Estimating survival benefit of adjuvant therapy based on a Bayesian network prediction model in curatively resected advanced gallbladder adenocarcinoma

BACKGROUND The factors affecting the prognosis and role of adjuvant therapy in advanced gallbladder carcinoma(GBC)after curative resection remain unclear.AIM To provide a survival prediction model to patients with GBC as well as to identify the role of adjuvant therapy.METHODS Patients with curatively resected advanced gallbladder adenocarcinoma(T3 and T4)were selected from the Surveillance,Epidemiology,and End Results database between 2004 and 2015.A survival prediction model based on Bayesian network(BN)was constructed using the tree-augmented na?ve Bayes algorithm,and composite importance measures were applied to rank the influence of factors on survival.The dataset was divided into a training dataset to establish the BN model and a testing dataset to test the model randomly at a ratio of 7:3.The confusion matrix and receiver operating characteristic curve were used to evaluate the model accuracy.RESULTS A total of 818 patients met the inclusion criteria.The median survival time was 9.0 mo.The accuracy of BN model was 69.67%,and the area under the curve value for the testing dataset was 77.72%.Adjuvant radiation,adjuvant chemotherapy(CTx),T stage,scope of regional lymph node surgery,and radiation sequence were ranked as the top five prognostic factors.A survival prediction table was established based on T stage,N stage,adjuvant radiotherapy(XRT),and CTx.The distribution of the survival time(>9.0 mo)was affected by different treatments with the order of adjuvant chemoradiotherapy(cXRT)>adjuvant radiation>adjuvant chemotherapy>surgery alone.For patients with node-positive disease,the larger benefit predicted by the model is adjuvant chemoradiotherapy.The survival analysis showed that there was a significant difference among the different adjuvant therapy groups(log rank,surgery alone vs CTx,P<0.001;surgery alone vs XRT,P=0.014;surgery alone vs cXRT,P<0.001).CONCLUSION The BN-based survival prediction model can be used as a decision-making support tool for advanced GBC patients.Adjuvant chemoradiotherapy is expected to improve the survival significantly for patients with node-positive disease.

Inhibition of nitric oxide synthase aggravates brain injury in diabetic rats with traumatic brain injury

Studies have shown that hyperglycemia aggravates brain damage by affecting vascular endothelial function. However, the precise mechanism remains unclear. Male Sprague-Dawley rat models of diabetes were established by a high-fat diet combined with an intraperitoneal injection of streptozotocin. Rat models of traumatic brain injury were established using the fluid percussion method. Compared with traumatic brain injury rats without diabetic, diabetic rats with traumatic brain injury exhibited more severe brain injury, manifested as increased brain water content and blood-brain barrier permeability, the upregulation of heme oxygenase-1, myeloperoxidase, and Bax, the downregulation of occludin, zona-occludens 1, and Bcl-2 in the penumbra, and reduced modified neurological severity scores. The intraperitoneal injection of a nitric oxide synthase inhibitor N(5)-(1-iminoethyl)-L-ornithine(10 mg/kg) 15 minutes before brain injury aggravated the injury. These findings suggested that nitric oxide synthase plays an important role in the maintenance of cerebral microcirculation, including anti-inflammatory, anti-oxidative stress, and anti-apoptotic activities in diabetic rats with traumatic brain injury. The experimental protocols were approved by the Institutional Animal Care Committee of Harbin Medical University, China(approval No. ky2017-126) on March 6, 2017.

Copolymers with fluorescence properties in mesoporous silica SBA-15:Synthesis and characterization

A novel copolymer with fluorescence properties in mesoporous silica SBA-15 was prepared via a combination of surface-initiated reversible addition-fragmentation chain transfer（RAFT） polymerization and ＂click＂ chemistry.A sufficient amount of peroxide groups were introduced into mesoporous silica SBA-15 channel pores and were further used to initiate the RAFT polymerization of styrene and 4-vinylbenzyl azide,resulting in SBA-15 supported polystyrene-co-poly（4-vinylbenzyl azide） copolymer（PS-co-PVBA/SBA-15） hybrid material.The samples were characterized by Fourier transform infrared spectroscopy（FT-IR）,transmission electron microscopy（TEM）,thermogravimetry analysis（TGA）,N_2 adsorption-desorption isotherms and X-ray diffraction（XRD）,respectively.The results show that the styrene and 4-vinylbenzyl azide had copolymerized inside mesoporous silica SBA-15.Subsequently,Npropargyl-carbazole（PC） was connected to PS-co-PVBA/SBA-15 hybrid material via ＂click＂ reaction,resulting in PS-co-PVBC/SBA-15 with carbazole side groups hybrid material.The fluorescence spectrum is dominated by a broad band from 350 nm to 400 nm in narrow region and the maximum peak is 362 nm,indicating the characteristic absorption of the carbazole group of PS-co-PVBC/SBA-15 hybrid material.

1990年与2017年中国前列腺癌疾病负担分析

目的分析1990年与2017年中国前列腺癌的疾病负担及变化趋势。方法采用2017年全球疾病负担(The Global Burden of Diseases 2017,GBD 2017)的研究结果,通过前列腺癌发病率、死亡率、伤残调整寿命年(Disability-Adjusted Life Years,DALY)、过早死亡损失寿命年(Years of Life Lost,YLL)、伤残损失寿命年(Years Lived with Disability,YLD)及其标化率对1990年和2017年间中国前列腺癌的疾病负担进行描述。结果2017年中国前列腺癌发病例数为14.49万,标化发病率为16.57/10万,死亡例数为5.17万,标化死亡率为6.8/10万。与1990年相比,发病例数增加了432.72%,标化发病率增加了98.21%,死亡例数增加了158.5%,标化死亡率降低了3.82%。发病率和死亡率随年龄的增加呈现出上升的趋势。相比1990年,2017年我国前列腺癌的DALY标化率降低了3.81%,YLL标化率降低了9.73%,YLD标化率增加了134.56%。结论与1990年相比,2017年我国前列腺癌的疾病负担整体呈下降趋势,但YLD呈现上升的趋势。老年人群的前列腺癌疾病负担仍然很高,应为重点关注人群。

Who benefits from RO resection?A single-center analysis of patients with stage Ⅳ gallbladder cancer

Objectives:Most patients with gallbladder cancer(GBC)present with advanced-stage disease and have a poor prognosis.Radical resection remains the only therapeutic option to improve survival in patients with GBC.This study aimed to analyze the prognostic factors in patients with stageⅣGBC and to identify a subgroup of patients who might benefit from RO resection.Methods:A total of 285 patients with stageⅣGBC were retrospectively analyzed at our institution from January 2008 to December 2012.Factors potentially influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analyses.Results:The 1-,3-,and 5-year overall survival rates were 6.6%(15/229),0.9%(2/229),and 0(0/229),respectively.Ascites(relative risk[RR]=1.631,95%confidence interval[C/]:1.221-2.180,P=0.001),pathological grade(RR=1.337,95%Cl:1.050-1.702,P=0.018),T stage(RR=1.421,95%Cl:1.099-1.837,P=0.000),M stage(RR=1.896,95%Cl:1.409-2.552,P=0.000),and surgery(RR=1.542,95%Cl:1.022-2.327,P=0.039)were identified as independent risk factors influencing prognosis.The median survival time(MST)was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection(6.0 vs.2.7 months;P<0.001).In subgroup analyses,stage IVA patients benefited from R0 resection(MST for R0 vs.R1/R2,11.0 vs.4.0 months;P=0.003),while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage IVB GBC without distant metastasis(MST for R0 vs.R1/R2,6.0 vs.3.0 months;P=0.007).Conclusion:Ascites,pathological grade,T stage,M stage,and surgery were independent risk factors influencing prognosis in patients with stageⅣGBC.N2 lymph node metastasis did not preclude curative resection,and radical resection should be considered in patients with stageⅣGBC without distant metastasis once R0 margin was achieved.