Camrelizumab in combination with chemotherapy versus concurrent chemoradiotherapy for the conversion of locally advanced unresectable oesophageal squamous carcinoma: protocol for a two-arm, open-label phase II trial.

INTRODUCTION: Oesophageal cancer (OC) has higher morbidity and mortality rate than most other malignancies. The standard treatment for unresectable locally advanced oesophageal squamous cell carcinoma (OSCC) is concurrent chemoradiotherapy, with tumour regression observed in a proportion of patients after treatment, but prognostic improvement remains limited. Immunotherapy in combination with chemotherapy (CT) has been shown to be efficacious as the first-line treatment of advanced OC and neoadjuvant therapy. Therefore, we conducted a prospective, two-arm, randomised, unblinded phase II study to explore the efficacy of camrelizumab in combination with CT versus chemoradiotherapy for the conversion of unresectable advanced OSCC. METHODS AND ANALYSIS: All participants meeting the inclusion criteria will be enrolled after signing an informed consent form. Patients with clinically cT4b or spread to at least one group of lymph nodes with possible invasion of surrounding organs and unresectable locally advanced squamous carcinoma of the thoracic segment of the oesophagus will be included in the study. Patients with suspected distant metastases on the preoperative examination will be excluded from this study. Patients eligible for enrolment will be grouped by centre randomisation according to the study plan. Patients will undergo radical surgery after completion of two cycles of chemotherapy (CT) combined with camrelizumab induction therapy or concurrent chemoradiotherapy if assessed to be operable. Patients evaluated as inoperable will be scheduled for a multidisciplinary consultation to determine the next treatment option. The primary endpoint is the R0 resection rate in patients undergoing surgery after treatment. Secondary endpoints are the rate of major pathological remission, pathological complete response rate, overall survival, progression-free survival and adverse events for all patients. ETHICS AND DISSEMINATION: Ethical approval was obtained from the ethics committees of Fujian Medical University Union Hospital (No. 2022YF039-02). The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT05821452.

Comparison of indocyanine green-near-infrared fluorescence guided and traditional mediastinal lymphadenectomy during radical esophagectomy: A randomized controlled trial.

BACKGROUND: The extent of lymph node dissection during radical esophagectomy remains a controversial topic. Thus, this study mainly aimed to explore the location of sentinel lymph nodes in esophageal squamous cell carcinoma and the application value of the indocyanine green-near-infrared fluorescence system in lymphadenectomy. METHODS: This randomized controlled clinical trial (ClinicalTrials.gov, NCT04615806) included 42 participants without neoadjuvant therapy who were lymph node negative based on positron emission tomography/computed tomography findings. Traditional esophagectomy with indocyanine green-near-infrared fluorescence imaging was performed after injecting 0.5 mL indocyanine green (1.25 mg/mL) into the esophageal submucosa in the 4 peritumoral quadrants. The primary endpoint was to determine the location of the sentinel lymph node in esophageal squamous cell carcinoma based on postoperative pathologic reports. RESULTS: A total of 40 patients, with 20 in each group, were included in the final analysis. In the indocyanine green group, indocyanine green-near-infrared fluorescence imaging was successful in all subjects. Seven cases (cases 2, 3, 9, 11, 17, 18, and 20) in the indocyanine green group exhibited lymph node metastases, all of which were near-infrared positive. The detection rate, positive predictive value, negative predictive value, sensitivity, and specificity were 100% (20 of 20 cases), 8.7% (13/150), 100% (265/265), 100% (13/13), and 65.9% (265/402), respectively. All near-infrared-negative lymph nodes were nonmetastatic lymph nodes. In addition, the number of mediastinal lymph nodes resected in the indocyanine green group was significantly higher than in the non-indocyanine green group. CONCLUSION: Indocyanine green-near-infrared might be an important and promising technique in predicting sentinel lymph nodes of esophageal squamous cell carcinoma and could significantly improve the detection rate of lymph nodes of esophageal squamous cell carcinoma.

Prediction of pulmonary metastasis in esophageal carcinoma patients with indeterminate pulmonary nodules.

BACKGROUND: Indeterminate pulmonary nodules (IPNs) are common after surgery for esophageal cancer. The paucity of data on postoperative IPNs for esophageal cancer causes a clinical dilemma. OBJECTIVE: The aim of this study was to identify the characteristics and clinical significance of IPNs after radical esophagectomy for metastatic esophageal cancer, determine the risk factors for pulmonary metastasis, and construct a risk score model to standardize the appropriate time to either follow up or treat the patient. METHODS: All consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent radical surgery between 2013 and 2016 were included in this retrospective study. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and develop risk score models. RESULTS: A total of 816 patients were enrolled in the study. During a median follow-up period of 45 months, IPNs were detected in 221 (27.1%) patients, of whom 66 (29.9%) were diagnosed with pulmonary metastases. The following five variables maintained prognostic significance after multivariate analyses: the pathologic N category, number of IPNs, shape of IPNs, time of detection of IPNs, and size of IPNs. The Pulmonary Metastasis Prediction Model (PMPM) scale ranges from 0 to 15 points, and patients with higher scores have a higher probability of pulmonary metastases. The Hosmer-Lemeshow test showed a good calibration performance of the clinical prediction model (χ2 = 8.573, P = 0.380). After validation, the PMPM scale showed good discrimination with an AUC of 0.939. CONCLUSION: A PMPM scale for IPNs in patients who underwent esophagectomy for ESCC may be clinically useful for diagnostic and therapeutic decision-making.

Safety and efficacy of camrelizumab combined with radiotherapy as neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma: a prospective single-arm phase II clinical trial protocol.

BACKGROUND: Neoadjuvant chemoradiotherapy followed by esophagectomy is the standard of care for locally advanced esophageal squamous cell carcinoma (ESCC). However, approximately 30% of patients still develop distant metastases and have a high incidence of treatment-related adverse events. Immunotherapy, as a new modality for anti-cancer treatment, has shown promising clinical benefits for patients with ESCC. The synergistic effects of immunotherapy and radiotherapy make their combination promising as neoadjuvant treatment for locally advanced ESCC. METHODS: All participants who meet the inclusion criteria will be enrolled after signing the informed consent form. Patients with thoracic segment esophageal cancer with clinical stage T2-3 N0 M0 or T2-3 N + M0 will be included. A total of 25 patients are to be recruited for the study. Twelve patients will be recruited in phase I, with at least two achieving major pathological response (MPR) before entering phase II. They will be treated with radical surgery within 4-8 weeks after the completion of two cycles of neoadjuvant radiotherapy in combination with camrelizumab according to the study schedule. The primary endpoint is the major pathological remission rate of all per-protocol patients. The secondary endpoints are the R0 resection rate, pathological complete remission rate, and adverse events. The interim analysis will be conducted after 12 patients have been enrolled. The trials will be terminated when more than two treatment-related deaths occur or fewer than five patients have major pathological remission. DISCUSSION: We designed this prospective single-arm phase II clinical study to evaluate the combination of camrelizumab and standard radiotherapy as preoperative neoadjuvant therapy for patients with resectable ESCC as part of the quest for better treatment options for patients with locally advanced ESCC. TRIAL REGISTRATION: This trial protocol has been registered on the NIH Clinical Trials database ( www. CLINICALTRIALS: gov/ , NCT05176002. Registered on 2022/01/04). The posted information will be updated as needed to reflect protocol amendments and study progress.

Learning curve analysis of single-port thoracoscopic combined subsegmental resections.

Background: Combined subsegmental surgery (CSS) is considered to be a safe and effective resection modality for early-stage lung cancer. However, there is a lack of a clear definition of the technical difficulty classification of this surgical case, as well as a lack of reported analyzes of the learning curve of this technically demanding surgical approach. Methods: We performed a retrospective study of single-port thoracoscopic CSS performed by the same surgeon between April 2016 and September 2019. The combined subsegmental resections were divided into simple and complex groups according to the difference in the number of arteries or bronchi which need to be dissected. The operative time, bleeding and complications were analyzed in both groups. Learning curves were obtained using the cumulative sum (CUSUM) method and divided into different phases to assess changes in the surgical characteristics of the entire case cohort at each phase. Results: The study included 149 cases, including 79 in the simple group and 70 in the complex group. The median operative time in the two groups was 179 min (IQR, 159-209) and 235 min (IQR, 219-247) p < 0.001, respectively. And the median postoperative drainage was 435 mL (IQR, 279-573) and 476 mL (IQR, 330-750), respectively, with significant differences in postoperative extubation time and postoperative length of stay. According to the CUSUM analysis, the learning curve for the simple group was divided by the inflection point into 3 phases: Phase I, learning phase (1st to 13th operation); Phase II, consolidation phase (14th to 27th operation), and Phase III, experience phase (28th to 79th operation), with differences in operative time, intraoperative bleeding, and length of hospital stay in each phase. The curve inflection points of the learning curve for the complex group were located in the 17th and 44th cases, with significant differences in operative time and postoperative drainage between the stages. Conclusion: The technical difficulties of the simple group of single-port thoracoscopic CSS could be overcome after 27 cases, while the technical ability of the complex group of CSS to ensure feasible perioperative outcomes was achieved after 44 operations.

Measuring the Diameter of Single-Wall Carbon Nanotubes Using AFM.

In this work, we identify two issues that can significantly affect the accuracy of AFM measurements of the diameter of single-wall carbon nanotubes (SWCNTs) and propose a protocol that reduces errors associated with these issues. Measurements of the nanotube height under different applied forces demonstrate that even moderate forces significantly compress several different types of SWCNTs, leading to errors in measured diameters that must be minimized and/or corrected. Substrate and nanotube roughness also make major contributions to the uncertainty associated with the extraction of diameters from measured images. An analysis method has been developed that reduces the uncertainties associated with this extraction to <0.1 nm. This method is then applied to measure the diameter distribution of individual highly semiconducting enriched nanotubes in networks prepared from polyfluorene/SWCNT dispersions. Good agreement is obtained between diameter distributions for the same sample measured with two different commercial AFM instruments, indicating the reproducibility of the method. The reduced uncertainty in diameter measurements based on this method facilitates: (1) determination of the thickness of the polymer layer wrapping the nanotubes and (2) measurement of nanotube compression at tube-tube junctions within the network.

Thickness measurements of graphene oxide flakes using atomic force microscopy: results of an international interlaboratory comparison.

Flake thickness is one of the defining properties of graphene-related 2D materials (GR2Ms), and therefore requires reliable, accurate, and reproducible measurements with well-understood uncertainties. This is needed regardless of the production method or manufacturer because it is important for all GR2M products to be globally comparable. An international interlaboratory comparison on thickness measurements of graphene oxide flakes using atomic force microscopy has been completed in technical working area 41 of versailles project on advanced materials and standards. Twelve laboratories participated in the comparison project, led by NIM, China, to improve the equivalence of thickness measurement for two-dimensional flakes. The measurement methods, uncertainty evaluation and a comparison of the results and analysis are reported in this manuscript. The data and results of this project will be directly used to support the development of an ISO standard.

"Separated" precise subsegmentectomy: Single-port thoracoscopic noncombined subsegmentectomy in one lung lobe.

BACKGROUND: In clinical practice, combined segmental resection (CSS) can avoid resection of multiple segments to preserve lung function. When two or more distant lung segments or subsegments of the same lobe present with a ground glass opacity (GGO) that meets the indications for sublobar resection, conventional CSS or wedge resection could not remove all the nodules, and lobectomy is performed in most of these patients. For these particular types of nodules, we perform a single lobe noncombined subsegmental resection, or "separated" precise subsegmentectomy, to preserve more lung tissue. This study was designed to initially assess the feasibility and safety of "separated" precise subsegmentectomy. METHODS: Selected cases of specific GGO were subjected to "separated" precise subsegmentectomy and the results of general clinical data, perioperative operative time, bleeding, length of stay, computed tomography (CT) review, lung function and its dynamic changes were collected and analyzed in these patients. RESULTS: "Separated" precise subsegmentectomy was performed in 12 patients and successfully completed. The median operation time, bleeding amount, and length of hospital stay were 96 min, 50 ml and 4 days, respectively. There was one case of pulmonary infection and one case of persistent air leakage, no death or pulmonary torsion, bronchopleural fistula and other pulmonary complications occurred. After 3 months, the median percentage of lung function retention was 91.7%, and the CT scan showed that the reserved lung tissue of 12 patients was well inflated and there was no obvious imaging manifestation of atelectasis. CONCLUSION: "Separated" precise subsegmentectomy is a novel and safe surgical method that provides a more optimized way for patients with specific multiple nodules to preserve lung function. Further prospective large studies are needed to verify this finding.

Comparative analysis of electromagnetic navigation bronchoscopy versus computed tomography-guided lung puncture for the sampling of indeterminate pulmonary nodules in the middle of an anatomic lung segment: A cohort study.

BACKGROUND: To compare the diagnostic positive rate and complication rate between the electromagnetic navigation bronchoscopy (ENB) technique and computed tomography (CT)-guided lung puncture for the biopsy of lung nodules located in the middle of an anatomic lung segment. METHODS: Electronic medical records of 114 patients who underwent lung nodule biopsy between June 2021 and June 2022 were retrospectively evaluated. In all patients, the nodules were located in the middle third lung segment. To compare the diagnostic positive and complication rates between the two biopsy modalities performed in this lung region, clinical data, complication rates, nodule pathology, and imaging results were reviewed based on nodule characteristics retrieved from the electronic medical records. RESULTS: Ninety-three patients underwent CT-guided lung puncture, while the remaining 21 patients underwent the ENB technique. No significant difference was observed in the diagnostic positive rate between the two groups (73.6 and 76.1%, respectively). In the CT-guided lung puncture group, pneumothorax incidence, tube placement, postoperative hemorrhage, and symptomatic hemorrhage rates were 16.1, 6.5, 6.5, and 1.1%, respectively. In contrast, no complications occurred in the ENB group. CONCLUSIONS: The ENB technique is a safe and effective method for performing biopsies of pulmonary nodules with a diagnostic positive rate comparable to that of CT-guided lung puncture and with a lower postoperative complication rate.

Understanding the tunable sodium storage performance in pillared MXenes: a first-principles study.

Pillared MXenes with large interlayer spacing have shown great potential as an anode material for sodium-ion batteries (SIBs). To better understand the underlying mechanism of the pillar effect in enhancing the electrochemical performance, first-principles calculations were used to investigate the adsorption and diffusion of Na in MXenes (Ti2CO2 and Ti3C2O2), as well as the mechanical properties of the system under different MXenes layer spacings. The results showed that when the MXene layer spacing was ∼4 Å, the strongest adsorption of Na on MXenes was achieved due to the interlayer synergy effect. However, when the MXene layer spacing was greater than 5 Å, double Na-atomic layer adsorption would be formed, which increased the Na storage capacity. Interestingly, the diffusion of Na was not only affected by the interlayer spacing of MXenes, but also by the interlayer stacking mode of MXenes. Moreover, it was found that when the MXene layer spacing was more than 8 Å, the sodium storage properties basically did not change significantly. The optimal layer spacing for Ti2CO2 and Ti3C2O2 was predicted to be 7 and 6 Å, respectively. This work provides valuable theoretical guidance for developing high-performance anode materials for SIBs.

Immunochemotherapy includes pembrolizumab for stage IIIB lung squamous cell carcinoma: a case report.

Background: Lung cancer is a malignant tumor with high morbidity and mortality, and its incidence continues to increase. With the emergence of new drugs and treatment modalities, the prognosis of lung cancer patients has improved to some extent. However, the prognosis of initially unresectable, locally advanced lung cancer with immunotherapy combined with chemotherapy remains uncertain. Case Description: We report a case of a 57-year-old man diagnosed with stage IIIB la with negative targeted therapy-related gene mutation and a 2% programmed death 1/programmed cell death-ligand 1 (PD-1/PD-L1) expression level, who underwent transformation treatment with pembrolizumab after multidisciplinary consultation. Lung images indicated partial response after 4 cycles. However, preoperative examination found hypothyroidism considered the immune-related, and giving hormone replacement treatment after the endocrinology department consultation. Thyroid function improved after 1 month. The patient successfully underwent single-hole thoracoscopic radical lung cancer (left whole lung resection + mediastinal lymph node dissection). Postoperative pathology was consistent with major pathological remission (MPR). The patient was scheduled to receive 8 cycles of single-drug maintenance therapy with pembrolizumab after surgery. To date, no tumor recurrence and metastasis have been found at follow up, and maintenance treatment continues to improve. Conclusions: This case reminds us that the induction treatment pattern of pembrolizumab combined with chemotherapy for subsequent conversion surgery can be a potentially curative treatment option for locally advanced stage IIIB patients. The monitoring of thyroid-related indicators is important during immunotherapy, especially in the first 1-2 months. The cause of thyroid dysfunction should be detected early so that it can be treated promptly to improve the prognosis of the patient. Pembrolizumab in combination with paclitaxel and platinum drugs provides a new option for patients with locally advanced stage IIIB lung squamous cell carcinoma who eager to undergo radical surgery.

A novel form of precise segmentectomy-Triumphal arch-like anatomical segmentectomy.

The increasingly accurate sublobar anatomical resection is constantly being explored and practiced. Surgeons try to preserve as much viable lung tissue as possible. Sublobar resection of the target tissue is similar with a cone-shaped structure which penetrates deeply into the pulmonary parenchyma and runs through the lobe at both ends. This has not previously been described. The remaining lung tissue resembles the Triumphal Arch in Paris, France. Here, we describe triumphal arch-like sublobectomy in detail, aiming to provide clinicians with an idea to explore this novel sublobectomy under similar conditions.

How to distinguish thoracic and cervical lymph nodes during minimally invasive esophagectomy.

PURPOSE: In this article, we aimed to reconstruct the cervical-thoracic junction plane (CTJP) using a three-dimensional (3D) reconstruction system. Thus, the CTJP can be judged during surgery to better distinguish cervical-thoracic lymph nodes. METHODS: We included patients in Fujian Medical University Union Hospital from December 2019 to March 2020. All patients underwent a thin-slice and enhanced computed tomography scan of the chest with 3D reconstruction using the IQQA system (EDDA technology) to reconstruct the CTJP, brachiocephalic trunk, right common carotid artery, and right subclavian artery. The distance from the intersection of the right subclavian artery and the CTJP to the origin of the right subclavian artery (ORSA) was measured, and the relationship between this distance and the patient's sex, BMI and height was analyzed. RESULTS: Seventy-three patients were enrolled, of whom 12 had ORSA above the CTJP, while 61 had ORSA below the plane. There was a significant difference in age between the two groups (p = 0.04), compared with height, weight and BMI (p > 0.05). In 61 patients with the ORSA below the CTJP, the average distance was 24.7 ± 7.6 mm. The difference between the distance and BMI (p = 0.02) was statistically significant, and it was increased with increasing BMI. CONCLUSIONS: The relationship between the ORSA and CTJP can be clarified through 3D reconstruction. The cervical-thoracic recurrent laryngeal nerve lymph nodes can be distinguished clearly in minimally invasive esophagectomy, contributing to the accurate N staging of middle-thoracic esophageal cancer.

The clinical characteristics, treatments and prognosis of post-esophagectomy airway fistula: a multicenter cohort study.

Background: Post-esophagectomy airway fistula (PEAF) is a serious complication after esophageal cancer resection. At present, the clinical characteristics, treatments and prognosis of PEAF patients remain inconclusive. We aimed to investigate these problems of patients with PEAF through a multi-center retrospective cohort study. Methods: We included consecutive patients who underwent esophagectomy for esophageal cancer in seven major Chinese esophageal cancer centers from January 2010 to December 2020. Based on the anatomic characteristics of PEAF patients, PEAFs were divided into Union type I (without digestive fistula) and Union type II [respiratory-digestive fistula (RDF)], and subtypes a and b (tracheal or bronchial fistulas), as well as L1 and L2 (same or different level of fistulas). The clinical characteristics, diagnoses, managements, and effects of the various types were retrospectively analyzed. Results: PEAF occurred in 85 of 26,608 patients (0.32%), including eight females and 77 males. There were 16 patients with type I and 69 with type II. The numbers of healings, non-healings, and deaths at discharge were 45 (52.9%), 20 (23.5%), and 20 (23.5%), respectively. Type Ib was common in type I, and type II L1 was common in type II. The healing rates of surgical, stent, and conservative treatments were 50%, 60%, and 50%, respectively. All type I patients treated with stent implantation were healed at discharge. The healing rates, mortality, and 3-year survival of type II L1 and type II L2 patients were 55.4% and 30.8%, 17.9% and 30.8%, and 34.3% and 15.4%, respectively. The 5-year survival rates of all PEAFs were 21.1%. Conclusions: PEAF is an infrequent and life-threatening complication after esophagectomy. Patients with different types of PEAF often have different inducements. In this study, we found that the healing rates of surgical and conservative treatments were similar, and stent implantation may have the potential to improve efficacy. Type II L2 patients were the most difficult to cure.

Prognostic variables for conditional survival in patients with esophageal squamous cell carcinoma who underwent minimally invasive surgery.

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) survival is mainly reported at the time of treatment. Conditional survival is another prognostic tool to evaluate ESCC patients who has survived more than one year since treatment. METHODS: We analyzed data from 705 ESCC patients who underwent minimally invasive surgery between 2013 and 2016. Using the Kaplan-Meier method, we computed a 5-year relative conditional survival. We also investigated the prognostic factors associated with survival using Cox proportional hazards models. RESULTS: Conditional survival improved over time for all cohorts of ESCC patients who survived a period after surgery. The greatest improve in conditional survival were observed in patients 2 years after surgery. In addition, the results of the Cox survival model from the time of surgery, T stage (p < 0.001), N stage (p < 0.001), and anastomotic leak (p = 0.022), were significantly associated with survival. However, the results of the Cox survival model from 2 years after surgery, N stage (p < 0.001), and anastomotic leak (p = 0.032) were significantly associated with survival. CONCLUSION: For ESCC patients who survived a period after surgery, the largest increases in conditional survival were observed in patients 2 years after surgery. We suggest that patients with anastomotic leakage and higher T and N stages should be strictly screened according to various time, and that conditional survival should be used as a powerful prognostic tool for ESCC patients.

Influence of ligand geometry on cholinesterase enzyme - A comparison of 1-isoindolinone based structural analog with Donepezil.

Donepezil (DNPZ) is one of the few FDA-approved widely used medication in the clinical care of Alzheimer's disease (AD) patients. To investigate the effect of geometry and to find the significance of an enol form if any in DNPZ on acetylcholinesterase (AChE) inhibition, we changed the tetrahedral geometry of DNPZ to planar trigonal pyramidal geometry by replacing the α-carbon atom next to ketone functionality with a nitrogen atom. To mimic 1-indanone in DNPZ, we selected 1-isoindolinone framework to synthesize 25 new DNPZ derivatives and characterized using 1H NMR, 13C NMR and ESI-MS spectroscopy methods. Drug likeliness profile for each compound was predicted using Molinspiration online software following Lipinski's rule. Commercially available assay kits were used to measure AChE and butyrylcholinesterase (BuChE) inhibitory effects. NIH/3T3 mouse embryonic fibroblast cell line was used to measure cytotoxic and proliferation effects using LDH and MTT assay, respectively. Compound #20 was selected for comparative computational docking, modelling and physicochemical studies. Our results show that DNPZ with tetrahedral geometry has 3-fold higher AChE inhibition as compared to compound #20 with planar trigonal pyramidal geometry. Our approach may be useful as a novel indirect method to study the significance of the enol form in DNPZ (or similar compounds), since constant interconversion between the keto and enol forms does not permit a direct determination of the effect of the enol form of DNPZ in vivo. Overall, we conclude that the tetrahedral is a better fit and any change in geometry significantly drives down the cholinesterase inhibitory effect of DNPZ.

Postoperative follow-up strategy based on event dynamics for esophageal squamous cell carcinoma.

BACKGROUND: Despite the improvements in radical surgery for esophageal squamous cell carcinoma (ESCC), a large number of patients still develop recurrence. This research sought to graphically depict patterns in ESCC recurrence following curative surgical treatment using event dynamics and clarify approaches to postsurgical follow-up on the basis of recurrence time. METHODS: This study included 717 individuals with ESCC who received radical surgery in the Thoracic Department at Fujian Medical University Union Hospital between 2013 and 2016. Event dynamics analysis was performed on the basis of hazard rates. An initial event was defined as the occurrence of local recurrence, distant metastasis, or both. RESULTS: After complete resection, patients were followed up for a median of 44 months (range, 2-83 months). A total of 223 (31.1%) patients developed recurrence, including 122 (17.0%) patients who developed only locoregional recurrence, and 101 (14.1%) patients who developed only distant metastasis or both locoregional recurrence and distant metastasis. Recurrences were concentrated mainly (98.2%) in the first 4 years of follow-up among all recurrences, with 100 cases (44.8%) in the first year, 69 cases (30.9%) in the second year, and 50 cases (22.4%) in the third and fourth years. CONCLUSIONS: After curative surgery in a multimodal setting, a significant number of patients still experienced recurrence within 4 years after surgery, which suggests that current postoperative esophageal cancer follow-up strategies may need to be modified.

Conformational Order in Aggregated rra-P3HT as an Indicator of Quality of Boron Nitride Nanotubes.

We report on investigation, by correlated polarized excitation fluorescence microscopy (PEFM) and atomic force microscopy (AFM) imaging, of the conformational order of regiorandom poly(3-hexyl-thiophene) (rra-P3HT) aggregated on two boron nitride nanotube (BNNT) materials (BNNT-2 and BNNT-3) processed by different purification methods. rra-P3HT photoluminescence excited by linearly polarized light shows polarization direction-dependent intensity with a modulation depth, M, generally >0.5 for rra-P3HT on nanotubes and <0.5 for rra-P3HT on nontubular impurities. PEFM-measured modulation depth value distributions can be decomposed into two components, one corresponding to ordered rra-P3HT on nanotubes and the other to disordered rra-P3HT on impurities. The nanotube component peaks at M = 0.64 and 0.70 and comprises 60% and 78% of the normalized distribution for rra-P3HT on BNNT-2 and BNNT-3, respectively, indicating higher quality and higher fraction of nanotubes in the latter material. The method can be integrated in a material development platform to monitor production and purification progress.

Adjuvant chemoradiotherapy for patients with pathologic node-positive esophageal cancer following radical resection is associated with improved survival.

BACKGROUND: Depending on the pathological stage, patients with esophageal squamous cell carcinoma (ESCC) can experience poor prognosis after surgery. This study was designed to analyze the effect of various treatments on prognosis in pathologic node-positive esophageal cancer patients who undergo radical surgery. METHODS: We evaluated 210 pathologic stage IIb-IIIc patients (pT1-4aN + M0) who had undergone esophagectomy for thoracic ESCC from January 2013 to October 2015 at our institute. Surgery alone was applied in 65 patients, postoperative chemotherapy alone was applied in 112 patients, and postoperative adjuvant chemoradiotherapy was applied in 33 patients. Kaplan--Meier and Cox regression analysis were used to compare overall survival (OS) and disease-free survival (DFS). A nomogram was constructed to visualize the multivariate Cox regression analysis model. RESULTS: The median follow-up period was 49.4 months. The 3- and 5-year OS rates of the patients in the surgery group, postoperative chemotherapy group, postoperative chemoradiotherapy group were 55.4%, 61.6%, and 75.8%, and 30.1%, 44.0%, and 63.0% respectively. The 3- and 5-year DFS rates of the patients in the surgery group, postoperative chemotherapy group, postoperative chemoradiotherapy group were 44.6%, 52.7%, and 72.7%, and 20.0%, 24.1%, and 39.4%, respectively. Both the OS and DFS of the patients in the postoperative chemoradiotherapy group were better than those of the patients in the surgery and postoperative chemotherapy group. Among them, the OS of the postoperative radiotherapy group was longer than that of the surgery group (P=0.011) and the postoperative chemotherapy group (P=0.190), while the DFS of postoperative chemoradiotherapy group was longer than that of the surgery group and postoperative chemotherapy group, but the difference was not statistically significant (P>0.05). CONCLUSIONS: This study showed that postoperative adjuvant chemoradiotherapy could improve 3-year OS and DFS compared with treatment using surgery alone or postoperative chemotherapy alone. However, an evaluation of long-term prognosis requires a longer follow-up.

Quantification of amine functional groups on silica nanoparticles: a multi-method approach.

Surface chemistry is an important factor for quality control during production of nanomaterials and for controlling their behavior in applications and when released into the environment. Here we report a comparison of four methods for quantifying amine functional groups on silica nanoparticles (NPs). Two colorimetric assays are examined, ninhydrin and 4-nitrobenzaldehyde, which are convenient for routine analysis and report on reagent accessible amines. Results from the study of a range of commercial NPs with different sizes and surface loadings show that the assays account for 50-100% of the total amine content, as determined by dissolution of NPs under basic conditions and quantification by solution-state 1H NMR. To validate the surface quantification by the colorimetric assays, the NPs are modified with a trifluoromethylated benzaldehyde probe to enhance sensitivity for quantitative 19F solid state NMR and X-ray photoelectron spectroscopy (XPS). Good agreement between the assays and the determination from solid-state NMR is reinforced by elemental ratios from XPS, which indicate that in most cases the difference between total and accessible amine content reflects amines that are outside the depth probed by XPS. Overall the combined results serve to validate the relatively simple colorimetric assays and indicate that the reactions are efficient at quantifying surface amines, by contrast to some other covalent modifications that have been employed for functional group quantification.