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Polyetheretherketone (PEEK) is a frequently utilized orthopedic implant material in clinical settings. However, the adverse inflammatory and immunological reactions due to the PEEK surface after implantation often cause poor osseointegration and thereby hinder its clinical utility. To improve osseointegration and enhance the success rate of PEEK implants, the surface can be biofunctionalized to be immunomodulatory. Consequently, in this study, lithium-doped bioglass nanospheres (Li/BGs) was coated on the sulfonated PEEK surface. Furthermore, we assessed the anti-inflammatory potential of the biofunctionalized PEEK implants and their impact on osteogenesis. In our study, it was observed that the in vitro biofunctionalized PEEK surface exhibited enhanced osteogenesis and immunomodulatory osteogenesis properties, while also effectively suppressing the acute inflammatory response initiated by macrophages. Furthermore, our in vivo experiments demonstrated that the biofunctionalized PEEK surface contributed to improved osteogenesis properties and mitigated the formation of fibrous capsules. Therefore, the in vitro and in vivo results demonstrated that PEEK surface modification with Li/BGs not only changed the disadvantage of being bioinert on the surface but also endowed it with osteoimmunomodulatory regulation and bone-promoting properties. Thus, the biofunctionalized PEEK may be a promising candidate for use as an orthopedic implant in clinical settings.

Understanding the spatial-temporal dynamics of crop nitrogen (N) use efficiency (NUE) and the relationship with explanatory environmental variables can support land-use management and policymaking. Nevertheless, the application of statistical models for evaluating the explanatory variables of space-time variation in crop NUE is still under-researched. In this study, stepwise multiple linear regression (SMLR) and Random Forest (RF) were used to evaluate the spatial and temporal variation of NUE indicators (i.e., partial factor productivity of N (PFPN); partial nutrient balance of N (PNBN)) at county scale in Northeast China (Heilongjiang, Liaoning and Jilin provinces) from 1990 to 2015. Explanatory variables included agricultural management practices, topography, climate, economy, soil and crop types. Results revealed that the PFPN was higher in the northern parts and lower in the center of the Northeast China and PNBN increased from southern to northern parts during the 1990–2015 period. The NUE indicators decreased with time in most counties during the study period. The model efficiency coefficients of the SMLR and RF models were 0.44 and 0.84 for PFPN, and 0.67 and 0.89 for PNBN, respectively. The RF model had higher relative importance of soil and climatic covariates and lower relative importance of crop covariates compared to the SMLR model. The planting area index of vegetables and beans, soil clay content, saturated water content, enhanced vegetation index in November & December, soil bulk density, and annual minimum temperature were the main explanatory variables for both NUE indicators. This is the first study to show the quantitative relative importance of explanatory variables for NUE at a county level in Northeast China using RF and SMLR. This novel study gives reference measurements to improve crop NUE which is one of the most effective means of managing N for sustainable development, ensuring food security, alleviating environmental degradation and increasing farmer's profitability.

Purpose: Only 9% of adult rhabdomyosarcomas (RMS) present with primary disease in the head and neck (HNRMS). Management is often extrapolated from the pediatric experience in which prognosis is better but treatment imperatives differ. We report management and outcomes of adult HNRMS treated over 3 decades. Methods and Materials: Adult HNRMS treated from 1984 to 2017 were reviewed. HNRMS were categorized as embryonal/alveolar (E/A) or pleomorphic (P). Standard management was as follows: E/A-HNRMS were treated with neoadjuvant chemotherapy, definitive chemoradiotherapy (CRT), and then maintenance chemotherapy. P-HNRMS were generally treated with surgery +/– radiation. Intensity modulated radiation therapy (IMRT) was adopted from 2005 onward. Results: Fifty-eight patients were eligible; the median age was 32 years. Seventy-six percent of tumors (n = 45) were parameningeal and 45% (n = 26) were >5 cm. Of 45 patients with M0 HNRMS treated with curative intent, 33 (73%) were E/A-HNRMS and 12 (27%) P-HNRMS. Patients with E/A-HNRMS received definitive RT with 66 to 70 Gy in 2 Gy per fraction. Elective nodal RT was routinely delivered. In the pre-IMRT era (before 2005), 12 of 23 (52%) patients with M0 E/A-HNRMS experienced locoregional recurrences. In the IMRT era (2005 and onward), 1 of 10 patients (10%) with M0 disease recurred locally; this patient achieved a complete clinical response despite a 3-week interruption after 48 Gy because of local toxicity but experienced an in-field local recurrence 45 months later that resulted in death. Locoregional control was superior in the IMRT era vs pre-IMRT era (P = .049). Distant metastasis among patients with E/A-HNRMS was the predominant mode of treatment failure (n = 17 of 33, 52%). Conclusions: Our study shows a high rate of locoregional control for adult E/A-HNRMS following definitive CRT using IMRT, and CRT should be considered for the majority of patients in this population. In contrast, P-HNRMS is distinct and requires surgery +/– RT.

Purpose: To facilitate understanding statistical principles and methods for clinicians involved in cancer research. Methods: An overview of study design is provided on cancer research for both observational and clinical trials addressing study objectives and endpoints, superiority tests, non-inferiority and equivalence design, and sample size calculation. The principles of statistical models and tests including contemporary standard methods of analysis and evaluation are discussed. Finally, some statistical pitfalls frequently evident in clinical and translational studies in cancer are discussed. Results: We emphasize the practical aspects of study design (superiority vs non-inferiority vs equivalence study) and assumptions underpinning power calculations and sample size estimation. The differences between relative risk, odds ratio, and hazard ratio, understanding outcome endpoints, purposes of interim analysis, and statistical modeling to minimize confounding effects and bias are also discussed. Conclusion: Proper design and correctly constructed statistical models are critical for the success of cancer research studies. Most statistical inaccuracies can be minimized by following essential statistical principles and guidelines to improve quality in research studies.

Purpose/objective(s): To examine the therapeutic ratio and mortality profile over time in a radiotherapy randomized trial in stage III-IV larynx/pharynx cancer with long-term follow-up. Materials/methods: From 1988 to 1995, 331 cases were randomized to either hyperfractionated (HF) (58 Gy/40 fractions, twice daily) or conventional (CF) (51 Gy/20 fractions, once daily) radiotherapy. Overall survival (OS), locoregional (LRC), distant control (DC), ≥Grade 3 late toxicity (LT), and relative mortality risk profile over time were compared between both arms. Results: Median follow-up was 13.6 years. HF had a 10% improved OS at 5-years (40% vs 30%, p = 0.04), but the benefit diminished to 3% at 10-years (21% vs 18%). A trend towards higher LRC with HF remained (5-year: 49% vs 40%; 10-year: 49% vs 39%, p = 0.05). DC rates were unchanged (5-year: 87% vs 85%; 10-year: 87 vs 84%, p = 0.56). LT rates were similar (HF vs CF: 5-year: 9% vs 12%; 10-year: 11% vs 14%, p = 0.27). Multivariable analysis confirmed that HF reduced mortality risk by 31% [HR 0.69 (0.55–0.88), p

Oral tongue squamous cell carcinoma (OTSCC) displays variable levels of immune cells within the tumor microenvironment. The quantity and localization of tumor infiltrating lymphocytes (TILs), specific functional TIL subsets (e.g., CD8+), and biomarker-expressing cells (e.g., PD-L1+) may have prognostic and predictive value. The purpose of this study was to evaluate the robustness and utility of computer-assisted image analysis tools to quantify and localize immunohistochemistry-based biomarkers within the tumor microenvironment on a tissue microarray (TMA). We stained a 91-patient OTSCC TMA with antibodies targeting CD3, CD4, CD8, FOXP3, IDO, and PD-L1. Cell populations were segmented into epithelial (tumor) or stromal compartments according to a mask derived from a pan-cytokeratin stain. Definiens Tissue Studio was used to enumerate marker-positive cells or to quantify the staining intensity. Automated methods were validated against manual tissue segmentation, cell count, and stain intensity quantification. Univariate associations of cell count and stain intensity with smoking status, stage, overall survival (OS), and disease-free survival (DFS) were determined. Our results revealed that the accuracy of automated tissue segmentation was dependent on the distance of the tissue section from the cytokeratin mask and the proportion of the tissue containing tumor vs. stroma. Automated and manual cell counts and stain intensities were highly correlated (Pearson coefficient range: 0.46–0.90; p

The tumor, node, metastases (TNM) anatomic staging system plays a pivotal role in cancer care, research, and cancer control activities. Since the first edition of the American Joint Committee on Cancer TNM staging classification published in 1977, soft tissue sarcomas have been staged in an anatomic site agnostic fashion whereby the primary tumor size (T) was categorized as T1 if 5 cm; this remained unchanged through the 7th edition of the TNM. However, soft tissue sarcomas of the head and neck (STSHN) usually present smaller than sarcomas of other sites, but carry a disproportionate risk of local recurrence. Up to 70% of tumors are less than 5 cm at presentation, and therefore classified together as T1. Given the rarity of STSHN, there is a paucity of data to guide progress in their classification. Moreover, the majority of publications only report tumor size as less than or greater than 5 cm, presumably based on conventions of the TNM system that remained unchanged for 40 years, thereby affecting progress of STSHN classification. This formed the impetus for change in the 8th edition in 2 key ways: 1) several soft tissue sarcoma site based changes occurred including STSHN now having its own system, and 2) primary tumor size cut-offs of 2 cm and 4 cm used in STSHN now reflect sizes that head and neck specialists commonly encounter in their practice. This update was pragmatic in modifying the TNM from a system with a T category not serving STSHN and which was originally based on sarcoma data from non-head and neck anatomic sites. The background to this change is outlined which provides a framework in which data can be reported to generate evidence for future staging modifications. Keywords: Head and neck cancer, Soft tissue sarcoma, Cancer staging, TNM staging

Osteomyelitis, infection of the bone and marrow, following high dose (chemo-)radiotherapy for head and neck cancer is uncommon and rarely seen in the cervical spine or temporal bone. Due to its proximity to critical structures, osteomyelitis in the latter regions could carry potentially important consequences. Furthermore, involvement near the skull base (e.g. temporal bone and high cervical vertebrae) presents unique challenges in diagnosis (especially in the differentiation from disease recurrence) and treatment, making early detection and timely intervention critical. In this report, we describe two cases of osteomyelitis, one involving the temporal bone and the other affecting the 2nd and 3rd cervical vertebrae, diagnosed and treated with good outcome in the setting of definitive chemoradiotherapy for locally advanced pharyngeal carcinomas. We suggest that for new or evolving post-radiotherapy osseous changes in regions that have received a high dose of radiotherapy, associated with unexpected and deteriorating spinal symptoms such as pain and spasm, radiation-related osteomyelitis should be considered in the differential diagnosis from tumor progression. Timely referral to a surgical oncologist and infectious diseases specialist is paramount in achieving satisfactory clinical outcomes.