On-Chip Monolithically Integrated Ultraviolet Low-Threshold Plasmonic Metal-Semiconductor Heterojunction Nanolasers.

The metal-semiconductor heterojunction is imperative for the realization of electrically driven nanolasers for chip-level platforms. Progress in developing such nanolasers has hitherto rarely been realized, however, because of their complexity in heterojunction fabrication and the need to use noble metals that are incompatible with microelectronic manufacturing. Most plasmonic nanolasers lase either above a high threshold (101 -103 MW cm-2 ) or at a cryogenic temperature, and lasing is possible only after they are removed from the substrate to avoid the large ohmic loss and the low modal reflectivity, making monolithic fabrication impossible. Here, for the first time, record-low-threshold, room-temperature ultraviolet (UV) lasing of plasmon-coupled core-shell nanowires that are directly grown on silicon is demonstrated. The naturally formed core-shell metal-semiconductor heterostructure of the nanowires leads to a 100-fold improvement in growth density over previous results. This unprecedentedly high nanowire density creates intense plasmonic resonance, which is outcoupled to the resonant Fabry-Pérot microcavity. By boosting the emission strength by a factor of 100, the hybrid photonic-plasmonic system successfully facilitates a record-low laser threshold of 12 kW cm-2 with a spontaneous emission coupling factor as high as ≈0.32 in the 340-360 nm range. Such architecture is simple and cost-competitive for future UV sources in silicon integration.

A new nursing pattern based on ERAS concept for patients with lumbar degenerative diseases treated with OLIF surgery: A retrospective study.

Objective: The purpose of this study was to introduce enhanced recovery after surgery (ERAS) concept into patients with lumbar degenerative diseases who were treated with oblique lumbar interbody fusion (OLIF), and to assess whether it could increase clinical efficacy, reduce perioperative complications, shorten length of hospital stay (LHS), decrease readmission rate, and improve patient satisfaction. Methods: The study included patients with lumbar degenerative diseases (LDDs) who underwent OLIF between July 2017 and October 2018 (non-ERAS group), and between November 2018 and July 2020 (ERAS group). The two groups were compared according to the demographic and clinical characteristics. Results: There was no significant difference in descriptive characteristics and concomitant diseases between the two groups. The preoperative Oswestry disability index (ODI) score (P = 0.191), lumbar visual analogue scale (VAS) score (P = 0.470), and leg VAS score (P = 0.657) did not significantly different. Most of the ERAS measures were also well implemented after surgery, except for early delivery (74.2%), early catheter removal (63.9%), and multimodal analgesia (80.6%). The LHS in the ERAS group was significantly shorter than that in the non-ERAS group (P = 0.004). Besides, Hamilton Anxiety Rating Scale (HAMA) score at 3 days after surgery showed a significant difference between the two groups (P = 0.019). The patient satisfaction in ERAS group was significantly higher than that in the non-ERAS group (P = 0.001). Conclusion: The new nursing pattern combined with ERAS in patients with LDDs who underwent OLIF did not improve the short-term prognosis of surgery, while it could effectively reduce postoperative complications, shorten the LHS, and improve patient satisfaction, and did not lead to additional adverse events.

Development and validation of nomograms to predict survival in patients with invasive micropapillary carcinoma of the breast.

OBJECTIVES: The present study aimed to develop and validate nomograms to predict the survival of patients with breast invasive micropapillary carcinoma (IMPC) to aid objective decision-making. DESIGN: Prognostic factors were identified using Cox proportional hazards regression analyses and used to construct nomograms to predict overall survival (OS) and breast cancer-specific survival (BCSS) at 3 and 5 years. Kaplan-Meier analysis, calibration curves, the area under the curve (AUC) and the concordance index (C-index) evaluated the nomograms' performance. Decision curve analysis (DCA), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were used to compare the nomograms with the American Joint Committee on Cancer (AJCC) staging system. SETTING: Patient data were collected from the Surveillance, Epidemiology, and End Results (SEER) database. This database holds data related to the incidence of cancer acquired from 18 population-based cancer registries in the US. PARTICIPANTS: We ruled out 1893 patients and allowed the incorporation of 1340 patients into the present study. RESULTS: The C-index of the AJCC8 stage was lower than that of the OS nomogram (0.670 vs 0.766) and the OS nomograms had higher AUCs than the AJCC8 stage (3 years: 0.839 vs 0.735, 5 years: 0.787 vs 0.658). On calibration plots, the predicted and actual outcomes agreed well, and DCA revealed that the nomograms had better clinical utility compared with the conventional prognosis tool. In the training cohort, the NRI for OS was 0.227, and for BCSS was 0.182, while the IDI for OS was 0.070, and for BCSS was 0.078 (both p<0.001), confirming its accuracy. The Kaplan-Meier curves for nomogram-based risk stratification showed significant differences (p<0.001). CONCLUSIONS: The nomograms showed excellent discrimination and clinical utility to predict OS and BCSS at 3 and 5 years, and could identify high-risk patients, thus providing IMPC patients with personalised treatment strategies.

Prognostic significance of the skeletal muscle index and systemic inflammatory index in patients with lymph node-positive breast cancer after radical mastectomy.

BACKGROUND: The role of skeletal muscle index (SMI) and systemic inflammation index (SII) for patients with lymph node-positive breast cancer remain controversial. This retrospective study aims to evaluate the individual and synergistic value of SMI and SII in outcomes prediction in this population. METHODS: Lymph node-positive breast cancer patients who received mastectomy between January 2011 and February 2013 were included in this retrospective study. We used abdominal computed tomography (CT) to measure skeletal muscle mass at the third lumbar (L3) level. The optimal cut-off values of SMI and SII were determined through maximizing the Youden index on the receiver operating characteristic (ROC) curves. Kaplan-Meier method was used to assess the correlation between SMI, SII, and overall survival (OS). The prognostic value of SMI and SII were analyzed with the multivariable Cox proportional hazards model. RESULTS: Of 97 patients included in our study (mean age: 46 [range: 27-73] years; median follow-up: 62.5 months), 71 had low SMI (sarcopenia), 59 had low SII, and 56 had low SMI + SII. Kaplan-Meier survival curves showed that both high SMI (P = 0.021, 5-year OS: 84.0% vs. 94.1%) and high SII (P = 0.043, 5-year OS: 81.0% vs. 97.3%) were associated with worse OS. Additionally, patients with either low SMI or low SII had significantly better OS (P = 0.0059, 5-year OS: 100.0% vs. 84.6%) than those with high SMI + SII. Multivariable analysis confirmed the predictive values of high SMI (P = 0.024, hazard ratio [HR]: 9.87) and high SII (P = 0.048, HR: 6.87) for poor OS. Moreover, high SMI + SII was significantly associated with poor survival (P = 0.016, HR: 16.36). CONCLUSIONS: In this retrospective analysis, both SMI and SII independently predicted the prognosis of patients with lymph node-positive breast cancer. SMI + SII might be a stronger prognostic factor than either alone based on our findings, but should be further verified in a larger study.

Multiplex-Heterogeneous Network-Based Capturing Potential SNP "Switches" of Pathways Associating With Diverse Disease Characteristics of Asthma.

Asthma is a complex heterogeneous respiratory disorder. In recent years nubbly regions of the role of genetic variants and transcriptome including mRNAs, microRNAs, and long non-coding RNAs in the pathogenesis of asthma have been separately excavated and reported. However, how to systematically integrate and decode this scattered information remains unclear. Further exploration would improve understanding of the internal communication of asthma. To excavate new insights into the pathogenesis of asthma, we ascertained three asthma characteristics according to reviews, airway inflammation, airway hyperresponsiveness, and airway remodeling. We manually created a contemporary catalog of corresponding risk transcriptome, including mRNAs, miRNAs, and lncRNAs. MIMP is a multiplex-heterogeneous networks-based approach, measuring the relevance of disease characteristics to the pathway by examining the similarity between the determined vectors of risk transcriptome and pathways in the same low-dimensional vector space. It was developed to enable a more concentrated and in-depth exploration of potential pathways. We integrated experimentally validated competing endogenous RNA regulatory information and the SNPs with significant pathways into the ceRNA-mediated SNP switching pathway network (CSSPN) to analyze ceRNA regulation of pathways and the role of SNP in these dysfunctions. We discovered 11 crucial ceRNA regulations concerning asthma disease feature pathway and propose a potential mechanism of ceRNA regulatory SNP → gene → pathway → disease feature effecting asthma pathogenesis, especially for MALAT1 (rs765499057/rs764699354/rs189435941) → hsa-miR-155 → IL13 (rs201185816/rs1000978586/rs202101165) → Interleukin-4 and Interleukin-13 signaling → inflammation/airway remodeling and MALAT1 (rs765499057/rs764699354/rs189435941) → hsa-miR-155 → IL17RB (rs948046241) → Interleukin-17 signaling (airway remodeling)/Cytokine-cytokine receptor interaction (inflammation). This study showed a systematic and propagable workflow for capturing the potential SNP "switch" of asthma through text and database mining and provides further information on the pathogenesis of asthma.

Clinical effect analysis of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF.

BACKGROUND: To explore the clinical effect of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF. METHODS: A retrospective study was conducted on the clinical data of 142 patients with TOLF and laminectomy who underwent spine surgery at XXX Medical University from January 2003 to January 2018. According to whether the laminectomy was combined with instrumentation, the patients were divided into two groups: group A (laminectomy alone (LA), n = 77) and group B (laminectomy with instrumentation (LI), n = 65). Comparisons of possible influencing factors of demographic variables and operation-related variables were carried out between the two groups. In this study, the clinical effects of LA and LI in the treatment of TOLF were discussed. Thus, we explored the clinical effect of LA and LI in the treatment of TOLF. RESULTS: In terms of demographics, there was a statistically significant difference in BMI between group A and group B (P < 0.05). The differences in age, sex, smoking, drinking, heart disease, hypertension and diabetes were not statistically significant (P > 0.05). In terms of preoperative symptoms, there was a significant difference in gait disturbance, pain in the LE, and urination disorder between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). In terms of operation-related variables, there was a significant difference in the preoperative duration of symptoms, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, operation time, pre-mJOA, post-mJOA at 1 year, and leakage of cerebrospinal fluid between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). The preoperative average JOA score of group A was 6.37 and that of group B was 5.19. In group A, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.87, 8.23 and 8.26, respectively, and the average JOA score improvement rate was 32.79 %, 38.32 and 38.53 %, respectively. In group B, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.74, 8.15 and 8.29, respectively, and the average JOA score improvement rate was 39.15 %, 46.86 and 47.12 %, respectively. CONCLUSIONS: Currently, there is no consensus on whether instrumentation is needed after laminectomy for TOLF. We found that for patients with a long duration of gait disturbance, urination disorder, preoperative duration of symptoms, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT less than 60 %, and shape on the sagittal MRI being beak and low, pre-mJOA had better clinical effects after LI as compared to those after LA, and the incidence of perioperative complications was lower.

Ultralow-Threshold Continuous-Wave Room-Temperature Crystal-Fiber/Nanoperovskite Hybrid Lasers for All-Optical Photonic Integration.

Continuous-wave (CW) room-temperature (RT) laser operation with low energy consumption is an ultimate goal for electrically driven lasers. A monolithically integrated perovskite laser in a chip-level fiber scheme is ideal. However, because of the well-recognized air and thermal instabilities of perovskites, laser action in a perovskite has mostly been limited to either pulsed or cryogenic-temperature operations. Most CW laser operations at RT have had poor durability. Here, crystal fibers that have robust and high-heat-load nature are shown to be the key to enabling the first demonstration of ultralow-threshold CW RT laser action in a compact, monolithic, and inexpensive crystal fiber/nanoperovskite hybrid architecture that is directly pumped with a 405 nm diode laser. Purcell-enhanced light-matter coupling between the atomically smooth fiber microcavity and the perovskite nanocrystallites gain medium enables a high Q (≈1500) and a high ß (0.31). This 762 nm laser outperforms previously reported structures with a record-low threshold of 132 nW and an optical-to-optical slope conversion efficiency of 2.93%, and it delivers a stable output for CW and RT operation. These results represent a significant advancement toward monolithic all-optical integration.

Influence of SCA on clinical outcomes and cervical alignment after laminoplasty in patients with multilevel cervical spondylotic myelopathy.

BACKGROUND: To study the impact of changes in spino-cranial angle (SCA) on sagittal alignment and to investigate the relationship between SCA and Neck Disability Index (NDI) scores after laminoplasty (LP) MATERIAL AND METHODS: In total, 72 patients with multilevel cervical spondylotic myelopathy (MCSM) after laminoplasty (LP) were retrospectively enrolled. Based on the optimal cut-off values of preoperative SCA, patients were classified into low SCA and high SCA groups. Radiographic data were measured, including spino-cranial angle (SCA), T1-slope (T1s), C2-7 lordosis (CA), T1s minus CA (T1sCA), and C2-7 sagittal vertical axis (cSVA). JOA and NDI scores were both applied to assess postoperative and follow-up clinical efficacy. Pearson correlation coefficient and linear regression analysis were respectively calculated between radiographic data and between SCA and NDI. RESULTS: The preoperative SCA was significantly correlated with T1s (r = - 0.795), CA (r = - 0.857), and cSVA (r = 0.915). A receiver operating characteristic (ROC) curve model predicted a threshold of SCA (value of 85.2°). At the follow-up period, patients with lower SCA had a higher T1s and CA and a lower cSVA, simultaneously accompanied by greater △T1s, △CA, and △cSVA. The linear regression model demonstrated that SCA in the higher group was positively correlated with NDI, and patients with higher SCA had worse NDI scores (pre: p < 0.001; post: p < 0.001; F/U: p = 0.003) and greater changes of NDI (post: p < 0.010; F/U: p = 0.002). CONCLUSION: SCA may be a good predictor of evaluating sagittal balance and planning surgery. Changes in sagittal alignment in the low SCA group were affected more easily, and a higher SCA was associated with worse quality of life. Laminoplasty could be a good choice for patients with lower SCA.

Precise Surgical Treatment of Thoracic Ossification of Ligamentum Flavum Assisted by O-Arm Computer Navigation: A Retrospective Study.

OBJECTIVE: O-arm computer navigation-assisted technology (OACNAT) has been widely used in the treatment of thoracic ossification of ligamentum flavum (TOLF) in recent years, but there are few in-depth studies on the safety and effectiveness of this approach. The purpose of this study was to investigate the clinical effect of accurate surgical treatment for TOLF with OACNAT. METHODS: From January 2010 to January 2018, the clinical data of 64 patients with TOLF who underwent laminectomy and internal fixation in the Third Hospital of Hebei Medical University were retrospectively reviewed. The patients were divided into group A (with OACNAT, n = 33) and group B (without OACNAT, n = 31) according to the application of OACNAT during the operation. The possible operation-related variables, imaging results, and clinical effects were compared between the 2 groups. RESULTS: In terms of demographics, there were no significant differences between group A and group B in age, sex, body mass index, smoking, drinking, heart disease, hypertension and diabetes (P > 0.05). In terms of operation-related variables, imaging results, and clinical efficacy, there were significant differences in operation time, wound length, postoperative modified Japanese Orthopaedic Association (JOA) score, JOA score improvement rate, accuracy of screw placement, number of intraoperative fluoroscopy procedures, and cerebrospinal fluid leakage between group A and group B (P < 0.05). There were no significant differences in other variables between the 2 groups (P > 0.05). In contrast to group A, in group B, 2 patients had incorrect segmental localization, 3 patients had residual ossified ligamentum flavum after the operation, and 1 patient had postoperative neurologic impairment. On further analysis, compared with group B, group A had a shorter operation time, more accurate screw placement, fewer fluoroscopy procedures, higher JOA score improvement rate, and lower incidence of complications. CONCLUSIONS: The use of OACNAT accurately located the position, size, shape, and boundary of ossification of the ligamentum flavum during the operation, which could guide accurate decompression and improve the accuracy of pedicle screw placement. This approach not only reduced the incidence of incorrect segmental localization and incomplete or excessive decompression but also reduced the risk of related complications and improved the accuracy, safety, and effectiveness of the operation.

Electromagnetic navigational bronchoscopy-directed dye marking for locating pulmonary nodules.

BACKGROUND: Small peripheral pulmonary nodules, which are usually deep-seated with no visual markers on the pleural surface, are often difficult to locate during surgery. At present, CT-guided percutaneous techniques are used to locate pulmonary nodules, but this method has many limitations. Thus, we aimed to evaluate the accuracy and feasibility of electromagnetic navigational bronchoscopy (ENB) with pleural dye to locate small peripheral pulmonary nodules before video-associated thoracic surgery (VATS). METHODS: The ENB localisation procedure was performed under general anaesthesia in an operating room. Once the locatable guide wire, covered with a sheath, reached the ideal location, it was withdrawn and 0.2-1.0 mL of methylene blue/indocyanine green was injected through the guide sheath. Thereafter, 20-60 mL of air was instilled to disperse the dye to the pleura near the nodules. VATS was then performed immediately. RESULTS: Study subjects included 25 patients with 28 nodules. The mean largest diameter of the pulmonary nodules was 11.8 mm (range, 6.0-24.0 mm), and the mean distance from the nearest pleural surface was 13.4 mm (range, 2.5-34.9 mm). After the ENB-guided localisation procedure was completed, the dye was visualised in 23 nodules (82.1%) using VATS. The average duration of the ENB-guided pleural dye marking procedure was 12.6 min (range, 4-30 min). The resection margins were negative in all malignant nodules. Complications unrelated to the ENB-guided localisation procedure occurred in two patients, including one case of haemorrhage and one case of slow intraoperative heart rate. CONCLUSION: ENB can be used to safely and accurately locate small peripheral pulmonary nodules and guide surgical resection. TRIAL REGISTRATION NUMBER: ChiCTR1900021963.

Impact of the 21-gene recurrence score assay on chemotherapy decision making and outcomes for breast cancer patients with four or more positive lymph nodes.

BACKGROUND: To assess the impact of the 21-gene recurrence score (RS) on chemotherapy decision making and survival outcomes for breast cancer patients with >4 positive lymph nodes. METHODS: Patients with non-metastatic estrogen receptor-positive breast cancer with >4 positive lymph nodes diagnosed between 2004 and 2013 were identified using the Surveillance, Epidemiology, and End Results database. The relationships between the 21-gene RS value and survival outcomes, chemotherapy decision-making, and chemotherapy benefit were analyzed. RESULTS: A total of 410 patients were identified, including 191 (46.6%), 164 (40.0%), and 55 (13.4%) in the low-, intermediate-, and high-risk RS groups, respectively. The 21-gene RS assay results were independently related to chemotherapy receipt. A total of 59.0%, 68.0%, and 78.0% of patients received chemotherapy in the low-, intermediate-, and high-risk RS groups, respectively. The 21-gene RS was an independent indicator of breast cancer specific survival (BCSS) and overall survival (OS). Intermediate-risk [BCSS: hazards ratio (HR), 2.832, 95% confidence interval (CI): 1.160-6.910, P=0.022; OS: HR, 3.704, 95% CI: 1.750-7.836, P=0.001] and high-risk RS (BCSS: HR, 6.440, 95% CI: 2.597-15.974, P<0.001; OS: HR, 5.053, 95% CI: 2.199-11.608, P<0.001) cohorts had significantly lower survival outcomes compared to low-risk RS cohort. The 5-year BCSS were 92.7%, 88.3%, and 70.7% in patients in the low-, intermediate-, and high-risk RS cohorts, respectively (P<0.001), and the 5-year OS were 92.1%, 80.6%, and 66.6%, respectively (P<0.001). CONCLUSIONS: The 21-gene RS is an independent predictor of chemotherapy receipt and survival outcomes for breast cancer patients with > 4 positive lymph nodes.

The Effect of Post-mastectomy Radiotherapy in Patients With Metaplastic Breast Cancer: An Analysis of SEER Database.

Introduction: Metaplastic breast cancer (MBC) is a rare and aggressive form of breast cancer. The present study aimed to assess the effect of post-mastectomy radiotherapy (PMRT) in MBC patients with intermediate-risk (T1-2N1M0 and T3N0M0) and high-risk (T1-4N2-3M0 and T4N0-1M0) disease. Methods: The Surveillance, Epidemiology and End Results database was used to analyze patients with MBC between 2000 and 2014. Kaplan-Meier analysis, log-rank tests, and the multivariate Cox proportional model were used for statistical analysis. Results: We identified 460 patients with a median follow-up time of 31 months (range, 2-178 months). Five-year breast cancer specific survival (BCSS) for all patients was 57.5%. In the entire group, multivariate analysis showed that PMRT was associated with better BCSS (hazard ratio (HR) 0.500, 95% confidence interval (CI) 0.366-0.683, P < 0.001). The 5-year BCSS in PMRT and non-PMRT groups were 62.3 and 50.3%, respectively (P = 0.001). When stratified the patients into intermediate-risk and high-risk groups, PMRT could improve BCSS compared with that in non-PMRT patients in both the intermediate- and high-risk groups. For the intermediate-risk group, the 5-year BCSS was 74.3 and 64.7% in PMRT and non-PMRT groups (P = 0.042), respectively, and was 52.1 and 28.8% in high-risk patients treated with PMRT and non-PMRT, respectively (P < 0.001). Conclusion: PMRT could improve the BCSS of MBC patients with intermediate- and high-risk disease.

Real-World Impact of Survival by Period of Diagnosis in Epithelial Ovarian Cancer Between 1990 and 2014.

Introduction: Although advances in surgical and chemotherapeutic approaches have improved management of epithelial ovarian cancer (EOC) in recent decades. The mortality of EOC over time remains controversial. The aim of this study was to assess the survival trends of EOC according to period of diagnosis using real-world data. Methods: Patients with EOC diagnosed from 1990 to 2014 were included from the Surveillance, Epidemiology, and End Results database. The Kaplan-Meier method and multivariate Cox regression models were used to evaluate the trends in survival over time. Results: We identified 59,763 patients diagnosed with EOC as follows: 6,586 (11.0%) in 1990-1994, 7,408 (12.4%) in 1995-1999, 15,348 (25.7%) in 2000-2004, 14,908 (24.9%) in 2005-2009, and 15,513 (26.0%) in 2010-2014. In the distant stage, the use of surgery decreased from 92.0% in 1990-1994 to 88.9% in 2010-2014. The use of chemotherapy increased from 67.4% in 1990-1994 to 75.0% in 2010-2014. The 5-year cause-specific survival (CSS) increased from 48.6% in 1990-1994 to 57.4% in 2010-2014 (P < 0.001). The 5-year overall survival (OS) increased from 42.7% in 1990-1994 to 51.7% in 2010-2014 (P < 0.001). The 5-year CSS and OS showed slight improvement in the localized stage (CSS, 91.9 vs. 93.1%; OS, 85.6 vs. 88.5%), and largely improved in the distant stage (CSS, 31.4 vs. 42.7%; OS, 26.7 vs. 37.4%) between 1990-1994 and 2010-2014. The multivariate analysis indicated that being diagnosed in the later years was related to better CSS and OS of EOC. Conclusion: The trends in survival of EOC have improved over time, but net survival remains poor overall in distant-stage EOC.

Progesterone receptor status and tumor grade predict the 21-gene recurrence score of invasive lobular breast cancer.

Aim: To assess the association between established clinicopathological variables and the 21-gene recurrence score (RS) stratification of invasive lobular carcinoma (ILC) of the breast. Materials & methods: We identified 9030 ILC patients from the Surveillance, Epidemiology and End Results database. Results: Older age, higher grade tumor and progesterone receptor (PR)-negative disease were independent predictors of high-risk RS stratification. Among patients with PR-positive tumors, 3, 6 and 15% with well-differentiated (G1), moderately-differentiated (G2) and poorly and/or undifferentiated (G3) disease were in the high-risk cohort, respectively. In patients with PR-negative tumors: 16, 24 and 41% of patients with G1, G2 and G3 disease were in the high-risk cohort, respectively. Conclusion: The 21-gene RS testing may not be necessary for patients with PR+/G1-2 ILC.

21-Gene Recurrence Score Assay Could Not Predict Benefit of Post-mastectomy Radiotherapy in T1-2 N1mic ER-Positive HER2-Negative Breast Cancer.

Introduction: It is still controversial whether post-mastectomy radiotherapy (PMRT) is necessary for women with T1-2 N1mic ER-positive HER2-negative breast cancer. The 21-gene recurrence score (RS) assay has been validated in T1-2 N1 breast cancer to be prognostic of locoregional recurrence (LRR) and overall survival (OS). This study aims to evaluate the predict value of 21-gene recurrence score assay for the benefit of PMRT in T1-2 N1mic ER-positive HER2-negative breast cancer. Methods: A population-based cohort study was performed on women with T1-2 N1mic ER-positive HER2-negative breast cancer who underwent mastectomy and were evaluated using the 21-gene RS in the Surveillance, Epidemiology, and End Results (SEER) registry between 2004 and 2015. Clinical characteristics as well as OS and breast cancer-specific survival (BCSS) were compared between patients with and without PMRT in patients with a Low-, Intermediate-, and High-RS. Multivariate COX regression analysis was performed to investigate if the 21-gene RS assay could predict benefit of PMRT in this group of breast cancer patients. Results: A total of 1571 patients met the criteria of our study and were enrolled, including 970 patients in the Low-Risk group (score <18), 508 in the Intermediate-Risk group (score 18-30), and 93 patients in the High-Risk group (score >30). In the High-Risk group, there were more patients with age ≥50 (87.0 vs. 64.3%, P = 0.040) and received chemotherapy with a borderline significance (91.3 vs. 72.9%, P = 0.066) in the PMRT subgroup than in the no PMRT subgroup. In all three groups, OS was comparable between the PMRT subgroup and the no PMRT subgroup. Furthermore, multivariate analysis did not show any OS benefit for PMRT based on the 21-gene recurrence score. Conclusion: This study showed that the 21-gene RS assay was not able to predict the benefit of PMRT for OS in women with T1-2 N1mic ER-positive HER2-negative breast cancer. However, further prospective larger sample-size trials are warranted to determine if a benefit exists.

Analyses of effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL: a retrospective cohort study.

OBJECTIVES: This study aimed to investigate the effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL. METHODS: In this study, 194 patients, who underwent open-door laminoplasty for cervical OPLL from January 2009 to January 2016, were retrospectively reviewed. The Patient Satisfaction Index (PSI) was collected at discharge, 6 months, 1 year, and the last follow-up. According to the PSI, patients were divided into satisfied group and dissatisfied group. The possible effect factors included demographic variables and surgery-related variables. RESULTS: At discharge, 42 (21.6%) patients were in the dissatisfied group, as compared to the satisfied group, the hospitalization cost, hospital stay, postoperative depression, the axial neck pain, delayed wound healing, and VAS-neck had significant statistical differences. At 6-month follow-up, 25 (12.9%) patients were in the dissatisfied group. The axial neck pain and JOA score had significant statistical differences between the two groups, and no significant differences were found between the two groups in other items. At 1 year with 18 (9.3%) dissatisfied patients and last follow-up with 14 (7.2%) dissatisfied patients, the JOA score and symptom recurrence had significant statistical differences. For further analysis, the dissatisfied patients with axial neck pain at 6 months were significantly higher than that at other terms and the JOA score of the two groups increased gradually with prolonging of restoration years but compared with the dissatisfied group, the JOA scores were obviously better in the satisfied group at the last follow-up. CONCLUSIONS: Overall, to patients undergoing open-door laminoplasty for cervical OPLL, hospitalization cost and neck pain might be mainly associated with patient dissatisfaction at the early and middle recovery. Patient dissatisfaction at the long-term treatment outcome might be mainly associated with the low improvement rate of JOA score and symptom recurrence.

Noninferior Outcome After Breast-Conserving Treatment Compared to Mastectomy in Breast Cancer Patients With Four or More Positive Lymph Nodes.

Introduction: We conducted a non-inferiority analysis using real-world data to compare the survival outcomes of stage T1-2N2-3 (tumor size ≤5 cm and four or more node metastases) breast cancer after breast-conserving surgery (BCS) and mastectomy (MAST). Methods: The study included patients with stage T1-2N2-3 invasive breast carcinoma from the Surveillance, Epidemiology, and End Results program, who underwent BCS or MAST between 2004 and 2012, along with both radiotherapy and chemotherapy. The statistical analyses used included the chi-squared test, multivariate Cox proportional hazards models, and propensity score matching (PSM). Results: The study population comprised 13,263 patients, including 4,787 (36.1%) and 8,476 (63.9%) patients who were treated with BCS and MAST, respectively. Patients with younger age and advanced stage were more likely to have received MAST. The probability of receiving MAST increased over the years, while the probability of BCS decreased (p < 0.001). The 5-year breast cancer-specific survival (BCSS) was 86.1% in the BCS cohort compared to 83.1% in the MAST cohort (p < 0.001). Surgical procedure was an independent prognostic factor for BCSS. Patients who received MAST had worse BCSS than those treated with BCS (hazard ratio = 1.179, 95% confidence interval = 1.087-1.278, p < 0.001). These results remained significant after stratification by age, tumor grade, T stage, N stage as well as marital status. Similar results were obtained after PSM. Conclusions: BCS resulted in noninferior outcome than MAST in patients with T1-2/N2-3 invasive breast carcinoma. BCS may therefore be an optimal treatment option when both treatment options are feasible and appropriate.

Impact of 21-Gene Recurrence Score on Chemotherapy Decision in Invasive Ductal Carcinoma of Breast with Nodal Micrometastases.

PURPOSE: The purpose of this study was to investigate the effect of 21-gene recurrence score (RS) on predicting prognosis and chemotherapy decision in node micrometastases (N1mi) breast invasive ductal carcinoma (IDC). Methods Patients with stage T1-2N1mi and estrogen receptor-positive IDC diagnosed between 2004 and 2015 were included. The associations of 21-gene RS with breast cancer-specific survival (BCSS), chemotherapy decision, and benefit of chemotherapy were analyzed. RESULTS: We identified 4,758 patients including 1,403 patients (29.5%) treated with adjuvant chemotherapy. In the traditional RS cutoffs, 2,831 (59.5%), 1,634 (34.3%), and 293 (6.2%) patients were in the low-, intermediate-, and high-risk RS groups, respectively. In 3,853 patients with human epidermal growth factor receptor-2 (HER2) status available, most patients were HER2-negative disease (98.3%). A higher RS was independently related to chemotherapy receipt, and 14.0%, 47.7%, and 77.8% of patients in the low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. The multivariate analysis indicated that a higher RS was related to worse BCSS (p < 0.001). The 5-year BCSS rates were 99.3%, 97.4%, and 91.9% in patients with low-, intermediate-, and high-risk RS groups, respectively (p < 0.001). However, chemotherapy receipt did not correlate with better BCSS in low-, intermediate-, or high-risk RS groups. There were similar trends using Trial Assigning Individualized Options for Treatment RS cutoffs. CONCLUSION: The 21-gene RS does predict outcome and impact on chemotherapy decision of N1mi breast IDC. Large cohort and long-term outcomes studies are needed to identify the effects of chemotherapy in N1mi patients by different 21-gene RS groups.

The 21-gene recurrence score and effects of adjuvant radiotherapy after breast conserving surgery in early-stage breast cancer.

Aim: To investigate the associations with the 21-gene recurrence score (RS) and effect of adjuvant radiotherapy (RT) for early-stage breast cancer after breast conserving surgery. Methods: We included 13,246 patients in the SEER database. Results: Patients with a higher RS were independently related to nonreceipt of RT (p < 0.001). In both the traditional and Trial Assigning Individualized Options for Treatment (TAILORx) RS cut-offs, the receipt of RT was not related to better breast cancer-specific survival in low- and high-risk RS groups, but was independently related to better breast cancer-specific survival in intermediate-risk RS group before (p = 0.029) and after (p = 0.001) propensity score matching. Conclusion: The 21-gene-RS may impact the decision-making of adjuvant RT in early-stage breast cancer after breast conserving surgery. The survival benefit of adjuvant RT may be limited to patients with intermediate-risk RS.

21-Gene Recurrence Score Assay and Outcomes of Adjuvant Radiotherapy in Elderly Women With Early-Stage Breast Cancer After Breast-Conserving Surgery.

Introduction: To assess the role of the 21-gene recurrence score (RS) assay on decision-making of postoperative radiotherapy (RT) following breast-conserving surgery (BCS) in elderly women with early-stage breast cancer. Methods: The 21-gene RS for elderly (≥65 years) women with stage T1-2N0M0 estrogen receptor-positive breast cancer who underwent BCS from 2004 to 2015 was obtained from the Surveillance, Epidemiology, and End Results program. We estimated the association of 21-gene RS and adjuvant RT related to breast cancer-specific survival (BCSS) using propensity score matching (PSM). Results: We identified 18,456 patients, of which 15,326 (83.0%) received postoperative RT. Of identified patients, 58.9, 34.0, and 7.1% of patients had a low-, intermediate-, and high-risk RS, respectively. Receipt of postoperative RT was not related to the year of diagnosis according to the 21-gene RS groups. Multivariate analysis suggested that receipt of postoperative RT was an independent predictor of better BCSS before (hazard ratio [HR] 0.587, 95% confidence interval [CI] 0.426-0.809, P = 0.001) and after (HR 0.613, 95%CI 0.390-0.963, P = 0.034) PSM. However, subgroups analyses indicated that receipt of postoperative RT was related to better BCSS in women with intermediate-risk RS before (HR 0.467, 95%CI 0.283-0.772, P = 0.003) and after (HR 0.389, 95%CI 0.179-0.846, P = 0.017) PSM, but not in women with low- and high-risk RS groups before and after PSM. Conclusions: Although causation cannot be implied, adjuvant RT in elderly women was associated with a greater effect size in patients with an intermediate-risk RS.