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Guo-Tian Ruan,1– 3,&ast; Ming Yang,1– 3,&ast; Xiao-Wei Zhang,1– 3,&ast; Meng-Meng Song,1– 3 Chun-Lei Hu,1– 3 Yi-Zhong Ge,1– 3 Hai-Lun Xie,1– 3 Tong Liu,1– 3 Meng Tang,1– 3 Qi Zhang,1– 3 Xi Zhang,1– 3 Kang-Ping Zhang,1– 3 Xiang-Rui Li,1– 3 Qin-Qin Li,1– 3 Yong-Bing Chen,1– 3 Kai-Ying Yu,1– 3 Ming-Hua Cong,4 Kun-Hua Wang,5 Han-Ping Shi1– 3 1Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China; 2Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China; 3Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China; 4Comprehensive Oncology Department, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100038, People’s Republic of China; 5Department of Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Han-Ping ShiDepartment of Gastrointestinal Surgery and Beijing Shijitan Hospital, Capital Medical University, 10 Tie Yi Road, Beijing, 100038, People’s Republic of ChinaTel +86-10- 6392 6985Fax +86-10 -6392 6325Email shihp@ccmu.edu.cnBackground: Systemic inflammation and cachexia are associated with adverse clinical outcomes in elderly patients with cancer. The survival outcomes of elderly patients with cancer cachexia (EPCC) with high inflammation and a high risk of mortality are unknown. This study aimed to investigate the impact of high inflammation on the prognosis of EPCC patients with high mortality.Patients and Methods: This multicenter cohort study included 746 EPCC (age > 65 years) with a mean age of 72.00 ± 5.24 years, of whom 489 (65.5%) were male. The cut-off value for the inflammation index was obtained using the optimal survival curve. The different inflammatory indicators were assessed using the concordance index (C-index), decision curve analysis (DCA), and prognostic receiver operating characteristic (ROC). The high mortality risk group of EPCC was defined by the 2011 Fearon Cancer Diagnostic Consensus. EPCC were divided into the high-risk group, which satisfies three diagnostic criteria, and a low-risk group, which satisfies only one or two diagnostic criteria.Results: The C-index, DCA, and prognostic ROC indicated the superiority of advanced lung cancer inflammation index (ALI) compared with other indicators, including neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and platelet–lymphocyte ratio (PLR). Whether ALI was used as a continuous or a categorical variable, ALI had a better prognostic value in EPCC compared with other inflammatory indicators. In particular, patients with low ALI (< 25.03) had a worse overall survival (OS) than patients with high ALI (≥ 25.03) (P < 0.001, HR [95% CI] = 2.092 [1.590– 2.751]). The combination effect analysis showed that the risk of mortality of the patients in the low-ALI and high-risk groups was 3.095-fold higher than that of patients in the high-ALI and low-risk groups.Conclusion: The prognostic and discriminative value of the inflammatory indicator ALI was better than that of NLR, PNI, SII, and PLR in EPCC. The high-risk group of EPCC with a low ALI would increase the death risk of OS.Keywords: ALI, systemic inflammation, cancer cachexia, elderly, overall survival

Cong-Li Hu,1,2 Yan-Jun Zhang,3 Xiao-Feng Zhang,2 Xiang Fei,4 Hai Zhang,5 Chun-Guang Li,4 Bin Sun2 1Translational Medicine Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201620, People’s Republic of China; 2Department of Molecular Oncology, Eastern Hepatobiliary Surgical Hospital & National Center for Liver Cancer, Second Military Medical University, Shanghai, 200438, People’s Republic of China; 3School of Health and Social Care, Shanghai Urban Construction Vocational College, Shanghai, 201415, People’s Republic of China; 4Department of Thoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200438, People’s Republic of China; 5Department of Pharmacy, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, People’s Republic of ChinaCorrespondence: Bin SunDepartment of Molecular Oncology, Eastern Hepatobiliary Surgical Hospital & National Center for Liver Cancer, Second Military Medical University, Shanghai, 200438, People’s Republic of ChinaEmail sunbin05301984@outlook.comChun-Guang LiDepartment of Thoracic Surgery, Changhai Hospital, Second Military Medical University, 225 Changhai Road Shanghai, 200438, People’s Republic of ChinaEmail dr_lichunguang@sina.comPurpose: Circulating tumor cells (CTCs) are considered to be a key factor involved in tumor metastasis. However, the isolation and culture of CTCs in vitro remains challenging, and their clinical application for predicting prognosis and survival is still limited. The development of accurate evaluating system for CTCs will benefit for clinical assessment of HCC.Methods: Density gradient centrifugation and magnetic separation based on CD45 antibody were used to isolate CTCs. 3D culture was used to maintain and amplify CTCs and HCC cells. Cellular immunofluorescence was used to identify CTCs and spheroids. The cutoff value of CTC spheroid was calculated using X-tile software. The relationship between clinicopathological variables and CTC spheroids in HCC patients is analyzed. In vivo models were used to evaluate tumor growth and metastasis of CTC spheroids.Results: Patient-derived CTCs/HCC cells were isolated and expanded to form spheroids using 3D culture. CTC spheroids could be used to predict short-term recurrence of CTCs compared with conventional CTC enumeration. Different cell lines exhibited different formation rates and grew to different sizes. Identification of CTC spheroids revealed that EpCAM and β-catenin were expressed in spheroids derived from HCC cells and in the HCC/CTCs. EpCAM-positive HCC cells exhibited improved spheroid formation in 3D culture and were more tumorigenic and likely to metastasize to the lung in vivo. Abnormal activation of the Wnt/β-catenin signaling pathway was observed in EpCAM positive cells.Conclusion: CTC spheroids could predict prognosis of HCC more precisely compared with conventional CTC enumeration. EpCAM may participate in the formation and survival of CTC spheroids which dependent on Wnt/β-catenin signaling pathway.Keywords: 3D culture, circulating tumor cells, early recurrence, metastasis, hepatocellular carcinoma

Kaida Jiang,1 Lingjiang Li,2 Xueyi Wang,3 Maosheng Fang,4 Jianfei Shi,5 Qiuyun Cao,6 Jincai He,7 Jinan Wang,8 Weihao Tan,8 Cuili Hu8 1Psychiatry Department, Shanghai Mental Health Center, Shanghai, 2Psychiatry Department,The Second Xiangya Hospital, Central South University, Changsha, 3Psychiatry Department, First affiliated Hospital of Hebei Medical University, Shijiazhuang, 4Psychiatry Department, Wuhan Mental Health Center, Wuhan, 5Psychiatry Department, Hangzhou the 7th Hospital, Hangzhou, 6Psychology Department, Nanjing Drum Tower Hospital, Nanjing, 7Neurology Department, First affiliated Hospital of Wenzhou Medical University, Wenzhou, 8Medical Affairs Department, Xi’an Janssen Pharmaceutical Ltd., Beijing, People’s Republic of China Background: Significant anxiety symptoms are associated with poor clinical course and outcome in major depressive disorder (MDD). This single-arm, open-label study aimed to evaluate the efficacy and tolerability of escitalopram treatment in patients with MDD and anxiety symptoms. Methods: Adult patients with MDD and anxiety symptoms (Montgomery–Asberg Depression Rating Scale [MADRS] ≥22 and Hamilton Anxiety Rating Scale [HAM-A] ≥14) were enrolled and received escitalopram (10–20 mg/day) treatment for 24 weeks. Symptom status was assessed by MADRS, 17-item-Hamilton Depression Rating Scale, HAM-A, and Clinical Global Impression Scale at baseline and the following visits. Quality of life was assessed by Short Form-12, and safety was evaluated by adverse events, laboratory investigations, vital signs, and physical findings. Results: Overall, 200 of 318 (66.2%) enrolled patients completed the 24-week treatment. The remission (MADRS ≤10 and HAM-A ≤7) rate in the full analysis set (N=285) was 73.3% (95% confidence interval: 67.80, 78.38) at week 24. Mean (± standard deviation) MADRS total score was 33.4 (±7.13) and HAM-A score was 27.6 (±7.26) at baseline, which reduced to 6.6 (±10.18) and 6.0 (±8.39), respectively, at week 24. Patients with higher baseline depression and anxiety level took longer to achieve similar remission rates. Overall, 80 of the 302 (26.5%) patients included in the safety set reported at least 1 treatment-emergent adverse event (TEAE). Most frequently reported TEAEs (>2%) were headache (4.0%), nasopharyngitis (3.6%), nausea (3.0%), and dizziness (2.6%). Serious TEAEs were reported by 1.3% patients; no deaths were reported. Conclusion: Escitalopram 10–20 mg/day was effective and well-tolerated in the long-term treatment of MDD with anxiety symptoms in adult Chinese population. Keywords: anxiety, Chinese, escitalopram, long term, major depressive disorder

Chih-Ling Hu, Kai-Ling Peng Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan Purpose: We report a rare case of silicone oil droplets adhering to the posterior surface of an intraocular lens (IOL) after removal of silicone oil for a patient with retinal reattachment, who had a history of pseudophakic rhegmatogenous retinal detachment. Case report: A 45-year-old male with a history of cataract surgeries of both eyes developed pseudophakic retinal detachment in his left eye. He received surgeries of scleral buckle and standard 3-port pars plana vitrectomy with silicon oil tamponade. With retinal attachment for 7 months, he underwent removal of silicone oil in the left eye. However, a big silicone oil droplet was found on the posterior surface of the IOL with complaints of distorted micropsia and poor vision, a month later. Pars plana vitrectomy using a 20-gauge vitreous cutter, which was supposed to have a higher cleaning capability compared with a smaller size device, was performed to aspirate the main part of the big oil droplet. The residual dispersed smaller droplets at the center of the visual axis were swept peripherally using a 27-gauge bending tip cannula. Fortunately, the patient regained his vision of 20/20 without distortion and micropsia in his left eye. Conclusion: This was a rare case where silicone oil droplets were found adhering to the posterior surface of an IOL after removing silicone oil a month later. We used a 20-gauge vitrectomy system to remove large oil droplets and swept smaller ones off the visual axis to improve the vision and visual quality. Keywords: silicone oil droplet, silicone intraocular lens, retinal detachment, retinal reattachment, 20-gauge vitreous cutter, 27-gauge bending tip cannula

Prefabricated lightweight concrete building fas cade can improve the energy e ciency of buildings and reduce the carbon emission of transportation. However, it is essential to maintain the dimensional stability of the full scale element. The drying shrinkage of lightweight foamed concrete was investigated in this study. The hypothesis of using the drying shrinkage of normal weight concrete to approximate that of lightweight foamed concrete of dry density about 1,500 kg/m3 counterpart was veri ed. Three di erent strategies of reducing drying shrinkage were studied. The drying shrinkage of common ingredients of ordinary Portland cement (OPC) and ground granulated blast-furnace slag (GGBS) was commonly up to 2,000-3,000 ". The use of magnesium expansive agent with di erent calcination conditions could not reduce the drying shrinkage. The use of calcium sulfoaluminiate(CSA) cement with OPC and GGBS could signi cantly reduce the drying shrinkage within 1,000 " in standard testing environment. The formulation developed in laboratory was scaled up in a concrete production plant for prefabricated concrete elements. A lightweight full scale panel (the wet density was about 1,700 kg/m3) was fabricated. The drying shrinkage of the developed formulation with CSA cement was only 161 " in the eld test. A hygro-mechanical model was developed to model the di usion, shrinkage and plastic strain evolution. The incremental stress-strain constitutive relationship of the hygro-mechanical model was derived for incorporating it into general nite element routine. The model parameters were calibrated by the drying shrinkage measurements in this study. The calibrated model demonstrated the cracking potential of three typical reinforced concrete panels of three di erent formulations studied in this study.

Chih-Ling Hu, Kai-Ling Peng Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan, Republic of China Abstract: We report a rare case of bilateral macular infarction as an ocular presenting sign of systemic lupus erythematosus (SLE). A 29-year-old woman presented to our ophthalmologic clinic with a 1-week history of progressive visual loss in her left eye after she had visited a rheumatologic clinic where SLE was diagnosed. At examination, best-corrected visual acuity (BCVA) of the right eye was 6/6, and for the left was counting fingers. Fundus examination revealed perivascular hard exudates along some branches of vessels in both eyes. After pulse therapy, her BCVA in the right eye declined to 6/30and in the left improved to 3/60. She was administered sub-Tenon’s injections of triamcinolone acetonide 50mg/week in both eyes for 3weeks. Her BCVA improved to 3/6in her right eye and remained at 3/60in her left eye. Macular infarction is an uncommon but most severe complication of SLE. Early and regular exam of the fundus in patients with SLE is necessary to avoid progression of severe ocular complications. Keywords: bilateral macular infarction, systemic lupus erythematosus