Efficacy of neoadjuvant chemo-immunotherapy in non-small cell lung cancer: a real-world, multicenter, retrospective study.

Background: Resectable non-small cell lung cancer (NSCLC) patients have a high risk of recurrence. Multiple randomized controlled trials (RCTs) have shown that neoadjuvant chemo-immunotherapy brings new hope for these patients. The study aims to evaluate the safety, surgery-related outcomes and oncological outcomes for neoadjuvant chemo-immunotherapy in real-world setting with a large sample size and long-term follow-up. Methods: Patients with clinical stage IB-IIIB NSCLC who received neoadjuvant chemo-immunotherapy at two Chinese institutions were included in this retrospective cohort study. Surgical and oncological outcomes of the enrolled NSCLC patients were collected and analyzed. Results: There were 158 patients identified, of which 124 (78.5%) were at stage IIIA-IIIB and the remaining 34 (21.5%) were at stage IB-IIB. Forty-one patients (25.9%) received two cycles of neoadjuvant treatment, 80 (50.6%) had three cycles, and 37 (23.4%) had four cycles. Twenty-four patients (15.2%) experienced grade 3 or worse immune-related adverse events. The median interval time between the last neoadjuvant therapy and surgery was 37 [interquartile range (IQR), 31-43] days. Fifty-eight out of 96 (60.4%) central NSCLC patients who were expected to undergo complex surgery had the scope or the difficulty of operation reduced. Ninety-five (60.1%) patients achieved major pathologic response (MPR), including 62 (39.2%) patients with pathologic complete response (pCR). Multivariate regression analysis showed that no clinical factor other than programmed death-ligand 1 (PD-L1) expression was predictive of the pathological response. The median follow-up time from diagnosis was 27.1 months. MPR and pCR were significantly associated with improved progression-free survival (PFS) and overall survival (OS). Neither stage nor PD-L1 expression was significantly associated with long-term survival. Conclusions: The neoadjuvant chemo-immunotherapy is a feasible strategy for NSCLC with a favorable rate of pCR/MPR, modified resection and 2-year survival. No clinical factor other than PD-L1 expression was predictive of the pathological response. pCR/MPR may be effective surrogate endpoint for survival in NSCLC patients who received neoadjuvant chemo-immunotherapy.

TREM1/DAP12 based novel multiple chain CAR-T cells targeting DLL3 show robust anti-tumour efficacy for small cell lung cancer.

Small cell lung cancer (SCLC), recognized as the most aggressive subtype of lung cancer, presents an extremely poor prognosis. Currently, patients with small cell lung cancer face a significant dearth of effective alternative treatment options once they experience recurrence and progression after first-line therapy. Despite the promising efficacy of immunotherapy, particularly immune checkpoint inhibitors in non-small cell lung cancer (NSCLC) and various other tumours, its impact on significantly enhancing the prognosis of SCLC patients remains elusive. DLL3 has emerged as a compelling target for targeted therapy in SCLC due to its high expression on the membranes of SCLC and other neuroendocrine carcinoma cells, with minimal to no expression in normal cells. Our previous work led to the development of a novel multiple chain chimeric antigen receptor (CAR) leveraging the TREM1 receptor and DAP12, which efficiently activated T cells and conferred potent cell cytotoxicity. In this study, we have developed a DLL3-TREM1/DAP12 CAR-T (DLL3-DT CAR-T) therapy, demonstrating comparable anti-tumour efficacy against SCLC cells in vitro. In murine xenograft and patient-derived xenograft models, DLL3-DT CAR-T cells exhibited a more robust tumour eradication efficiency than second-generation DLL3-BBZ CAR-T cells. Furthermore, we observed elevated memory phenotypes, induced durable responses, and activation under antigen-presenting cells in DLL3-DT CAR-T cells. Collectively, these findings suggest that DLL3-DT CAR-T cells may offer a novel and potentially effective therapeutic strategy for treating DLL3-expressing SCLC and other solid tumours.

Enzymatic biofuel cell: A potential power source for self-sustained smart textiles.

Self-sustained smart textiles require a miniaturized and flexible power source, while the state-of-the-art lithium-ion battery cannot be seamlessly integrated into smart textiles. Enzymatic biofuel cells (EBFC), utilizing physiological glucose or lactate as fuels to convert chemical energy into electricity, are a potential alternative power source. In comparison to other proposed energy harvesters relying on solar and biomechanical energy, EBFCs feature several key properties, including continuous power generation, biocompatible interfaces without using toxic elements, simple configuration without extra packaging, and biodegradability. There is an urgent need to introduce EBFCs to the researchers working on smart textiles, who typically are not expert on bioelectrochemistry. This minireview first introduces the working principle of EBFC and then summarizes its recent progress on fibers, yarns, and textiles. It's expected that this review can help to bridge the knowledge gap and provide the community of smart textiles with information on both the strengths and limitations of EBFCs.

Occult lymph node metastasis is not a favorable factor for resected NSCLC patients.

BACKGROUND: This study was to compare the clinical presentations and survivals between the non-small cell lung cancer (NSCLC) patients with occult lymph node metastasis (OLNM) and those with evident lymph node metastasis (ELNM). We also intended to analyze the predictive factors for OLNM. METHODS: Kaplan-Meier method with log-rank test was used to compare survivals between groups. Propensity score matching (PSM) was used to reduce bias. The least absolute shrinkage and selection operator (LASSO)-penalized Cox multivariable analysis was used to identify the prognostic factors. Random forest was used to determine the predictive factors for OLNM. RESULTS: A total of 2,067 eligible cases (N0: 1,497 cases; occult N1: 165 cases; evident N1: 54 cases; occult N2: 243 cases; evident N2: 108 cases) were included. The rate of OLNM was 21.4%. Patients with OLNM were tend to be female, non-smoker, adenocarcinoma and had smaller-sized tumors when compared with the patients with ELNM. Survival curves showed that the survivals of the patients with OLNM were similar to those of the patients with ELNM both before and after PSM. Multivariable Cox analysis suggested that positive lymph nodes (PLN) was the only prognostic factor for the patients with OLNM. Random forest showed that clinical tumor size was an important predictive factor for OLNM. CONCLUSIONS: OLNM was not rare. OLNM was not a favorable sign for resected NSCLC patients with lymph node metastasis. PLN determined the survivals of the patients with OLNM. Clinical tumor size was a strong predictive factor for OLNM.

Investigation of Early-Stage Non-Small Cell Lung Cancer Patients with Different T2 Descriptors: Real Word Data From a Large Database.

INTRODUCTION: The current study evaluated a large cohort of T2N0M0 NSCLC patients with different T2 descriptors to investigate the prognostic disparities and further externally validate the T category of these patients. METHODS: The Kaplan-Meier Method with the log-rank test was used to plot survival curves. The propensity score matching (PSM) method was used to reduce bias. Univariable and multivariable Cox analyses were used to determine prognostic factors. RESULTS: A total of 13,015 eligible T2N0M0 NSCLC patients were included. There were 5,287, 2,577 and 5,151 patients in the T2a, T2b and non-sized determined T2N0M0 (T2non-sized) groups, respectively. Before PSM, the survival of T2non-sized patients was comparable to that of T2a patients (P = 0.080) but was superior to that of T2b patients (P < 0.001). After PSM, the survival of T2non-sized patients was inferior to that of T2a patients (P = 0.028) but was similar to that of T2b patients (P = 0.325). The T category was further subdivided based on the specific non-sized T2 descriptors and tumor size. The results of the multivariate Cox analysis found that the prognosis of T2 tumors with visceral pleural invasion (size: 0-30 mm) was better than that of T2a tumors, and the prognosis of T2 tumors with visceral pleural invasion (size: 30-40 mm) was inferior to that of T2a tumors but comparable to that of T2b tumors. CONCLUSION: T2 tumors with visceral pleural invasion (size: 30-40 mm) should be assigned to the T2b category, and those with a size interval of 0-30 mm should be assigned to a better prognostic T2a category.

Investigations of the distant metastatic non-small cell lung cancer without local lymph node involvement: Real world data from a large database.

INTRODUCTION: This study aimed to investigate the presentations and survival outcomes of the distant metastatic non-small cell lung cancer (NSCLC) without lymph node involvement to obtain a clearer picture of this special subgroup of metastatic NSCLC. METHOD: A least absolute shrinkage and selection operator (LASSO) penalized Cox regression analysis was used to select the prognostic variables. A nomogram and corresponding risk-classifying systems were constructed. The C-index and calibration curves were used to evaluate the performance of the model. Overall survival (OS) curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare OS differences between groups. Propensity score matching (PSM) was performed to reduce bias. RESULT: A total of 12 610 NSCLC patients with M1 category (N0 group: 3045 cases; N1-3 group: 9565 cases) were included. Regarding the N0 group, multivariate analysis demonstrated that age, sex, race, surgery, grade, tumor size, and M category were independent prognostic factors. A nomogram and corresponding risk-classifying systems were formulated. Favorable validation results were obtained from the C-index, calibration curves, and survival comparisons. Survival curves demonstrated that N0 NSCLC patients had better survival than N1-3 NSCLC patients both before and after PSM. Furthermore, the survival of resected N0M1 patients was superior to that of those without surgery. CONCLUSION: In this study, a prognostic nomogram and risk-classifying systems designed for the T1-4N0M1 NSCLC patients showed acceptable performance. Primary lung tumor resection might be a feasible treatment for this population subset. Additionally, we proposed that lymph node stage might have a place in the forthcoming tumor-node-metastasis (TNM) staging proposal for NSCLC patients with M1 category.

Investigation of the non-size-determined T4N0-2M0 non-small-cell lung cancer: what is the proper T category for the tumour with additional nodules in different lobes of ipsilateral lung?

OBJECTIVES: This study aimed to explore the prognostic disparity among T4N0-2M0 non-small-cell lung cancer (NSCLC) patients with different T4 descriptors. METHODS: T3-4N0-2M0 NSCLC patients were included. Patients were assigned to 7 subgroups: T3, T4 tumours with size larger than 70 mm (T4-size), T4 tumours with aorta/vena cava/heart invasion (T4-blood vessels), T4 tumours with vertebra invasion (T4-vertebra), T4 tumours with carina/trachea invasion (T4-carina/trachea), T4 tumours with additional tumour nodules in different lobes of ipsilateral lung (T4-add) and T4 tumours had at least 2 T4 descriptors (T4-multiple). Univariable and multivariable Cox analyses were used to explore the effect of T4 category on overall survival. Kaplan-Meier method with log-rank test was used to compare survival differences among subgroups. Propensity score matching was used to minimize the bias caused by imbalanced covariates between groups. RESULTS: A total of 41 303 eligible T3-4N0-2M0 NSCLC cases were included (17 057 T3 cases and 24 246 T4 cases). There were 10 682 cases, 573 cases, 557 cases, 64 cases, 2888 cases and 9482 cases in the T4-size, T4-blood vessels, T4-vertebra, T4-carina/trachea, T4-add and T4-multiple subgroups, respectively. Multivariable Cox analyses revealed that T4-add patients had the best prognosis in the entire cohort and in several subgroups. In the matched cohort of T4-add and T4-size and T4-add and T3, the survival of T4-add patients was superior to that of T4-size patients (P < 0.001) but was comparable to that of T3 patients (P = 0.115). CONCLUSIONS: Among NSCLC patients with different T4 descriptors, T4-add patients had the best prognosis. T4-add patients and T3 patients had similar survivals. Herein, we proposed that T4-add patients should be downstaged from T4 to T3 category. Our results served as a novel supplement to the proposals for the T category revision.

Reconsidering the T category for the T3 non-small cell lung cancer with additional tumor nodules in the same lobe: A population-based study.

Background: This study aimed to evaluate the prognosis of the T3 non-small cell lung cancer (NSCLC) patients with additional tumor nodules in the same lobe (T3-Add), and externally validate the current T category of this population. Methods: NSCLC data deposited in the Surveillance, Epidemiology, and End Results (SEER) dataset was extracted. Survivals were estimated using the Kaplan-Meier method with a log-rank test. Propensity score matching (PSM) was performed to reduce bias. The least absolute shrinkage and selection operator (LASSO)-penalized Cox model was used to determine the prognostic factors. Results: A total of 41,370 eligible cases were included. There were 2,312, 20,632, 12,787, 3,374 and 2,265 cases in the T3-Add, T1, T2, T3 and T4 group, respectively. The Kaplan-Meier curves demonstrated that the survivals of the T3-Add patients were superior to those of the T3 patients both before and after PSM. Additionally, the OS of the T3-Add patients were worse than that of the T2 patients, but the CSS differences between these two groups were not statistically significant. In the subset analyses, the survivals of the T3-Add patients were inferior to those of the T2a patients, but were comparable to those of the T2b patients (5-year OS rate: 54.3% vs. 57.2%, P = 0.884; 5-year CSS rate: 76.2% vs. 76.8%, P = 0.370). In the T3-Add & T2b matched pair, multivariable Cox analysis further confirmed that T category was not a prognostic factor for survivals. Conclusion: T3-Add and T2b NSCLC patients had similar survivals, and we proposed that it is necessary to reconsider the T category of the patients with additional nodules in the same lobe in the forthcoming 9th edition of TNM staging manual.

Is prior cancer history a hindrance for non-small cell lung cancer patients to participate in clinical trials?

BACKGROUND: This study aimed to explore the effect of a prior cancer history on the survivals of resected non-small cell lung cancer (NSCLC) patients. METHODS: Kaplan-Meier method with a log-rank test was used to compare overall survival (OS) and disease-free survival (DFS) between groups. Propensity score matching (PSM) method was used to reduce bias. The least absolute shrinkage and selection operator (LASSO)-penalized Cox multivariable analysis was used to identify the prognostic factors. RESULTS: A total of 4,102 eligible cases were included in this study. The rate of patients with a prior cancer was 8.2% (338/4,102). Patients with a prior cancer tended to be younger and have early-stage tumors when compared with those without prior cancer. Before PSM, the survivals of the patients with a prior cancer were similar to those of the patients without prior cancer (OS: P = 0.591; DFS: P = 0.847). After PSM, patients with a prior cancer and those without prior cancer still had comparable survival rates (OS: P = 0.126; DFS: P = 0.054). The LASSO-penalized multivariable Cox analysis further confirmed that a prior cancer history was not a prognostic factor for both OS and DFS. CONCLUSIONS: A prior cancer history was not associated with resected NSCLC patients' survivals, and we proposed that it might be reasonable for clinical trials to enroll the NSCLC patients with a prior cancer.

Non-small Cell Lung Cancer Surpassing the Elastic Layer Should Remain Classified as pT2a.

We aimed to evaluate the prognostic value of visceral pleural invasion on the survival of node-negative non-small cell lung cancer ≤3 cm using a large cohort. The Kaplan-Meier method was used to compare overall survival (OS); competing risk analysis with Fine-Gray's test was used to compare cancer- specific survival between groups. The least absolute shrinkage and selection operator penalized Cox regression model was used to identify prognostic factors. In total, 9725 eligible cases were included in this study, and they were separated into 3 groups: tumor invasion beneath the elastic layer (PL0), 8837 cases; tumor invasion surpassing the elastic layer (PL1), 505 cases; and tumor invasion to the visceral pleural surface (PL2), 383 cases. Visceral pleural invasion was more likely to occur in poorly differentiated and larger-sized tumors. Survival curves displayed that PL0 conferred better survival rates than PL1 and PL2, and PL1 achieved outcomes equivalent to those of PL2. Tumor size and histology subset analyses further corroborated this conclusion. Least absolute shrinkage and selection operator -penalized Cox regression analysis confirmed that PL status was an independent prognostic factor for both OS and cancer- specific survival. This study supported the notion that in node-negative non-small cell lung cancer ≤3 cm, PL1 patients should remain classified as pT2a, which could improve staging accuracy.

Is adjacent lobe invasion an T category upgrade factor for resected non-small cell lung cancer ≤ 5 cm?

PURPOSE: Controversy exists with regard to the T category of non-small cell lung cancer (NSCLC) with adjacent lobe invasion (ALI), and dispute arises on assigning this subset into T2 or T3 category. We evaluated the effect of ALI on the survival of resected NSCLC ≤ 5 cm, with purpose of determining the most appropriate T category for this population. METHODS: The entire cohort was divided into three subgroups (ALI group, T2 group and T3 group). Kaplan-Meier with log-rank method was carried out to compare overall survival (OS) differences. Propensity score matching (PSM) was performed to minimize bias. RESULTS: A total of 12,564 eligible NSCLC cases (ALI group: 114 cases; T2 group: 10,046 cases; T3 group: 2404 cases) were included in this study. The incidence of ALI was about 0.9%. Before PSM, survival analyses demonstrated that no significant OS differences were observed between ALI group and T2 group, and between ALI group and T3 group, neither in the entire cohort analysis nor in the subgroup analysis. After PSM, there were 102 pairs and 98 pairs in the ALI and T2 matching group and ALI and T3 matching group, respectively. In the matched cohorts, survival curves showed that the OS of ALI group was comparable to that of T2 group (P = 0.950), but superior to that of T3 group (P = 0.012). CONCLUSIONS: The current study proposed that NSCLC with ALI ≤ 5 cm should be still categorized as T2 category, which could improve staging accuracy.

Is there a prognostic difference among patients with T3N0-3M0 non-small-cell lung cancer with different T3 descriptors?

OBJECTIVES: Our goal was to evaluate the survival disparities among the patients with T3N0-3M0 non-small-cell lung cancer with different T3 descriptors and to further externally validate the current T3 category. METHODS: Overall survival and cancer-specific survival were compared using the Kaplan-Meier method with a log-rank test. A univariable and a multivariable Cox regression model were performed to determine the prognostic factors. RESULTS: A series of 28,519 eligible cases was included. There were 17,971 cases with tumours that were larger than 5 cm but equal to or less than 7 cm (T-size group); 3,028 cases with tumours with chest wall/pericardium/phrenic nerve invasion (T-invasion group); 4,600 cases with tumours with additional tumour nodules in the same lobe (T-add group); and 2,900 cases with tumours that had at least 2 T3 descriptors (T-multiple group). The survival data indicated that patients in the T-add group had the best survival rates compared with other patients both in the entire cohort and in the subgroup analyses. Multivariable Cox models indicated that T3 descriptor was an important prognostic factor. Of the patients with different T3 descriptors, patients in the T-add group had the best prognosis, followed by patients in the T-size and in the T-invasion groups, and patients in the T-multiple group had the worst prognosis both in the pathological and clinical tumor-node-metastasis (TNM) stage cohorts. CONCLUSIONS: Patients with T3N0-3M0 non-small-cell lung cancer with different T descriptors had inconsistent survival rates. T-add yielded the best survivals, followed by T-size and T-invasion, and T-multiple was associated with the worst survivals. Our results were exploratory in nature and need to be further validated.

Stage IV non-small cell lung cancer among young individuals: Incidence, presentations, and survival outcomes of conventional therapies.

Background: There is a paucity of data published on the clinicopathological features and prognosis of stage IV non-small cell lung cancer (NSCLC) patients aged ≤45 years. Herein, we evaluated a large clinical series in an effort to provide a clearer picture of this population. Methods: The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression model was performed to identify prognostic factors for NSCLC among individuals aged ≤45 years. The Kaplan-Meier method with log-rank test was used to compare overall survival (OS) differences between groups. Competing risk analysis with the Fine-Gray test was used to analyze cancer-specific survival (CSS) differences. Propensity score matching (PSM) was used to minimize selection bias. Results: Incidence-rate analyses, including 588,680 NSCLC cases (stage IV, 233,881; age ≤ 45 years stage IV, 5,483; and age > 45 years stage IV, 228,398) from 2004 to 2015, showed that the incidence of stage IV NSCLC among young individuals decreased over the years. In comparative analyses of clinical features and survival outcomes, a total of 48,607 eligible stage IV cases (age ≤ 45 years stage IV, 1,390; age > 45 years stage IV, 47,217) were included. The results showed that although patients in the young cohort were more likely to be diagnosed at advanced stages, they were also more likely to receive aggressive treatments. In addition, the survival rates of the young patients were superior to those of the older patients both before and after PSM. Conclusions: Stage IV NSCLC patients aged ≤45 years comprise a relatively small but special NSCLC subgroup. Although this population had better survival outcomes than older patients, these patients deserve more attention due to their young age and the significant socioeconomic implications.

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

OBJECTIVES: We aimed to investigate the clinical features, prognosis and predictive factors for the non-small cell lung cancer (NSCLC) patients with uncertain resection [R(un)]. MATERIALS AND METHODS: Kaplan-Meier method with a log-rank test was used to compare overall survival (OS) and disease-free survival (DFS) between groups. The least absolute shrinkage and selection operator (LASSO)-penalized Cox multivariable analysis was used to identify the prognostic factors. Random forest was used to determine the important predictive factors of R(un) resection. RESULTS: A total of 2,782 eligible cases (R0 group: 1,897 cases; R(un) group: 885 cases) were included in this study. The rate of conventional R0 to R(un) reclassification was 31.8%. Patients with R(un) resection were more likely to have left-sided tumors, receive open surgery, and be diagnosed with advanced tumors. The survivals of the patients with R(un) resection were inferior to those of the patients with R0 resection in the entire cohort and in the nodal category, histology and adjuvant therapy subgroups. The LASSO-penalized multivariable Cox analysis confirmed that R(un) resection was an adverse prognostic factor for both OS and DFS. At last, surgical extent, surgical approach and tumor location were proven as the predictive factors for R(un) resection. CONCLUSION: NSCLC patients with R(un) resection was not rare. R(un) had an adverse impact on the survivals of resected patients. Patients received non-lobectomy and open surgery, and patients with left-sided tumors were more likely to be suffered from R(un) resection.

Lymphovascular invasion: A non-sized T descriptor for stage IA non-small cell lung cancer.

BACKGROUND: Lymphovascular invasion (LVI) has not been included in the tumor-node-metastasis (TNM) staging manual of non-small-cell lung cancer (NSCLC). We aimed to investigate the predictive value of LVI on stage IA NSCLC and proposed a method of incorporating LVI into the T category based on the latest TNM staging manual. METHODS: The least absolute shrinkage and selection operator (LASSO)-penalized Cox multivariable regression model was performed to identify prognostic factors. The Kaplan-Meier method was used to compare overall survival (OS) and disease-free survival (DFS) between groups. Propensity score matching (PSM) was used to minimize bias. RESULTS: A total of 1452 eligible stage I NSCLC cases (stage IA without LVI, 1022 cases; stage IA with LVI, 120 cases; stage IB, 310 cases) were included. LASSO-penalized multivariable Cox analysis revealed that LVI was an independent prognostic factor for both OS and DFS. Survival analysis demonstrated that the survivals of stage IA NSCLCs without LVI were better than those of stage IA with LVI and stage IB NSCLCs. In the matched cohort, the survivals of stage IA NSCLCs with LVI were comparable to those of stage IB NSCLCs. CONCLUSIONS: Stage IA NSCLCs with LVI and stage IB NSCLCs had similar survivals, and we proposed that LVI might be a non-sized T descriptor that upstaged stage IA diseases to stage IB.

Occult Non-Small Cell Lung Cancer: An Underappreciated Disease.

BACKGROUND: The number of researches on occult non-small cell lung cancer (NSCLC) is modest. Herein, we defined the clinicopathological features, prognosis and survival outcome of this underappreciated tumor, with purpose of obtaining a clearer picture on this disease. METHODS: The entire cohort was categorized into two groups (occult NSCLC and other NSCLC) and further into five groups (occult, T1, T2, T3 and T4). A least absolute shrinkage and selection operator (LASSO) penalized Cox regression model was performed to identify the prognostic indicators. A nomogram and a risk-classifying system were formulated. Kaplan-Meier with Log-rank method was carried out to compare overall survival (OS) and cancer specific survival (CSS) differences between groups. RESULTS: 59,046 eligible NSCLC cases (occult NSCLC: 1158 cases; other NSCLC: 57,888 cases) were included. Occult NSCLC accounted for 2.0% of the included cases. Multivariate analysis revealed that age, sex, tumor location, histology, grade and surgery were prognostic factors for OS. The corresponding prognostic nomogram classified occult NSCLC patients into low-risk and high-risk group, and its performance was acceptable. Survival curves demonstrated that occult NSCLC patients exhibited worse survivals than other NSCLC. In further analyses, the survival of low-risk occult NSCLC and stage T3 NSCLC were comparable, and the high-risk occult NSCLC patients still owned the worst survival rate. CONCLUSIONS: Occult NSCLC was an aggressive tumor with poor prognosis, and surgery was the preferred treatment. More attention should be paid to this overlooked disease due to no evidence of tumor imaging.

Proactive exploration of inferior parathyroid gland using a novel meticulous thyrothymic ligament dissection technique.

INTRODUCTION: The inferior parathyroid gland (IPTG) is widely distributed; effective techniques for its safe exploration and protection during thyroid surgery have not been documented. The thyrothymic ligament (TTL) is a connective tissue located between the thymic tongue and thyroid. This study aims to introduce a novel meticulous thyrothymic ligament dissection technique and assess its role in proactive exploration and situ preservation of IPTG. MATERIALS AND METHODS: 737 patients undergoing initial thyroid surgery between 2017 and 2021 in the Department of General Surgery of the First Affiliated Hospital of Nanjing Medical University were retrospectively recruited for this clinical study. In 391 of the recruited patients, the TTL was dissected, and the number and location of IPTG were recorded. Among them, 214 patients underwent total/near-total thyroidectomy (TT) plus central neck dissection (CND) were assigned to the observation group. The control group included 346 consecutive patients who underwent conventional TT plus CND. After 1:1 propensity score matching, each group contained 206 patients. The incidence of postoperative hypoparathyroidism was recorded. RESULTS: Among the 391 patients, 596 sides were dissected, out of which 436 sides (73.2%) had TTL, and approximately 90.1% of IPTG were located and identified. A statistically significant difference in incidence of temporary (27.7 vs. 49.0%, P < 0.001) and permanent hypoparathyroidism (0 vs. 8.2%, P = 0.047) was noted between the observation group and the control group. CONCLUSION: The meticulous thyrothymic ligament dissection technique helps to protect IPTG in situ and reduce the incidence of postoperative hypoparathyroidism.

Bimetallic Selenide Decorated Nanoreactor Synergizing Confinement and Electrocatalysis of Se Species for 3D-Printed High-Loading K-Se Batteries.

The potassium-selenium (K-Se) battery has been considered an appealing candidate for next-generation energy storage systems owing to the high energy and low cost. Nonetheless, its development is plagued by the tremendous volume expansion and sluggish reaction kinetics of the Se cathode. Moreover, implementing favorable areal capacity and longevous cycling of a high-loading K-Se battery remains a daunting challenge facing commercial applications. Herein, we devise a Se and CoNiSe2 coembedded nanoreactor (Se/CoNiSe2-NR) affording low carbon content as an advanced cathode for K-Se batteries. We systematically uncover the enhanced K2Se2/K2Se adsorption and promoted K+ diffusion behavior with the incorporation of Co throughout theoretical simulation and electrokinetic analysis. As a result, Se/CoNiSe2-NR harvests high cycling stability with a capacity decay rate of 0.038% per cycle over 950 cycles at 1.0 C. More encouragingly, equipped with a 3D-printed Se/CoNiSe2-NR electrode with tunable Se loadings, K-Se full batteries enable steady cycling at an elevated Se loading of 3.8 mg cm-2. Our endeavor ameliorates the capacity and lifetime performance of the emerging K-Se device, thereby offering a meaningful tactic in pursuing its practical application.

Nomogram to Predict Cancer Specific Survival in Patients with Pathological Stage IA Non-small Cell Lung Cancer.

We identified the prognostic factors of resected stage IA non-small cell lung cancer (NSCLC) and developed a nomogram, with purpose of defining the high-risk population who may need closer follow-up or more intensive care. Eligible stage IA NSCLC cases from the Surveillance, Epidemiology, and End Results (SEER) database and the Sun Yat-sen University Cancer Center (SYSUCC) were included. Stage IB NSCLCs were also included for evaluating the risk stratification efficacy. Cancer specific survival (CSS) was compared between groups. Statistically significant factors from multivariate analysis were entered into the nomogram. The performance of the nomogram was evaluated by concordance index (C-index) and calibration plots. A total of 23,112 NSCLC cases (SEER stage IA training cohort, N=7,777; SEER stage IA validation cohort, N=7,776; SEER stage IB cohort, N=7,559) from the SEER database were included. 1,304 NSCLC cases (SYSUCC stage IA validation cohort, N=684; SYSUCC stage IB cohort, N=620) from the SYSUCC were also included. Younger age, female, lobectomy, well differentiated, smaller size and more examined lymph nodes were identified as favorable prognostic factors. A nomogram was established. The C-index was 0.68 (95%CI, 0.67-0.69), 0.66 (95% CI, 0.64-0.68) and 0.66 (95% CI, 0.61-0.71) for the SEER training cohort, SEER validation cohort and SYSUCC validation cohort. A risk classification system was constructed to stratify stage IA NSCLC into low-risk subgroup and high-risk subgroup. The CSS curves of these two subgroups showed statistically significant distinctions. This nomogram delivered a prognostic prediction for stage IA NSCLC and may aid individual clinical practice.

A Dual-Functional Fibrous Skeleton Implanted with Single-Atomic Co-Nx Dispersions for Longevous Li-S Full Batteries.

Although lithium-sulfur (Li-S) batteries have long been touted as next-generation energy storage devices, the rampant dendrite growth at the anode side and sluggish redox kinetics at the cathode side drastically impede their practical application. Herein, a dual-functional fibrous skeleton implanted with single-atom Co-Nx dispersion is devised as an advanced modificator to realize concurrent regulation of both electrodes. The rational integration of single-atomic Co-Nx sites could convert the fibrous carbon skeleton from lithiophobic to lithiophilic, helping assuage the dendritic formation for the Li anode. Meanwhile, the favorable electrocatalytic activity from the Co-Nx species affording a lightweight feature effectively enables expedited bidirectional conversion kinetics of sulfur electrochemistry, thereby inhibiting the polysulfide shuttle. Moreover, the interconnected porous framework endows the entire skeleton with good mechanical robustness and fast electron/ion transportation. Benefiting from the synergistic effects between atomically dispersed Co-Nx sites and three-dimensional conductive networks, the integrated Li-S full batteries can achieve a reversible areal capacity (>7.0 mAh cm-2) at a sulfur loading of 6.9 mg cm-2. This work might be beneficial to the development of practically viable Li-S batteries harnessing single-atom mediators.