Polyneuropathy organomegaly endocrinopathy M-protein and skin changes syndrome with ascites as an early-stage manifestation:A case report

BACKGROUND Polyneuropathy organomegaly endocrinopathy M-protein and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor.The clinical manifestations of POEMS syndrome are diverse.Due to the insidious onset and lack of specific early-stage manifestations,POEMS syndrome is easily misdiagnosed or never diagnosed,leading to delayed treatment.Neurological symptoms are usually the first clinical manifestation,while ascites is a rare symptom in patients with POEMS syndrome.CASE SUMMARY A female patient presented with unexplained ascites as an initial symptom,which is a rare early-stage manifestation of the condition.After 1 year,the patient gradually developed progressive renal impairment,anemia,polyserosal effusion,edema,swollen lymph nodes on the neck,armpits,and groin,and decreased muscle strength of the lower extremities.The patient was eventually diagnosed with POEMS syndrome after multidisciplinary team discussion.Treatment comprised bortezomib+dexamethasone,continuous renal replacement therapy,chest and abdominal closed drainage,transfusions of erythrocytes and platelets,and other symptomatic and supportive treatments.The patient’s condition initially improved after treatment.However,then her symptoms worsened,and she succumbed to the illness and died.CONCLUSION Ascites is a potential early manifestation of POEMS syndrome,and this diagnosis should be considered for patients with unexplained ascites.Furthermore,multidisciplinary team discussion is helpful in diagnosing POEMS syndrome.

Effects of Early-stage Phased Rehabilitation Training on Acute Respiratory Distress Syndrome:A Systematic Review and Meta-analysis

[Objectives]To systematically evaluate the effects of early-stage phased rehabilitation training on the oxygenation index,ICU length of stay,duration of mechanical ventilation,and occurrence of complications(ventilator-associated pneumonia,pressure ulcers,delirium)in ARDS patients,thus contributing evidence for the clinical application of early-stage phased rehabilitation training.[Methods]The China National Knowledge Infrastructure(CNKI),Wanfang,and other databases were searched.Literature screening,data extraction,and systematic analysis of the included studies were performed using Revman software.[Results]Thirteen randomized controlled trials involving a total of 860 patients were included in this review.The results of the meta-analysis showed that compared to the traditional rehabilitation training group,the early-stage phased rehabilitation training group demonstrated a significant increase in the oxygenation index of ARDS patients[SMD=1.18,95%CI(1.01,1.35),P<0.01],with statistically significant differences.Furthermore,there were significant reductions in ICU length of stay[SMD=-0.70,95%CI(-0.90,-0.50),P<0.01],duration of mechanical ventilation[SMD=-1.15,95%CI(-1.36,-0.94),P<0.01],and occurrence of complications[OR=0.16,95%CI(0.10,0.26),P<0.01],all of which were statistically significant.[Conclusions]Early-stage phased pulmonary rehabilitation training for ARDS patients effectively improves the oxygenation index,shortens ICU length of stay and duration of mechanical ventilation,and reduces complications.These findings support the clinical application and promotion of early-stage phased rehabilitation training.

Provision of Fertility Preservation for Young Women with Early-Stage Breast Cancer

Breast cancer is the most common cancer in women worldwide, constituting 25% of all cancer diagnoses. Even though it is only affecting 4% - 6% of women under the age of 40, it remains the most common malignancy among younger patients. Advancement in the treatment and earlier detection gives excellent 5 years of survival. However, the standard treatment that comprises surgical-chemo radiation therapy or hormonal treatment often results in an increased incidence of treatment-induced infertility. Therefore, adding fertility preservation to primary cancer treatment may offer the best opportunity for future fertility. However, despite advancements in Assisted Reproductive Technology (ART), the uptake of fertility services in this group remains low. In this review, we highlighted the effect of all breast cancer treatments on women’s fertility, the effectiveness and safety of ART in breast cancer patients as well as the safety of pregnancy in breast cancer survivors. Our aim is to improve awareness of fertility preservation for breast cancer to ensure all women diagnosed with breast cancer have multidisciplinary approaches with early referral to fertility specialists to discuss regarding potential risks and benefits of fertility preservation to improve the uptake of fertility preservation among this group of patients.

Prediction of lymph node metastasis and sentinel node navigation surgery for patients with early-stage gastric cancer

Accurate prediction of lymph node(LN) status is crucially important for appropriate treatment planning in patients with early gastric cancer(EGC). However,consensus on patient and tumor characteristics associated with LN metastasis are yet to be reached. Through systematic search,we identified several independent variables associated with LN metastasis in EGC,which should be included in future research to assess which of these variables remain as significant predictors of LN metastasis. On the other hand,even if we use these promising parameters,we should realize the limitation and the difficulty of predicting LN metastasis accurately. The sentinel LN(SLN) is defined as first possible site to receive cancer cells along the route of lymphatic drainage from the primary tumor. The absence of metastasis in SLN is believed to correlate with the absence of metastasis in downstream LNs. In this review,we have attempted to focus on several independent parameters which have close relationship between tumor and LN metastasis in EGC. In addition,we evaluated the history of sentinel node navigation surgery and the usefulness for EGC.

Differential gene expression profiling of gastric intraepithelial neoplasia and early-stage adenocarcinoma

AIM:To investigate the differentiated whole genome expression profiling of gastric high-and low-grade intraepithelial neoplasia and early-stage adenocarcinoma.METHODS:Gastric specimens from an upper magnifying chromoendoscopic targeted biopsy were collected from March 2010 to May 2013.Whole genome expression profiling was performed on 19 low-grade intraepithelial neoplasia(LGIN),20 high-grade intraepithelial neoplasia(HGIN),19 early-stage adenocarcinoma(EGC),and 19 chronic gastritis tissue samples using Agilent 4×44K Whole Human Genome microarrays.Differentially expressed genes between different types of lesions were identified using an unpaired t-test and corrected with the Benjamini and Hochberg false discovery rate algorithm.A gene ontology(GO)enrichment analysis was performed using the Gene Spring software GX 12.6.The differentially expressed gene was verified using a real-time TaqManPCR assay with independent tissue samples,including 26 LGIN,15 HGIN,14 EGC,and 20 chronic gastritis.The expression of G0S2 were further validated by immunohistochemical staining(IHC)in 24 LGIN,40 HGIN,30 EGC and 61 chronic gastritis specimens.RESULTS:The gene expression patterns of LGIN and HGIN tissues were distinct.There were 2521 significantly differentially expressed transcripts in HGIN,with951 upregulated and 1570 downregulated.A GO enrichment analysis demonstrated that the most striking overexpressed transcripts in HGIN compared with LGIN were in the category of metabolism,defense response,and nuclear factorκB(NF-κB)cascade.While the vast majority of transcripts had barely altered expression in HGIN and EGC tissues,only 38 transcripts were upregulated in EGC.A GO enrichment analysis revealed that the alterations of the immune response were most prominent in the progression from HGIN to EGC.It is worth noting that,compared with LGIN,289 transcriptswere expressed at higher levels both in HGIN and EGC.A characteristic gene,G0/G1 switch 2(G0S2)was one of the 289 transcripts and related to metabolism,the immune response,and the NF-κB cascade,and its expression was validated in independent samples through real-time TaqManPCR and immunohistochemical staining.In real-time PCR analysis,the expression of G0S2 was elevated both in HGIN and EGC compared with that in LGIN(P<0.01 and P<0.001,respectively).In IHC analysis,G0S2 immunoreactivity was detected in the cytoplasmic of neoplastic cells,but was undetectable in chronic gastritis cells.The G0S2 expression in HGIN was higher than that of LGIN(P=0.012,χ2=6.28)and EGC(P=0.008,χ2=6.94).CONCLUSION:A clear biological distinction between gastric high-and low-grade intraepithelial neoplasia was identified,and provides molecular evidence for clinical application.

Treatment patterns for adjuvant docetaxel-based chemotherapy in early-stage breast cancer in China：A pooled retrospective analysis of four observational studies

Objective：Adjuvant docetaxel-based chemotherapy is frequently used for operable early breast cancer（EBC）.This study investigated patterns of use of docetaxel（T）in real-life clinical practice in China.Methods：This was a retrospective pooled analysis of the Asia-Pacific Breast Initiatives（APBI）Ⅰ（2006–2008）and Ⅱ（2009–2011）registries,and two Chinese observational studies;BC STATE（2011–2014）and BC Local Registry（2007–2010）.Female Chinese adults（≥18 years）with operable breast cancer treated with docetaxel-based adjuvant chemotherapy were included in the analysis.Patients with metastatic disease were excluded.The primary endpoint was assessment of treatment patterns and patient profiles.A logistic regression analysis was conducted to identify factors associated with choice of adjuvant chemotherapy regimen.Results：Data from 3,020 patients were included.The most frequently used adjuvant regimen was docetaxel/anthracycline combination[n=1,421（47.1%）;of whom 52.0%received T/epirubicin（E）/cyclophosphamide（C）],followed by docetaxel/other[n=705（23.3%）;of whom 72.8%received TC],docetaxel/anthracycline sequential[n=447（14.8%）;of whom 40.9%and 39.6%received 5-Fu/EC-T and EC-T,respectively],and＂other＂[n=447（14.8%）;of whom 91.5%received T].A significant association was found between adjuvant therapy with docetaxel/anthracycline combination and patient weight,menopausal status and estrogen receptor status.Conclusions：Real-world data revealed that docetaxel/anthracycline combination is the most commonly used category of docetaxel-based adjuvant therapy for patients with operable breast cancer in China;of which TEC is the most frequently used regimen.

Clinicopathological analysis of early-stage breast cancer patients that meet indications for BRCA 1/2 genetic testing

Objective:To investigate the clinicopathological characteristics and prognostic factors of early-stage breast cancer patients with indications for breast cancer susceptibility genes 1/2(BRCA1/2)genetic testing in China.Methods:Based on the indication criteria for BRCA genetic testing specified in the National Comprehensive Cancer Network(NCCN)clinical practice guidelines in oncology,genetic/familial high-risk assessment:Breast and ovarian(Version 2.2019),a retrospective analysis was performed on patients with early-stage invasive breast cancer treated at Breast Disease Center,Peking University First Hospital between January 2008 and December 2016.Clinicopathological characteristics of all patients were analyzed,and prognoses were calculated using the KaplanMeier method and a Cox proportionate hazards model.Results:A total of 906 early-stage breast cancer patients who had indications for BRCA genetic testing and had complete clinicopathological data and follow-up information were included in the study group,accounting for34.7%of all breast cancer patients treated in Breast Disease Center,Peking University First Hospital during the study period.Compared with breast cancer patients without indications for BRCA genetic testing,the overall survival(OS)and disease-free survival(DFS)of patients with indications were not significantly different.In the study group,patients with premenopausal status,high T stage,lymph node positive,estrogen receptor(ER)negative,Ki-67>20%and presence of a vascular tumor thrombus had worse prognosis.There were more family histories of gastrointestinal cancer in patients with related indications than in patients without such indications.Conclusions:Single-center data showed that more than 30%of patients with early-stage breast cancer had indications for BRCA genetic testing.There was no prognostic difference in patients with or without indications for BRCA genetic testing.Premenopausal status,high T stage,lymph node positive,ER negative,Ki-67>20%,and presence of a vascular tumor thrombus were associated with poor prognosis.

Prediction of fibril formation by early-stage amyloid peptide aggregation

Amyloid fibrils are found in systemic amyloidosis diseases such as Alzheimer's disease,Parkinson's disease,and type II diabetes.Currently,these diseases are diagnosed by observation of fibrils or plaques,which is an ineffective method for early diagnosis and treatment of disease.The goal of this study was to develop a simple and quick method to predict the possibility and speed of fibril formation before its occurrence.Oligomers generated from seven representative peptide segments were first isolated and detected by ion-mobility mass spectrometry(IM-MS).Then,their assemblies were disrupted using formic acid(FA).Interestingly,oligomers that showed small ion intensity changes upon FA addition had rapid fibril formation.By contrast,oligomers that had large ion intensity changes generated fibrils slowly.Two control peptides(aggregation/no fibrils and no aggregation/no fibrils)did not show changes in their ion intensities,which confirmed the ability of this method to predict amyloid formation.In summary,the developed method correlated MS intensity ratio changes of peptide oligomers on FA addition with their amyloid propensities.This method will be useful for monitoring peptide/protein aggregation behavior and essential for their mechanism studies.

Comparison of Stereotactic Body Radiotherapy Delivery Techniques for Early-Stage Lung Cancer Using Lung Toxicity Modeling

Purpose: Lung toxicity is a primary side effect in stereotactic radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We aimed to use a set of radiobiological models to evaluate and compare modern IMRT delivery techniques with three-dimensional conformal techniques for SBRT treatment of NSCLC in terms of lung toxicity, and aimed to compare the results from different radiobiologcal models. Methods: Ten early-stage NSCLC patients treated with SBRT were retrospectively selected. Five treatment plans were generated to deliver 50 Gy in five fractions to the planning target volume for each case: a helical tomotherapy (HT) plan, two three-dimensional cofnromal radiotherapy (3D-CRT) plans using 6-MV and 10-MV photon beams respectively, and two volumetric modulated arc therapy (VMAT) plans using one and two arc fields respectively. The lung RDV was calculated with three parallel functional sub-unit (FSU) models and two normal tissue complication probability (NTCP) models. Results: Both the HT and VMAT plans showed significantly higher contralateral mean lung dose and lower ipsilateral mean lung dose compared to the 3D-CRT plans. There was no statistically significant difference in terms of lung toxicities between the IMRT and 3D-CRT techniques using either the FSU models or the NTCP models. Based on both the FSU and the NTCP models, there was strong correlation between lung toxicity and the mean lung dose in SBRT treatment plans. Conclusions: Based on both the NTCP and parallel FSU models, both IMRT and traditional 3D-CRT delivery techniques could achieve comparable lung sparing inn SBRT treatment of early-stage lung cancer. However, the validity of the radiobiological model results should be checked by clinical data.

Detection of the <i>PIK3CA</i>Mutation in Circulating Tumor DNA as a Possible Predictive Indicator for Poor Prognosis of Early-Stage Breast Cancer

Objectives: Circulating tumor DNA (ctDNA) is shown to provide the real-time genomic information of metastatic breast cancer. This study elucidates the clinico-pathological significance of ctDNA in early-stage breast cancer using the PIK3CA mutation as an indicator. Materials and Methods: Twenty-seven primary breast cancers without metastasis were surgically resected and pathologically diagnosed at the University of Tokyo Hospital, Japan. Genomic DNA of primary tumor was extracted from formalin-fixed and paraffin-embedded specimens. ctDNA was extracted from fresh-frozen plasma from patients. The PIK3CA mutations at E542K, E545K and H1047R were examined by Sanger sequencing or droplet digital PCR in 27 tumors and pre- and post-surgery plasma. Results: The PIK3CA mutations were detected in 13 (48%) of 27 primary tumors. These mutations did not significantly correlate with specific clinico-pathological characteristics of tumors. When ctDNA was examined, 4 (33%) of 12 cases carrying the mutated PIK3CA showed the identical mutation in pre-surgery plasma and 2 (50%) of them showed the identical mutations in post-surgery plasma. Interestingly, in these 2 cases in pathological stages IIIA and IA, fractional abundance of the mutated PIK3CA alleles to the total alleles in pre-surgery ctDNA was around 1% or more and was higher than that of the other two cases without PIK3CA mutations in post-surgery ctDNA. Conclusions: The PIK3CA mutation in ctDNA is detectable even in a subset of early-stage breast cancer. Furthermore, fractional abundance of the mutated PIK3CA in pre-surgery ctDNA could provide a possible predictive indicator for tumor burden and for choosing the appropriate adjuvant treatment of breast cancer.

Postoperative UFT-/Tegafur-based Chemotherapy Versus Postoperative Radiotherapy for Early-stage Non-small Cell Lung Cancer:A Systematic Review and Network Meta-analysis

Background:Both of UFT-/Tegafur-based postoperative chemotherapy and postoperative radiotherapy have made large progress in treatment of early-stage non-small cell lung cancer.While it is unclear that,whether UFT-/Tegafur-based postoperative chemotherapy is superior to postoperative radiotherapy for early-stage non-small cell lung cancer with no direct evidence.Methods:Electronic databases(Pubmed,embase,cochrane library and clinicaltrials.gov)were searched to obtain relevant studies.This systematic review and meta-analysis is reported in accordance with the Preferred Items for Systematic Reviews and Meta-analysis(PRISMA)Statement and was registered at International Prospective Register of Systematic Reviews(number CRD42018095979).Sensitive analysis was conducted by excluding overweight studies.Funnel plot and egger’s test were performed to conduct publication bias.Results:Twenty-one randomized control trials were included.Our results suggested UFT-/Tegafur-based postoperative chemotherapy could improve overall survival over postoperative radiotherapy[HR=0.69(0.59-0.80),p=0.000].But subgroup analysis about stage showed there was no significant difference between them,no matter of stage I,II and III.As to chemotherapy regime,both UFT-/Tegafur+platinum+vinca alkaloid[HR=0.68(0.56-0.82),p=0.000]and UFT-/Tegafur only[HR=0.66(0.54-0.79),p=0.000]were superior to radiotherapy.Subgroup analysis about radiotherapy delivery method and dose showed,significant improvement of chemotherapy over radiotherapy for Cobalt-60 only[HR=0.54(0.39-0.75),p=0.000],Cobalt-60 and linac[HR=0.69(0.59-0.81),p=0.000]and≥45 Gy[HR=0.64(0.54-0.75),p=0.000],but not for linac only[HR=0.78(0.60-1.03),p=0.081]and≥45 Gy[HR=0.86(0.67-1.11),p=0.241].Conclusion:UFT-/Tegafur-based postoperative chemotherapy was superior to postoperative radiotherapy for improving overall survival of early-stage non-small cell lung cancer,but it is not always so under certain circumstance,such as RT delivery method and radiation dose.Of course,it is imperative to further explore differences in specific stage,such as I A and I B.

Radical Vaginal Hysterectomy and Trachelectomy in Early-Stage Cervical Cancer

Objective: To communicate a minimally invasive technique for surgical handling of early-stage cervical cancer and its results. Methods: 110 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 5 years in both hospitals, are presented. Laparoscopic systemic pelvic lymphadenectomy with radical vaginal hysterectomy or radical vaginal trachelectomy was performed to patients, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: Between April 2008 and May 2013, 110 patients were submitted to this technique. 15 patients had their surgery aborted: 13 presented positive nodes for carcinoma in contemporary biopsy and 2 had extensive cervical compromise when performing radical vaginal hysterectomy or trachelectomy. Analysis of the remaining 95 cases shows an average age of 43.9 years (26 - 61), all of them had given birth before, 23 (21%) of them through C-section. BMI averaged 30.5 and 31 (28.2%) had cone surgery performed previously. Average duration of surgery was of 220 minutes. Postoperative hospitalization averaged 3.1 days. Bleeding volume was estimated at 125 cc and one patient required blood transfusion. En 25 patients’ uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 25.4 pelvic nodes were obtained. Complications 13.6% with eight patients suffered bladder injury, two had rectovaginal fistula, 3 patients requires surgical repair of ureteral obstruction, two patients present thromboembolic disease. The disease-free and overall survivals are consistent with reports in the literature. Conclusion: We believe that handling patients with this technique is possible and has the advantages of vaginal and laparoscopic surgery with minimal complications.

Experimental observation of rat's early-stage fracture healing with different kinds of nerve injuries

To investigate the impact of different kinds of nerve injuries of early-stage fracture healing.Methods Three groups of rats were included in the experiment among which group 1 was inflicted with femoral fracture and T10 spinal cord transsection (SCI),group 2 was inflicted with femoral and peripheral nerve resection (PNR),and group 3 with simple femoral fracture as control group.Two weeks after operation the femoral bones were collected for X-ray checking and 2 more weeks later X-ray checking was performed again followed by pathomorphologic exams.Results X-ray result showed no massive calluses in the bones in the 2nd week postoperatively,while in the 4th week,callus appeared with larger size in group 3 than that of group 1 and with smaller size than that of group 2.It was the same with the result of pathomorphologic examining.Cortical bone bridges between fracture point and osteiod were also found in group 2 and there were less normal blood vessels and worse bone remodeling than that of group 3.There were relatively immature calluses with more fibroblast-like cells and disordered bone structure in group 2.Group 3 showed normal healing process and callus structure.Conclusion Early-stage bone fracture healing can be influenced significantly by different kinds of nerve injuries.6 refs,6 figs.

Association between high body mass index and prognosis of patients with early-stage breast cancer: A systematic review and meta-analysis

Background:A high body mass index(BMI)can indicate overweight or obesity and is a crucial risk factor for breast cancer survivors.However,the association between high BMI and prognosis in early-stage breast cancer(EBC)remains unclear.We aimed to assess the effects of high BMI on the prognosis of patients with EBC.Methods:The PubMed,Embase,and Cochrane Library databases and proceedings of major oncological conferences related to the effects of BMI on the prognosis of breast cancer were searched up to November 2021.Fixedand random-effects models were used for meta-analyses.Pooled hazard ratios(HRs)and 95%confidence intervals(CIs)for disease-free survival(DFS)and overall survival(OS)were extracted from the included literature.Results:Twenty retrospective cohort studies with 33,836 patients with EBC were included.Overweight patients had worse DFS(HR:1.16,95%CI:1.05-1.27,P=0.002)and OS(HR:1.20;95%CI:1.09-1.33,P<0.001).Obesity also had adverse effects on DFS(HR:1.17,95%CI:1.07-1.29,P=0.001)and OS(HR:1.30,95%CI:1.17-1.45,P<0.001).Likewise,patients with high BMI had worse DFS(HR:1.16,95%CI:1.08-1.26,P<0.001)and OS(HR:1.25,95%CI:1.14-1.39,P<0.001).In subgroup analyses,overweight had adverse effects on DFS(HR:1.11,95%CI:1.04-1.18,P=0.001)and OS(HR:1.18,95%CI:1.11-1.26,P<0.001)in multivariate analyses,whereas the relationship that overweight had negative effects on DFS(HR:1.21,95%CI:0.99-1.48,P=0.058)and OS(HR:1.39,95%CI:0.92-2.10,P=0.123)was not statistically significant in univariate analysis.By contrast,obesity had adverse effects on DFS(HR:1.21,95%CI:1.06-1.38,P=0.004 and HR:1.14,95%CI:1.08-1.22,P<0.001)and OS(HR:1.33,95%CI:1.15-1.54,P<0.001 and HR:1.23,95%CI:1.15-1.31,P<0.001)in univariate and multivariate analyses,respectively.Conclusions:Compared with normal weight,increased body weight(overweight,obesity,and high BMI)led to worse DFS and OS in patients with EBC.Once validated,these results should be considered in the development of prevention programs.

A Matched Comparison Study of Uniportal Versus Triportal Thoracoscopic Lobectomy and Sublobectomy for Early-stage Nonsmall Cell Lung Cancer

Background： Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer （NSCLC）. The aim of this study was to compare the perioperative outcomes of uniportal and triportal thoracoscopic Iobectomy and sublobectomy for early-stage NSCLC. Methods： A total of 405 patients with lung lesions underwent thoracoscopic lobectomy or sublobectomy through a uniportal or triportal procedure in approximately 7-month period （From November 2014 to May 2015）. A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes of patients who received uniportal or triportal thoracoscopic lobectomy and sublobectomy. Results： Fifty-eight patients underwent uniportal and 347 patients underwent triportal pulmonary resection. The conversion rate for uniportal and triportal procedure was 3.4% （2/58） and 2.3% （8/347）, respectively. The complication rate for uniportal and triportal procedure was 10.3% and 9.5%, respectively. There was no perioperative death in either group. Most patients had early-stage NSCLC in both groups （uniportal： 45/47, 96%; triportal： 313/343, 91%）. Propensity score-matching analysis demonstrated no significant differences in operation time, intraoperative blood loss, numbers of dissected lymph nodes, number of stations of lymph node dissected, duration of chest tube, and complication rate between uniportal and triportal group for early-stage NSCLC. However, the duration of postoperative hospitalization was longer in the uniportal group （6.83 ± 4.17 vs. 5.42 ± 1.86 d, P = 0.036） compared with the triportal group. Conclusions： Uniportal thoracoscopic lobectomy and sublobectomy is safe and feasible, with comparable short-term outcomes with triportal thoracoscopic pulmonary resection. Uniportal lobectomy and sublobectomy lead to similar cure rate as triportal Iobectomy and sublobectomy for early NSCLC.

Development and validation of radiomics model built by incorporating machine learning for identifying liver fibrosis and early-stage cirrhosis

Background:Liver fibrosis(LF)continues to develop and eventually progresses to cirrhosis.However,LF and early-stage cirrhosis(ESC)can be reversed in some cases,while advanced cirrhosis is almost impossible to cure.Advances in quantitative imaging techniques have made it possible to replace the gold standard biopsy method with non-invasive imaging,such as radiomics.Therefore,the purpose of this study is to develop a radiomics model to identify LF and ESC.Methods:Patients with LF(n=108)and ESC(n=116)were enrolled in this study.As a control,patients with healthy livers were involved in the study(n=145).Diffusion-weighted imaging(DWI)data sets with three b-values(0,400,and 800 s/mm2)of enrolled cases were collected in this study.Then,radiomics features were extracted from manually delineated volumes of interest.Two modeling strategies were performed after univariate analysis and feature selection.Finally,an optimal model was determined by the receiver operating characteristic area under the curve(AUC).Results:The optimal models were built in plan 1.For model 1 in plan 1,the AUCs of the training and validation cohorts were 0.973(95%confidence interval[CI]0.946-1.000)and 0.948(95%CI 0.903-0.993),respectively.For model 2 in plan 1,the AUCs of the training and validation cohorts were 0.944,95%CI 0.905 to 0.983,and 0.968,95%CI 0.940 to 0.996,respectively.Conclusions:Radiomics analysis of DWI images allows for accurate identification of LF and ESC,and the non-invasive biomarkers extracted from the functional DWI images can serve as a better alternative to biopsy.

Record of Early-Stage Rodingitization from the Purang Ophiolite Complex,Western Tibet

Rodingitization,commonly coupled with serpentinization of ultramafic rocks,bears significant information for fluid-rock interactions and element transfer from sea-floor to subduction zone environments.Numerous outcrops of rodingites are exposed along the Yarlung Zangbo suture zone(YZSZ)of southern Tibet,providing us an excellent opportunity to probe the petrogenetic processes,and unravel their implications for regional tectonic evolution.Several studies have been performed on rodingites from the eastern to central portions of the YZSZ,whereas limited work has ever been conducted on rodingitized rocks from the western segment of the YZSZ,precluding a comprehensive understanding of this lithological type.In this paper,we present detailed studies of petrology,mineral,whole-rock geochemistry and phase equilibrium modeling on a suite of newly recognized rodingites within the Purang ophiolite massif in the southwestern part of the YZSZ.The rodingites have a major metasomatic mineral association of chlorite,clinozoisite,amphibole and minor amounts of plagioclase,representing products of an early-stage rodingitization.They generally present compositions of low SiO2(48.89 wt.%–53.57 wt.%),Fe2O3^T(3.77 wt.%–5.56 wt.%),Na2O(1.31 wt.%–1.93 wt.%),Al2O3(4.78 wt.%–8.84 wt.%),moderate CaO(9.69 wt.%–11.23 wt.%),and high MgO(24.11 wt.%–26.08 wt.%)concentrations with extremely high Mg^# values[Mg^#=100×Mg/(Mg+Fe^2+)molar]of 89–92.Bulk-rock recalculation reveals that the rodingites have a protolith of mantle-derived olivine gabbro or gabbronorite.They have low rare earth element compositions(∑REE=2.4 ppm–6.5 ppm)and are characterized by flat LREE and slightly enriched HREE patterns with positive Eu anomalies;they also exhibit positive anomalies in Sr,U and Pb and negative anomalies in high-field strength elements,including Nb,P and Ti,suggesting for a subduction-zone imprinting.Phase equilibrium modeling shows that the rodingitization did take place at P<2 kbar and T=~350–400℃,consistent with low greenschist facies conditions.Taking into account of all these petrological and geochemical features,we propose that the rodingites record evidence of early-stage fluid-rock interactions between olivine gabbroic rocks and Ca-rich fluids,which may have derived from weakly serpentinized ultramafic country rocks.Although this process may initially have occurred in a mid-ocean ridge setting,an obvious overprinting by supra-subduction zone fluids in a fore-arc environment is recognized.

Long-term outcomes of endoscopic submucosal dissection for high-grade dysplasia and early-stage carcinoma in the colorectum

Background:Colorectal carcinomas(CRCs)arise from premalignant precursors in an adenoma-carcinoma sequence,in which adenoma with high-grade dysplasia(HGD)and early-stage carcinoma are defined as advanced neoplasia.A limited number of studies have evaluated the long-term outcomes of endoscopic submucosal dissection(ESD)for advanced colorectal neoplasia.This study aimed to assess the efficacy and safety of ESD for advanced colorectal neoplasia as well as the long-term outcomes,including local recurrence and metastasis.Methods:We analyzed data collected from 610 consecutive patients with 616 advanced colorectal neoplasia lesions treated with ESD between January 2007 and December 2013.Clinical,endoscopic,and histological data were col-lected over a median follow-up period of 58 months to determine tumor stage and type,resection status,complica-tions,tumor recurrence,and distant metastasis.Results:The overall rates of en bloc resection,histological complete resection,and major complications were 94.3%,89.4%,and 2.3%,respectively.Hybrid ESD was an independent factor of piecemeal resection.Tumor location in the colon was associated with increased risk of ESD-related complications.During the follow-up period,all patients remained free of metastasis.However,local recurrence occurred in 4 patients(0.8%);piecemeal resection was a risk factor.Conclusions:ESD is effective and safe for resection of advanced colorectal neoplasia,with a high en bloc resection rate and favorable long-term outcomes.ESD is indicated for the treatment of HGD and early-stage CRC to obtain cura-tive resection and reduce local recurrence rate.

Perspectives on early-stage lung cancer identification and challenges to thoracic surgery

Lung cancer is one of the leading causes of cancer-related death worldwide with the long-term survival rate for stage I cancers treated with surgery reaching over 80%,but rapidly reducing as disease develops with stage III cancer patients presenting with a long-term survival rate of just 20%.Altliough surgery remains die most effective strategy for treating early stage lung cancers,screening and early diagnosis remain critical for improving prognosis in lung cancer.In addition to advancements in surgical techniques,die rapid development of artificial intelligence(AI),liquid biopsy,and other technologies in recent years has led to new breakthroughs in the diagnosis of this disease.Clinical application of neoadjuvant therapies using immune checkpoint inhibitors have also shown promise for improved efficacy in the treatment of early stage lung cancers.This editorial was designed to summarize the recent progress around the screening and diagnosis of early stage lung cancers and the challenges associated with various surgical strategies for treating these patients.

Deep learning for estimating energy savings of early-stage facade design decisions

The selection of high-performance building facade systems is essential to promote building energy efficiency.However,this selection is highly dependent on early-stage design decisions,which are extremely challenging considering numerous design parameters with early-stage uncertainties.This paper aims to evaluate the appli-cability of deep learning networks in estimating the energy savings of different facade alternatives in the early-stage design of buildings.The energy performance of two competing façade systems(i.e.,Ultra-High-Performance Fiber-Reinforced-Concrete and conventional panels)was estimated for different scenarios through building en-ergy simulations using EnergyPlusTM.Three deep learning networks were trained using the collected data from the simulation of fourteen buildings in fourteen different locations to estimate the heating,cooling,and total site energy savings.The accuracy of trained deep networks was compared with the accuracy of three common data-driven prediction models including,Gradient Boosting Machines,Random Forest,and Generalized Linear Regression.The results showed that the deep learning network trained to predict building total site energy savings had the highest accuracy among other models with a mean absolute error of 1.59 and a root mean square error of 3.48,followed by Gradient Boosting Machines,Random Forest,and last Generalized Linear Regression.Similarly,deep networks trained to predict building cooling and heating energy savings had the lowest mean average error of 0.20 and 1.17,respectively,compared to other predictive models.It is expected the decision support system developed based on this methodology helps architects and designers to quantify the energy savings of different facade systems in early stages of design decisions.