Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer

BACKGROUND Endoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection. The indications for ESD have been recently expanded to include larger, ulcerated, and undifferentiated mucosal lesions, and differentiated lesions with slight submucosal invasion. The risk of lymph node metastasis (LNM) is the most important consideration when deciding on a treatment strategy for EGC. Despite the advantages over surgical procedures, lymph nodes cannot be removed by ESD. In addition, whether patients who meet the expanded indications for ESD can be managed safely remains controversial. AIM To determine whether the ESD indications are applicable to Chinese patients and to investigate the predictors of LNM in EGC. METHODS We retrospectively analyzed 12552 patients who underwent surgery for gastric cancer between June 2007 and December 2018 at the Affiliated Hospital of Qingdao University. A total of 1262 (10.1%) EGC patients were eligible for inclusion in this study. Data on the patients’ clinical, endoscopic, and histopathological characteristics were collected. The absolute and expanded indications for ESD were validated by regrouping the enrolled patients and determining the positive LNM results in each subgroup. Predictors of LNM in patients were evaluated by univariate and multivariate analyses. RESULTS LNM was observed in 182 (14.4%) patients. No LNM was detected in the patients who met the absolute indications (0/90). LNM occurred in 4/311 (1.3%) patients who met the expanded indications. According to univariate analysis, LNM was significantly associated with positive tumor marker status, medium (20-30 mm) and large (>30 mm) lesion sizes, excavated macroscopic-type tumors, ulcer presence, submucosal invasion (SM1 and SM2), poor differentiation, lymphovascular invasion (LVI), perineural invasion, and diffuse and mixed Lauren’s types. Multivariate analysis demonstrated SM1 invasion (odds ration [OR]= 2.285, P = 0.03), SM2 invasion (OR = 3.230, P < 0.001), LVI (OR = 15.702, P < 0.001), mucinous adenocarcinoma (OR = 2.823, P = 0.015), and large lesion size (OR = 1.900, P = 0.006) to be independent risk factors. CONCLUSION The absolute indications for ESD are reasonable, and the feasibility of expanding the indications for ESD requires further investigation. The predictors of LNM include invasion depth, LVI, mucinous adenocarcinoma, and lesion size.

Neuroprotective effect of ischemic postconditioning on sciatic nerve transection

Ischemic preconditioning or postconditioning has been shown to have neuroprotective effect on cerebral ischemia, but it has not been studied in peripheral nerve injury. In this study, a rat model of sciatic nerve transection was established, and subjected to three cycles of ischemia for 10 minutes ＋ reperfusion for 10 minutes, once a day. After ischemic postconditioning, serum insulin-like growth factor 1 expression increased; sciatic nerve Schwann cell myelination increased; sensory function and motor function were restored. These findings indicate that ischemic postconditioning can effectively protect injured sciatic nerve. The protective effect is possibly associated with upregulation of insulin-like growth factor 1.

Multi-model coupling-based dynamic control system of ladle slag in argon blowing refining process

Since the current slagging of argon blowing refining process is relatively fixed,which cannot adapt to the fluctuation of converter smelting process,it poses the problems of poor metallurgical property of refining slag and a large amount of molten heel.An optimization system coupled with multiple models was proposed to dynamic control the ladle slagging in the argon blowing refining process.It can compile the optimal dynamic slagging scheme in real time under the guarantee of deoxidation performance and reasonable fluidity.The argon blowing refining slag composition range of CaO/Al_(2)O_(3)=1.3-1.7,CaO/SiO_(2)=6-12,w(MgO)=2%-6% was determined based on FeO activity and liquidus temperature by equilibrium thermodynamic calculation.In addition,it demonstrated better performance in the viscosity prediction task of the presented Visual Geometry Group 16-like one-dimensional convolutional neural network deep learning algorithm versus the Random Forest ensemble learning algorithm,as the adjusted coefficients of determination were 0.9712 and 0.9637,respectively.After the system was applied in operation,the argon blowing refining process was stable,and the steel yield was enhanced,which promoted the intelligent steelmaking level while achieving the cost reduction and efficiency improvement.

Candida Balanitis with Hyperplastic Plaque Mimicking Vascular Neoplasm

To the Editor：A 6 1-year-old diabetic male presented with a growing hyperplastic plaque measured 1.5 cm × 1.0 cm on the glans of his penis for 2 months [Figure l a].The plaque was pruritic burning.Polarized dermoscopy revealed multiple red papules with whitish areas of erosions [Figure 1 b].The patient was diagnosed as vascular neoplasm at other hospitals and he came to the Department of Dermatology,Peking University People＇s Hospital for further consultation before an excision surgery.