Adjuvant Chemotherapy for Patients with Adenocarcinoma of the Esophagogastric Junction: A Retrospective, Multicenter, Observational Study.

BACKGROUND: Although the incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing since the past decade, the proportion of AEG cases in two previous clinical trials (ACTS-GC and CLASSIC) that investigated the efficacy of adjuvant chemotherapy was relatively small. Therefore, whether AEG patients can benefit from adjuvant chemotherapy remains unclear. METHODS: Patients who were diagnosed with pathological stage II/III, Siewert II/III AEG, and underwent curative surgery at three high-volume institutions were assessed. Clinical outcomes were analyzed by using Kaplan-Meier curves, log-rank test, and Cox regression model. Propensity score matching (PSM) was used to reduce the selection bias. RESULTS: A total of 927 patients were included (the chemotherapy group: 696 patients; the surgery-only group: 231 patients). The median follow-up was 39.0 months. The 5-year overall survival was 63.1% (95% confidence interval [CI]: 59.0-67.6%) for the chemotherapy group and 50.2% in the surgery-only group (hazard ratio [HR] = 0.69, 95% CI: 0.54-0.88; p = 0.003). The 5-year, disease-free survival was 35.4% for the chemotherapy group and 16.6% for the surgery-only group (HR = 0.66, 95% CI: 0.53-0.83; p < 0.001). After PSM, the survival benefit of adjuvant chemotherapy for AEG was maintained. Multivariate analysis for overall survival and disease-free survival further demonstrated the survival benefit of adjuvant chemotherapy, with HRs of 0.63 (p < 0.001) and 0.52 (p < 0.001), respectively. CONCLUSIONS: Postoperative adjuvant chemotherapy was associated with improved overall survival and disease-free survival in patients with operable stage II or III AEG after D2 gastrectomy.

Estimation of trapezoidal-shaped overlapping nuclear pulse parameters based on a deep learning CNN-LSTM model.

The Long Short-Term Memory neural network (LSTM) has excellent learning ability for the time series of the nuclear pulse signal. It can accurately estimate the parameters (such as amplitude, time constant, etc.) of the digitally shaped nuclear pulse signal (especially the overlapping pulse signal). However, due to the large number of pulse sequences, the direct use of these sequences as samples to train the LSTM increases the complexity of the network, resulting in a lower training efficiency of the model. The convolution neural network (CNN) can effectively extract the sequence samples by using its unique convolution kernel structure, thus greatly reducing the number of sequence samples. Therefore, the CNN-LSTM deep neural network is used to estimate the parameters of overlapping pulse signals after digital trapezoidal shaping of exponential signals. Firstly, the estimation of the trapezoidal overlapping nuclear pulse is considered to be obtained after the superposition of multiple exponential nuclear pulses followed by trapezoidal shaping. Then, a data set containing multiple samples is set up; each sample is composed of the sequence of sampling values of the trapezoidal overlapping nuclear pulse and the set of shaping parameters of the exponential pulse before digital shaping. Secondly, the CNN is used to extract the abstract features of the training set in these samples, and then these abstract features are applied to the training of the LSTM model. In the training process, the pulse parameter set estimated by the present neural network is calculated by forward propagation. Thirdly, the loss function is used to calculate the loss value between the estimated pulse parameter set and the actual pulse parameter set. Finally, a gradient-based optimization algorithm is applied to update the weight by getting back the loss value together with the gradient of the loss function to the network, so as to realize the purpose of training the network. After model training was completed, the sampled values of the trapezoidal overlapping nuclear pulse were used as input to the CNN-LSTM model to obtain the required parameter set from the output of the CNN-LSTM model. The experimental results show that this method can effectively overcome the shortcomings of local convergence of traditional methods and greatly save the time of model training. At the same time, it can accurately estimate multiple trapezoidal overlapping pulses due to the wide width of the flat top, thus realizing the optimal estimation of nuclear pulse parameters in a global sense, which is a good pulse parameter estimation method.

Surgical Outcome and Long-Term Survival of Conversion Surgery for Advanced Gastric Cancer.

BACKGROUND: The present study aims to report the surgical outcome and long-term survival of conversion surgery and clarify its role in advanced gastric cancer. PATIENTS AND METHODS: A total of 95 primary advanced gastric adenocarcinoma patients who underwent systemic chemotherapy and conversion surgery were reviewed retrospectively. The survival of conversion surgery was analyzed by Cox regression and the Kaplan-Meier method. Surgical outcomes were analyzed according to the Clavien-Dindo classification. RESULTS: The median survival time (MST) of the 95 patients was 26.8 months, and the postoperative MST was 19.3 months. The MSTs of the patients in categories 1, 2, 3, and 4 were 28.8, 25.5, 43.6, and 11.3 months, respectively. The MSTs of the patients who underwent R0 resection (47 cases) and R1/2 resection (48 cases) were 49.3 months and 21.9 months, respectively. The MST of patients treated with total gastrectomy was shorter (21.9 months) than that of patients who underwent proximal (55.0 months) or distal (46.3 months) gastrectomy. Patients who received more than 6 cycles of induction chemotherapy had a longer MST than patients who received 3-5 cycles or 1-2 cycles (MST: 55.0 months versus 21.1 months versus 21.7 months). The incident postoperative complications and postoperative mortality rates were 10.5% and 1.1%, respectively. CONCLUSIONS: Advanced gastric cancer patients may obtain a survival benefit from conversion surgery, except category 4. Performing a sufficient number of cycles of induction chemotherapy (usually ≥ 6 cycles) is recommended. Surgical oncologists should perform R0 resection and avoid total gastrectomy.

[Dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius].

OBJECTIVE: To explore clinical efficacy of dorsal plate assisted fixation of dorsal lunate fossa fracture block of distal radius. METHODS: From January 2019 to January 2022, 30 patients were treated with dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius, including 13 males and 17 females, aged from 42 to 68 years old with an average of (48.7±5.6) years old;According to Doi fracture classification, 24 patients were type 3 blocks and 6 patients were type 4 blocks. The degree of palmar angle of anterior and posterior distal radius was fixed by dorsal steel plate during operation. Fracture healing and functional recovery of wrist were observed after operation. Functional evaluation was performed by Gartland and Werley scoring system at 12 months after operation. RESULTS: All patients were followed up from 12 to 13 months with an average of (11.3±0.9) months. All fractures healed for 4 to 5 months with an average of(4.7±0.8) months. Median palpal inclination of anterior and posterior distal radius fixed by dorsal plate was 5.30°(4.85°, 6.03°), 12.45°(11.98°, 13.43°) respectively, and had statistical difference( P<0.01). Gartland and Werley scores was (1.1±0.4) at 12 months afteropertaion, and 27 patients got excellent result and 3 good. CONCLUSION: Dorsal plate assisted fixation of dorsal lunate fossa fractures is beneficial to reduction and stabilization of displaced dorsal fractures and restoration of palmar inclination.

LAG3-PD1 or CTLA4-PD1 Inhibition in Advanced Melanoma: Indirect Cross Comparisons of the CheckMate-067 and RELATIVITY-047 Trials.

Objective: To compare the inhibition of LAG3-PD1 versus the inhibition of CTLA-4-PD1 in patients with previously untreated advanced melanoma. Methods: The individual participant data (IPD) were extracted from the KM plots using a graphical reconstructive algorithm. Log-rank, Cox proportional hazard model, Bayesian hierarchical model with time-varying hazard ratio (HR) effect, and restricted mean survival time (RMST) were performed to estimate survival benefits. Results: The CheckMate-067 (n = 630) and RELATIVITY-047 (n = 714) trials were included for analysis. The graphical reconstructive algorithm showed that IPD had similar HRs and log-rank values as the original plots. The HR of nivolumab plus relatlimab (LAG3 inhibitor) versus nivolumab plus ipilimumab (CTLA4 inhibitor) was 1.19 (95% confidence interval [CI] 0.96 to1.48). The 24-months RMST of nivolumab plus relatlimab versus nivolumab was 2.35 (95% CI 0.77-3.94) months, compared with 1.87 (95% CI, 0.25-3.49) months for nivolumab plus ipilimumab versus nivolumab. The Bayesian hierarchical model showed that patients treated with nivolumab plus relatlimab had earlier PFS benefits than those with nivolumab plus ipilimumab. Grade 3 or 4 treatment-related adverse events occurred in 18.9% of patients using nivolumab plus relatlimab and 55.0% of patients using nivolumab plus ipilimumab. Conclusions: These findings suggest that the PFS of LAG3-PD1 and CTLA4-PD1 inhibition were similar and LAG3-PD1 inhibition exhibited earlier survival benefit and lesser TRAEs.

[Case-control study on calcaneal locking plates and tension band with Kirschner's nail for the treatment of patellar fracture].

OBJECTIVE: To compare clinical effect between calcaneal locking plates and tension band with Kirschner's nail for the treatment of patellar fracture. METHODS: From December 2009 to December 2017, 58 patients with patellar fracture were divided into plate group(calcaneal locking plate) and tension band(tension band with Kirschner's nail) by surgical method. There were 29 patients in plate group, including 14 males and 15 females, aged from 18 to 72 years old with an average of (36.9±11.5) years old; while there were 29 patients in tension band group, including 17 males and 12 females, aged from 20 to 70 years old with an average of (37.7±14.4) years old. Operative time, blood loss, fracture healing time, follow-up time and postoperative complications were compared between two groups. Böstman score was applied to compared therapeutic effects at 12 months after operation. RESULTS: There was no significant differences in following-up time between plate group(18.4±2.6) months and tension band group(17.8±3.6) months. According to Böstman score at 12 months after operation, plate group was (28.5±4.6) and (25.7±4.3) in tension band group, and had statistical difference between two group(t=2.395, P=0.020). Twenty-six patients got excellent results, 3 moderate in plate group; while 14 patients got excellent results, 11 moderate and 4 poor in tension band group, and had obviously meaning between two groups(χ²=12.17 P=0.02). There were no significant differences in operative time(t=1.978, P=0.53), blood loss(t=1.740, P=0.87), fracture healing time(t=0.65, P=0.517) and postoperative complications(χ²=0.268, P=0.604) between two groups. CONCLUSIONS: Calcaneal locking plates for patellar fracture has advantages of more wide range of clinical application, more reliable fixation, and more satisfactory surgical curative method, its clinical effects is better than that of tension band with kirschner nail.

[Surgical treatment of ulnar lateral mass fractures of distal radius].

OBJECTIVE: To investigate the type and corresponding operation methods of ulnar lateral mass in distal radial fractures. METHODS: From January 2004 to September 2010,32 cases of distal radial fractures with ulnar lateral mass were treated by surgical incision and relocate ulnar lateral mass,including 23 males and 9 females with an average age of (34 +/- 9) years old ranging from 28 to 65 years old. According to the classification of Melone-Doi, 2 cases with type I, 24 cases of type II, 6 cases with type III. The operative appoach involved palm-radial, palm-ulnar, radial-dorsal. Among them, 28 patients with closed fractures were fixed with plate, 4 cases (including 2 cases of open fractures) were fixed by Kirschner pin and braces. RESULTS: Thirty-two patients were followed up for 8 to 18 months with an average of 12 months. All fractures were healing without complications. According to modified Gartland-Werley scoring system (GWSS), the total score was 1.12 +/- 0.45, the remain deformity was 0, subjective evaluation was 0.50 +/- 0.30, objective evaluation was 0.30 +/- 0.21, complications was 0.40 +/- 0.09; the result was excellent in 21 cases, good in 11 cases. CONCLUSION: The location of ulnar lateral mass in distal radial fractures is one of the important prognostic factors in wrist function and surgical treatment is an effective method of fixing ulnar lateral mass in distal radial fractures.

[Minimally invasive percutaneous plate osteosynthesis for the treatment of intertrochanteric femoral fractures of Evans IlI and IV in elderly patients].

OBJECTIVE: To study therapeutic effects of minimally invasive percutaneous plate osteosynthesis for the treatment of intertrochanteric femoral fractures of Evans III, IV in elderly patients. METHODS: From December 2007 to April 2010, 23 patients with intertrochanteric femoral fractures were reviewed. Among the patients, 11 patients were male and 12 patients were female,ranging in age from 62 to 90 years, with a mean of 72.8 years. According to Evans classification, 13 patients were type III and 10 patients were type IV. All the patients were treated with proximal femoral locking plate (minimally invasive percutaneous plate osteosynthesis, MIPPO) surgery. RESULTS: The operative time ranged from 45 to 60 min, with an average of 50 min. The blood loss ranged from 60 to 100 ml, averaged 80 ml. All the patients were followed up,and the duration ranged from 9 to 18 months, with an average of 11 months. The healing time based X-ray ranged from 3 to 6 months, with an average of 4 months. According to hip scoring criteria evaluation: 18 patients got an excellent results, 5 good. CONCLUSION: For the treatment of intertrochanteric femoral fractures of Evans III, IV in elderly patients, MIPPO has advantages such as small trauma, reliable fixation, which has good clinical application.