Comparison of neoadjuvant immunotherapy plus chemotherapy versus chemotherapy alone for patients with locally advanced esophageal squamous cell carcinoma: A propensity score matching.

Objectives: Clinical studies on immune checkpoint inhibitors (ICIs) combined with neoadjuvant chemotherapy (nCT) have been carried out for the resectable esophageal squamous cell carcinoma (ESCC). So far, few studies have compared the survival outcomes of nCT plus ICIs and nCT alone. This study aimed to compare the efficacy and safety of neoadjuvant ICIs combined with nCT versus nCT followed by esophagectomy for patients with resectable locally advanced ESCC. Methods: A retrospective analysis of ESCC patients underwent nCT or nCT combined with ICIs followed by esophagectomy (from March 2013 to April 2021) was performed. A 1:1 propensity score matching (PSM) with a caliper 0.01 was conducted to balance potential bias. Results: A total of 47 comparable pairs of ESCC patients receiving nCT and nCT combined with ICIs were selected for the final analysis. The tumor regression grade (TRG) 0 and pathologic complete response (pCR) rates in the nCT+ICIs group were significantly higher than those of the nCT group (21.7% vs. 4.5%, P=0.016; and 17.0% vs. 2.1%, P=0.035, respectively). The rate of nerve invasion was 4.3% in the nCT+ICIs group, significantly lower than 23.4% of the nCT group (P=0.007). The incidences of adverse events in the nCT+ICIs group were similar compared with the nCT group and there was no grade 5 toxicity in either group. The 1-, 2-year disease-free survival rates (DFS) were 95.7%, 80.7% and 76.1%, 63.8% in the two groups (P=0.001, and P=0.046, respectively). The 1-year OS was improved in the nCT+ICIs group, which was close to a statistical difference (95.7% vs. 84.8%, P=0.074). Local recurrence rate in the nCT+ICIs group was 6.4%, significantly lower than 21.3% of the nCT group (P=0.036), while there was no significant difference in the distant metastasis. Conclusions: Compared with nCT alone, neoadjuvant immunotherapy plus nCT for patients with locally advanced ESCC has an advantage in pathological response, and could improve DFS with a good safety and feasibility, while long term survival validation is still needed further.

Ultralow thermal conductivity and anisotropic thermoelectric performance in layered materials LaMOCh (M = Cu, Ag; Ch = S, Se).

In layered materials with the stacking axis perpendicular to the basal plane, anharmonicity strongly affects phonon propagation due to weak interlayer coupling, which is helpful to reduce the lattice thermal conductivity and improve the thermoelectric (TE) performance significantly. By combining first-principles calculations and the Boltzmann transport equation, we systematically analyzed and evaluated the lattice thermal conductivity and TE properties of LaMOCh (M = Cu, Ag; Ch = S, Se). The results indicate that these layered materials exhibit ultralow lattice thermal conductivities of 0.24-0.37 W m-1 K-1 along the interlayer direction at room temperature. The low lattice thermal conductivities have been analyzed from some inherent phonon properties, such as low acoustic phonon group velocity, large Grüneisen parameters, and a short phonon relaxation time. Originating from their natural layered crystal structure, the thermal and electronic transports (i.e., thermal conductivity, Seebeck coefficient, and electrical conductivity) are both highly anisotropic between their intralayer and interlayer directions. Finally, we obtained ZT values of 1.17 and 1.26 at 900 K along the interlayer direction for n-type LaCuOSe and LaAgOSe, respectively. Generally, LaMOSe exhibit larger anisotropy than LaMOS, in both n- and p-types of doping. Our findings of low thermal conductivities and large anisotropic TE performances of these layered systems should stimulate much attention in BiCuOSe and alike layered TE families.

Cystathionine ß-synthase expression correlates with tumor development and poor prognosis in lung squamous cell carcinoma patients.

The purpose of this study was to investigate the correlation between the expression of cystathionine ß-synthase (CBS) in lung squamous cell carcinoma (LUSC) and the microvascular density (MVD) and clinicopathological features. Firstly, the expression status of CBS in diffuse carcinoma and LUSC was searched through the public bioinformatics database. Subsequently, immunohistochemical staining and scoring were performed on tumor tissues and matched normal tissues from 108 LUSC patients to assess CBS expression; the MVD of tumor tissues was also detected. The results showed that CBS was overexpressed in some tumor tissues, including LUSC. Immunohistochemical results showed that the positive expression rate of CBS in tumor tissues (63.0%) was higher than that in normal tissues (17.6%). The expression of CBS was correlated with T (p=0.01), N (p=0.004), TNM (p=0.011) stages, and tumor differentiation degrees (p<0.001), with the increase of T, N, and TNM stages or the decrease of differentiation, the expression level of CBS also increased. In addition, the expression level of CBS was positively correlated with MVD (r=0.6997, p<0.0001). Survival analysis showed that the survival rate of the CBS negative expression group was better than that of the positive expression group (p=0.004). Cox multivariate analysis showed that CBS expression status (p<0.001), T stages (p=0.020), and TNM stages (p=0.021) were independent factors affecting the prognosis of LUSC. In conclusion, the high expression of CBS affects tumor development and is associated with the poor prognosis of LUCS, which may be used as a biomarker to evaluate prognosis and find a new direction for the treatment of LUSC.

Low thermal conductivity and high performance anisotropic thermoelectric properties of XSe (X = Cu, Ag, Au) monolayers.

Combining density functional theory (DFT) and semi-classic Boltzmann transport theory, we report the thermoelectric (TE) performance of a family of two-dimensional (2D) group IB-selenides XSe (X = Cu, Ag, Au). The results show that these monolayers exhibit small and anisotropic phonon velocities (0.98-3.84 km s-1), large Grüneisen parameters (up to 100), and drastic phonon scattering between the optical and acoustic phonons. These intrinsic properties originate from strong phonon anharmonicity and suppress the heat transport capacity, resulting in low lattice thermal conductivities (12.54 and 1.22 W m-1 K-1) along the x- and y-directions for a CuSe monolayer. Among our studied monolayers, the 2D CuSe monolayer possesses the most remarkable TE performance with ultrahigh ZT (3.26) for n-type doping along the y-direction at 300 K. CuSe monolayer can achieve higher thermoelectric conversion efficiency at a lower synthetic preparation cost than the expensive AgSe and AuSe monolayers, and our work provides a theoretical basis for paving the way for further experimental studies.

Clinical characteristics and prognostic value of EGFR mutation in stage I lung adenocarcinoma with spread through air spaces after surgical resection.

The clinical data of stage I invasive lung adenocarcinoma patients with spread through air spaces (STAS) who underwent lobectomy from January 1, 2013 to January 1, 2016 at the Department of Thoracic Surgery of Hebei Medical University were analyzed retrospectively, and statistical analysis was carried out to explore their clinical features and prognostic value of EGFR mutation. A total of 280 patients were included in the study cohort, and EGFR mutations were detected in 154 patients. EGFR mutations were more common in non-smokers (p=0.045), females (p<0.001), without vascular tumor thrombus (p=0.037), and histological subtype LPA/APA/PPA (p=0.001). Multivariate analysis of the Cox risk regression model showed that EGFR gene mutation (p=0.807) was not an independent influencing factor of recurrence-free survival (RFS), but EGFR mutation was an independent influencing factor of overall survival (OS) (p=0.012), and OS of patients with EGFR mutation was better. The EGFR mutation also significantly increased the progression-free survival (PFS) of relapsed patients (p<0.001), but the PFS of relapsed EGFR mutation patients who received adjuvant chemotherapy after the operation was worse than that of patients who did not receive adjuvant chemotherapy (p=0.029). EGFR gene mutation is not a risk factor for postoperative recurrence in patients with stage I lung adenocarcinoma with STAS but the 5-year survival rate of patients with EGFR gene mutation is better than that of wild-type. Postoperative adjuvant chemotherapy for patients with EGFR mutation should be carefully considered.

A novel region-based level set method initialized with mean shift clustering for automated medical image segmentation.

Appropriate initialization and stable evolution are desirable criteria to satisfy in level set methods. In this study, a novel region-based level set method utilizing both global and local image information complementarily is proposed. The global image information is extracted from mean shift clustering without any prior knowledge. Appropriate initial contours are obtained by regulating the clustering results. The local image information, as extracted by a data fitting energy, is employed to maintain a stable evolution of the zero level set curves. The advantages of the proposed method are as follows. First, the controlling parameters of the evolution can be easily estimated by the clustering results. Second, the automaticity of the model increases because of a reduction in computational cost and manual intervention. Experimental results confirm the efficiency and accuracy of the proposed method for medical image segmentation.

Lack of association between the CYP1A1 Ile462Val polymorphism and endometrial cancer risk: a meta-analysis.

PURPOSE: Any association between the CYP1A1 Ile462Val polymorphism and endometrial cancer risk remains inconclusive. For a more precise estimate, we performed the present meta-analysis. METHODS: PUBMED, OVID and EMBASE were searched for the studies which met inclusion criteria. Data in all eligible studies were evaluated and extracted by two authors independently. The meta-analysis estimated pooled odds ratio (OR) with 95% confidence interval (CI) for endometrial cancer risk attributable to the CYP1A1 Ile462Val polymorphism. RESULTS: A total of 7 studies were included in this meta-analysis. The results indicated no association between endometrial cancer risk and the CYP1A1 Ile462Val polymorphism (for Val vs Ile allele model [OR 1.09, 95% CI 0.73-1.62]; for Val.Val vs Ile.Ile genotype model [OR 1.54, 95% CI 0.56-4.23]; for (Ile.Val + Val.Val) vs Ile.Ile genotype model [OR 1.08, 95% CI 0.71-1.63]; for Val.Val vs (Ile.Ile + Ile.Val) genotype model [OR 1.46, 95% CI 0.53-4.04]). CONCLUSIONS: This meta-analysis suggests that there is no association between endometrial cancer risk and the CYP1A1 Ile462Val polymorphism.

Diagnostic accuracy of ultrasonograph guided fine-needle aspiration cytologic in staging of axillary lymph node metastasis in breast cancer patients: a meta-analysis.

PURPOSE: To evaluate the diagnostic accuracy of ultrasonograph and fine-needle aspiration cytologic examination (USG-FNAC) in the staging of axillary lymph node metastasis in breast cancer patients. METHODS: We conducted an electronic search of the literature addressing the performance of USG-FNAC in diagnosis of axillary lymph node metastasis in databases such as Pubmed, Medline, Embase, Ovid and Cochrane library. We introduced a series of diagnostic test indices to evaluate the performance of USG-FNAC by the random effect model (REM), including sensitivity, specificity, likelihood ratios, and diagnostic odds ratios and area under the curve (AUC). RESULTS: A total of 20 studies including 1371 cases and 1289 controls were identified. The pooled sensitivity was determined to be 0.66 (95% CI 0.64-0.69), specificity 0.98 (95% CI 0.98-0.99), positive likelihood ratio 22.7 (95% CI 15.0-34.49), negative likelihood ratio 0.32 (95% CI 0.25-0.41), diagnostic OR 84.2 (95% CI 53.3-133.0). Due to the marginal threshold effect found in some indices of diagnostic validity, we used a summary SROC curve to aggregate data, and obtained a symmetrical curve with an AUC of 0.942. CONCLUSION: The results of this meta-analysis indicated that the USG-FNAC techniques have acceptable diagnostic validity indices and can be used for early staging of axillary lymph node in breast cancer patients.

No association between the CYP1B1 C4326G polymorphism and endometrial cancer risk: a meta-analysis.

PURPOSE: Any association between the CYP1B1 C4326G polymorphism and endometrial cancer risk remains inconclusive. In order to provide a more precise estimate, we performed the present meta-analysis. METHODS: We used fixed effect or random effect models to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs) for endometrial cancer risk, with the Chi-square-based Q-test used to test for heterogeneity. Begg's and Egger's tests were adopted to check publication bias. RESULTS: Six published case-control studies of association between the CYP1B1 C4326G polymorphism and endometrial cancer risk covering 6,577 subjects were included in the meta-analysis, but the results indicated no significant correlation with allele contrast and genotype comparisons (G vs C: OR 1.01, 95% CI 0.93-1.09; GG vs CC: OR 1.04, 95% CI 0.88-1.23; CG + GG vs CC: OR 1.08, 95% CI 0.97-1.21; GG vs CC + CG: OR 1.01, 95% CI 0.87-1.17). Heterogeneity hypothesis test did not reveal any heterogeneity and Begg's and Egger's tests did not detect obvious publication bias. CONCLUSIONS: There is no association between the CYP1B1 C4326G polymorphism and endometrial cancer risk.

[Prevention and treatment of complications after surgical resection for esophageal and gastric cardiac cancers].

OBJECTIVE: To summarize the experience in surgical resection for esophageal and gastric cardiac cancers so as to put forward countermeasures to prevent the post-operative complications. METHODS: From September 1952 to December 2005, 20,796 patients with esophageal and gastric cardiac cancers underwent surgical operation. The category and incidence of the complications in different decades were retrospectively analyzed. RESULTS: (1) 18,772 of the 20 796 patients with esophageal and gastric cardiac cancers underwent surgical resection. Operative complications occurred in 1741 patients (9.27%), death occurred in 433 of which (24.87%). (2) The complication rate was 39.77% in 1950s, and decreased to 4.10% in 2000s. The mortality rate of complication was 44.29% in 1950s, and decreased to 15.42% in 2000s. (3) The incidence and mortality rates of closely-surgery-related complications declined obviously over the period of study. The incidence and mortality rates of anastomotic leakage were 4.55% and 50.00% respectively in 1950s, and then decreased to 1.21% and 3.33% respectively in 2000s. The incidence and the mortality rates of empyema were 7.39% and 38.46% respectively in 1950s, and decreased to 0.36% and 5.56% respectively in 2000s. The incidence and the mortality rates of chylothorax was 0.16% and 0% recently. (4) The incidence of non-surgical-related complications declined slightly but the mortality rate was still very high over the period of study. The mortality rates of pulmonary and cardiovascular complication were 27.42% and 25.00% respectively recently. CONCLUSION: (1) One of the advantages of surgical treatment for esophagus and gastric cardiac cancers is the obvious decline of the incidence and the mortality rates of complications. (2) In order to reduce the incidence of systemic complication, especially pulmonary complication, active and corresponding preoperative preparation should be improved along with the expansion of the scope of surgical indication. (3) The key for prevention of post-operative complications is consummate surgery techniques. Prevention and treatment of anastomotic leakage, gastric wall necrosis, and intrathoracic and intraabdominal bleeding are still the focal points.

[Estimation of morbidity risk in aged patients undergoing resections of esophagus carcinoma and gastric cardiac carcinoma using physiological and operative severity score].

OBJECTIVE: To test the clinical validity of physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) in aged patients undergoing resections of esophagus carcinoma and gastric cardiac carcinoma. METHODS: POSSUM was used in 167 aged patients undergoing esophagus carcinoma and gastric cardiac carcinoma resection. The physiological score and the operative severity score were compared between the groups with and without postoperative complications. The morbidity rates were calculated. Observed morbidity rates were compared with the rates predicted by POSSUM. RESULTS: Seventy-six of the 167 patients suffered from postoperative complications. The physiological score of the group with complications was 16.75 +/- 0.4, significantly higher than that of the group without complications (15.4 +/- 0.3, P < 0.0017). The number of the patients with complications predicted by POSSUM was 70, not significantly different from the observed number of the patients with complications (78, P = 0.378). There were 94 person-times of complications in these 78 patients, 12 being with hypertension, 37 with arrhythmia; 5 with asthma; 3 with febrile; 2 with pneumonia; 1 with atelectasis; 1 with respiratory failure; 3 with wound infection; 3 with wound liquefaction; 2 with anastomotic leakage; 6 with phlebitis; 2 with pneumothorax; 2 with acute dilatation of stomach; 1 with chylothorax; 2 with hemorrhage; 1 with cardiac failure; 1 with infectious shock; 2 with empyema; 2 with deep vein thrombo-embolism; 1 with pulmonary infarction; 1 with cerebral infarction; 1 with urinary infection; and 1 with psychiatric symptom. CONCLUSION: The POSSUM makes satisfactory prediction of postoperative morbidity in aged patients undergoing esophagus carcinoma and gastric cardiac carcinoma resection. Intensive monitoring and organ supporting therapy after the operation according to the score is of great benefit to decrease the post-operative complications.