Esophageal surgical Apgar score (eSAS): A predictor for postoperative morbidity in patients undergoing neoadjuvant therapy and esophagectomy.

BACKGROUND: The surgical Apgar score (SAS) quantifying three intraoperative indexes has been confirmed to be significantly associated with postoperative morbidity and prognosis in many surgical specialties. However, there are great limitations in its application for esophageal cancer (EC). This study aimed to assess the predictive capability of esophagectomy SAS (eSAS) in determining postoperative morbidity and overall survival (OS) in EC patients who had undergone neoadjuvant therapy. METHODS: A retrospective evaluation was conducted on a cohort of 221 patients in which surgery- and tumor-related data were extracted and analyzed. Major morbidity was defined as complications meeting the criteria of Clavien-Dindo classification III or higher during hospitalization. Univariate and multivariate analyses were performed to identify potential risk factors for major morbidity. Kaplan-Meier analysis was utilized to calculate the OS and relapse-free survival (RFS). RESULTS: The results exhibited that eSAS demonstrated potential predictive value for postoperative morbidity with an optimal cutoff value of 6. The eSAS and diabetes mellitus were two independent risk factors for the major morbidity; however, no correlation between the eSAS and the OS or RFS was detected. CONCLUSION: The eSAS could be used as a predictor of major morbidity, while it was not correlated with OS and RFS.

A novel tumor staging system incorporating cN status for stratifying early stage esophageal squamous cell carcinoma patients after trimodal therapy.

BACKGROUNDS: The aim of this study is to investigate the prognostic value of cN status for early stage esophageal squamous cell carcinoma (ESCC) patients after neoadjuvant chemoradiotherapy (nCRT) and construct a new staging model for individual survival prediction. METHODS: Patients with ESCC who underwent nCRT and esophagectomy were included in this study. Both the Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC) were meticulously ascertained to assess the cogency of each oncological staging system. A discernible abatement in the values of AIC and BIC signifies a model endowed with enhanced predictive prowess and exemplary veracity. RESULTS: A new staging model was established based on ypTNM stage and cN status by precisely stratifying ypI ESCC patients. The novel ypTNM-cN staging demonstrated superior overall survival trend alignment over the AJCC 8th ypTNM staging, with a notably lower AIC of 3143.014 versus 3149.950. This superiority was supported by a BIC of 3146.605 against 3153.541. In the context of disease-free survival outcomes, the emergent ypTNM-cN staging, with an AIC value registering at 3196.057 and a BIC value at 3199.648, distinctively eclipsed the AJCC 8th ypTNM staging, which documented values of 3203.853 and 3207.444, respectively. CONCLUSION: We constructed a new staging system based on ypTNM stage and cN status to precisely stratify the patients with ypI stage. Our new ypTNM-cN staging system provides new insights for classifying stage ypI ESCC and shows reliable classification efficacy for all ESCC patients after nCRT and surgery.

Postoperative complications analysis of circular stapled versus linear stapled anastomosis for patients undergoing esophagectomy: a systematic review and meta-analysis.

BACKGROUND: The choice of anastomosis technique after esophagectomy is closely associated with the postoperative complications. Whether circular stapled or linear stapled anastomosis is the optimal technique has not been established. Therefore, we conducted this meta-analysis to show the latest and most comprehensive published assessment of circular stapled anastomosis in comparison with linear stapled anastomosis in postoperative complications. METHODS: Databases (PubMed, Embase, Web of science, Cochrane Library) were searched for all randomized controlled trials and comparative studies comparing circular stapled anastomosis with linear stapled anastomosis after esophagectomy. The odd ratio and mean difference with 95% confidence interval were calculated. We used the Higgins I² statistics to assess the statistical heterogeneity between studies. Review manager (version 5.4) software was used in this analysis. RESULTS: Sixteen studies with 2322 patients were included in our study. The study demonstrated that the use of linear stapled technique after esophagectomy could reduce the risk of both anastomotic leakage (P = 0.0003) and stricture (P < 0.00001) compared with circular stapled technique. Stratification by anastomotic site showed that no matter what kind of anastomotic site (cervical or thoracic anastomosis) was used, linear stapled anastomosis could effectively reduce the anastomotic stricture in comparison with circular stapled anastomosis. Moreover, linear stapled anastomosis could decrease the risk of thoracic anastomotic leakage. There were no significant differences between circle stapled anastomosis and linear stapled anastomosis in reflux esophagitis (P = 0.17), pneumonia (P = 0.91), operation time (P = 0.41) and hospital stay (P = 0.38). CONCLUSIONS: The study suggested that linear stapled anastomosis could be considered to be an optimal treatment associated with a reduced risk of anastomotic leakage and stricture in comparison with circular stapled anastomosis.

Single-Cell RNA-Seq Analysis Reveals Macrophages Are Involved in the Pathogenesis of Human Sporadic Acute Type A Aortic Dissection.

Macrophages play an important role in the progression of sporadic acute type A aortic dissection (ATAAD). The aim of this study was to characterize the cellular heterogeneity of macrophages in ATAAD tissues by scRNA-seq. Ascending aortic wall tissue from six ATAAD patients and three heart transplant donors was assessed by scRNA-seq and then analyzed and validated by various bioinformatic algorithms and histopathology experiments. The results revealed that the proportion of macrophages in ATAAD tissues (24.51%) was significantly higher than that in normal tissues (13.69%). Among the six macrophage subclusters, pro-inflammatory macrophages accounted for 14.96% of macrophages in the AD group and 0.18% in the normal group. Chemokine- and inflammation-related genes (CCL2, CCL20, S100A8, and S100A9) were expressed more intensively in macrophages in ATAAD tissue than in those in normal tissue. Additionally, intercellular communication analysis and transcription factor analysis indicated the activation of inflammation and degradation of the extracellular matrix in ATAAD tissue. Finally, immunohistochemistry, immunofluorescence, and Western blot experiments confirmed the overexpression of macrophage marker genes (CD68 and CD163) and matrix metalloproteinases (MMP9 and MMP2) in ATAAD tissue. Collectively, our study provides a preliminary evaluation of the role of macrophages in ATAAD, and the results could aid in the development of therapeutic options in the future.

Influence of gymnastic games on standing long jump / Influência dos jogos de ginástica em saltos em distância horizontal / Influencia de los juegos gimnásticos en el salto de longitud horizontal

ABSTRACT Introduction The standing long jump consists of four parts: pre-swing, take-off, flying, and landing. Objective Analyze the influence of gymnastics game fitness on standing long jump. Methods Eight kindergartens in a city were selected and divided into experimental and control groups. The children in the experimental group were intervened in gymnastics and game fitness modules. Each module was intervened in a rolling cycle in the morning and afternoon outdoor activities of children from June 1, 2021, to March 31, 2010, for nine months. Results During the intervention period, there was no significant difference between the experimental group and the control group (P > 0.05), but there was a significant difference between the experimental group and the girls before and after the experimental intervention (P < 0.05), while the difference between boys was not statistically significant, indicating that the range of ankle movement of girls was slightly more affected than boys during the fitness intervention. Conclusion With the increase in age and training time, the change range of joint angles of older children in the experimental group is significantly higher than that in the control group. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução O salto em distância horizontal consiste em quatro partes: corrida de aproximação, impulsão, voo e queda. Objetivo Estudar a influência da ginástica no salto em distância horizontal. Métodos Oito jardins de infância em uma cidade foram selecionados e divididos em um grupo experimental e um grupo de controle. As crianças do grupo experimental atuaram nos módulos de ginástica e de condicionamento físico. Cada módulo foi submetido a um ciclo contínuo de atividades ao ar livre de manhã e à tarde de atividades infantis, de 1º de junho de 2021 a 31 de março de 2010, por um total de 9 meses. Resultados Durante o período de intervenção, não houve diferença significativa entre o grupo experimental e o grupo controle (P > 0,05), mas houve diferença significativa entre o grupo experimental e as meninas antes e depois da intervenção experimental (P < 0,05), enquanto a diferença entre os meninos não foi estatisticamente significativa, indicando que a amplitude do movimento do tornozelo das meninas foi ligeiramente mais afetada do que a dos meninos durante a intervenção de condicionamento físico. Conclusão Com o aumento da idade e do tempo de treinamento, a faixa de variação do ângulo de articulação das crianças mais velhas no grupo experimental foi significativamente maior do que a do grupo de controle. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El salto de longitud horizontal consta de cuatro partes: carrera de aproximación, impulsión, vuelo y caída. Objetivo Analizar la influencia de la gimnasia en el salto de longitud de pie. Métodos Se seleccionaron ocho guarderías de una ciudad y se dividieron en un grupo experimental y otro de control. Los niños del grupo experimental realizaron módulos de gimnasia y fitness. Cada módulo intervino en un ciclo continuo de actividades al aire libre por la mañana y por la tarde desde el 1 de junio de 2021 hasta el 31 de marzo de 2010, durante nueve meses. Resultados Durante el período de intervención, no hubo diferencias significativas entre el grupo experimental y el grupo de control (P > 0,05), pero sí entre el grupo experimental y las chicas antes y después de la intervención experimental (P < 0,05), mientras que la diferencia entre los chicos no fue estadísticamente significativa, lo que indica que la amplitud de movimiento del tobillo de las chicas se vio ligeramente más afectada que la de los chicos durante la intervención de acondicionamiento físico. Conclusión Al aumentar la edad y el tiempo de entrenamiento, el rango de variación de los ángulos articulares de los niños mayores del grupo experimental es significativamente mayor que el del grupo de control. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Evaluation of the efficacy and surgical-related safety of neoadjuvant immunochemotherapy in advanced resectable none small cell lung cancer (NSCLC).

Background: The emergence of immune checkpoint inhibitors (ICIs) has brought about a paradigm shift in the treatment landscape of non-small cell lung cancer (NSCLC). Despite the promising long-term survival outcomes and optimization of pathological complete response (cPR) demonstrated by various studies such as Impower010 and Checkmate-816, the effectiveness of neoadjuvant immunotherapy in advanced resectable NSCLC remains a subject of debate. Although previous research has explored the connection between the efficacy of neoadjuvant therapy and surgical-related safety, limited studies have specifically investigated the surgical-related safety of neoadjuvant immunotherapy. Therefore, our study aims to assess the efficacy and surgical-related safety of neoadjuvant immunotherapy in advanced resectable non-small cell lung cancer. Method: We conducted a retrospective study on a cohort of 93 patients with stage IIIA-IIIC NSCLC who underwent neoadjuvant therapy and surgical resection. Among them, 53 patients received neoadjuvant immunotherapy, 18 patients underwent neoadjuvant chemotherapy while the remaining 22 underwent neoadjuvant targeted therapy. The patients were separated into further groups according to their pathological type. Data analyses were performed using Mann-Whitney U test, chi-square test. Results: All patients were categorized into six distinct groups. Notably, the neoadjuvant immunotherapy squamous carcinoma group exhibited a favorable edge over the neoadjuvant targeted squamous carcinoma group concerning the duration of drainage tube indwelling and the extent of lymph node dissection. Furthermore, the neoadjuvant immunotherapy adenocarcinoma group outperformed neoadjuvant targeted therapy adenocarcinoma counterpart in terms of achieving complete pathological response (cPR). Simultaneously, the neoadjuvant immunotherapy adenocarcinoma group surpassed the neoadjuvant chemotherapy adenocarcinoma group in the incidence of hydrothorax. Nevertheless, no statistically significant disparities were noted between the neoadjuvant immunotherapy squamous carcinoma group and the neoadjuvant chemotherapy carcinoma group. Conclusion: Regarding surgical outcomes, neoadjuvant immunotherapy conferred notable advantages compared to conventional neoadjuvant chemotherapy and neoadjuvant targeted therapy for patients diagnosed with adenocarcinoma. In the case of squamous carcinoma, neoadjuvant immunotherapy exhibited superiority over neoadjuvant targeted therapy, although additional evidence is required to conclusively establish its precedence over neoadjuvant chemotherapy.

Comparison of the clinical outcomes after esophagectomy between intrathoracic anastomosis and cervical anastomosis: a systematic review and meta-analysis.

OBJECTIVES: Esophageal cancer is a high-mortality disease. Esophagectomy is the most effective method to treat esophageal cancer, accompanied with a high incidence of post-operation complications. The anastomosis has a close connection to many severe post-operation complications. However, it remains controversial about the choice of intrathoracic anastomosis (IA) or cervical anastomosis (CA). The study was conducted to compare the clinical outcomes between the two approaches. METHODS: We searched databases for both randomized controlled trials (RCTs) and cohort studies comparing post-operation outcomes between IA and CA. Primary outcomes were the incidences of anastomotic leakage and mortality. Secondary outcomes were the incidences of anastomotic stenosis, pneumonia and re-operation. RESULTS: Twenty studies with a total of 7,479 patients (CA group: n = 3,183; IA group: n = 4296) were included. The results indicated that CA group had a higher incidence of anastomotic leakage than IA group (odds ratio [OR] = 2.05, 95% confidence intervals [CI] = 1.61-2.60, I2 = 53.31%, P < 0.01). Subgroup analyses showed that CA group had higher incidences of type I (OR = 2.19, 95%CI = 1.05-4.57, I2 = 0.00%, P = 0.04) and type II (OR = 2.75, 95%CI = 1.95-3.88, I2 = 1.80%, P < 0.01) anastomotic leakage than IA group. No difference was found in type III anastomotic leakage (OR = 1.23, 95%CI = 0.82-1.86, I2 = 20.92%, P = 0.31). The 90-day mortality (OR = 1.66, 95%CI = 1.11-2.47, I2 = 0.0%, P = 0.01) in IA group were lower than that in CA group. No difference was found in in-hospital mortality (OR = 1.31, 95%CI = 0.91-1.88, I2 = 0.00%, P = 0.15) and 30-day mortality (OR = 1.08, 95%CI = 0.69-1.70, I2 = 0.00%, P = 0.74). CONCLUSIONS: IA might be a better anastomotic approach than CA, with a lower incidence of anastomosis leakage and no increase in short-term mortality. Significant heterogeneity and publication bias might limit the reliability of the results. More high-quality studies are needed to verify and update our findings.

The Prognostic Value of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma: A Propensity-Matched Study Based on SEER Database.

(1) Objectives: The effect of postoperative radiotherapy (PORT) for thymoma and thymic carcinoma remains controversial. This study aimed to investigate the prognostic value of PORT for thymoma and thymic carcinoma in a population-based registry. (2) Methods: This retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with thymoma and thymic carcinoma between 2010 and 2019. Propensity score matching was performed to adjust statistical influences between the PORT and non-PORT groups. (3) Results: A total of 2558 patients with thymoma (n = 2138) or thymic carcinoma (n = 420) were included. In the multivariate analysis, PORT was an independent prognostic factor for OS (overall survival; p < 0.001) and CSS (cancer-specific survival; p = 0.001) in thymoma and an independent prognostic factor for OS in thymic carcinoma (p = 0.018). Subgroup analyses revealed that PORT was beneficial to OS and CSS in patients with Masaoka-Koga stage IIB-IV thymoma (OS: IIB, p < 0.001; III-IV, p = 0.005; CSS: IIB, p = 0.015; III-IV, p = 0.002) and stage IIB thymic carcinoma (OS: p = 0.012; CSS: p = 0.029). (4) Conclusion: This propensity-matched analysis identified the prognostic value of PORT in thymoma and thymic carcinoma based on the SEER database. For patients with stage IIB-IV thymoma and stage IIB thymic carcinoma, PORT was associated with improved OS and CSS. A more positive attitude towards the use of PORT for nonlocalized thymoma and thymic carcinoma may be appropriate.

Home enteral nutrition for patients with esophageal cancer undergoing esophagectomy: A systematic review and meta-analysis.

Introduction: Home enteral nutrition (HEN) is a relatively new nutritional intervention that provides patients with EN support at home through jejunostomy or nasogastric feeding tubes. We conducted this systematic review and meta-analysis to explore the safety and effect of HEN compared with normal oral diet (NOD) in postoperative patients with esophageal cancer (EC). Methods: EMBASE, Medline, Web of Science, and the Cochrane Library were used to search articles in English-language journals. The intervention effect was expressed using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcome measures, with 95% confidence intervals (95% CIs). The chi-square test and I-square test were used to test heterogeneity among studies. Results: Four studies were eventually included in this meta-analysis. Compared with NOD, HEN has a favorable impact on postoperative body mass index (BMI) (weighted mean difference [WMD] = 0.70, 95% CI: 0.09-1.30, P = 0.02), lean body mass (LBM) (WMD = 0.76, 95% CI: 0.04-1.48, P = 0.04), and appendicular skeletal muscle mass index (ASMI) (WMD = 0.30, 95% CI: 0.02-0.58, P = 0.03). Physical function (WMD = 9.26, 95% CI: 8.00-10.53, P < 0.001), role function (WMD = 9.96, 95% CI: 8.11-11.82, P < 0.001), and social function (WMD = 8.51, 95% CI: 3.48-13.54, P = 0.001) of the HEN group were better than those of the NOD group at 3 months, and HEN could reduce the fatigue of patients (WMD = -12.73, 95% CI: -14.8 to -10.66, P < 0.001) and the incidence of postoperative pneumonia (RR = 0.53, 95% CI: 0.34-0.81, P = 0.004). There was no significant difference in albumin between HEN and NOD groups (WMD = 0.05, 95% CI: -0.03 to 0.13, P = 0.20). Conclusion: HEN improved nutritional status and quality of life (QOL) in postoperative patients with EC and reduced fatigue and the incidence of postoperative pneumonia. All in all, the results of our meta-analysis support the use of HEN after esophagectomy.

Efficacy of immunonutritional supplement after neoadjuvant chemotherapy in patients with esophageal cancer.

BACKGROUND: In recent years, preoperative nutrition has received great attention, especially for patients who received surgical reconstruction of the digestive tract such as esophagectomy. Preoperative nutrition therapy was reported to accelerate the patient's postoperative recovery. In addition, immune suppression, nausea, and vomiting may lead to poor immune and nutritional status of patients with esophageal cancer who underwent neoadjuvant chemotherapy (NAC), which is not conducive to surgery. Therefore, preoperative nutritional treatment is necessary for patients with esophageal cancer who underwent NAC. METHOD: Patients with esophageal cancer who received NAC at Nanjing Jinling Hospital from January 2018 to September 2020 were retrospectively identified. Patients were divided into enteral immunonutrition (EIN) group (those who received a conventional diet and immunonutrition supplement, Peptisorb, Nutricia, 500 mL/day * 7 via oral intake), and control group (those who only received a conventional diet were divided into). The primary outcomes were immune and nutritional indicators changes, including immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin G (IgG), and albumin (ALB), which were measured at preoperative day (PRD) 7, PRD-1, postoperative day (POD) 1 and POD-7. The secondary outcomes were postoperative complications, adverse reactions, and length of hospital stay. RESULTS: A total of 124 eligible patients were included in the study, with 21 patients in EIN group. After 1:2 matching, significant difference in baseline characteristics between the two groups was not observed (EIN: n = 21, Control group: n = 42). Compared with the control group, the IgA is significantly increased in the EIN group at POD-7 (p = 0.017). However, we observed that the IgM level in the control group was significantly higher than those in the EIN group at POD-7 (p = 0.007). The incidence of pneumonia and total complications in the EIN group were significantly lower than those in control group (p = 0.024, p = 0.028, respectively). There is no significant difference in ALB and adverse reactions between two groups (p = 0.303, p = 0.108, respectively). CONCLUSION: Immunonutritional supplement after NAC is an effective strategy to improve the postoperative immune status of esophageal cancer patients and could reduce the incidence of infectious complication. More well-designed prospective studies are needed to verify and update our finding.

Neoadjuvant Programmed Cell Death Protein 1 Blockade Combined With Stereotactic Body Radiation Therapy for Stage III(N2) Non-Small Cell Lung Cancer: A Case Series.

The addition of radiotherapy in neoadjuvant chemotherapy did not improve event-free or overall survival in resectable non-small cell lung carcinoma (NSCLC). Neoadjuvant immunotherapy produced major pathologic response(MPR) rate of up to 45%. The potential synergy between radiotherapy and immunotherapy has been described in several studies. We reported outcomes of three cases of stage III/N2 NSCLC treated with neoadjuvant immunotherapy and stereotactic body radiation therapy (SBRT) in a single center. This explanatory trial included treatment-naive patients with stage III resectable NSCLC who received two doses of the programmed cell death protein 1 (PD-1) inhibitor toripalimab after 1 week of receiving SBRT for lung lesions. Thereafter, surgery was planned 4-6 weeks after the second dose. The primary endpoints were safety and feasibility, while the secondary endpoint was the pathologic response rate. Toripalimab combined with SBRT as a neoadjuvant treatment had well-tolerable side effects and did not lead to a delay in surgery. Among the included patients, one achieved pathologic complete response (PCR), one achieved MPR, and one with 20% residual tumor did not achieve MPR. There were few side effects of toripalimab combined with SBRT as a neoadjuvant treatment, and the treatment did not cause a delay in surgery. This study preliminarily explored the outcomes of a new neoadjuvant treatment.

Distinguishing optimal esophagectomy candidates in elderly patients: A nomogram based on propensity score matching.

BACKGROUND: A survival benefit from esophagectomy was observed in elderly patients. But it's unclear how to identify specific patients who can benefit. Thus, we aimed to establish a predictive model to identify optimal candidates for esophagectomy. METHODS: Patients (age ≥75 years) with esophageal cancer in Surveillance, Epidemiology and End Results (SEER) database were used to establish the predictive model. Propensity-score matching (PSM) was applied to eliminate the imbalance between esophagectomy group and non-esophagectomy group. We hypothesized that elderly patients could benefit from esophagectomy with longer cancer specific survival (CSS) time than those who did not receive esophagectomy. Patients received surgery were divided into beneficial group and non-beneficial group according to the median CSS time of non-esophagectomy group. Prognostic factors affecting patients' long-term survival were identified. Among esophagectomy group, a logistic regression model based on these factors was established to build a nomogram. RESULTS: A total of 7,025 eligible patients were extracted from the SEER database, with 831 patients received esophagectomy. Surgery was independently associated with better long-term survival (median CSS time in the matched population: 35 vs. 8 months, p < 0.001). As a result, 361 (68.6%) patients were divided into beneficial group (CSS >8 months). Factors including age, tumor site, histology, differentiation grade, TNM stage, and tumor size were used to formulate the nomogram, which was named as esophagectomy candidates screening score (ECSS). The validation from two aspects showed the model a useful and stable one. CONCLUSION: A predictive model was established to distinguish optimal candidates for esophagectomy among elderly patients with EC.

Prognostic significance of tumor regression grade in esophageal squamous cell carcinoma after neoadjuvant chemoradiation.

Backgrounds: Trimodal therapy (neoadjuvant chemoradiotherapy followed by esophagectomy) for locally advanced esophageal squamous cell carcinoma (ESCC) is associated with a significant survival benefit. Modified Ryan score is an effective tool to evaluated the tumor regression grade (TRG) after neoadjuvant therapy. The aim of this study was to evaluate the prognostic value of TRG for overall survival (OS) and disease-free survival (DFS) in ESCC patients undergoing neoadjuvant chemoradiation. Methods: The study retrospectively reviewed 523 ESCC patients who underwent neoadjuvant chemoradiotherapy and radical esophagectomy at Jinling Hospital from January 2014 to July 2020. Kaplan-Meier curves with log-rank test and Cox regression model were used to evaluate the prognostic factor of TRG based on modified Ryan scoring system on OS and DFS. Results: After application of inclusion and exclusion criteria, 494 patients with ESCC following neoadjuvant chemoradiotherapy and radical esophagectomy were available for analysis. The TRG scores are significantly associated with smoke history (p = 0.02), lymphovascular invasion (LVI) and/or peripheral nerve invasion (PNI) (p < 0.01), and postoperative adjuvant therapy (p < 0.01). Meanwhile, tumor characteristics including tumor length (p < 0.01) and tumor differentiation grade (p < 0.01) are also significantly associated with TRG score. The results of multivariable Cox regression modal showed that TRG is not an independently prognostic factor for OS (p = 0.922) or DFS (p = 0.526) but tumor length is an independently prognostic factor for DFS (p = 0.046). Conclusions: This study evaluated the prognostic value of modified Ryan scoring system for ESCC after trimodal therapy and concluded that modified Ryan scoring system can predict survival and recurrence rates but is not an independently prognostic factor for OS and DFS.

Deep embeddings and logistic regression for rapid active learning in histopathological images.

BACKGROUND AND OBJECTIVE: Recognizing different tissue components is one of the most fundamental and essential works in digital pathology. Current methods are often based on convolutional neural networks (CNNs), which need numerous annotated samples for training. Creating large-scale histopathological datasets is labor-intensive, where interactive data annotation is a potential solution. METHODS: We propose DELR (Deep Embedding-based Logistic Regression) to enable rapid model training and inference for histopathological image analysis. DELR utilizes a pretrained CNN to encode images as compact embeddings with low computational cost. The embeddings are then used to train a Logistic Regression model efficiently. We implemented DELR in an active learning framework, and validated it on three histopathological problems (binary, 4-category, and 8-category classification challenge for lung, breast, and colorectal cancer, respectively). We also investigated the influence of active learning strategy and type of the encoder. RESULTS: On all the three datasets, DELR can achieve an area under curve (AUC) metric higher than 0.95 with only 100 image patches per class. Although its AUC is slightly lower than a fine-tuned CNN counterpart, DELR can be 536, 316, and 1481 times faster after pre-encoding. Moreover, DELR is proved to be compatible with a variety of active learning strategies and encoders. CONCLUSIONS: DELR can achieve comparable accuracy to CNN with rapid running speed. These advantages make it a potential solution for real-time interactive data annotation.

The ratio of gastric tube length to thorax length: a vital factor affecting leak after esophageal cervical anastomosis.

BACKGROUND: Esophagogastric anastomotic leak (AL) is a severe complication following esophageal resection. This study aims to explore preliminarily whether the ratio of the gastric conduit length to the thorax length can be regarded as a potential prognostic variable for AL, and if so, a cut-off value can be found to divide the patients into distinct risk groups. METHODS: We retrospectively reviewed the clinical data of 273 patients who underwent esophagectomy. The gastric conduit length, the thorax length, and other covariates were collected. Logistic regression was first conducted to probe the rationality of the ratio as a risk indicator of AL. Then the dichotomizing analysis was applied to find the optimal cut-off value. RESULTS: The incidence of AL was 12.5% (34/273). The coefficient of the ratio in the logistic regression equation was -7.901 with P<0.001, which indicated that the larger the ratio, the smaller the risk of AL. Further smoothed scatter plots revealed that a potential step function of the ratio of AL incidence exists, of which the steep part ranges from 1.74 to 1.90. Results of the accurate cut-off value search through a minimum P value approach give the optimal dichotomization point of 1.79. CONCLUSIONS: The ratio of the gastric conduit length to the thorax length can reflect the tension in the anastomosis. The research proposes that surgeons can control the length of the gastric conduit during reconstruction to reduce the tension in the anastomosis and thus lead to a decrease in the incidence of AL.

The Gut Microbiota and Traditional Chinese Medicine: A New Clinical Frontier on Cancer.

Gut microbiota is a complex microecosystem, which is called the second genome of the human body. Herbal medicine can balance tumor-suppressing bacteria and tumor-promoting bacteria and exert its anti-cancer effect by regulating gut microbiota. Traditional Chinese medicine (TCM) has a history of thousands of years in prevention and treatment of diseases in China. In recent decades, TCM has been shown to have an obvious advantage in prolonging the survival time and improving the living quality of patients with cancer. Notably, gut microbiota has become a new pathway to understanding TCM. In this review, we will focus on gut microbiota and tumor progression, especially the diversity, functionality and metabolites of gut microbiota affected by TCM in various cancer. We will also discuss the potential mechanism of gut microbiota for exploring TCM in anti-cancer effect. This article aims to comprehensively review the anti-cancer research of TCM by regulating gut microbiota, and address future perspectives and challenges of gut microbiota in TCM intervention for cancer.

The prognostic value of modified NUTRIC score for patients in cardiothoracic surgery recovery unit: A retrospective cohort study.

BACKGROUND: Malnutrition is highly prevalent in critically ill patients. The modified Nutrition Risk in the Critically ill (mNUTRIC) score has been introduced to evaluate the nutritional risk of patients in an intensive care unit (ICU). The mNUTRIC score is a predictive factor of mortality for patients in a medical or mixed ICU, whereas the relationship between mNUTRIC and prognosis of patients in a cardiothoracic surgery recovery unit (CSRU) is unclear and related researches are limited. METHODS: We conducted this retrospective cohort study to explore the value of mNUTRIC score in CSRU patients. We identified totally 4059 patients from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III) database. RESULTS: The optimal cut-off value of mNUTRIC score was 4 and a total of 1498 (36.9%) patients were considered to be at high nutritional risk (mNUTRIC ≥ 4). A multivariate logistic regression model indicated that patients at high nutritional risk have higher hospital mortality compared to those at low nutritional risk (odds ratio = 2.49, 95% confidence interval (CI) = 1.32-4.70, p = 0.005]. Furthermore, a Cox regression model was established adjusted for age, white blood cell and body mass index. The Kaplan-Meier curve indicated that patients at high nutritional risk have poorer 365-days [hazard ratio (HR) = 1.76, 95% CI = 1.30-2.37, p < 0.001] and 1000-days (HR = 2.30, 95% CI = 1.87-2.83, p < 0.001) overall survival. CONCLUSIONS: The mNUTRIC score could not only predict hospital mortality, but also be an independent prognostic factor for long-term survival in CSRU patients. More well-designed clinical trials are needed to verify and update our findings.

Controlling nutritional status is a prognostic factor for patients with lung cancer: a systematic review and meta-analysis.

BACKGROUND: Nowadays, controlling nutritional status (CONUT) has been used as a prognostic factor in variety of cancers. However, no consensus has been reached on the prognostic value of CONUT in lung cancer. In this study, we aim to investigate the role of CONUT in survival of patients with lung cancer. METHODS: EMBASE, web of science, and Medline were used to search articles in English-language journals. The association between CONUT score and survival of patients with lung cancer was evaluated by using pooled HRs and their 95% CIs. Chi-square test and I-Square was used to test heterogeneity among studies. Analyses were all performed using Stata 13.0 (Stata Corporation, College Station, TX). RESULTS: Eight studies with 1,836 patients were eventually included in this meta-analysis. The pooled results showed that high CONUT score had an unfavorable impact on OS (HR =1.63, 95% CI: 1.30-2.04), DFS (HR =1.75, 95% CI: 1.35-2.26), CSS (HR =1.45, 95% CI: 1.01-2.07) and PFS (HR =1.67, 95% CI: 0.99-2.35), compared with those with low-CONUT. CONCLUSIONS: CONUT can be used as a predictor of prognosis in patients with lung cancer. High-CONUT score was significantly associated with poor OS, DFS, CSS and PFS.

Combustion Synthesis of Nanostructured ZrC: Formation Process and Influencing Factors.

ZrC was produced by the combustion synthesis technology using Cu, Zr, and graphite as the starting element powders. The synthesis mechanism of ZrC was investigated by the combustion wave quenching experiment. Furthermore, the effects of sizes of C and Cu on the combustion synthesis behavior and products were also explored. Results revealed that ZrC was fabricated through the displacement reaction between C and Cu-Zr liquid. The Cu size hardly affected the combustion temperature and resultant products, indicating that the preparation cost of ZrC could be decreased by employing coarse Cu powders. With increasing C size, the burning temperature and ceramic particle size reduced. Graphite with size of 2.6 µm was used as the C source, and only ZrC nanoparticles and Cu were obtained. The products could be employed to prepare nano-sized ZrC/Cu composites without the elimination of by-products.

Outcomes of treatment with genioplasty and temporomandibular joint anchorage surgery.

BACKGROUND: Anterior Disc Displacement without Reduction (ADDwoR) in adolescence can result in condylar resorption which produces mandibular retrusion/deviation (MR/D) in adulthood. This study aims to analyze the therapeutic effect of simultaneous genioplasty and temporomandibular joint (TMJ) anchorage surgery on ADDwoR with MR/D patients. METHODS: During 2016-2018, ADDwoR with MR/D cases were included and underwent TMJ anchorage surgery and genioplasty guided by digital design. Pre-/Post-surgical clinical manifestations, facial photography, radiographic data, facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed. RESULTS: A total of 32 cases (52 joints) were included. The average age was 24.09. Ratio of male/female was 4/28. Visual analog pain scale (VAS) score pre-/post-surgical ranged from 3 to 9 and 0-3, with an average of 6.03 and 1.18 (p < 0.01). Maximal mouth opening pre-/post-surgical ranged from 16 to 33 mm and 33-40 mm, with an average of 22.43 mm and 36.46 mm (p < 0.01). MRI was completed and showed stable disc reduction without recurrence 1 year postoperatively. MR/D was corrected and a better face shape was obtained. The satisfaction rate of clinicians, patients and third-parties was 92.375%, 94.156% and 94.218%, with an average of 93.583%. CONCLUSION: For ADDwoR with MR/D patients, simultaneous TMJ anchorage surgery and genioplasty can improve TMJ symptoms/functions, correct facial appearance, and enhance the degree of satisfaction. The postoperative effect is stable, safe and reliable, which is worthy of clinical promotion.