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Purpose The aim of this study was to establish individualized nomograms to predict survival outcomes in older female patients with stage IV breast cancer who did or did not undergo local surgery, and to determine which patients could benefit from surgery. Methods A total of 3,129 female patients with stage IV breast cancer aged ≥70 years between 2010 and 2015 were included in the Surveillance, Epidemiology, and End Results program. Multivariate Cox regression analysis was used to identify risk factors for overall survival (OS) and breast cancer-specific survival (BCSS). Survival analysis was performed using the Kaplan–Meier plot and log-rank test. Nomograms and risk stratification models were constructed. Results Patients who underwent surgery had better OS (HR = 0.751, 95% CI [0.668–0.843], P, Graphical abstract Image 1, Highlights • The effect of surgery in older patients with stage IV breast cancer (BC) is discussed. • The proportion of older patients with stage IV BC who underwent surgery declined. • A specific group of older patients with stage IV BC can benefit from surgery. • Nomograms can be used to predict the prognosis of older patients with stage IV BC.

Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prognostic model of cervical spinal cord injury without radiological abnormality. This retrospective analysis included 43 patients with cervical spinal cord injury without radiological abnormality. Seven potential factors were assessed: age, sex, external force strength causing damage, duration of disease, degree of cervical spinal stenosis, Japanese Orthopaedic Association score, and physiological cervical curvature. A model was established using multiple binary logistic regression analysis. The model was evaluated by concordant profiling and the area under the receiver operating characteristic curve. Bootstrapping was used for internal validation. The prognostic model was as follows: logit(P) = -25.4545 + 21.2576VALUE + 1.2160SCORE - 3.4224TIME, where VALUE refers to the Pavlov ratio indicating the extent of cervical spinal stenosis, SCORE refers to the Japanese Orthopaedic Association score (0-17) after the operation, and TIME refers to the disease duration (from injury to operation). The area under the receiver operating characteristic curve for all patients was 0.8941 (95% confidence interval, 0.7930-0.9952). Three factors assessed in the predictive model were associated with patient outcomes: a great extent of cervical stenosis, a poor preoperative neurological status, and a long disease duration. These three factors could worsen patient outcomes. Moreover, the disease prognosis was considered good when logit(P) ≥ -2.5105. Overall, the model displayed a certain clinical value. This study was approved by the Biomedical Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University, China (approval number: 2018063) on May 8, 2018.

Background Neuroendocrine carcinoma (NEC) of the breast is a very rare malignant tumor whose clinic pathological features and prognosis are not well defined. The aim of this study was to compare the clinic pathological features and clinical outcome between breast neuroendocrine carcinoma and breast invasive ductal carcinoma (IDC) and to know the independent prognostic risk factors of NEC.Method Patients with breast NEC and breast IDC were identified through the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Then we compared the clinic pathological features and outcome between the two cohorts. Propensity score matching (PSM) was performed to balance the effects of baseline clinic pathological differences. Potential prognostic factors of breast NEC were identified by the univariate and multivariate Cox analysis.Results In total, we identified 208 patients with breast NEC and 275,878 cases with breast IDC.Compared with IDC, NEC was significantly correlated with higher stage, larger tumor size, more distant transfers and no population of HER2 enriched subtype. There were significant differences on the choice of treatment therapy between NEC and IDC (p=0.000). More patients chose not to undergo surgery (35.1% vs. 9.0%), and fewer patients chose breast conserving surgery than IDC patients (32.2% vs. 51.1%). Compared with IDC patients, NEC patients were more likely to choose chemotherapy (p=0.039) and more conservative in radiotherapy (p=0.000). The 66-month overall survival (OS) rate in NEC and IDC was 44.5% and 80.2% before PSM and was 49.8% and 71.4% after PSM, respectively. The 66-month breast cancer specific survival (BCSS) rate in NEC and IDC was 56.3% and 88.8% before PSM and was 54.1% and 80.5% after PSM, respectively. Finally, we identified independent prognostic factors, age, stage, pathological type, distant metastasis, chemotherapy, and molecular typing. Conclusions Breast NEC has distinct clinic pathological features and a significantly worse clinical outcome than common IDC.

Well-designed test patters are useful to investigate the integrity of gate dielectric, especially in advanced nano-node process technology with high-k Hf-based dielectric. Besides monitoring the growth of gate dielectric, the antenna effect coming from the back-end of line (BEOL) process or etch contribution can be detected through the demonstration of electrical performance of sub-threshold voltage, interface-state density, and gate leakage. Adopting the capacitance-voltage (C-V) and gate leakage measurement, the integrity of high-k gate dielectric with the assistance of fringe and area patterns can be reflected. This study mainly focused on gate dielectric on p-substrate with the electrical measurement. Through the data analysis, we also performed the performance comparison with various annealing temperature as nitridation treatment.

Spruce is the commonly-used tonewood for the top plate of violin-family instruments, such as violins and cellos. The wood properties can critically determine the acoustic quality. It’s been shown the wood of famous old instruments differ from modern ones due to chemical treatment and aging. To reveal the differences microscopically in both spatial and spectral domains, a two-photon hyperspectral system has been applied to investigate the autofluorescence and second harmonic generation within wood samples. Not only the cellular structures were observed through optical sectioning, but the spectral variations were revealed among different age wood samples and different cellular structures.

As a typical large rotary dual-drive device, three-car dumper is an essential and important equipment of raw materials storage and transport in the power, chemical industry, metallurgy, ports and other industries. It has some characters such as massive structure, heavy bearer, low-frequency running, frequent starting and braking and mechanical center of gravity which often shifts. The low-speed drive system has some working characteristics such as heavy loads, heavy shocks, low speed, poor working conditions, often breaking teeth and so on, so we propose a reverse design method for low-speed overloaded open gears through using design principles of reverse transformation. By using product reverse technology, we make the parameter design of low-speed and overloaded open gear pairs of Delafu dumper localization, so it extends the service life of gear pair and parts replacement period.

Background To analyze the causes and consequence of treatment refusal and abandonment in childhood acute lymphoblastic leukemia (ALL) treated in Wuhan Union Hospital of China. Methods We collected recorded data and interviewed families of the children with ALL diagnosed between January 1997 and August 2007, who refused or abandoned treatment. Results 323 patients were diagnosed with ALL. 173 patients (173/323, 53.6%) refused therapy and 35 (35/323, 10.8%) cases abandoned treatment. 191 (191/208, 91.8%) of these children were telephone/mail-visited. Different people had different reasons for refusal or abandonment. Financial difficulty and belief of ALL incurability were the main reasons for abandonment. Transportation difficulties and fear of severe side effects were also important reasons. Of the 173 patients who refused treatment, 13 patients lost follow-up. 160 parents were interviewed and 1 (6.3%) child was still alive at the date of last follow-up. Of the 35 patients who abandoned treatment, 4 patients lost follow-up. 31 parents were interviewed and 2 (6.5%) children were still alive at the date of last follow-up. Conclusion Medical insurance and a systemic health education are extremely required for childhood ALL in low middle income countries.

Primary carcinoma of the renal calyx is extremely rare. The present study reported nephron sparing endoscopic treatment for primary carcinoma of the renal calyx. An 81-year-old female presented with a 1-year history of intermittent painless gross hematuria. Computed tomography and X-ray of the urinary tract were unable to definitively identify any lesion. Flexible ureteroscopic examination revealed a tumor with epicenter in the lower calyx of the right kidney, with additional involvement around the calyx. Biopsies were obtained and pathology revealed low-grade urothelial carcinoma. Considering additional co-morbidities, the patient elected to undergo endoscopic management with thulium laser. The present report described the feasibility of flexible ureteroscopic thulium laser resection for the treatment of renal calyx carcinoma.

Aimed at the center fuzzy linear regression model with real input and fuzzy output, the model parameter estimation is discussed on data deletion of fuzzy decentring degree. Statistical diagnostic quantity is established to test outliers or strong influential points in the observed data. And the step is given to examine with the statistical diagnostic quantity. At last the example suggests that the method can improve the accuracy of the computational results effectively.

Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. The 5-year event-free survival (EFS) rate has improved greatly in recent years [1, 2]. But only 10 to 50% ALL received ...