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We study an M/M/1/K queue where customers can reschedule their appointments. Rescheduled customers show up with higher probabilities, incurring lower no-show costs, but rescheduling also frees up slots that may not be filled later, leading to wasted service capacity and lower throughput. The system manager aims to minimize the long-run average cost by controlling rescheduling policies. We derive conditions under which rescheduling should be allowed for different scenarios depending on whether customers can reschedule only once or multiple times.

BACKGROUND Various surgical procedures have been described for gastrointestinal stromal tumors (GISTs) at the esophagogastric junction (EGJ) close to the Z-line. However, surgery for EGJ-GIST involving Z-line has been rarely reported. AIM To introduce a novel technique called conformal resection (CR) for open resection of EGJ-GIST involving Z-line. METHODS In this retrospective study, 43 patients having GISTs involving Z-line were included. The perioperative outcomes of patients receiving CR (n = 18) was compared with that of proximal gastrectomy (PG) (n = 25). RESULTS CR was successfully performed in all the patients with negative microscopic margins. The mean operative time, time to first passage of flatus, and postoperative hospital stay was significantly shorter in the CR group (P < 0.05), while the intraoperative blood loss was similar in the two groups. The postoperative gastroesophageal reflux as diagnosed by esophageal 24-h pH monitoring and quality of life at 3 mo were significantly in favor of CR compared to PG (both P < 0.001). The 5-year disease-free survival between the two groups was similar (P = 0.163). The cut- off value for the determination of CR or PG was 7.0 mm above the Z-line (83.33% sensitivity, 84.00% specificity, 83.72% accuracy). CONCLUSION CR is safe and feasible for EGJ-GIST located within 7.0 mm above the Z-line.

Backgrounds Salivary biomarkers hold huge potential for the non-invasive diagnosis of oral squamous cell carcinoma. Angiogenic factors and matrix-metalloproteinases (MMPs) are highly expressed in OSCC tissue, but their expression patterns in the saliva are unknown. This study aimed to analyze the levels of angiogenic factors and MMPs in tumor tissue and saliva of OSCC patients. Methods OSCC-tissue, adjacent normal tissue (ANT), saliva from OSCC patients, and healthy controls were obtained. The expression patterns of angiogenic factors and MMPs were analyzed by immunohistochemistry, protein chip array, and RT-qPCR. Results Results showed higher expression of ANG, ANG-2, HGF, PIGF, VEGF, MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, MMP-10, MMP-13, TIMP-1, and TIMP-2 in OSCC-tissues compared to the ANT. Among the overexpressed markers in OSCC-tissues, HGF, VEGF, PIGF, PDGF-BB, MMP-1, MMP-3, MMP-8, MMP-9, MMP-10, MMP-13, and TIMP-2 were significantly upregulated in the saliva of OSCC patients compared to healthy controls. Conclusions The levels of HGF, VEGF, PIGF, MMP-1, MMP-3, MMP-8, MMP-9, MMP-10, MMP-13, and TIMP-2 were upregulated both in OSCC tissue and saliva of OSCC patients. Bioinformatic analysis revealed the correlation of these factors with patient survival and cancer functional states in head and neck cancer, indicating these factors as possible saliva-based non-invasive diagnostic/prognostic markers and therapeutic targets of OSCC.

Purpose Gastrointestinal stromal tumors (GISTs) are commonly known to be derived from the gastrointestinal (GI) tract, but recently there have been more and more literature describing lesions with similar pathological and immunohistochemical resembling GISTs but located outside the GI tract, and they have been termed as extra-GISTs (eGISTs). However, due to the rare incidence of eGISTs, its association with survival outcomes is poorly understood, especially in the Chinese population. Here, we aimed to identify the risk factors of eGISTs and to assess their association with overall survival (OS) and disease-free survival (DFS). Patients and methods Data of pathologically confirmed eGISTs cases, without radiological and perioperative evidence of other primary lesions, and with no microscopically identified adhesion between the tumor and the gastrointestinal serosa, which were surgically treated between January 2006 and September 2017 were retrieved from the database of four high-volume hospitals. Immunohistochemical and genetic testing were performed on the postoperative lesions and were staged using the National Institutes of Health (NIH) criteria. Results A total of 55 cases were retrieved. eGISTs were identified from the retroperitoneum (36.4%), mesocolon (25.5%), small bowel mesentery (12.7%), abdominopelvic cavity (12.7%), lesser omental sac (5.5%), ovary (3.6%), pancreatic capsule (1.8%), or urinary bladder (1.8%). Based on the NIH risk classification, majority of the lesion were classified as high risk (85.5%). KIT 11 was the most common mutation site (76.5%) and 25.0% of the cases were wild-type eGISTs. Multivariate analyses showed that tumor location and size were independent factors affecting prognoses. Patients with tumors in the retroperitoneum had significantly poorer OS and DFS as compared to those in the non-retroperitoneum (HR [95% CI] for OS and DFS: 2.546 [1.023-6.337] [P = 0.037] and 2.475 [0.975-6.273] [P = 0.049], respectively). Similar findings were found for tumors of size >15 cm, compared to ≤15 cm (HR [95% CI] for OS and DFS: 5.350 [2.022-14.156] [P Conclusion eGISTs were predominantly found from the retroperitoneum and mostly classified as high risk. Those located in the retroperitoneum and of size >15 cm had the poorer OS and DFS as compared to those in the non-retroperitoneum and of size

Objective: There are controversial indications for neoadjuvant chemotherapy (NAT) in the treatment of locally advanced gastric cancer (LAGC). Here, we aimed to identify indications for NAT based on pre-treatment clinicopathological and laboratory parameters. Methods: This study included a retrospective cohort of 1083 LAGC patients who had underwent radical D2 gastrectomy in the Cancer Hospital of China Medical University between 2012 and 2016. After propensity score matching, 756 patients were recruited and were separated into NAT (n=378) or primary surgery (PS) (n=378) groups. Cox regression identified pre-treatment risk factors for overall survival (OS). A nomogram was established to predict OS and calculate scores for risk factors. Recursive partitioning analysis (RPA) determined cut off values, where the entire patient cohort was divided into low and high risk groups. Results: Seven risk factors that were significantly related to OS were incorporated in the nomogram. These risk factors included age, tumor size, tumor site, carbohydrate antigen 199 (CA199), carcino-embryonic antigen (CEA), clinical T stage (cT) and clinical N stage (cN). The model contained a C-index of 0.637. The calibration curve revealed anticipated values that were reflective of actual values. The decision curve revealed an achievement of optimal clinical impact when threshold possibility was 0-54%. Next, the cohort was split into low (≤ 252 points) or high (> 252 points) risk groups based on the 5-year OS projected by RPA. The PS group showed a worse OS compared to the NAT group for high-risk patients (P =0.004). There was no significant difference when comparing OS between the PS and NAT groups for low-risk patients (P =0.407). Conclusions: A feasible, quantifiable and practical prognostic tool was generated to screen for potential survival benefits for patients receiving NAT. Surgeons can use this model to identify optimal treatment regimens for individualized treatment strategies during the diagnosis of LAGC patients. For these patients, NAT is suggested for high-risk patients.

Background The age thresholds for differentiating young and elderly patients are still under debate. This study aimed to evaluate the cut-off age for differentiating patients along with the prognostic value of age for operable gastric cancer (GC). Methods Patients diagnosed with resected gastric adenocarcinoma were identified from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database (training cohort and internal validation cohort) and Liaoning Cancer Hospital (external validation cohort). Kaplan-Meier plots were used to compare cancer-specific survival (CSS) across different age groups. Univariate and multivariate analysis was conducted using a Cox regression model. Predictive ability of the nomogram was determined by the Harrell’s concordance index (C-index), calibration curves, and Akaike’s Information Criterion (AIC). Results A total of 17,339 patients with GC were included. According to the univariate analysis results, CSS was similar among patients aged 20–69 years old, started to worsen for patients over the age of 70, and was the worst for patients older than 79 years in the training cohort. Thus, we further divided the age groups into 20–69, 70–79, and >79, and multivariate analysis showed that patients above 70 years of age had worse CSS. The nomogram was established based on the results of the multivariate analysis. The C-indexes for the training, internal, and external validation cohorts were 0.7531, 0.7344, and 0.7431, respectively. Conclusions This study showed that age had a relative predictive ability for CSS, 70 years should be the cut-off age, and age ≥70 years is an independent prognostic risk factor for GC patients who undergo surgery. These data highlight the importance of individualized treatment to improve the prognosis of patients with GC.

Objective. Primary duodenum lymphoma (PDL) is extremely rare with limited data available in the literature. In this study, we sought to describe clinical features and identify factors affecting survival in patients with PDL using a large population cohort. Methods. The Surveillance, Epidemiology, and End Results (SEER) database was queried from 1998 to 2015. Results. A total of 1060 cases of PDLs were identified. Clinicopathological features as well as survival data of PDLs were analyzed and compared with 10573 primary gastric lymphomas (PGLs) and 3239 primary small intestinal lymphomas (PSILs) from the SEER database. PDL patients were younger in age (60.96 ± 15.205), and the proportion of stage I (53.21%) was higher in Ann Arbor staging. The proportion of PDLs treated by surgery (8.68%) is the lowest among PDLs, PGLs, and PSILs. The DSS of PDLs were significantly better than those of PGLs and PSILs, respectively (10-year survival rate: 21.24% vs. 20.40%, P=0.027; 10-year survival rate: 21.24% vs. 16.79%, P=0.001). Age, gender, Ann Arbor staging, and histological type were regarded as independent prognostic factor for the DSS by multivariate analysis (all P<0.05). Patients with Conclusions. The clinicopathologic features of duodenal lymphoma were significantly different from those of gastric lymphoma and small intestinal lymphoma. The prognosis of PDLs was significantly better than those of the other two groups, and there was no statistical survival benefit from surgery in PDLs.

Transformer shielding techniques are widely applied to suppress common-mode (CM) noise. As an important shielding method, winding shielding gains lots of attention because of its convenience and cost effectiveness. For suppressing CM noise effectively, the number of shielding winding turns should be carefully decided. This paper proposes a design method of the number of transformer shielding winding turns for minimizing low-frequency CM noise in flyback converters. This is realized through exploring the relation between low-frequency CM current and the number of shielding winding turns. With this method, the optimal number of shielding winding turns can be obtained without calculation and comparison of CM currents in converters with different shielding winding turns. By comparing CM noise measurement results, the proposed method is validated. The proposed method can be a guideline on the design of transformer shielding winding.

Given that collaborative representation (CR) methods have achieved great success in traditional single image based classification, recently, researchers have exploited the mechanism of collaborative representation to handle the case of image set based classification problem. However, without considering a proper criterion for feature extraction, this extension of collaborative representation mechanism suffers from the misleading coefficients of the incorrect classes on the uncontrolled datasets with small class separability. To address this limitation, inspired by large margin principle in discriminative analysis that aims to separately exploit the inter-class and intra-class variability, this paper proposes a novel theoretical framework of set oriented multiple kernel learning for dimensionality reduction based on collaborative representation classification. To achieve this framework, we integrate the learning of an optimal kernel from the multiple base kernels and a discriminative projection into a unified formulation. Moreover, robust feature information can be effectively extracted by minimizing the intra-class reconstruction residual and maximizing the inter-class reconstruction residual of the regularized hull modeled for the image sets. Since the criterion of feature extraction conforms to the mechanism of the collaborative representation classifier, the collaborative representation coefficients in our model can be much discriminative across classes. Notably, this research has important theoretical significance in improving the classification performance for collaborative representation classifier from the perspective of large margin discriminative learning. By employing the method of trace ratio maximization, we also develop a framework to solve the resulting nonconvex optimization problem efficiently. Extensive experiments on benchmark datasets well demonstrate the effectiveness of the proposed method.

BackgroundThe validity of lymphadenectomy of the lymph node along the superior mesenteric vein (LN14v) in gastric cancer remains controversial. The study investigated the characteristics and prognosis of gastric cancer with metastasis or micrometastasis to LN14v.MethodsA retrospective study of 626 patients undergoing radical gastrectomy in our center from January 2003 to December 2015 was analyzed. In total, 303 patients had lymphadenectomy of LN14v, and lymph node micrometastasis was evaluated by immunohistochemical staining for cytokeratin nodes CK8/18. A logistic regression model was applied to confirm the predictive factors of micrometastasis. Survival analysis was performed to evaluate the effect of micrometastasis or metastasis on prognosis.ResultsThe metastatic rate of the LN14v lymph node was 15.8%, and the micrometastatic rate was 3.3%. Multivariate analysis showed site, Borrmann classification, postoperative lymph node metastasis (pN), and metastasis in LN6 and LN9 were predictive factors for LN14v micrometastasis or metastasis (P < 0.05). The 5-year survival rate in the positive group (LN14v micrometastasis or metastasis) was 12.4%. The prognosis of patients without LN14v lymph node micrometastasis was better than that of the positive group, whereas the difference between group of LN14v micrometastasis and LN14v metastasis was not obvious. In matched analysis, patients with stage III gastric cancer L/M area, pN2-3, and LN6(+) who underwent lymphadenectomy of LN14v had better survival than those without lymphadenectomy of LN14v.ConclusionLymph node micrometastasis may provide accurate prognostic information for patients with gastric cancer. Moreover, lymphadenectomy of LN14v might improve the survival of patients with stage III gastric cancer of L/M area, pN2-3, and LN6(+).

Sepsis-3 Definition Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. The clinical criteria of sepsis include organ dysfunction, which is defined as an increase of two points or more on the sequential organ failure assessment (SOFA). For patients with infection, an increase of 2 SOFA points yields an overall mortality rate of 10%. Patients with suspected infection who are likely to have a prolonged intensive care unit (ICU) stay or to have in-hospital mortality can be promptly identified at the bedside with a quick SOFA (qSOFA) score of 2 or higher. Importance The sepsis-3 criteria have emphasized the value of a change of two or more points on the SOFA, introduced the qSOFA, and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition. Objective To externally validate and assess the discriminatory capacities of an increase in the SOFA score by two or more points, the presence of two or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes in 5109 patients, the vast majority of whom were postcardiac surgery patients who were admitted to a Cardiothoracic Surgical ICU in Singapore. Design, Setting, and Participants A retrospective cohort analysis of 5109 patients with an infection-related primary admission diagnosis in the cardiothoracic intensive care unit (CTICU) at the National University Hospital (NUH) in Singapore from 2010 to 2016. Exposures The SOFA, qSOFA, and SIRS criteria were applied to the data representing the worst condition within 24 hours of ICU admission. Main Outcomes and Measures The primary outcome was in-hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). Results In 5109 patients, the average mortality of patients with an increase in the SOFA scores of less than 2 points was 3.5% (n = 64), and it was 6% (n = 199) for those with an increase in the SOFA scores of 2 or more points. The mortality of patients with an increase in the qSOFA scores of less than 2 points was 2.6% (n = 7), and it was 5.3% (n = 256) for those with an increase in the qSOFA scores of 2 or more points. The mortality of patients with an increase in the SIRS criteria of less than 2 points was 3.6% (n = 30), and it was 5.4% (n = 233) for those with an increase in the SIRS criteria of 2 or more points. The AUROC of in-hospital mortality of patients with an increase in the SOFA, qSOFA, and SIRS criteria of 2 or more points was 0.96, 0.95, and 0.95, respectively. Conclusions and Relevance In adults with suspected infection admitted to the CTICU in NUH, the change in in-hospital mortality between patients with an increase in SOFA scores of less than 2 and those with an increase of 2 or more was 2.5 percentage points. In contrast to other studies, the absolute change in mortality was nearly the same compared to the qSOFA and SIRS criteria, and the qSOFA score had the greatest percentage increase of 104%, compared to 71% for the SOFA score and 50% for the SIRS criteria. Besides, from the perspective of discriminatory capacities, an increase in SOFA scores of 2 or more did not demonstrate significantly greater prognostic accuracy for in-hospital mortality than equivalent increases in qSOFA scores or SIRS criteria. These findings suggest distinctive characteristics of the study population in the CTICU that are different from the general population.

We study the effects of rescheduling on no-show behavior in an outpatient appointment system for both new and follow-up patients. Previous literature has primarily focused on new patients and investigated the role of waiting time on no-show probability. We offer a more nuanced understanding of this costly phenomenon. Using comprehensive clinical data, we demonstrate that for follow-up patients, their no-show probability decreases by 10.9 percentage points if their appointments were rescheduled at their own request, but increases by 6.2 percentage points if they were rescheduled by the clinic. New patients, in contrast, are less sensitive to who initiates rescheduling. Their no-show probability decreases by 2.3 percentage points if their appointments were rescheduled at their own request, and increases by 3.2 percentage points—but is statistically insignificant at the 10% level—if they were rescheduled by the clinic. New patients are more concerned about waiting time compared with follow-up patients. For patients whose appointments were not rescheduled, new patients’ no-show probability decreases by 1.3 percentage points if their waiting time is reduced by one week, but the waiting time has a small and statistically insignificant effect on follow-up patients’ no-show probability. Using data-driven simulation, we conduct counterfactual investigation of the impact of allowing active rescheduling on the performance of appointment systems. In particular, allowing the flexibility of patient rescheduling can reduce the overall no-show rate and increase system utilization, but at a cost of increased wait time for new patients. If patients are able to reschedule at least one week in advance, new patients’ wait time is largely reduced, whereas the no-show rate remains the same; this is equivalent to the effect of a 5% increase in the clinic’s capacity.

Background Extubation is a critical step in the intensive care unit (ICU). In this study, we aim to investigate the risk factors for both extubation failure and deterioration with further mechanical ventilation (MV). Methods Data were collected from a cardiothoracic ICU in a tertiary hospital. The risk factors for extubation failure and deterioration with further MV were investigated by multivariate logistic regression. Results A total of 676 patients were enrolled in the study. Patients with extubation failure had a longer ICU length of stay and a higher mortality rate than patients without extubation failure. An age greater than 65 years, abnormal heart rate, respiratory rate exceeding 20 times/min, arterial pH lower than 7.35, pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio lower than 300 mmHg, mean arterial pressure lower than 70 mmHg, duration of MV longer than 12 hours, and high quick Sequential Organ Failure Assessment (qSOFA) score were independent risk factors for extubation failure. Furthermore, we found that a respiratory rate greater than 20 times/min and a PaO2/fraction of Inspired Oxygen FiO2 ratio less than 300 mmHg were protective factors, while a mean arterial pressure lower than 70 mmHg, arterial pH lower than 7.35, and high qSOFA score were risk factors for deterioration on continued MV. Conclusions Since the duration of MV increases the risk of extubation failure, physicians should consider not only the risk of extubation failure but also the risk of deterioration with further MV.

The MAGIC trial has shown perioperative chemotherapy does significantly improve overall survival of patients with gastric and esophagogastric junction carcinoma. The approach to evaluate the effectiveness of adjuvant chemotherapy is urgent in clinical practice. Totally, 264 patients with locally advanced gastric carcinoma (including esophagogastric junction carcinoma) treaded by perioperiate chemotherapy (SOX or XELOX) from May 2012 to December 2017 in our cancer center were included. Tumor response was evaluated by tumor regression grade (TRG, Mandard system) and Response Evaluation Criteria in Solid Tumor (RECIST v1.1). The clinical characteristics and the effect on survival were analyzed. Univariate analysis showed TRG was correlated to tumor size, Lauren classification, grade of differentiation, histological type, postsurgical T category (ypT), postsurgical N category (ypN), vascular invasion or lymphatic invasion and so on. However, only Lauren classification and ypT were independent factors for TRG. On contrary to RECIST, TRG was founded to be a prognostic factor for DFS and OS on univariate analysis. Cox proportional hazards were established to evaluate the relationship among TRG, clinical-pathological factors and survival. On multivariate analysis, the chemotherapy cycle, Lauren classification, vascular invasion or lymphatic invasion, ypN and postsurgical pathologic stage were independent factors for OS and DFS, while TRG were negatively correlated to survival. TRG seems to be a promising prognostic indicator and it predicts the prognosis of patients with locally advanced gastric cancer after adjuvant chemotherapy more reasonably in comparisons to RECIST v1.1.

In recent years, collaborative representation-based classification (CRC) methods have shown impressive performance in many recognition tasks. However, when the training data have different distributions with the testing data, the performance of CRC will be degraded significantly. On the other hand, concatenating training data from different sources as a single data set will affect the performance of CRC, as the shift exists between the different source domains. To address these problems, in this paper, we propose a Jointly Discriminative projection and Dictionary learning for domain adaptive Collaborative Representation-based Classification method (JD2-CRC). As the distributions of different source domains may be dissimilar, the data from all domains are projected into a common feature subspace where the latent shared structures can be found. Then a compact dictionary is learned to represent the projected data well. To find the most suitable projection matrices and dictionary for CRC, we design the objective function of JD2-CRC,according to the classification rule of CRC in feature subspace, which minimizes the ratio of within-class reconstruction errors over between-class reconstruction errors. Different to traditional optimization methods, an effective optimization procedure is presented based on gradient descent. Thus, the obtained collaborative representations have a better discriminability and suit the classification rule of CRC well. The experimental results demonstrate that the proposed method can achieve superior performance against other state-of-the-art methods.

The purpose of this study was to explore the differences between stage T2N0M0 and stage T1N1M0 gastric cancer (GC) and to identify the necessity of adjuvant treatment (AT) for these stages. Between years 2004 and 2015, 1971 stage IB GC patients who underwent radical surgery were recruited using the Surveillance, Epidemiology and End Results database. We conducted univariate/multivariate analyses, the propensity score matching and evaluated gastric cancer-specific survival (GCSS) and overall survival (OS) with the log-rank test. T1N1M0 had a significantly worse survival than T2N0M0 in both GCSS and OS before and after the propensity score matching. Examined lymph nodes (ELN) ≤ 15 and T1N1M0 were independent risk factors for worse GCSS and OS in stage IB GC. The absence of adjuvant chemotherapy (CT) was an independent risk factor for worse GCSS and OS in T1N1M0 but not in T2N0M0. AT demonstrated similar GCSS and OS with surgery alone (SA) for T2N0M0 but better survival for T1N1M0. Compared to CT and adjuvant chemoradiotherapy (CRT) group, SA demonstrated significantly worse GCSS and OS for T1N1M0. There was no significant difference between CT and CRT in both T2N0M0 and T1N1M0 stages. T2N0M0 had a better survival than T1N1M0 in ELN ≤ 15 subgroup. However, similar survival was demonstrated in ELN > 15 subgroup. T2N0M0 GC has a better survival rate than T1N1M0 GC when ELN are ≤ 15. Moreover, T2N0M0 GC may not benefit from AT. T1N1M0 GC requires CT but not adjuvant radiotherapy.

We constructed a prognostic risk model for colon adenocarcinoma (COAD) using microRNAs (miRNAs) as biomarkers. Clinical data of patients with COADs and miRNA-seq data were from TCGA, and the differential expression of miRNAs (carcinoma vs. para-carcinoma tissues) was assessed using R software. COAD data were randomly divided into Training and Testing Sets. A linear prognostic risk model was constructed using Cox regression analysis based on the Training Set. Patients were classified as high-risk or low-risk according to the score of the prognostic model. Survival analysis and receiver operating characteristic (ROC) curves were used to evaluate model performance. The gene targets in the prognostic model were identified and their biological functions were analyzed. Analysis of COAD and normal cell lines using qPCR was used to verify the model. There were 134 up-regulated and 140 down-regulated miRNAs. We used the Training Set to develop a prognostic model based on the expression of seven miRNAs. ROC analysis indicated this model had acceptable prediction accuracy (area under the curve=0.784). Kaplan-Meier survival analysis showed that overall survival was worse in the high-risk group. Cox regression analysis showed that the 7-miRNA Risk Score was an independent prognostic factor. The 2,863 predicted target genes were mainly enriched in the MAPK, PI3K-AKT, proteoglycans in cancer, and mTOR signaling pathways. For unknown reasons, expression of these miRNAs in cancerous and normal cells differed somewhat from model predictions. Regardless, the 7-miRNA Risk Score can be used to predict COAD prognosis and may help to guide clinical treatment.

Background Curing locally advanced gastric cancer through surgery alone is difficult. Adjuvant and neoadjuvant chemotherapy bring potential benefits to more patients with gastric cancer based on several clinical trials. According to phase II studies and guidelines, SOX regimen as neoadjuvant chemotherapy is efficient. However, the optimal duration of neoadjuvant chemotherapy has not been established. In this study, we will evaluate the efficacy and safety of different cycles of SOX as neoadjuvant chemotherapy for patients with locally advanced gastric cancer. Methods RESONANCE-II trial is a prospective, multicenter, randomized, controlled phase III study which will enroll 524 patients in total. Eligible patients will be registered, pre-enrolled and receive three cycles of SOX, after which tumor response evaluations will be carried out. Those who show stable disease or progressive disease will be excluded. Patients showing complete response or partial response will be enrolled and assigned into either group A for another three cycles of SOX (six cycles in total) followed by D2 surgery; or group B for D2 surgery (three cycles in total). The primary endpoint is the rate of pathological complete response and the secondary endpoints are R0 resection rate, three-year disease-free survival, five-year overall survival, and safety. Discussion This study is the first phase III randomized trial to compare the cycles of neoadjuvant chemotherapy using SOX for resectable locally advanced cancer. Based on a total of six to eight cycles of perioperative chemotherapy usually applied in locally advanced gastric cancer, patients in group A can be considered to have completed all perioperative chemotherapy, the results of which may suggest the feasibility of using chemotherapy only before surgery in gastric cancer. Trial registration Registered prospectively in the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) with registration number ChiCTR1900023293 on May 21st, 2019.

Background Infantile hepatic hemangiomas (IHHs) are the most common liver tumor in infancy. And they have proved to lead to cardiac insufficiency and consumptive hypothyroidism. Case presentation A two-month-old girl had two purple skin lesions. An abdominal ultrasound and MRI showed multiple hypoechoic lesions in the liver. Her TSH level was over 150.00 μIU/mL and Thyroglobulin (TG) was over 500 ng/ml. She was diagnosed with hypothyroidism and IHHs. The levothyroxine was started at 50 μg/d for hypothyroidism and propranolol was started at 0.5 mg/kg/d for IHHs. But she suffered cardiac insufficiency when her thyroid function was still abnormal. Propranolol was stopped and the levothyroxine was increased to 100 μg/d as a treatment. Two weeks later, The baby's cardiac insufficiency improved. Conclusion Consumptive hypothyroidism can cause cardiac insufficiency. A normal thyroid function is important for patients with IHHs, especially those with heart failure. The dosage of propranolol should be increased more slowly. High TG levels can help to distinguish consumptive hypothyroidism from congenital hypothyroidism.

Acute kidney injury (AKI) is a frequent complication of cardiac surgery, which can lead to higher mortality and long-term renal function impairment. The effect of perioperative renin-angiotensin system inhibitors (RASi) therapy on AKI incidence in patients undergoing cardiac surgery remains controversial. We reviewed related studies in PubMed, Scopus, and Cochrane Library from inception to February 2020. Two randomized controlled trials and 21 cohort studies were included in the meta-analysis, involving 76,321 participants. The pooled odds ratio and 95% confidence interval were calculated using the DerSimonian and Laird random-effects model. The results showed no significant association between perioperative RASi therapy and postoperative AKI in patients undergoing cardiac surgery. We highlighted the limitations of existing studies and called for well-designed large-scale randomized controlled trials to verify the conclusion.

Background: Totally laparoscopic gastrectomy (TLG) has recently been accepted as a treatment strategy for gastric cancer (GC). Aim: In this study, we conducted a meta-analysis to evaluate the safet...

Objective: The benefit of adjuvant therapy (AT) remains controversial in stage IB gastric cancer (GC). This study aimed to offer a reference for the rational indications of AT. Methods: We retrospectively included 1216 stage IB GC who experienced curative surgery from the SEER database between 2004 and 2015. These patients were allocated into two groups: Group AT and Group surgery alone (Group SA). We established a nomogram to predict OS and then divided whole cohort into low-risk and high-risk groups based on the OS predicted by the nomogram. Results: Six variables, which were significantly related with OS of entire patients after matched, were incorporated in the nomogram. These variables were age, examined lymph nodes, tumor site, marital, family income and stage IB. The C-index of the model was 0.637 and the calibration curve showed that the anticipated values were in accordance with the actual values. The decision curve demonstrated that the optimal clinical impact was achieved when the threshold possibility was 0–56%. Then, the entire cohort was separated into low-risk (≤159 points) as well as high-risk (>159 points) groups based on the projected 5-year OS of recursive partitioning analysis. Group SA revealed a significantly poorer OS than Group AT for high-risk patients (p < .001); on the other hand, there was a comparable OS for low-risk patients (p = .361). Conclusions: We have developed an effective, intuitional and applied prognostic tool to clinical decision-making. For stage IB GC after surgical resection, AT was only recommended for high-risk patients. However, AT may be dispensable for low-risk patients.

Collaborative representation-based classifier (CRC) has achieved superior classification performance in the field of face recognition. However, the performance of CRC will degrade significantly when facing non-linear structural data. To address this problem, many kernel CRC (KCRC) methods have been proposed. These methods usually use a predetermined kernel function which is difficult to be selected. In addition, how to select appropriate parameters remains a challenging problem. Hence, multiple kernel technology (MKL) is applied on CRC, which called MK-CRC. However, it only considers the representation errors while ignoring the class label information in the training process. In this paper, we propose a multiple kernel locality-constrained collaborative representation-based classifier (MKLCRC) which is the multiple kernel extension of CRC and considers the local structures of data. Based on the classification rule of MKLCRC, we propose a dimensionality reduction (DR) method called multiple kernel locality-constrained collaborative representation-based discriminant projection (MKLCR-DP). The goal of MKLCR-DP is to learn a projection matrix and a set of kernel weights to generate a low-dimensional subspace where the between-class reconstruction errors are maximized and the within-class reconstruction errors are minimized. Thus MKLCRC can achieve better performance in this low-dimensional subspace. The proposed method can be efficiently optimized with the trace ratio optimization. Experiments on AR, extended Yale B, FERET, CMU PIE and LFW face databases demonstrate that our method outperforms related state-of-the-art algorithms.

Aim: Patient-Generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening 2002 (NRS2002) are used to evaluate patients’ nutritional status. Materials & methods: The data of 114 gastric cancer patients with pyloric obstruction treated between July 2016 and July 2017 were assessed retrospectively. Results: Based on clinical evaluation, 70.1% had malnutrition, with 61.4% at nutritional risk by NRS2002 and 66.7% by PG-SGA. The area under the receiver operating characteristic curve was 0.858 for PG-SGA and 0.706 for NRS2002. Sensitivity and specificity were 89 and 85% for PG-SGA and 78 and 76% for NRS2002. In both assessments, patients at risk showed more postoperative complications. Conclusion: PG-SGA was more suitable for evaluating the preoperative nutritional status of gastric cancer patients with pyloric obstruction, with higher diagnostic efficacy.

The homework tidiness assessment aims to auto evaluate the writing tidiness of homework, playing an important role in daily teaching. However, there is still no comprehensive basis for homework tidiness assessment. For this, a benchmark for homework tidiness assessment (HTA) is proposed. Firstly, a database named HTA 1.0 containing 1000 homework images is collected. Each image is manually annotated by multiple volunteers. Secondly, a comprehensive evaluation protocol is designed, using mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE) and accuracy (Acc) as performance indicators. Finally, three deep learning models (i.e., LeNet, AlexNet and VGGNet) are applied as baseline methods and the results are reported and analyzed.

The purpose of this study is to determine the efficacy of adjuvant immunotherapy with autologous cytokine-induced killer (CIK) for postoperative patients with gastric cancer and to investigate the impacts of the predictors on the efficacy of CIK immunotherapy. Ninety-two gastric cancer patients who have accepted radical resection were enrolled. The CIK and control groups were established by 1:1 matching on their baseline. As prognosis indicators, preoperative blood cell counts, the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were analyzed, respectively. Statistical analyses were done using IBM SPSS Statistics ver.19.0. CIK treatment significantly prolonged disease-free survival (DFS) (p

This paper is motivated by the following question: How to construct good approximation for the distribution of the solution value to linear optimization problem when the random objective coefficients follow a multivariate normal distribution? Using Stein’s Identity, we show that the least squares normal approximation of the random optimal value can be computed by estimating the persistency values of the corresponding optimization problem. We further extend our method to construct a least squares quadratic estimator to improve the accuracy of the approximation; in particular, to capture the skewness of the objective. Computational studies show that the new approach provides more accurate estimates of the distributions of project completion times compared to existing methods.

Lowe syndrome is an x-linked disorder characterized by congenital cataracts, nervous system abnormalities and renal tubular dysfunction. With the rising number of reported cases, more patients are found to suffer from endocrine abnormalities. Hereby, three Chinese patients with typical symptoms and extremely short stature were described. The

Gastric cancer (GC) is the most common and aggressive cancer of the digestive system and poses a serious threat to human health. Since genes do not work alone, our aim was to elucidate the potential network of mRNAs and noncoding RNAs (ncRNAs) in this study. Transcriptome data of GC were obtained from TCGA. R and Perl were used to obtain the differentially expressed RNAs and construct a competing endogenous RNA (ceRNA) regulatory network. To investigate the biological functions of differentially expressed RNAs, loss-of-function and gain-of-function experiments were performed. Real-time PCR (RT-qPCR), western blot analysis, dual-luciferase reporter assays and fluorescence in situ hybridization were conducted to explore the underlying mechanisms of competitive endogenous RNAs (ceRNAs). Based on TCGA data and bioinformatics analysis, we identified the LINC00163/miR-183/A-Kinase Anchoring Protein 12 (AKAP12) axis. We observed that AKAP12 was weakly expressed in GC and suppressed invasion and metastasis in GC cells, which could be abolished by miR-183. In addition, LINC00163 can be used as a ceRNA to inhibit the expression of miR-183, thus enhancing the anticancer effect of AKAP12. Our results demonstrated that weak LINC00163 expression in GC can sponge miR-183 to promote AKAP12. We established that the LINC00163/miR-183/AKAP12 axis plays an important role in GC invasion and metastasis and may be a potential biomarker and target for GC treatment.

Weaning patients from mechanical ventilators is a critical decision in intensive care units (ICUs), especially during the COVID-19 pandemic. In this study, we aim to improve the extubation decision for ventilated patients by exploiting data analytics and predictive information. We develop a discrete-time, finite-horizon Markov decision process (MDP) with predictions on future information to support the extubation decision. We characterize the structure of the optimal policy and provide important insights into how predictive information can lead to different decision protocols. Using a comprehensive data set from an ICU in a tertiary hospital in Singapore, we compare the performance of different policies and demonstrate that incorporating predictive information can reduce ICU length of stay (LOS) by up to 9.4% and, simultaneously, decrease the failure rate of ventilated patients by up to 18.9%. The benefits are more significant for patients with poor initial conditions. Furthermore, simply optimizing LOS using a classical MDP model without incorporating predictive information leads to an increased failure rate of ventilated patients by up to 6%. Using publicly available data on critical COVID-19 patients, we show that applying the extubation protocols using predictive information can improve ICU throughput by up to 9.0%.

Collaborative Representation-based Classifier (CRC) has shown its advantages and impressive results in face recognition. To further imporve the performance of CRC, we propose a novel dimensionality reduction method termed Multiple Discriminant Analysis for Collaborative Representation-based Classification (MDA-CRC). Considering the labeling criterion of CRC is class-specific, MDA-CRC solves a group of binary classification problems where specific feature subspaces are learned for each class. In each binary classification problem, an orthogonal discriminant analysis method based on collaborative representation is adopted. Hence, MDA-CRC can improve the discriminant ability of collaborative representation and be consistent with the labeling criterion of CRC simultaneously. Further, the convergence of MDA-CRC is proven. Extensive experiments on several benchmark datasets demonstrate the effectiveness of MDA-CRC.

Grouped studs are typically used in composite bridges built with prefabricated concrete decks. However, the dense distribution of the grouped studs in areas of high shear makes the prefabrication and placement of a concrete deck difficult, and the small walking space on the top flanges raises safety concerns for construction workers. To further simplify the construction details of composite bridges made of prefabricated concrete decks, this study proposed a novel bearing-shear (B-S) connector with a compact structure and an ideal elastic–plastic load-slip curve. To verify the mechanical properties of the B-S connectors, five groups of fifteen push-out specimens were introduced. The test results indicated that: the shear capacity of a single B-S connector exceeds 1180 kN, which is close to nine studs with a diameter of 19 mm, and the required area of reserved holes in prefabricated decks is approximately 1/3 of that required for grouped studs with the same shear capacity. The B-S connectors exhibited high shear stiffness and almost no cracks in the elastic stage. Finite element analysis results showed that the stress concentration of the B-S connector was less than that of grouped studs in the elastic stage. The ultimate slip S0.9 varied between 17.2 mm and 35 mm, which is larger than the 6 mm requirement for plastic design in Eurocode 4. Finally, the shear capacity of the B-S connector was predicted fairly well by the proposed formulae.

307 Background: Although gastric cancer (GC) is a leading cause of cancer-related death in China, important questions about optimal management remain unanswered. The EVIDENCE registry study evaluated data from patients with GC in China to assess the pattern of treatments and long-term clinical outcomes. Methods: Five cohorts of patients with different HER2 and metastatic (m) status were evaluated from April 2013 to June 2018 in this prospective, multicenter, non-interventional, real-world study. Data from patients with operable non-mGC are reported: Cohort III (HER2+) and Cohort V (HER2−). Outcome measures included overall survival (OS), event-free survival (EFS), and disease-free survival (DFS). Results: Cohorts III/V included 758 patients (Cohort III, 271; Cohort V, 487); 75.5% were male and the mean age was 58.8 years. The majority of Cohort III/V patients (538/758; 71.0%) received only adjuvant treatment, with 215/758 (28.4%) receiving S1+oxaliplatin. Neoadjuvant or adjuvant trastuzumab was administered to 43/758 patients (Cohort III, 42; Cohort V, 1). Radiation during neoadjuvant or adjuvant treatment was administered to 23/758 (3.0%) patients. The median duration of follow-up was 515 days, during which 72 (9.5%) patients died due to progressive disease. OS rates (95% CI) for Cohorts III and V were 94% (89–96) and 95% (92–97) at 1 year, and 76% (67–83) and 70% (64–75) at 3 years, respectively. Respective EFS rates were 82% (76–87) and 86% (83–89) at 1 year, and 62% (53–70) and 57% (51–63) at 3 years; and respective DFS rates were 88% (82–93) and 86% (81–89) at 1 year and 69% (58–78) and 62% (55–68) at 3 years. Multivariate analysis indicated that the primary tumor site (p = 0.004) and overall cancer stage (p < 0.001) were associated with DFS. Regarding the primary tumor site, there was a trend towards better DFS for antrum tumors (hazard ratio 0.59; 95% CI 0.32–1.07) when evaluated against gastroesophageal junction tumors. Conclusions: This longitudinal analysis of clinicopathologic characteristics and outcomes of Chinese patients with non-mGC will provide critical information that will help to inform disease management. Clinical trial information: NCT01839500.

Hypoxia is an indispensable factor in the progression of metastasis. Hypoxia inducible factor-1α (HIF-1α), the core element in generating the hypoxia response, induces invasion and metastasis by promoting epithelial–mesenchymal transition (EMT). This study explored the underlying mechanism of hypoxia associated with the invasion and metastasis of gastric cancer (GC). Six methods were employed to assess the function of the long noncoding RNA (lncRNA) prostate cancer gene expression marker 1 (PCGEM1) including gene silencing, RT-PCR, the separation of nuclear and cytoplasmic fractions, scrape motility assay, transwell migration assay, and Western-blot. LncRNA PCGEM1 was overexpressed in GC cells and tissues, and was induced by hypoxia in GC cells. Additional experiments confirmed that the knockdown of PCGEM1 significantly repressed the invasion and metastasis of GC cells. SNAI1, a key transcription factor of EMT, was regulated by PCGEM1. Overexpression of SNAI1 rescued the inhibition of PCGEM1-knockdown during the invasion and metastasis of GC cells. In addition, PCGEM1 and SNAI1 jointly affected the biomarkers of EMT. Our findings indicated that PCGEM1 is a hypoxia-responsive lncRNA, and contributes to the invasion and metastasis of GC. The potential mechanism is attributed to the regulation of EMT by PCGEM1 and its influence on the expression of SNAI1.

Shielding techniques are widely applied in suppression of near electric field interference from power converters, so as to enhance their electromagnetic compatibility (EMC) performance. However, sometimes traditional shielding method cannot effectively suppress the electromagnetic interference (EMI) in the full frequency range. In order to make a power converter meet the limit requirement of EMC standard, this paper proposes an improved non-ideal electric field shielding method to balance the suppression effects of the low frequency and high frequency interference. A resistor with appropriate resistance is connected between the shielding layer and the reference ground so as to balance the suppression effect of the high frequency and the low frequency interference. The EMI measurement results show that the power converter with improved shielding method had good EMC performance.

Background: Neoadjuvant chemoradiation (CRT) remains controversial in the treatment of the oesophagus or gastro-oesophageal junction (GOJ) carcinomas. Methods: We conducted a meta-analysis to assess the efficacy and safety of Neoadjuvant CRT plus surgery comparing with neoadjuvant CT plus surgery or surgery alone. Feasible studies were searched from electronic databases. The outcomes of survival, R0 resection rate and adverse effects were analyzed. The outcomes were measured with relative risk (RR) and odds ratio(OR). Results: Seventeen records including 4095 patients were included. Neoadjuvant CRT improved 1-,2-,3-and 5-year survival. The relative risk (RR) [95% confidence interval (CI),P value] was respectively 1.08(1.03-1.14,0.002), 1.21(1.12-1.32

The development of a successful vaccine, which should elicit a combination of humoral and cellular responses to control or prevent infections, is the first step in protecting against infectious diseases. A vaccine may protect against bacterial, fungal, parasitic, or viral infections in animal models, but to be effective in humans there are some issues that should be considered, such as the adjuvant, the route of vaccination, and the antigen-carrier system. While almost all licensed vaccines are injected such that inoculation is by far the most commonly used method, injection has several potential disadvantages, including pain, cross contamination, needlestick injury, under- or overdosing, and increased cost. It is also problematic for patients from rural areas of developing countries, who must travel to a hospital for vaccine administration. Noninvasive immunizations, including oral, intranasal, and transcutaneous administration of vaccines, can reduce or eliminate pain, reduce the cost of vaccinations, and increase their safety. Several preclinical and clinical studies as well as experience with licensed vaccines have demonstrated that noninvasive vaccine immunization activates cellular and humoral immunity, which protect against pathogen infections. Here we review the development of noninvasive immunization with vaccines based on live attenuated virus, recombinant adenovirus, inactivated virus, viral subunits, virus-like particles, DNA, RNA, and antigen expression in rice in preclinical and clinical studies. We predict that noninvasive vaccine administration will be more widely applied in the clinic in the near future. © 2018, © 2018 The Author(s). Published with license by Taylor and Francis. © 2018, © Zhichao Zheng, Diana Diaz-Arévalo, Hongbing Guan, and Mingtao Zeng.

Human epidermal growth factor receptor 2 (HER2) plays an important role in the aggressiveness and progression of gastric cancer. With the publication of trial results, we conducted a meta-analysis to investigate its prognostic significance for patients with gastric cancer. PubMed, Ovid, Web of Science, and Cochrane databases were searched. Statistical analysis was carried out by STATA version 12.0 software. The Newcastle-Ottawa scale was used to assess the quality of evidence. Fifteen studies involving 5,290 patients met the inclusion criteria. The results showed that HER2 overexpression was significantly associated with patients' overall survival (HR = 1.56, 95% confidence interval (CI) 1.05-2.07; Z = 6.03; P = 0.000). The results also suggested that HER2 overexpression was associated with Bormann type (odds ratio (OR) = 1.76, 95% CI 1.19-2.59; Z = 2.85; P = 0.004), tumor differentiation (OR = 3.14, 95% CI 1.91-5.17; Z = 4.49; P = 0.000), Lauren's classification (OR = 6.25, 95% CI 4.29-9.10; Z = 9.54; P = 0.000), lymph node metastasis (OR = 1.43, 95% CI 1.15-1.77; Z = 3.23; P = 0.001), venous invasion (OR = 1.69, 95% CI 1.15-2.48; Z = 2.67; P = 0.008), and lymphovascular invasion (OR = 1.57, 95% CI 1.21-2.04; Z = 3.4; P = 0.001). However, it had no correlation with tumor size, depth of invasion, and tumor stage. This study showed that HER2 overexpression had an unfavorable prognostic role for patients with gastric cancer. HER2-positive expression was associated with Bormann type, Lauren's classification, tumor differentiation, lymph node status, venous invasion, and lymphovascular invasion.

Previous studies suggested glutathione S-transferase T1 (GSTT1) null genotype might be a candidate genetic polymorphism with a role in the susceptibility to gastric cancer, but studies form Chinese population reported controversial findings. Thus, a meta-analysis was performed to clarify the effect of GSTT1 null genotype on gastric cancer risk in Chinese population. Eligible studies were searched in Medline, Embase, and China National Knowledge Infrastructure databases. Between-study heterogeneity was assessed using the I (2) statistic. Odds ratios (OR) with the corresponding 95 % confidence intervals (95 % CI) were pooled to assess the association. Twenty case-control studies involving a total of 3,204 gastric cancer cases and 5,462 controls were finally included in the meta-analysis. Meta-analysis of all 20 studies showed that GSTT1 null genotype was associated with an elevated risk of gastric cancer in Chinese population (OR=1.26, 95 % CI 1.09-1.46, P OR=0.002). The cumulative meta-analysis showed a trend of a more obvious association between GSTT1 null genotype and risk of gastric cancer in Chinese population as information accumulated gradually. Sensitivity analysis by omitting individual study, in turns, did not materially alter the pooled ORs. This meta-analysis provides a strong evidence for the significant association between GSTT1 null genotype and gastric cancer risk in Chinese population, and GSTT1 null genotype contributes to increased risk of gastric cancer.

49 Background: According to WHO estimation, > 400,000 new cases of gastric cancer have occurred in 2012 in China, making it the second most common malignancy in the country. However, little is known about epidemiological data of gastric cancer in China. This analysis aimed to evaluate clinicopathological and socioeconomic characteristics of Chinese patients with non-mGC. Methods: EVIDENCE was a prospective registry study. 2,600 patients with newly diagnosed gastric cancer from 85 hospitals across China were planned to be enrolled into this study. Patients who have histopathologically confirmed diagnosis of gastric cancer and corresponding HER2 IHC status diagnostic results within 6 months before enrollment are eligible. According to overall stage of disease, HER2 status, and use of trastuzumab (Herceptin®), patients are continuously assigned to 5 different cohorts until number of patients has reached the designated limit of each cohort. Results: Until 31st May 2014, 885 eligible patients were continuously enrolled before completion of recruitment of any cohort. Of these patients, 538 (60.8%) patients who were diagnosed with non-mGC were included in this analysis. In this population, 15.6% of these patients were HER2-positive (IHC3+ or IHC2+/ISH+), 73.6% were male, median age of diagnosis was 60 (range: 26-85). 75.3% (403/535) of patients were diagnosed with upper endoscopy, 65% (348/535) with biopsy, and 23.9% (128/535) with surgery. Primary tumor site of 37.2% (191/514) of patients was at the antrum (the lower third of stomach), 22.8% (117/514) was at the body (the middle third of stomach), 17.7% (91/514) was at the gastro-oesophageal junction, and 10.9% (56/514) was at the fundus (the upper third of stomach). 43.0% were former or current smokers, 30.3% had reported light to moderate alcohol consumption habit. Most of the patients (39.5%) had completed primary education or below, 53.6% reported their family annual income of RMB 35,000 (US$5,700) or below. Conclusions: Analysis of clinicolpathological and socioeconomic characteristics of Chinese patients with GC will help to improve disease management of these patients. Patient recruitment and additional analyses will be continued as planned. Clinical trial information: NCT01839500.