Establishing a river health evaluation index system for seven rivers in Jiamusi City of China.

The Jiamusi section of the Songhua River is one of the first 17 model river construction sections in China. The implementation of river health assessments can determine the health dynamics of rivers and test the management's effectiveness. Targeting seven rivers, this study conducted river zoning and monitoring point deployment to conduct sufficient field research and monitoring. The authors selected hydrological and water resources, physical structure, water quality, aquatic life, social service functions, and management as guideline layers and 15 indicator layers. Subsequently, the authors established an evaluation index system to evaluate and analyze the ecological status and social service status of each river. The results showed that the Yindamu, Alingda, and Gejie rivers scored well as healthy rivers, with health evaluation scores of 78.98, 76.06, and 75.83, respectively. The Wangsanwu, Lujiagang, and Lingdangmai rivers are generally sub-healthy rivers with scores of 71.55, 67.97, and 60.7, respectively. The Yinggetu River has a score of 54.52 and is therefore assessed as unhealthy. Based on the scientific evaluation index method, this study analyses the current river health state in Jiamusi City to provide the basis for the evaluation of the river chief's work and future river management.

Utilization of spent coffee grounds as charring agent to prepare flame retardant poly(lactic acid) composites with improved toughness.

The objective was to utilize spent coffee grounds (SCG) as charring agent to combine with ammonium polyphosphate (APP) to prepare flame retardant poly(lactic acid) (PLA) composites with improved toughness. PLA/APP-SCG and PLA/APP-SCG/KH560 composites were prepared, and silane coupling agent KH560 was applied to improve particle-matrix interfacial compatibility. The particle-matrix interface, char formation, flame retardancy, mechanical properties and fracture morphology of PLA composites were studied. Results showed that PLA/APP-SCG5% and PLA/APP-SCG20% passed UL-94 V-0 rating, and increase in charred residues was favorable for improving flame retardancy. Improved toughness was also obtained compared to PLA, attributed to debonding of APP from matrix under external force as well as plasticization effect of coffee oil contained in SCG. PLA/APP-SCG5%/KH560 and PLA/APP-SCG20%/KH560 showed smaller elongation at break and impact strength compared to PLA/APP-SCG5% and PLA/APP-SCG20%, respectively. The improved interfacial compatibility was unfavorable for debonding of APP from matrix, and both APP and SCG played the role of enhancing strength, thus decreasing toughness. PLA/APP-SCG/KH560 counterparts were actually set as parallel samples to prove that PLA/APP-SCG composites showed improved toughness with weak interfacial compatibility. This study has provided a practical approach to utilize bio-derived wastes as charring agent to prepare flame retardant PLA composites with enhanced toughness.

Evaluation of Dual-Frequency Switching HIFU for Optimizing Superficial Ablation.

OBJECTIVE: Dual-frequency high-intensity focused ultrasound (HIFU) thermal ablation is an exceptionally promising technique for treating tumors due to its precision and effectiveness. However, there are still a few studies on improving the accuracy and efficiency of HIFU in superficial ablation applications. This study proposes a method utilizing dual frequency switching ultrasound (DFSU) to enhance the efficiency and precision of superficial treatments. METHODS: A dual-frequency HIFU transducer operating at 4.5 MHz and 13.7 MHz was designed, and a dual-frequency impedance matching network was designed to optimize electro-acoustic conversion efficiency. Phantom and ex vivo tests were conducted to measure and compare thermal lesion areas and temperature rises caused by single-frequency ultrasound (SFU) and DFSU. RESULTS: In both phantom and ex vivo tests, the utilization of DFSU resulted in larger lesion areas compared to SFU. Moreover, DFSU provided improved control and versatility, enabling precise and efficient ablation. CONCLUSION: DFSU exhibits the ability to generate larger ablation areas in superficial tissue compared to SFU, and DFSU allows flexible control over the ablation area and temperature rise rate. The acoustic power deposition of HIFU can be optimized to achieve precise ablation.

Multi-Frequency Ultrasound Imaging Fusion Method Based on Wavelet Transform for Guided Screw Insertion.

Intraosseous ultrasound imaging can serve as a guiding tool for the placement of pedicle screws during spinal fusion surgery; thus far, there has been limited scholarly exploration of methods for intraosseous multifrequency ultrasound imaging, which can achieve simultaneous high resolution and deep penetration. The proposed method introduced a dynamic fusion strategy grounded in wavelet transformation for multifrequency image decomposition. This strategy accomplished the effective amalgamation of high-frequency ultrasound images and low-frequency ultrasound images, enabling the obtaining of fused images with enhanced details and better overall image quality. A novel near-field effect elimination method was also proposed to improve the quality of ultrasound imaging in the near-field region. Experimental evaluations were conducted on isolated bovine circle bone and sheep spine with pedicle screw tracks. The fusion images are capable of effectively detecting areas within the pedicle screw track that have either ruptured or are in close proximity to rupture, even measuring the size of breaches. Evaluation criteria, including information entropy (IE), spatial frequency (SF), average gradient (AG), mutual information (MI), structural similarity index (SSIM), and edge information-based image fusion quality metric (QAB/F), were employed to assess the fusion performance; moreover, the influence of mother wavelet function selection and decomposition levels on computational complexity and fusion image quality was thoroughly discussed. The proposed method exhibited promising potential for intraosseous imaging navigation, which can aid in accurate diagnosis, treatment planning, and monitoring in fields such as orthopedics, surgery, and interventional procedures.

Neratinib for HER2-positive breast cancer with an overlooked option.

Positive human epidermal growth factor receptor 2 (HER2) expression is associated with an increased risk of metastases especially those to the brain in patients with advanced breast cancer (BC). Neratinib as a tyrosine kinase inhibitor can prevent the transduction of HER1, HER2 and HER4 signaling pathways thus playing an anticancer effect. Moreover, neratinib has a certain efficacy to reverse drug resistance in patients with BC with previous HER2 monoclonal antibody or targeted drug resistance. Neratinib, as monotherapy and in combination with other therapies, has been tested in the neoadjuvant, adjuvant, and metastatic settings. Neratinib with high anticancer activity is indicated for the prolonged adjuvant treatment of HER2-positive early BC, or in combination with other drugs including trastuzumab, capecitabine, and paclitaxel for the treatment of advanced HER2-positive BC especially cancers with central nervous system (CNS) metastasis to reduce the risk of BC recurrence. This article reviewed the pharmacological profiles, efficacy, safety, tolerability, and current clinical trials pertaining to neratinib, with a particular focus on the use of neratinib in patients with metastatic breast cancer (MBC) involving the CNS. We further discussed the use of neratinib for HER2-negative and HER2-mutant breast cancers, and mechanisms of resistance to neratinib. The current evidence suggests that neratinib has promising efficacy in patients with BC which is at least non-inferior compared to previous therapeutic regimens. The most common AE was diarrhea, and the incidence, severity and duration of neratinib-related grade 3 diarrhea can be reduced with loperamide. Of note, neratinib has the potential to effectively control and prevent brain metastasis in patients with advanced BC, providing a therapeutic strategy for HER2-positive BC.

Sewage network operational risks based on InfoWorks ICM with nodal flow diurnal patterns under NPIs for COVID-19.

Non-Pharmaceutical Interventions (NPIs) have been widely employed globally over the past three years to control the rapid spread of coronavirus disease 2019 (COVID-19). These measures have imposed restrictions on urban residents' activities and significantly influenced sewage discharge characteristics within sewage network, particularly in densely populated cities in China. This study focused on the nodal flow diurnal patterns and sewage network operational risks before and after epidemic lockdown in Beijing from March to May in 2022. Nodal flow diurnal patterns on weekdays and weekends before and after NPIs were analyzed using measured data through statistical and mathematical methods. A sewage network model was established to simulate and analyze the operational risks based on InfoWorks ICM before and after epidemic lockdown. The main conclusions were as follows: (1) In predominantly residential areas, the total wastewater volume increased by approximately 28.76 % to 33.52 % after the implementation of strict NPIs. The morning and midday "M" peaks on normalized weekdays transformed into "N" peaks, and the morning peak time was delayed by 0.5 to 1 hour after the lockdown; (2) Following NPIs, More than 90 % of manholes' average water levels rose to varying degrees, approximately 50 % of pipe lengths exhibited a full flow state; (3) When the lockdown was in place during a hot summer day, sewage overflow phenomena were observed in 4.6 % and 9.6 % of manholes, respectively, with per capita daily drainage equivalent reaching 40-50 %. These findings hold significant implications for the proactive planning and operational management of water industry infrastructure during major emergencies.

Comparison of microsatellite distribution in the genomes of Pteropus vampyrus and Miniopterus natalensis (Chiroptera).

BACKGROUND: Microsatellites are a ubiquitous occurrence in prokaryotic and eukaryotic genomes. Microsatellites have become one of the most popular classes of genetic markers due to their high reproducibility, multi-allelic nature, co-dominant mode of inheritance, abundance and wide genome coverage. We characterised microsatellites in the genomes and genes of two bat species, Pteropus vampyrus and Miniopterus natalensis. This characterisation was used for gene ontology analysis and the Kyoto Encyclopedia of Genes and Genomes pathway enrichment of coding sequences (CDS). RESULTS: Compared to M. natalensis, the genome size of P. vampyrus is larger and contains more microsatellites, but the total diversity of both species is similar. Mononucleotide and dinucleotide repeats were the most diverse in the genome of the two species. In each bat species, the microsatellite bias was obvious. The microsatellites with the largest number of repeat motifs in P. vampyrus from mononucleotide to hexanucleotide were (A)n, (AC)n, (CAA)n, (AAAC)n, (AACAA)n and (AAACAA)n, with frequencies of 97.94%, 58.75%, 30.53%, 22.82%, 54.68% and 22.87%, respectively, while in M. natalensis were (A)n, (AC)n, (TAT)n, (TTTA)n, (AACAA)n and (GAGAGG)n, with of 92.00%, 34.08%, 40.36%, 21.83%, 25.42% and 12.79%, respectively. In both species, the diversity of microsatellites was highest in intergenic regions, followed by intronic, untranslated and exonic regions and lowest in coding regions. Location analysis indicated that microsatellites were mainly concentrated at both ends of the genes. Microsatellites in the CDS are thus subject to higher selective pressure. In the GO analysis, two unique GO terms were found only in P. vampyrus and M. natalensis, respectively. In KEGG enriched pathway, the biosynthesis of other secondary metabolites and metabolism of other amino acids in metabolism pathways were present only in M. natalensis. The combined biological process, cellular components and molecular function ontology are reflected in the GO analysis and six functional enrichments in KEGG annotation, suggesting advantageous mutations during species evolution. CONCLUSIONS: Our study gives a comparative characterization of the genomes of microsatellites composition in the two bat species. And also allow further study on the effect of microsatellites on gene function as well as provide an insight into the molecular basis for species adaptation to new and changing environments.

[Height to diameter ratio model of Larix gmelinii in Daxing'anling Mountains, China]. / å¤§å ´å®‰å²­åœ°åŒºå ´å®‰è½å¶æ¾çš„é«˜å¾„æ¯”æ¨¡åž‹.

Based on data from 56 plots of natural Larix gmelinii forest in Cuigang Forest Farm of Daxing'anling Mountains, we constructed the height to diameter ratio (HDR) model of L. gmelinii with exponential decay function as the base model. We used the tree classification as dummy variables and the method of reparameterization. The aim was to provide scientific evidence for evaluating the stability of different grades of L. gmelinii trees and stands in Daxing'anling Mountains. The results showed that except for diameter at breast height, the dominant height, dominant diameter, individual tree competition index all had significant correlations with the HDR. The involvement of these variables significantly improved the fitted accuracy of the generalized HDR model, with the adjustment coefficients, root mean square error and mean absolute error being 0.5130, 0.1703 m·cm-1 and 0.1281 m·cm-1, respectively. When the tree classification as a dummy variable was added to parameters 0 and 2 of the generalized model, the fitting effect of the model was further improved. The three above-mentioned statistics were 0.5171, 0.1696 m·cm-1 and 0.1277 m·cm-1, respectively. Through comparative analysis, the generalized HDR model with tree classification as dummy variable had the best fitting effect, which was superior to the basic model, and had higher prediction precision and adaptability.

Prediction of Clinical Molecular Typing of Breast Invasive Ductal Carcinoma Using 18F-FDG PET/CT Dual-Phase Imaging.

RATIONALE AND OBJECTIVES: To investigate the diagnostic value of Fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (18F-FDG PET/CT) dual-phase imaging for the different molecular subtypes of invasive ductal carcinoma of the breast. MATERIALS AND METHODS: Clinical imaging data of 164 women with invasive ductal carcinoma of the breast confirmed by pathology who underwent 18F-FDG PET/CT dual-phase imaging were retrospectively analyzed. The maximum standard uptake values (SUVmax) of the early and delayed phases of the lesion were measured and recorded as SUVmax1 and SUVmax2, respectively, and the retention index (RI) was calculated. We analyzed the change rule of SUVmax1, SUVmax2, and RI for the different molecular subtypes and molecular marker expression groups. The diagnostic threshold of different molecular marker expression status was determined using receiver operating characteristic curve analysis. RESULTS: SUVmax1 and SUVmax2 were highest in the TNBC group and lowest in the luminal A group (p<0.001). TNBC and HER2 overexpression groups had higher RI than the luminal A and B groups (p<0.001), with no significant difference between the TNBC and HER2 overexpression groups or between the luminal A and B groups (p=0.640 and 0.345, respectively). The ER- and PR-negative groups had significantly higher SUVmax1, SUVmax2, and RI than the PR-positive group (p<0.001). The HER2-positive group had higher SUVmax1 and SUVmax2 than the negative group (p<0.001). The Ki67 overexpression group had higher SUVmax1 and SUVmax2 levels than the low expression group (p<0.001). There was no significant difference in RI between HER2-positive and negative groups or between Ki67 high and low expression groups (p=0.904 and 0.216, respectively). For ER-negative and positive expression status, the maximum area under the curve (AUC) of SUVmax2 was 0.852, diagnostic threshold was 10.87, sensitivity was 79.6%, and specificity was 74.5%. For PR-negative and positive expression status, the AUC of SUVmax2 was 0.858, diagnostic threshold was 10.45, sensitivity was 83.1%, and specificity was 75.3%. For HER2-negative and positive expression status, the AUC of SUVmax1 was 0.714, diagnostic threshold was 9.28, sensitivity was 79.6%, and specificity was 60.9%. For Ki67 high- and low expression status, the AUC of SUVmax2 was 0.915 at maximum, diagnostic threshold was 10.21, sensitivity was 83.4%, and specificity was 93.9%. CONCLUSION: 18F-FDG PET/CT dual-phase imaging facilitates the prediction of the expression of molecular markers and subtypes of invasive ductal carcinoma of the breast and the development of more tailored treatment plans for patients with this disease.

Reversible Switching CuII /CuI Single Sites Catalyze High-rate and Selective CO2 Photoreduction.

Herein, we first design a model of reversible redox-switching metal-organic framework single-unit-cell sheets, where the abundant metal single sites benefit for highly selective CO2 reduction, while the reversible redox-switching metal sites can effectively activate CO2 molecules. Taking the synthetic Cu-MOF single-unit-cell sheets as an example, synchrotron-radiation quasi in situ X-ray photoelectron spectra unravel the reversible switching CuII /CuI single sites initially accept photoexcited electrons and then donate them to CO2 molecules, which favors the rate-liming activation into CO2 δ- , verified by in situ FTIR spectra and Gibbs free energy calculations. As an outcome, Cu-MOF single-unit-cell sheets achieve near 100 % selectivity for CO2 photoreduction to CO with a high rate of 860 µmol g-1 h-1 without any sacrifice reagent or photosensitizer, where both the activity and selectivity outperform previously reported photocatalysts evaluated under similar conditions.

Evaluation of the dual-frequency transducer for controlling thermal ablation morphology using frequency shift keying signal.

PURPOSE: The catheter-based ultrasound (CBUS) can reach the target tissue directly and achieve rapid treatment. The frequency shift keying (FSK) signal is proposed to regulate and evaluate tumor ablation by a miniaturized dual-frequency transducer. METHODS: A dual-frequency transducer prototype (3 × 7 × 0.4 mm) was designed and fabricated for the CBUS applicator (OD: 3.8 mm) based on the fundamental frequency of 5.21 MHz and the third harmonic frequency of 16.88 MHz. Then, the acoustic fields and temperature field distributions using the FSK signals (with 0, 25, 50, 75, and 100% third harmonic frequency duty ratios) were simulated by finite element analysis. Finally, tissue ablation and temperature monitoring were performed in phantom and ex vivo tissue, respectively. RESULTS: At the same input electrical power (20 W), the output acoustic power of the fundamental frequency of the transducer was 10.03 W (electroacoustic efficiencies: 50.1%), and that of the third harmonic frequency was 6.19 W (30.6%). As the third harmonic frequency duty ratios increased, the shape of thermal lesions varied from strip to droplet in simulated and phantom experimental results. The same trend was observed in ex vivo tests. CONCLUSION: Dual-frequency transducers excited by the FSK signal can control the morphology of lesions. SIGNIFICANCE: The acoustic power deposition of CBUS was optimized to achieve precise ablation.

Plastics-to-syngas photocatalysed by Co-Ga2O3 nanosheets.

Plastics take hundreds of years to degrade naturally, while their chemical degradation typically requires high temperature and pressure. Here, we first utilize solar energy to realize the sustainable and efficient plastic-to-syngas conversion with the aid of water at ambient conditions. As an example, the commercial plastic bags could be efficiently photoconverted into renewable syngas by Co-Ga2O3 nanosheets, with hydrogen and carbon monoxide formation rates of 647.8 and 158.3 µmol g-1 h-1. In situ characterizations and labelling experiments unveil water is photoreduced into hydrogen, while non-recyclable plastics including polyethylene bags, polypropylene boxes and polyethylene terephthalate bottles are photodegraded into carbon dioxide, which is further selectively photoreduced into carbon monoxide. In-depth investigation illustrates that the efficiency of syngas production mainly depends on the carbon dioxide reduction process and hence photocatalysts of high carbon dioxide reduction activity should be designed to promote the efficiency of plastic-to-syngas conversion in the future. The concept for the photoreforming of non-recyclable plastics into renewable syngas helps to eradicate 'white pollution' and alleviate the energy crisis simultaneously.

In Situ Measurement of NO, NO2, and H2O in Combustion Gases Based on Near/Mid-Infrared Laser Absorption Spectroscopy.

In this study, a strategy was developed for in situ, non-intrusive, and quantitative measurement of the oxides of nitrogen (NO and NO2) to describe emission characteristics in gas turbines. The linear calibration-free wavelength modulation spectroscopy (LCF-WMS) approach combined with the temperature profile-fitting strategy was utilized for trace NO and NO2 concentration detection with broad spectral interference from gaseous water (H2O). Transition lines near 1308 nm, 5238 nm, and 6250 nm were selected to investigate the H2O, NO, and NO2 generated from combustion. Experiments were performed under different equivalence ratios in a combustion exhaust tube, which was heated at 450-700 K, with an effective optical length of 1.57 m. Ultra-low NOx emissions were captured by optical measurements under different equivalence ratios. The mole fractions of H2O were in agreement with the theoretical values calculated using Chemkin. Herein, the uncertainty of the TDLAS measurements and the limitation of improving the relative precision are discussed in detail. The proposed strategy proved to be a promising combustion diagnostic technique for the quantitative measurement of low-absorbance trace NO and NO2 with strong H2O interference in real combustion gases.

The Considerable Water Evaporation Induced by Human Perspiration and Respiration in Megacities: Quantifying Method and Case Study in Beijing.

The water cycle in urban areas is called the natural-social dualistic water cycle, and it is driven not only by natural forces, but also by human activities. As the drivers of the social water cycle, human perspire continuously, and this is often overlooked as a contributing factor to the water cycle. This paper proposes a method for quantifying the water evaporation induced by human perspiration and respiration in megacities. A calculation based on the sweating prediction model was applied to the city of Beijing to evaluate the evaporation from the human body. The results show that the greatest volume of evaporation produced by human occurs in summer, and the least in spring. The total evaporation produced by human was converted to the evaporation on unit area of the city and reached 5075.2 m3/km2 in the six core districts of Beijing. According to the calculation, the total volume was considerable and reached 14.0 million m3 in 2020, which was equivalent to the annual evapotranspiration from an area of 104.9 km2 of Acer truncatum forest (15 cm diameter at breast height, afforestation density 800 plants/hm2), and even twice the annual total water use in Tartu, Estonia. The results of the study provide a reference for dualistic water cycle research and water cycle flux calculation in urban areas.

Volumetric analysis of intravoxel incoherent motion diffusion-weighted imaging in preoperative assessment of non-small cell lung cancer.

PURPOSE: To evaluate the potential of intravoxel incoherent motion (IVIM) and apparent diffusion coefficient (ADC) in the prediction of tumor grade, lymph node metastasis and pleural invasion of non-small cell lung cancer (NSCLC) before surgery. MATERIALS AND METHODS: 65 patients diagnosed with NSCLC by surgery were enrolled. IVIM-DWI (10 b-values, 0-1000 s/mm2) was performed before surgery. The mean and minimum ADC (ADCmean, ADCmin) and IVIM parameters D, D* and f were independently measured and calculated by 2 radiologists by drawing regions of interest (ROIs) including the solid component of the whole tumor. Intraclass correlation coefficients (ICCs) were analysed. Spearman analysis was used to determine the correlation between IVIM parameters and tumor differentiation. Independent sample t-tests (normal distribution) or Mann-Whitney U tests (non-normal distribution) were used to compare the differences between the parameters in moderately-well and poorly differentiated groups, with and without lymph node metastasis and pleural invasion groups. Receiver operating characteristic (ROC) curves were generated. RESULTS: The ADCmean, ADCmin, D and f values were negatively correlated with the pathological grades of tumor (P < 0.05). The ADCmean and D values of patients with poor differentiation and lymph node metastasis were significantly lower than that of patients with moderately-well differentiation and without lymph node metastasis (P < 0.001-0.012). The D value was significantly lower and f value was significantly higher among patients with pleural invasion than those without (P = 0.033 and < 0.001). ROC analysis showed that the area under the ROC curve (AUC) was larger for D in predicting the degree of differentiation (0.832) and lymph node metastasis (0.806), and higher for f in predicting pleural invasion (0.832). CONCLUSIONS: IVIM is useful for predicting the tumor differentiation, lymph node metastasis and pleural invasion in NSCLC patients before surgery.

Acidic Tumor Microenvironment Promotes Pancreatic Cancer through miR-451a/MEF2D Axis.

Pancreatic cancer (PC), as a highly malignant and aggressive solid tumor, is common in the digestive system. The acidic microenvironment is one of the critical markers of cancer. Nonetheless, there are few studies on how the acidic microenvironment affects the development of PC. This study focused on investigating the specific molecular mechanisms of the acidic microenvironment in PC. In our study, qRT-PCR was conducted for examining microRNA (miR)-451a and myocyte enhancer factor 2D (MEF2D) expressions in PANC-1 cells. Then, detailed functional effects of an acidic environment on miR-451a and MEF2D in PANC-1 cells were detected by CCK-8, colony formation, flow cytometry, wound healing, transwell, mitochondrial functionality measurement, JC-1 staining, DCFH-DA staining, and sphere formation assays. The relationship between miR-451a and MEF2D was confirmed by luciferase reporter analysis. Under acidic conditions, the increase of proliferation, migration, and invasion of PANC-1 cells was observed. Moreover, the mitochondrial oxidative respiration-related gene miR-451a was reduced in acidic conditions. In addition, we found that, in PANC-1 cells under an acidic environment, miR-451a overexpression enhanced oxygen consumption, mitochondrial membrane potential (MMP) loss, and ROS generation and inhibited proliferation, migration, invasion, and stemness via sponging MEF2D. In a word, our results revealed that the acidic microenvironment regulated PC progression by affecting the miR-451a/MEF2D axis, indicating a novel avenue for the future treatment of PC.

Identifying optimal candidates for tumor resection among borderline and locally advanced pancreatic cancer: A population-based predictive model.

BACKGROUND: Whether patients with borderline resectable and locally advanced pancreatic cancer (BR/LAPC) benefit from resection of the primary cancer is controversial. We developed a nomogram to screen who would benefit from surgery for the primary tumor. METHODS: We identified patients from the Surveillance, Epidemiology, and End Results (SEER) database and then divided them into surgical and non-surgical groups. A 1:1 propensity score matching (PSM) was used to mitigate the bias. We hypothesized that patients who underwent surgery would benefit from surgery by having a longer median overall survival (OS) than patients who did not undergo surgery. Univariate and multivariate logistic regression analyses were used to determine the variables affecting surgical outcomes, and a nomogram was created based on the multivariate logistic results. Finally, we verified the discrimination and calibration of the nomogram with receiver operator characteristic (ROC) curve and calibration plots. RESULTS: A total of 518 pairs of surgical and non-surgical pancreatic cancer patients were matched after PSM. Survival curves showed longer OS in the surgical group than in the non-surgical group, median survival times were 14 months versus 8 months. In the surgical group, 340 (65.63%) patients have a longer survival time than 8 months (beneficial group). Multifactorial logit regression results showed that including age, tumor size, degree of differentiation, and chemotherapy were significant influences on the benefit of surgery for primary tumors and were used as predictors to construct a nomogram. The area under the ROC curve (AUC) reached 0.747 and 0.706 in the training and validation sets. CONCLUSION: We developed a practical predictive model to support clinical decision-making that can be used to help clinicians determine if there is a benefit to surgical resection of the primary tumor in patients with BR/LAPC.

Effects of Total Pancreatectomy on Survival of Patients With Pancreatic Ductal Adenocarcinoma: A Population-Based Study.

Background: Total pancreatectomy (TP) seems to be experiencing a renaissance in recent years. In this study, we aimed to determine the long-term survival of pancreatic ductal adenocarcinoma (PDAC) patients who underwent TP by comparing with pancreaticoduodenectomy (PD), and formulate a nomogram to predict overall survival (OS) for PDAC individuals following TP. Methods: Patients who were diagnosed with PDAC and received PD (n = 5,619) or TP (n = 1,248) between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. OS and cancer-specific survival (CSS) of the PD and TP groups were compared using Kaplan-Meier method and log-rank test. Furthermore, Patients receiving TP were randomly divided into the training and validation cohorts. Univariate and multivariate Cox regression were applied to identify the independent factors affecting OS to construct the nomogram. The performance of the nomogram was measured according to concordance index (C-index), calibration plots, and decision curve analysis (DCA). Results: There were no significant differences in OS and CSS between TP and PD groups. Age, differentiation, AJCC T stage, radiotherapy, chemotherapy, and lymph node ratio (LNR) were identified as independent prognostic indicators to construct the nomogram. The C-indexes were 0.67 and 0.69 in the training and validation cohorts, while 0.59 and 0.60 of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The calibration curves showed good uniformity between the nomogram prediction and actual observation. DCA curves indicated the nomogram was preferable to the AJCC staging system in terms of the clinical utility. A new risk stratification system was constructed which could distinguish patients with different survival risks. Conclusions: For PDAC patients following TP, the OS and CSS are similar to those who following PD. We developed a practical nomogram to predict the prognosis of PDAC patients treated with TP, which showed superiority over the conventional AJCC staging system.