A prospective randomized trial comparing the pocket-creation method and conventional method of endoscopic submucosal dissection in early gastric cancers and precancerous lesions.

BACKGROUND: Endoscopic submucosal dissection (ESD) is widely used as a standard treatment regimen for early gastric cancers (EGCs). However, such an approach is time-consuming and has a high risk of perforation and bleeding in some corner-site lesions because of the obscured view and difficulty in submucosal lifting. The newly developed pocket-creation method (PCM) provides a clearer view and better traction of the submucosal layer than conventional ESD (c-ESD). Nevertheless, no prospective randomized study has evaluated the efficacy of the PCM in EGCs and precancerous lesions. METHODS: This was a prospective randomized controlled trial. Patients with superficial gastric neoplastic lesions≥20mm were randomly assigned to the PCM-ESD group or c-ESD group. The primary outcome was dissection speed. RESULTS: There were 28 patients in the PCM-ESD group and 27 in the c-ESD group. The median dissection speed was significantly higher in the PCM-ESD group than in the c-ESD group (21.5 mm2/min vs. 14.3 mm2/min, P<0.001). Meanwhile, the operation time in the PCM-ESD group was significantly shorter than that in the c-ESD group (30min vs. 40min，P=0.047). In multiple linear regression analysis, the treatment method was independently associated with the resection speed of ESD. CONCLUSIONS: PCM-ESD was an effective and safe treatment for EGCs and precancerous lesions.

Early adenocarcinoma mixed with a neuroendocrine carcinoma component arising in the gastroesophageal junction: A case report.

BACKGROUND: Early adenocarcinoma mixed with a neuroendocrine carcinoma (NEC) component arising in the gastroesophageal junctional (GEJ) region is rare and even rarer in young patients. Here, we report such a case in a 29-year-old Chinese man. CASE SUMMARY: This patient presented to our hospital with a 3-mo history of dysphagia and regurgitation. Upper endoscopy revealed an elevated nodule in the distal esophagus 1.6 cm above the GEJ line, without Barrett's esophagus or involvement of the gastric cardia. The nodule was completely resected by endoscopic submucosal dissection (ESD). Pathological examination confirmed diagnosis of intramucosal adenocarcinoma mixed with an NEC component, measuring 1.5 cm. Immunohistochemically, both adenocarcinoma and NEC components were positive for P53 with a Ki67 index of 90%; NEC was positive for synaptophysin and chromogranin. Next-generation sequencing of 196 genes demonstrated a novel germline mutation of the ERCC3 gene in the DNA repair pathway and a germline mutation of the RNF43 gene, a common gastric cancer driver gene, in addition to pathogenic somatic mutations in P53 and CHEK2 genes. The patient was alive without evidence of the disease 36 mo after ESD. CONCLUSION: Early adenocarcinoma with an NEC component arising in the distal esophageal side of the GEJ region showed evidence of gastric origin.

Prognostic factors in clinicopathology of oesophagogastric adenocarcinoma: a single-centre longitudinal study of 347 cases over a 20-year period.

Oesophagogastric adenocarcinoma (EGA) includes oesophageal (EA), gastro-oesophageal junctional (GEJA), and gastric (GA) adenocarcinomas. The prognostic values of clinicopathological factors in these tumours remain obscure, especially for GEJA that has been inconsistently classified and staged. We studied the prognosis of EGA patients among the three geographic groups in 347 consecutive patients with a median age of 70 years (range 47-94). All patients were male, and 97.1% were white. Based on tumour epicentre location, EGAs were sub-grouped into EA (over 2 cm above the GEJ; n=3, 18.1%), GEJA (within 2 cm above and 3 cm below the GEJ; n=231, 66.6%), and GA (over 3 cm below the GEJ; n=53, 15.3%). We found that the median overall survival (OS) was the longest in EA (62.9 months), compared to GEJA (33.4), and GA (38.1) (p<0.001). Significant risk factors for OS included tumour location (p=0.018), size (p<0.001), differentiation (p<0.001), adenocarcinoma subtype (p<0.001), and TNM stage (p<0.001). Independent risk factors for OS comprised low-grade papillary adenocarcinoma [odds ratio (OR) 0.449, 95% confidence interval (CI) 0.214-0.944, p<0.05), mixed adenocarcinoma (OR 1.531, 95% CI 1.056-2.218, p<0.05), adenosquamous carcinoma (OR 2.206, 95% CI 1.087-4.475, p<0.05), N stage (OR 1.505, 95% CI 1.043-2.171, p<0.05), and M stage (OR 10.036, 95% CI 2.519-39.993, p=0.001)]. EGA was further divided into low-risk (common well-moderately differentiated tubular and low-grade papillary adenocarcinomas) and high-risk (uncommon adenocarcinoma subtypes, adenosquamous carcinoma) subgroups. In this grouping, the median OS was significantly longer in the low-risk (83 months) than in the high-risk (10 months) subgroups (p<0.001). In conclusion, the prognosis of EGA patients was significantly better in EA than in GEJA or GA and could be stratified into low and high-risk subgroups with significantly different outcomes.

Esophageal adenocarcinoma heterogeneity in clinicopathology and prognosis: A single center longitudinal study of 146 cases over a 20-year period.

Recent genomic studies suggest that esophageal adenocarcinoma (EAC) is not homogeneous and can be divided into true (tEAC) and probable (pEAC) groups. We compared clinicopathologic and prognostic features between the two groups of EAC. Based on endoscopic, radiologic, surgical, and pathologic reports, tumors with epicenters beyond 2 cm of the gastroesophageal junction (GEJ) were assigned to the tEAC group (N = 63), while epicenters within 2 cm of, but not crossing the GEJ, were allocated to the pEAC group (N = 83). All 146 consecutive patients were male (age: median 70 years, range: 51-88) and White-predominant (98.6 %). There was no significant difference in gastroesophageal reflux disease, obesity, comorbidity, and the prevalence of Barrett's esophagus, and cases diagnosed during endoscopic surveillance. However, compared to the pEAC group, the tEAC group had significantly more cases with hiatal hernia (P = 0.003); their tumors were significantly smaller in size (P = 0.007), more frequently with tubular/papillary adenocarcinoma (P = 0.001), had fewer cases with poorly cohesive carcinoma (P = 0.018), and demonstrated better prognosis in stage I disease (P = 0.012); 5-year overall survival (34.9 months) was significantly longer (versus 16.8 months in pEACs) (P = 0.043). Compared to the patients without resection, the patients treated with endoscopic or surgical resection showed significantly better outcomes, irrespective of stages. We concluded that EACs were heterogeneous with two distinct tEAC and pEAC groups in clinicopathology and prognosis; resection remained the better option for improved outcomes. CONDENSED ABSTRACT: Esophageal adenocarcinoma can be divided into true or probable groups with distinct clinicopathology and better prognosis in the former than in the latter. we showed that resection remained the better option for improved outcomes.

Mechanisms of chiral plasmonics-Scattering, absorption, and photoluminescence.

Chirality is a concept that one object is not superimposable on its mirror image by translation and rotation. In particular, chiral plasmonics have been widely investigated due to their excellent optical chiral properties, and have led to numerous applications such as optical polarizing element etc. In this study, we develop a model based on the concept of the interaction between harmonic oscillators to investigate and explain the optical chiral mechanisms of strongly coupled metal nanoparticles (MNPs). The chirality of the scattering, absorption, and photoluminescence spectra are carefully discussed in detail. The results show that the chirality of the system originates not only from the orientations of the MNPs, but also from the different eigen parameters between them. Specifically, the derived three factors contribute to the chirality: the symmetry, the coupling strength, and the coherent superposition of the emitted electric field. This work provides a deeper understanding on the chiral plasmonics and may guide relevant applications in theory.

Therapeutic Effect of Prolyl Endopeptidase Inhibitor in High-fat Diet-induced Metabolic Dysfunction-associated Fatty Liver Disease.

Background and Aims: Prolyl endopeptidase (PREP) is a serine endopeptidase that participates in many pathological processes including inflammation, oxidative stress, and autophagy. Our previous studies found that PREP knockout exhibited multiple benefits in high-fat diet (HFD) or methionine choline-deficient diet-induced metabolic dysfunction-associated fatty liver disease (MAFLD). However, cumulative studies have suggested that PREP performs complex functions during disease development. Therefore, further understanding the role of PREP in MAFLD development is the foundation of PREP intervention. Methods: In this study, an HFD-induced MAFLD model at different time points (4, 8, 12, and 16 weeks) was used to explore dynamic changes in the PREP proline-glycine-proline (PGP)/N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP) system. To explore its potential value in MAFLD treatment, saline, or the PREP inhibitor, KYP-2047, was administered to HFD-induced MAFLD mice from the 10th to 16th weeks. Results: PREP activity and expression were increased in HFD-mice compared with control mice from the 12th week onwards, and increased PREP mainly resulted in the activation of the matrix metalloproteinase 8/9 (MMP8/9)-PREP-PGP axis rather than the thymosin ß4-meprin α/PREP-AcSDKP axis. In addition, KYP-2047 reduced HFD-induced liver injury and oxidative stress, improved lipid metabolism through the suppression of lipogenic genes and the induction of ß-oxidation-related genes, and attenuated hepatic inflammation by decreasing MMP8/9 and PGP. Moreover, KYP2047 restored HFD-induced impaired autophagy and this was verified in HepG2 cells. Conclusions: These findings suggest that increased PREP activity/expression during MAFLD development might be a key factor in the transition from simple steatosis to steatohepatitis, and KYP-2047 might possess therapeutic potential for MAFLD treatment.

Spectral analysis of oxidation on localized surface plasmon resonance of copper nanoparticles thin film.

Copper nanoparticles (CuNPs) possess localized surface plasmon resonance (LSPR) effect. Cu thin films composed of individual CuNPs exhibit stronger LSPR than the individual CuNPs due to the LSPR coupling among CuNPs. However, CuNPs are easy to be oxidized, which results in the rapid LSPR damping of the CuNPs thin films. Simulation of the variations of the coupled LSPR of two adjacent CuNPs with the thickness of oxide shells formed during oxidation is of great importance for understanding the mechanisms of the strong LSPR of CuNPs thin films and its rapid attenuation. In this paper, Discrete-dipole approximation method is used to simulate the extinction spectra of two adjacent spherical CuNPs as a function of the shell thickness (t), the ambient refractive index (n), the diameter (D) of the CuNPs, and the inter-nanoparticle spacing (L). The calculation is validated by experimental results. According to our model, for a definite CuNPs thin films, the oxide shell thickness of CuNPs can be calculated only if the extinction spectra and the morphology are provided. Further, it is found when the oxide shell thickness is small (t/R< 0.3), increasing n and decreasing L/D have an obvious synergistic effect on enhancing the coupled LSPR, but this synergistic effect weakens with the deepening of oxidation, and disappeared when t/R > 0.5. This study provides a calculation method for coupled core-shell nanoparticles and throws light on the role of oxidation on the rapid damped LSPR of CuNPs thin films.

Adaptive filtering and smoothing algorithm based on variable structure interactive multiple model.

For maneuvering target tracking, a novel adaptive variable structure interactive multiple model filtering and smoothing (AVSIMMFS) algorithm is proposed in this paper. Firstly, an accurate model of the variable structure interactive multiple model algorithm is established. Secondly, by constructing a new model subset based on the original model subsets, the matching accuracy between the model subset and the actual maneuvering mode of the target is improved. Then, the AVSIMMFS algorithm is obtained by smoothing the filtered data of the new model subset. Because of the combination of forward filtering and backward smoothing, the target tracking accuracy is further improved. Finally, in order to verify the effectiveness of the algorithm, the simulation is carried out on two cases. The simulation results show that the tracking performance of AVSIMMFS algorithm is better than other methods and has lower calculation cost.

Prolyl endopeptidase remodels macrophage function as a novel transcriptional coregulator and inhibits fibrosis.

Macrophages are immune cells crucial for host defense and homeostasis maintenance, and their dysregulation is involved in multiple pathological conditions, such as liver fibrosis. The transcriptional regulation in macrophage is indispensable for fine-tuning of macrophage functions, but the details have not been fully elucidated. Prolyl endopeptidase (PREP) is a dipeptidyl peptidase with both proteolytic and non-proteolytic functions. In this study, we found that Prep knockout significantly contributed to transcriptomic alterations in quiescent and M1/M2-polarized bone marrow-derived macrophages (BMDMs), as well as aggravated fibrosis in an experimental nonalcoholic steatohepatitis (NASH) model. Mechanistically, PREP predominantly localized to the macrophage nuclei and functioned as a transcriptional coregulator. Using CUT&Tag and co-immunoprecipitation, we found that PREP was mainly distributed in active cis-regulatory genomic regions and physically interacted with the transcription factor PU.1. Among PREP-regulated downstream genes, genes encoding profibrotic cathepsin B and D were overexpressed in BMDMs and fibrotic liver tissue. Our results indicate that PREP in macrophages functions as a transcriptional coregulator that finely tunes macrophage functions, and plays a protective role against liver fibrosis pathogenesis.

New murine model of alcoholic hepatitis in obesity-induced metabolic-associated fatty liver disease.

Metabolic-associated fatty liver disease (MAFLD) and alcoholic hepatitis (AH) are among the most prevalent liver diseases worldwide, and their coexistence is common in clinical practice. However, currently established models of MAFLD-AH coexistence do not fully replicate their pathological characteristics and require sophisticated experimental techniques. Therefore, we aimed to develop an easily replicable model that mimics obesity-induced MAFLD-AH in patients. Our goal was to establish a murine model that replicates MAFLD and AH coexistence, resulting in significant liver injury and inflammation. To this end, we administered a single ethanol gavage dose to ob/ob mice on a chow diet. The administration of a single dose of ethanol led to elevated serum transaminase levels, increased liver steatosis, and apoptosis in ob/ob mice. Furthermore, ethanol binge caused a significant increase in oxidative stress in ob/ob mice, as measured via 4-hydroxynonenal. Importantly, the single dose of ethanol also markedly exacerbated liver neutrophil infiltration and upregulated the hepatic mRNA expression of several chemokines and neutrophil-related proteins, including Cxcl1, Cxcl2, and Lcn2. Whole-liver transcriptomic analysis revealed that ethanol-induced changes in gene expression profile shared similar features with AH and MAFLD. In ob/ob mice, a single dose of ethanol binge caused significant liver injury and neutrophil infiltration. This easy-to-replicate murine model successfully mimics the pathological and clinical features of patients with coexisting MAFLD and AH and closely resembles the transcriptional regulation seen in human disease.

Photodegradation of fleroxacin by g-C3N4/PPy/Ag and HPLC-MS/MS analysis of degradation pathways.

To improve the photocatalytic activity of g-C3N4, graphitic phase carbon nitride was prepared using melamine as the substrate and modified with PPy and Ag nanoparticles. The structure, morphology, and optical properties of the photocatalysts were investigated using various characterization methods such as XRD, FT-IR, TEM, XPS, and UV-vis DRS. The degradation of fleroxacin, a common quinolone antibiotic, was isolated and measured using the HPLC-MS/MS technique to trace its intermediates and deduce the main degradation pathways. The results showed that g-C3N4/PPy/Ag had high photocatalytic activity and a degradation rate of more than 90%. The fleroxacin degradation reactions were primarily oxidative ring opening of the N-methyl piperazine ring structure, defluorination reactions on fluoroethyl, HCHO, and N-methyl ethylamine removal reactions.

Patients with esophageal adenocarcinoma showed better prognosis than those with adenocarcinoma of the gastroesophageal junction.

OBJECTIVES: We followed The Cancer Genome Atlas (TCGA) grouping criteria and conducted a clinicopathological cohort study in a unique patient population to gain insight into the pathobiology of esophageal adenocarcinoma (EAC) and adenocarcinoma of the gastroesophageal junction (AGEJ). METHODS: We studied and statistically compared the clinicopathological and prognostic features of both cancers in 303 consecutive patients treated at the Veterans Affairs Boston Healthcare System over a 20-year period using uniform criteria and standardized routines. RESULTS: Over 99% of patients were white men with a mean age of 69.1 years and an average body mass index (BMI) of 28.0 kg/m2 . No significant differences were detected in age, gender, ethnicity, BMI, and history of tobacco abuse between the two groups. Compared to AGEJ patients, a significantly higher proportion of EAC patients had gastroesophageal reflux disease, long-segment Barrett's esophagus, common adenocarcinoma type, smaller tumor size, better differentiation, more stages I or II but fewer stages III or IV diseases, scarcer lymph node invasion, fewer distant metastases, and better overall, disease-free, and relapse-free survival. The 5-year overall survival rate was significantly higher in EAC patients than in AGEJ patients (41.3% vs 17.2%, P < 0.001). This improved survival among EAC patients remained significant after censoring all cases detected during endoscopic surveillance, suggesting different pathogenesis mechanisms between EAC and AGEJ. CONCLUSIONS: EAC patients showed significantly better outcomes than AGEJ patients. Our results require validation in other patient populations.

LncRNA DGCR5 Silencing Enhances the Radio-Sensitivity of Human Esophageal Squamous Cell Carcinoma via Negatively Regulating the Warburg Effect.

Recently, long noncoding RNAs (lncRNAs) and the Warburg effect have been reported to play important roles in the radio-sensitivity of tumor cells. Survival correlates with pathologic responses to chemoradiotherapy and improving responses to radiation may translate into improved survival. This study aims to examine the effects and mechanisms of lncRNA DGCR5 and the Warburg effect on ESCC cell radiosensitivity. Levels of DGCR5, miR-195 and hexokinase 2 (HK2) expression in ESCC tissues and cells were determined and their clinical significance was analyzed. TE-1 and KYSE150 cells received a 6 Gy dose of X-ray radiation and their survival, proliferation and apoptosis were evaluated using colony formation assays, CCK-8 assays, and flow cytometry, respectively. Lactic acid production and glucose consumption were also examined in both cell types. Finally, the expression of apoptotic proteins was assessed using Western blotting. Analysis revealed that DGCR5 and HK2 were overexpressed in ESCC, while miR-195 was under expressed. Moreover, it was demonstrated that down-regulation of DGCR5 inhibited cell proliferation and promoted apoptosis, resulting in increased radiosensitivity by inhibition of the Warburg Effect. Conversely, overexpression of DGCR5 exhibited an opposite phenomenon in vitro. When investigating the mechanism, we identified that miR-195 was predicted to be a direct downstream target of DGCR5. Meanwhile, HK2 was predicted to be a direct downstream target of miR-195. Dual-luciferase reporter assays verified the direct interaction between these molecules. Finally, in vivo experiments were utilized to validate that knockdown of DGCR5 suppressed the Warburg effect via targeting of the miR-195/HK2 axis to increase the radiosensitivity of ESCC. Our study reveals that down-regulation of DGCR5 resulted in inhibition of the Warburg effect through interaction with the miR-195/HK2 axis increasing ESCC cell apoptosis after irradiation, thus enhancing cell radiosensitivity.

The differences in biological behavior and gene expression characteristics between pure and mixed early gastric signet ring cell carcinomas.

BACKGROUND: The biological behavior of signet ring cell carcinoma (SRCC) in early gastric cancer (EGC) is not well understood. AIMS: We aimed to investigate the clinicopathologic and prognostic differences, and explore differences in the gene expression characteristics between pure early SRCC and mixed early SRCC. METHODS: We retrospectively analyzed 1707 EGC patients. We also conducted a meta-analysis to compare biological behavior in pure SRCC and mixed SRCC. We explored gene expression levels of N6-methyadenosine (m6A) regulators in pure SRCC and mixed SRCC. RESULTS: Compared with pure SRCC, mixed SRCC was associated with an increased risk of submucosal invasion, perineural invasion, LVI and LNM. LNM was more common in mixed SRCC than with pure SRCC who met the indications for endoscopic submucosal dissection (ESD) (16.67% vs 2.78%). There was no difference in the overall survival between pure SRCC and mixed SRCC in EGCs (P=0.10). Expression of m6A regulators WTAP, FTO and VIRMA was significantly higher in mixed SRCC than that in pure SRCC (P<0.05). CONCLUSION: Mixed SRCC displayed more aggressive biological behavior than pure SRCC in EGC. WTAP, FTO and VIRMA were expressed at significantly different levels in the two types of EGC, and may have important roles in the observed differences in biological behavior.

Molecular detection of Rickettsiales and a potential novel Ehrlichia species closely related to Ehrlichia chaffeensis in ticks (Acari: Ixodidae) from Shaanxi Province, China, in 2022 to 2023.

Important tick-borne diseases include spotted fever group Rickettsia (SFGR), Anaplasma, and Ehrlichia, which cause harm to animal and human health. Ixodidae are the primary vectors of these pathogens. We aimed to analyze the prevalence and genetic diversity of SFGR, Anaplasma, and Ehrlichia species in the Ixodidae in Shaanxi Province, China. Herein, 1,113 adult Ixodidae ticks were collected from domestic cattle and goats, and detected using nested PCR. A total of four Ixodidae species were collected and Ca. R. jingxinensis (20.58%, 229/1113), A. bovis (3.05%, 34/1113), A. capra (3.32%, 37/1113), A. marginale (0.18%, 2/1113), E. sp. Yonaguni138 (0.18%, 2/1113), and a potent novel Ehrlichia species named E. sp. Baoji96 (0.09%, 1/1113) were detected. A. marginale was detected for the first time in Rhipicephalus microplus. E. sp. Baoji96 was closely related to E. chaffeensis and was first identified in Haemaphysalis longicornis. In addition, co-infection with two Rickettsiales pathogens within an individual tick was detected in 10 (1.54%) ticks. This study provides a reference for the formulation of biological control strategies for ticks and tick-borne diseases in Shaanxi Province, and could lead to an improved control effect.

Impact of main residential locations on depressive symptoms among older adults in China: A Blinder-Oaxaca decomposition analysis.

Background: With the development of urbanization in China, the scale of internal migration and the number of immigrants among older adults are increasing. This requires paying attention to the living conditions and environment of immigrants. Many studies note a gap in the prevalence of depressive symptoms among older adults living in different main residential locations. However, few studies have examined the extent to which main residential locations influence depressive symptoms among older adults. This study aims to quantify the effect of main residential locations on depressive symptoms. Methods: For this study, we used data from the 2018 Chinese Longitudinal Health and Longevity Survey and randomly selected 8,210 individuals aged 65 years and older were from the community to determine the effect of main residential locations on depressive symptoms among older adults. We further used the Blinder-Oaxaca decomposition method to quantify the explanatory factors of depressive symptom gaps among older adults and to estimate the relative effect of individual characteristics on depressive symptoms. Results: In this study, we noted significant differences in depressive symptoms among older adults in different main residential locations. Rural-urban migrants had higher depressive symptom scores (7.164). According to the Blinder-Oaxaca decomposition analysis, the high proportion of the depressive symptom gap can be explained by years of education, income, and exercise among different main residential locations groups. In addition, in the main parts of the explained differences, the proportions of the limitation of activities of daily living (2.28, 0.46, and -52.11%) showed opposite effects, while their share in different main residential locations groups varied widely. Conclusion: Urbanization has resulted in more rural people moving to urban areas in China; Rural-urban migrants have the highest prevalence of depressive symptoms, which needs attention. Thus, there is an urgent need to integrate the health insurance and pension policy for urban and rural residents. This study provides a basis for formulating health policies and promoting the mental health of older adults in China as well as in low- and middle-income countries.

Differences in clinicopathology and prognosis between gastroesophageal junctional and gastric non-cardiac neuroendocrine carcinomas: a retrospective comparison study of consecutive 56 cases from a single institution in China.

Gastric neuroendocrine carcinoma (NEC), including mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN), is uncommon and differences in clinicopathological features and outcomes of NEC arising in various gastric regions remain elusive. We investigated 56 consecutive NECs identified among 3961 gastrectomies performed at our center between 2005 and 2021. We then compared clinicopathological characteristics and prognosis between gastroesophageal junctional (GEJ) NECs (N=39) and gastric non-cardiac NECs (N=17). No significant difference was found between the two groups in age, gender, tumor size, mixed non-neuroendocrine carcinoma component, MiNEN, NEC type, metastatic NEC component in lymph nodes, tumor infiltrating lymphocyte, lymph node metastasis, lymphovascular or perineural invasion, intestinal metaplasia in adjacent non-neoplastic mucosa, and expression of P53, PD-L1, TTF-1, HER2, and Ki-67. However, compared to gastric non-cardiac NECs, GEJ NECs displayed a significantly higher frequency of prevalence (2.79% versus 0.66%), pT3-T4 (92.3% versus 64.7%), advanced pathological stage (IIb-IV) (76.9% versus 47.1%), and a significantly lower 5-year overall survival rate (46.1% versus 73.1%) (P<0.05). The GEJ location was the only independent risk factor for overall survival. In stage-stratified comparisons, patients with stage II GEJ NEC demonstrated a significantly lower 5-year survival rate than those with gastric non-cardiac NEC at the same stage. Compared to non-NECs matched for age, gender, tumor location, and pathological summary stage, GEJ NEC was associated with significantly worse prognosis. In conclusion, GEJ NEC showed deeper invasion, more advanced pathological stages, and worse prognosis than gastric non-cardiac NEC. The findings provide pathologic evidence for individualized management strategies for patients with GEJ NEC. Future studies with larger samples are needed.

Random-walk shielding-potential viscosity model for warm dense metals.

We develop a model, called the "random-walk shielding-potential viscosity model" (RWSP-VM) that introduces the statistics of random-walk ions and the Debye shielding effect to describe the viscosities of warm dense metals. The viscosities of several metals with low to high atomic numbers (Be, Al, Fe, and U) are calculated using the analytical expression of RWSP-VM. Additionally, we simulate the viscosities of Fe and Be by employing the Langevin molecular dynamics (MD) and classical MD, while the MD data for Al and U are obtained from a previous work. The results of the RWSP-VM are in good agreement with the MD results, which validates the proposed model. Furthermore, we compare the RWSP-VM with the one-component plasma model and Yukawa viscosity model and show that the three models yield results in excellent agreement with each other in the regime where the RWSP-VM is applicable. These results indicate that the RWSP-VM is a universal, accurate, and highly efficient model for calculating the viscosity of metals in the warm dense state. The code of the proposed RWSP-VM is provided, and it is envisaged that it will have broad application prospects in numerous fields.

A Retrospective Cohort Study of Factors Influencing Lymph Node Metastasis in Patients With Early Gastric Papillary Adenocarcinoma.

INTRODUCTION: High risk of lymph node metastasis (LNM) in gastric papillary adenocarcinoma causes endoscopists to worry about the suitability of endoscopic resection for early gastric papillary adenocarcinoma (EPAC). We compared risk factors and attempted to establish a scoring system to stratify LNM risk in patients with EPAC. METHODS: A retrospective analysis was performed on 2,513 patients with early gastric carcinoma (EGC) who underwent radical resection in 4 tertiary hospitals in China. Univariate and multivariate analyses were performed to compare the invasiveness in EPAC and other types of EGC and to evaluate potential factors in predicting LNM risk in EPAC groups. RESULTS: Three hundred thirty-five patients with EPAC were enrolled in our study, of which 62 patients were found to have LNM. After comparing clinicopathological characteristics of EPAC with and without LNM, the following factors were included in the risk scoring system: 1 point each for lower stomach location and tumor size >2.0 cm, 3 points for lymphovascular invasion, and 4 points for submucosal invasion; the risk scoring system was validated in a small internal validation set with an area under the curve of 0.844. DISCUSSION: Our results suggested that EPAC was highly invasive compared with other EGCs, especially differentiated EGC types, and need to be treated more rigorously. This proposed risk scoring system could stratify LNM risk in patients with EPAC, and endoscopic resection may only be performed safely on the groups with a low LNM rate.

Mediating Factors Explaining the Associations between Solid Fuel Use and Self-Rated Health among Chinese Adults 65 Years and Older: A Structural Equation Modeling Approach.

Exposure to indoor air pollution from cooking with solid fuel has been linked with the health of elderly people, although the pathway to their association is unclear. This study aimed to investigate the mediating effects between solid fuel use and self-rated health by using structural equation modeling (SEM) with the baseline data from Chinese Longitudinal Healthy Longevity Survey (CLHLS). We conducted a cross-sectional survey among 7831 elderly people aged >65 years from the CLHLS. SEM was used to analyze the pathways underlying solid fuel use and self-rated health. We estimated indirect effects of sleep quality (ß = −0.027, SE = 0.006), cognitive abilities (ß = −0.006, SE = 0.002), depressive symptoms (ß = −0.066, SE = 0.007), systolic blood pressure (ß = 0.000, SE = 0.000), and BMI (ß = −0.000, SE = 0.000) on the association between solid fuel and the self-rated health using path analysis. Depressive symptoms emerged as the strongest mediator in the relationship between solid fuel use and self-rated health in the elderly. Interventions targeting sleep quality, cognitive abilities, depressive symptoms, systolic blood pressure, and BMI could greatly reduce the negative effects of solid fuel use on the health of the elderly population.