited the proliferation of the MCF­7 human breast cancer cell line and these inhibitory effects increased in a dose­ and time­dependent manner. The half maximal inhibitory concentration (IC50) value of SPS on breast cancer cells, following treatment for 72 h, was detected using an MTT assay and was calculated as 0.12 mg/ml. The apoptotic rate was detected using flow cytometry in the MCF­7 human breast cancer cell line and the results revealed that SPS induced cell apoptosis. The apoptotic rate of the MCF­7 cells treated with SPS was significantly higher compared with that of the untreated cells and increased in a dose­dependent manner. The expression of B­cell lymphoma 2 (Bcl­2) was downregulated and the expression of Bcl­2­associated X protein was upregulated in the MCF­7 cells treated with SPS in a time­dependent manner. Additionally, the expression of matrix metalloproteinase­9 was significantly reduced and the expression of tissue inhibitor of metalloproteinase­1 was increased in the MCF­7 human breast cancer cell treated with SPS. These results demonstrated that SPS inhibited the metastasis of MCF­7 breast cancer cells and understanding the underlying mechanisms may provide novel strategies in breast cancer therapy.

Long-term follow-up study and comparison of meso-atrial shunts and meso-cavo-atrial shunts for treatment of combined Budd-Chiari syndrome.

BACKGROUND: To investigate therapeutic effects of meso-atrial shunts (MASs) and meso-cavo-atrial shunt (MCASs) in combined Budd-Chiari syndrome (BCS). METHODS: We retrospectively gathered 29 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC). Of them, 12 were treated with a MAS and 17 with a MCAS. We analyzed pre- and postoperative clinical symptoms, IVC, and portal venous (PV) pressure, occurrence rate of postoperative complications, patency rate of artificial vessels, and survival rate. RESULTS: One patient in the MAS group died in the preoperative period. During the follow-up period from 3 d to 60 mo, 96.6% were included. The effective rates were 54% in MAS and 90.8% in MCAS. The occurrence rates of postoperative complications were 12.5% and 1.8%, respectively. The average decreases in IVC and PV pressure were 15.5 mm saline and 62.4 mm saline for MAS, and 12.3 mm saline and 184.7 mm saline for MCAS. The survival rates at 1, 3, and 5 y were 41.7%, 41.7%, and 16.7% for MAS, and 94.1%, 88.2%, and 82.4% for MCAS. The 5-y patency rates were 41.7% and 94.1%. Comparing these two groups, all of the studied factors, with the exception of PV pressure, were significantly different (P<0.05). Thus, the therapeutic effects of MCASs were better than those of MASs. CONCLUSION: MCAS can simultaneously relieve high IVC and PV pressure in combined BCS. Compared with MASs, MCASs showed a decreased postoperative complication rate, a higher 5-y survival and artificial vessel patency rate.

Wavelet transform-based frequency tuning ILC.

In this paper, a discrete wavelet transform-based cutoff frequency tuning method is proposed and experimental investigation is reported. In the method, discrete wavelet packet algorithm, as a time-frequency analysis tool, is employed to decompose the tracking error into different frequency regions so that the maximal error component can be identified at any time step. At each time step, the passband of the filter is from zero to the upper limit of frequency region where the maximal error component resides. Hence, the filter is a function of time as well as index of cycle. The experimental results show that this method can suppress higher frequency error components at proper time steps. While at the time steps where the major tracking error falls into lower frequency range, the cutoff frequency of the filter is set lower to reduce the influence of noises and uncertainties. This way, learning transient and long-term stability can be improved.