CircHIPK3 regulates fatty acid metabolism through miR-637/FASN axis to promote esophageal squamous cell carcinoma.

The oncogenic role of circRNA in cancers including esophageal cancer (EC) has been well studied. However, whether and how circRNAs are involved in cancer cell metabolic processes remains largely unknown. Here, we reported that circRNA, circHIPK3, is highly expressed in ESCC cell lines and tissues. Knockdown of circHIPK3 significantly restrained cell proliferation, colony formation, migration, and invasion in vitro and inhibited tumor growth in vivo. Mechanistically, circHIPK3 was found to act as a ceRNA by sponging miR-637 to regulate FASN expression and fatty acid metabolism in ESCC cells. Anti-sense oligonucleotide (ASO) targeting circHIPK3 substantially inhibited ESCC both in vitro and in vivo. Therefore, these results uncover a modulatory axis constituting of circHIPK3/miR-637/FASN may be a potential biomarker and therapeutic target for ESCC in the clinic.

Flood risk transfer analysis based on the "Source-Sink" theory and its impact on ecological environment: A case study of the Poyang Lake Basin, China.

Driven by climate change, the frequent occurrence of regional destructive floods poses a grave threat to socio-economic systems and ecological environments. Previous flood risk studies have disregarded risk transfer within a region, resulting in inadequate flood risk assessment and ineffective disaster prevention and mitigation outcomes. Therefore, this study introduced the "Source-Sink" theory into flood disaster field to constructing flood risk transfer model. Flood risk assessment and transfer was conducted in the Poyang Lake Basin, China, where the impacts of the initial and transfer statuses on ecosystem service values were quantified. The results showed that the flood risk in the Poyang Lake Basin was relatively low, with high spatial distribution characteristics in the central-north areas but low in the surrounding areas. High-risk zones were mainly distributed southwest of the Poyang Lake. The lower-risk zones exhibited a contiguous distribution and were surrounded by higher-risk zones. Following the completion of the flood risk transfer, high-risk zones increased significantly; but there were a few zones where the risk was transferred to other zones, thereby lowering their risks. Flood risk transfer occurs primarily in low- and medium-risk zones, with high-risk zones being the most important growth targets. The change in risk transfer was most evident in the area surrounding Poyang Lake, while that in the Upper Gan River Basin was lower and less sensitive to the transfer effect. Accounting for flood disaster risk, the ecosystem service values of the Poyang Lake Basin decreased by 8.18 %, with the most significant impacts observed in the surrounding environment and southwest Poyang Lake. After the completion of the flood risk transfer, the ecosystem service value in the Poyang Lake Basin declined by 24.66 %. This study provides a reference point for flood risk management and sustainable regional development that account for risk transfer.

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.

miR-1301-3p promotes invasion and migration and EMT progression in esophageal cancer by downregulating NBL1 expression.

BACKGROUND: Esophageal cancer (ESCA) is one of the most aggressive and lethal human malignant cancers. MicroRNA-1301-3p (miR-1301-3p) plays vital roles in a majority of malignancies. The aim of this study was to investigate the role of miR-1301-3p/NBL1 axis on ESCA cell invasion, migration, epithelial-mesenchymal transition (EMT) process, as well as its association with prognosis of ESCA patients. METHODS: The expression levels of miR-1301-3p and NBL1 were predicted by bioinformatics and further verified by RT-qPCR assays. Kaplan-Meier (K-M) plotter analysis and univariate and multivariate Cox analyses were used to evaluate the relationship between miR-1301-3p and clinicopathological variables and prognosis. The role of miR-1301-3p on cell invasion, migration was detected by transwell invasion, and wound healing assays, respectively. The EMT-related proteins were detected by western blot. The target genes and the target binding sites were predicted by bioinformatics and further determined by RT-qPCR assay. RESULTS: MiR-1301-3p was remarkably upregulated in ESCA tissues and cells, and its high expression was associated with poor prognosis of ESCA. Overexpression of miR-1301-3p promoted ESCA cell invasion, migration and mediated EMT process in vitro, whereas knockdown of miR-1301-3p showed the opposite effects. Moreover, NBL1 was predicted as a target gene of miR-1301-3p. NBL1 was lowly expressed in ESCA cells and significantly decreased after upregulation of miR-1301-3p. Meanwhile, we found that low expression of NBL1 was significantly associated with poor prognosis of ESCA patients. CONCLUSION: MiR-1301-3p is a potential biomarker for predicting the prognosis of ESCA patients. It may promote ESCA invasion, migration and EMT progression by regulating NBL1 expression.

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.

An artificial neural network-based radiomics model for predicting the radiotherapy response of advanced esophageal squamous cell carcinoma patients: a multicenter study.

Radiotherapy benefits patients with advanced esophageal squamous cell carcinoma (ESCC) in terms of symptom relief and long-term survival. In contrast, a substantial proportion of ESCC patients have not benefited from radiotherapy. This study aimed to establish and validate an artificial neural network-based radiomics model for the pretreatment prediction of the radiotherapy response of advanced ESCC by using integrated data combined with feasible baseline characteristics of computed tomography. A total of 248 patients with advanced ESCC who underwent baseline CT and received radiotherapy were enrolled in this study and were analyzed by two types of radiomics models, machine learning and deep learning. As a result, the Att. Resnet50 pretrained network model indicated superior performance, with AUCs of 0.876, 0.802 and 0.732 in the training, internal validation, and external validation cohorts, respectively. Similarly, our Att. Resnet50 pretrained network model showed excellent calibration and significant clinical benefit according to the C index and decision curve analysis. Herein, a novel pretreatment radiomics model was established based on deep learning methods and could be used for radiotherapy response prediction in advanced ESCC patients, thus providing reliable evidence for therapeutic decision-making.

Complete genome sequences and comparative secretomic analysis for the industrially cultivated edible mushroom Lyophyllum decastes reveals insights on evolution and lignocellulose degradation potential.

Lyophyllum decastes, also known as Luronggu in China, is a culinary edible and medicinal mushroom that was widely cultivated in China in recent years. In the present study, the complete high-quality genome of two mating compatible L. decastes strain was sequenced. The L. decastes LRG-d1-1 genome consists of 47.7 Mb in 15 contigs with a contig N90 of 2.08 Mb and 14,499 predicted gene models. Phylogenetic analysis revealed that L. decastes exhibits a close evolutionary relationship to the Termitomyces and Hypsizygus genus and was diverged from H. marmoreus ~ 45.53 Mya ago. Mating A loci of L. decastes compose of five and four HD genes in two monokaryotic strains, respectively. Mating B loci compose of five STE genes in both two monokaryotic strains. To accelerate the cross-breeding process, we designed four pairs of specific primers and successfully detected both mating types in L. decastes. As a wood-rotting mushroom, a total of 541 genes accounting for 577 CAZymes were identified in the genome of L. decastes. Proteomic analysis revealed that 1,071 proteins including 182 CAZymes and 258 secreted enzymes were identified from four groups (PDB, PDB + bran, PDB + cotton hull, and PDB + sawdust). Two laccases and a quinone reductase were strongly overproduced in lignin-rich cultures, and the laccases were among the top-3 secreted proteins, suggesting an important role in the synergistic decomposition of lignin. These results revealed the robustness of the lignocellulose degradation capacity of L. decastes. This is the first study to provide insights into the evolution and lignocellulose degradation of L. decastes.

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.

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.

"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.

Green growth and environmental sustainability in China: the role of environmental taxes.

This study aims to investigate the impact of environmental-related taxes on green growth and CO2 emissions in China covering the time 1996-2019. To get the short- and long-run estimates, we have applied the bounds testing approach. Estimates of the study provide some important results. In the short run, environmental taxes and environmental policy stringency estimates are negatively significant in the CO2 emissions models and positively significant in the green growth models. Likewise, the long-run estimates attached to environmental taxes are significantly negative in the basic and robust CO2 emissions models while insignificant in the green growth models. However, the long-run estimates of environmental policy stringency are significantly negative in the basic and robust CO2 emissions models and significantly positive in the basic and robust green growth models. In general, our findings imply that an increase in environment-related taxes and strictness in environmental policies help reduce CO2 emissions and promote green growth in China.

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.

An Experimental Investigation on Polarization Process of a PZT-52 Tube Actuator with Interdigitated Electrodes.

The manipulator is the key component of the micromanipulator. Using the axial expansion and contraction properties, the piezoelectric tube can drive the manipulator to achieve micro-motion positioning. It is widely used in scanning probe microscopy, fiber stretching and beam scanning. The piezoceramic tube actuator used to have continuous electrodes inside and outside. It is polarized along the radial direction. There are relatively high polarization voltages, but poor axial mechanical properties. A new tubular actuator is presented in this paper by combining interdigitated electrodes and piezoceramic tubes. The preparation, polarization and mesoscopic mechanical properties were investigated. Using Lead Zirconate Titanate (PZT-52) as a substrate, the preparation process of interdigitated electrodes by screen printing was studied. For initial polarization voltage determination, the local characteristic model of the actuator was extracted and the electric field was analyzed by a finite element method. By measuring the actuator's axial displacement, we measured the actuator's polarization effect. Various voltages, times and temperatures were evaluated to determine how polarization affects the actuator's displacement. Optimal polarization conditions are 800 V, 60 min and 150 °C, with a maximum displacement of 0.88 µm generated by a PZT-52 tube actuator with interdigitated electrodes. PZT-52 tube actuators with a continuous electrode cannot be polarized under these conditions. The maximum displacement is 0.47 µm after polarization at 4 kV. Based on the results, the new actuator has a more convenient polarization process and a greater axial displacement from an application standpoint. It provides technical guidance for the preparation and polarization of the piezoceramic tube actuator. There is potential for piezoelectric tubular actuators to be used in a broader range of applications.

Occult Fracture of the Fibula: One Case Report.

Occult fibula fracture in adults is a fairly rare disease. It is easy to overlook or misdiagnose, resulting in delayed treatment and serious sequelae, as well as medical conflicts. We describe a case of concealed distal fibula fracture. The radiograph revealed no visible abnormalities at first. Finally, the occult fibula fracture was confirmed by magnetic resonance imaging and the patient received timely, correct, and reasonable treatment after diagnosis. This case raises our awareness of occult fibula fractures that are easily missed, and it deserves to be shared.

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.

Acute Popliteal Artery Thrombosis Resulting From a Closed Comminuted Tibia Fracture: A Case Report.

Acute popliteal artery thrombosis is a rare and limb-threatening traumatic event. It can lead to soft-tissue necrosis or even amputation of the lower limb. In patients suffering from trauma around the knee joint, the clinician should be highly vigilant to risk of popliteal artery acute thrombosis. It is essential to detect and treat acute popliteal artery thrombosis timely for limb salvaging. We present a case of acute popliteal artery thrombosis resulting from a closed comminuted tibia fracture and discuss its injury mechanism, diagnostic methods, and treatment measures.

Finite Element Modeling and Test of Piezo Disk with Local Ring Electrodes for Micro Displacement.

A new piezoelectric actuator combining interdigitated ring electrodes and a PZT-52(Lead Zirconate Titanate) disk was investigated for the large displacement requirements of piezoelectric actuators. Finite element models were established according to the structural characteristics of the actuator and static analysis was carried out based on ANSYS software. Then Ø25 mm × 2 mm samples were prepared. The displacement detection system was established, and the influence of electrode structure on radial displacement was studied experimentally. A comparison between the experimental results and the finite element analysis confirmed that the finite element model was correct. The results showed that the effect of electrode width on displacement was small. With decrease in electrode center distance and increase in the number of electrodes pairs, the radial displacement increased correspondingly. The peak of radial displacement was 1.63 µm under a 200 V voltage excitation voltage of 0.2 Hz. This was 2.5 times that for a conventional electrode piezo disk with the same structure. The actuator demonstrated better displacement properties. The piezoelectric disk could be valuable in applications involving micro-nano devices.

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.

Finite Element Analysis and Polarization Test of IDEs Piezoelectric Actuator.

A new type of actuator is presented in the paper that integrates the IDEs into a conventional piezoelectric sheet. The electrodes and polarization play a key role in the strain. Adopting constitutive equations of piezoelectric theory and variation principles in elasticity theory, the piezoelectric component dynamic equation was deduced. Several finite element models of the IDEs piezoelectric actuator were established in ANSYS. The effect of branch electrodes on the strain of the actuator was analyzed. The results show that the strain can be bigger than that of the conventional piezoelectric sheet by decreasing the gap and increasing the width of electrodes. According to the FEM result, some IDEs piezoelectric actuators were prepared. The distribution of the static electric field inside the actuator was researched to determine the polarization voltage. The 2671 high voltage power and DU-20 temperature-controlled oil bath was applied to explore the polarization process. The effect of the voltage, time and temperature on the strain of the actuator was researched by a TF2000 and SIOS laser interferometer. The results show that the optimum polarization is 800 V, for 60 min and at 150 °C. The strain of the IDEs piezoelectric actuator is 1.87 times that of the conventional piezoelectric actuator. The actuators could prove to be helpful applications for micro-nano devices.