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The waste of the coal-based activated carbon (CBAC) production process, carbonised powder (CP) and oxidised powder (OP), easily store heat, trigger spontaneous combustion under hot storage conditions, and exhibit strong pyrophoricity. CP and OP pose a serious threat to local environments and inhabitants’ health. In this work, the spontaneous combustion of waste materials generated during the preparation of activated carbon in the coal chemical industry was studied, which has been less studied by previous researchers, and the spontaneous combustion was prevented and controlled by ionic liquid (ILs), a new type of environmentally friendly inhibitor. The influence of ILs containing [BMIM]+ ([BMIM][BF4], [BMIM][NO3], and [BMIM][I]) on the spontaneous combustion of CP and OP was studied and quantitatively analysed. The different samples’ mass loss at different stages was analysed using thermogravimetry at three heating rates (5.0, 10.0, and 15.0 °C/min). A temperature-programmed experiment was used to test the inhibiting effect in treated samples. The results indicated that ILs had varying inhibiting effects on the pyrophoricity of samples. The ILs [BMIM][BF4] [BMIM][NO3] [BMIM][I] had, in descending order of percent inhibition, an inhibitory effect on OP; the order for CP inhibition was as follows: [BMIM][NO3] > [BMIM][BF4] > [BMIM][I]. After IL treatment, the maximum, minimum, and average apparent activation energy all increased to varying degrees. At 30–180 °C, the average percent of inhibition of [BMIM][BF4]–Y (OP treated with [BMIM][BF4]) and [BMIM][NO3]–T (CP treated with [BMIM][NO3]) was 20.21% and 7.32%, respectively, and the maximum inhibition percent was 38.53% and 16.13%, respectively.

Benzoyl peroxide (BPO) is a common cross-linking agent and initiator that is widely used in the chemical industry. The instability of a substance may be influenced by the presence of impurities; therefore, the thermal hazard of organic peroxides under contamination has always been a topic of interest. In this study, the effects of hexanoic acid (HAA) on the thermal decomposition of BPO were investigated using differential scanning calorimetry (DSC; 2.0, 4.0, 6.0, 8.0, and 10.0 °C/min) experiments. By using the Kissinger-Akahira-Sunose and Flynn-Wall-Ozawa kinetic models, the progress of the obtained DSC curve was fitted linearly, and the thermokinetic parameters of BPO in the presence of HAA were further calculated. The two apparent activation energy calculations consistently indicated that HAA increased the thermal hazard of BPO. In addition, the Coats-Redfern model was adopted to compute the decomposition mechanism function of each phase of the material, and Gaussian 16 was used to determine the atomic bonding levels between the molecules to discover the thermal decomposition reaction path of BPO under the effect of HAA. The study results can be used as a reference for the loss prevention and control of BPO in practical engineering applications.

Nitrocellulose (NC) is widely used in both military and civilian fields. Because of its high chemical sensitivity and low decomposition temperature, NC is prone to spontaneous combustion. Due to the dangerous properties of NC, it is often dissolved in other organic solvents, then stored and transported in the form of a solution. Therefore, this paper took NC solutions (NC-S) with different concentrations as research objects. Under different atmospheric conditions, a series of thermal analysis experiments and different reaction kinetic methods investigated the influence of solution concentration and oxygen concentration on NC-S’s thermal stability. The variation rules of NC-S’s thermodynamic parameters with solution and oxygen concentrations were explored. On this basis, the spontaneous combustion characteristics of NC-S under actual industrial conditions were summarized to put forward the theoretical guidance for the spontaneous combustion treatment together with the safety in production, transportation, and storage.

Microbial toxins pose a significant threat to the natural environment and all forms of life on planet earth. These biological organisms, such as enzymes, viruses or fragments wreak havoc on the environment and pose a health risk. Toxicity from bioaerosols has a negative impact on human life, causing acute adverse reactions, various types of illnesses, and carcinogenic disorders, among other issues. Although various aspects of bioaerosols have been studied, such as identification, quantification, dispersion, and epidemiology, bioaerosol research is still in its infancy, particularly in terms of understanding anthropogenic behavior. Most of the studies identify the negative impact of bioaerosols, albeit epidemiological evidence remains equivocal. Further, the regulatory enactments and legislative mechanisms for bioaerosol surveillance have yet to be implemented ineffectively in both developed and developing countries. In this overview, we evaluate the pathways and challenges of bioaerosols, highlight gaps in bioaerosol epidemiology, and discuss the public health implications of exposure to complex ecosystems. We also provide an overview of the current state of bioaerosol research, including sampling and enumeration procedures, qualitative and quantitative modeling, global statutory policies, and potential future approaches to addressing the challenges.

A novel DEK-AFF2 fusion has been recently identified in four cases of basaloid to nonkeratinizing squamous cell carcinoma (SCC) in the sinonasal tract and middle ear with high-grade morphology. The exceptional response to immune checkpoint inhibitor in the first reported case highlights the potential clinical importance of identifying tumors with DEK-AFF2 fusions. We herein reported the first series of seven cases of DEK-AFF2 fusion-associated sinonasal SCC with deceptively bland morphology, including four cases of low-grade papillary Schneiderian carcinoma, which is a recently described tumor type with unknown molecular underpinnings. The DEK gene rearrangement was confirmed by DEK break-apart fluorescence in situ hybridization and DEK-AFF2 fusion transcripts were detected by reverse transcription polymerase chain reaction. In contrast to the previously reported DEK-AFF2 fusion-positive high-grade carcinomas, these tumors had a monotonous and bland morphology and were all initially diagnosed as sinonasal papilloma (SP) of various types, with or without dysplasia or carcinoma in situ. The tumor was characterized by mixed exophytic and inverted patterns, broad papillary fronds, acantholytic change, cellular monotony, dense neutrophilic infiltrates, and peripheral palisading. All tumors were diffusely positive for p40 or p63 and negative for NUT and p16. Molecular drivers associated with SP, including EGFR and KRAS mutations and both high and low-risk human papillomavirus infection, were negative in all cases. Although there was no overt stromal invasion or desmoplastic reaction in the initial specimens, these tumors tended to progress locoregionally through a prolonged clinical course and occasionally develop lymph node metastases, high-grade transformation, or extensively local destruction eventually leading to death. These justify more aggressive clinical management. Therefore, we propose the new terminology "DEK-AFF2 fusion-associated papillary SCC of the sinonasal tract" to better describe this clinicopathologically and molecularly distinct entity.

SMARCB1(INI1)-deficient sinonasal carcinoma is a recently recognized entity with wide histomorphologic spectrum. The classification of sinonasal adenocarcinoma (SNAC) is complex and yet to be redefined, especially the category of high-grade non-intestinal-type SNAC. Recently SMARCB1(INI1)-deficient SNACs with an unique oncocytoid/rhabdoid cytomorphology and variable degrees of glandular formation have been reported. Here we described a rare case of SMARCB1(INI1)-deficient SNAC composed of mainly oncocytoid/rhabdoid cells with mixed solid and cribriform patterns. This case was originally diagnosed as non-intestinal-type SNAC and was reclassified due to complete loss expression of SMARCB1(INI1) by immunohistochemistry (IHC). The SMARCB1(INI1) stain provides a valuable tool for identification of this specific type of SNAC. We compared this case with other SNACs diagnosed in our department and reviewed relevant literature for this specific type of SNAC.

INTRODUCTION: Tumor spread through air spaces (STAS) is associated with locoregional recurrence in patients undergoing limited resection (LR) for non-small cell lung carcinoma (NSCLC). We hypothesized that the observation of STAS in both the initial LR specimen and the additional resection specimen from the same patient, processed using different knives, would provide evidence that STAS is an in vivo phenomenon contributing to locoregional recurrence. METHODS: We retrospectively identified patients with NSCLC (9 adenocarcinoma, 1 squamous cell carcinoma) who underwent LR, had STAS in the LR specimen, and underwent additional resection (lobectomy or LR). The LR and additional resection specimens from each patient were processed at different times using different tissue-processing knives. All specimens were analyzed for STAS. RESULTS: All 10 patients underwent LR with negative margins (R0). All additional resection specimens had STAS: 8 patients had STAS clusters in their completion lobectomy specimens, and 2 had STAS in their additional LR specimens. In 2 patients, STAS was found in the completion lobectomy specimen only after extensive sampling (>10 sections) from the staple line adjacent to the initial LR. CONCLUSION: The presence of STAS in both the LR and the additional resection specimen processed using different knives supports the concept that STAS is an in vivo phenomenon, rather than an artifact from tissue processing. This observation indicates that occult STAS tumor cells can be present in the lung tissue of the remaining unresected lobe after LR and supports the concept that STAS is a contributing factor for locoregional recurrence following LR.

The choice between wedge resection and segmentectomy as a sublobar resection method for patients with cT1N0 lung cancer remains debatable. This study aimed to evaluate the clinical outcomes after wedge resection and segmentectomy for patients with cT1N0 lung adenocarcinoma. The study enrolled 1002 consecutive patients with cT1N0 lung adenocarcinoma who underwent sublobar resection at the authors’ institution between 2011 and 2017. A propensity score-matching analysis was used to compared the clinical outcomes between the wedge resection and segmentectomy groups. Wedge resection was performed for 810 patients (80.8%), and segmentectomy was performed for 192 patients (19.2%). Wedge resection resulted in better perioperative outcomes than segmentectomy. The multivariate analysis showed that the significant risk factors for poor disease-free survival (DFS) were elevated preoperative serum carcinoembryonic antigen levels, total tumor diameter greater than 2 cm, and a consolidation-to-tumor (C/T) ratio higher than 50%. After propensity-matching, no differences in overall survival or DFS were noted between the two matched groups. However, subgroup analysis showed that segmentectomy was associated with better DFS than wedge resection (p = 0.039) for the patients with a tumor diameter greater than 2 cm and a C/T ratio higher than 50%. Segmentectomy is the appropriate surgical method for sublobar resection in cT1N0 lung adenocarcinoma patients with a tumor diameter greater than 2 cm and a C/T ratio higher than 50%. Wedge resection may be a safe and feasible sublobar resection method for patients with a tumor diameter of 2 cm or smaller or a C/T ratio of 50% or lower.

Coal-based activated carbon (CBAC) is widely used in several industrial processes and daily life, however, it is susceptible to spontaneous combustion during storage and transportation. Therefore, ...

We sought to investigate whether preoperative dual-phase 2-[18F]FDG PET-CT identify predictors for poor survival in patients with ampullary carcinoma receiving pancreaticoduodenectomy. The preoperative PET-CT images of patients with resected ampullary carcinoma from June 2007 to July 2017 were analyzed. Survival curves were analyzed using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazard model was used to identify potential prognostic factors associated with disease-free survival (DFS) and overall survival (OS). Fifty-four subjects (26 men, 28 women) were enrolled with a median tumor size of 20 mm. All patients were followed for a median period of 36.9 months with 3- and 5-year DFS of 50.3% and 44.2%, and OS of 77.0% and 68.2%, respectively. Parameters associated with DFS in multivariate analysis were lymphovascular invasion (hazard ratio [HR]: 9.45, p < 0.001), involved margin in pathology (HR: 7.67, p < 0.001), and tumor retention index (RI) from the dual-phase PET (HR: 2.41, p = 0.03), whereas involved margin (HR: 13.14, p < 0.001), post-recurrence chemotherapy (HR: 0.10, p < 0.001), and metabolic tumor volume (MTV) (HR: 4.62, p = 0.009) emerged as independent prognostic factors for OS. Preoperative 2-[18F]FDG PET-CT offered independent prognostic biomarkers in patients with ampullary carcinoma receiving standard surgical resection. • 2-[ 18 F]FDG PET-CT offers good survival prediction before operation in primary malignant neoplasms at ampulla of Vater. • Dual-phase PET scan with bowel distention can better delineate Ampulla of Vater and characterize tumor physiology. • Preoperative risk stratification might aid in better treatment planning.

Differential scanning calorimetry (DSC) and thermogravimetric analyzer (TGA) were used to examine the thermal decomposition of benzoyl peroxide (BPO). The interruption rescanning method was adopted to examine the effect of thermal history on the autocatalysis and thermal decomposition of BPO. Autocatalysis of BPO was verified through isothermal experiments. According to the DSC linear temperature rise data of BPO, mathematical methods were used to decouple and divide the peaks. Kinetic analysis using both the Kissinger and Friedman methods was performed. The initial decomposition temperature of the decoupled BPO ranged between 101.4 and 104.6 °C. The peak temperature was 110.9–126.2 °C, and the decomposition enthalpy was 229.7–524.2 J g–1. The apparent activation energy was higher in the coupling state than after decoupling one. The thermal history and isothermal experiments demonstrated that BPO possessed autocatalytic properties. Results revealed that initial decomposition temperature tended to decrease with the increase in interruption temperature. In addition, the apparent activation energy of BPO decreased following the thermal history analysis because of the formation of intermediate products from BPO in the thermal history experiments, which further promoted BPO’s thermal decomposition. This effect led to a decrease in BPO’s initial decomposition temperature.

Cosmeceutical products have improved over the years; however, the explosions and fire accidents in cosmeceutical factories worldwide have not ceased. Literature researches on this genre of potential risk have been seldom published. Cosmeceutical benzoyl peroxide (CBPO) is usually used on facial products, especially for acne treatment. The thermal stability of CBPO with additions and calorimetric technology is utilized to obtain the thermal stability and reaction characteristics. Depending on the experimental thermal stability parameters, apparent activation energy was calculated by various integral and differential kinetic models. Uniting the isoconversional kinetic analysis and numerical simulation of the isothermal condition can better realize the decomposition characteristics and potential process risk. Dozens of milligrams of CBPO were dunked with 10,000 ppm of Cu, Fe, and Zn to inspect the exothermal behavior. The findings can be a reference for the essential safety parameters and customer safety design for the database.

Incense is an indispensable material with religion and life in Asia. It is also a bridge of cultural expression and inheritance. Because the operating environment concentration of dust generated during the production process is considerable, most of the research pertaining to the hazard of incense factories has investigated air pollution, such as PM2.5, PM10, and VOCs. However, the production of incense causes dust dispersion, high temperature from ovens, and static electricity generated by friction. It can all possibly lead a dust explosion. To prevent and alleviate hazard from re-occurring, we used sandalwood dust at an incense factory in Taiwan, measured the effect of moisture content on the explosion parameters under normal conditions by 20-L apparatus, and used the oven to diminish its moisture content to 0%, 10.0%, and 15.0% as a control group to analyze the explosion characteristics at the different moisture contents, such as maximum explosion pressure and explosion limit. The results showed that the minimum ignition energy of dry dust was 30 mJ. Beyond doubt, incense factories face potential explosion hazards. The above results could be evaluated by the most dangerous range to avoid incense dust in this range at the workplace, lessening hazards caused by a dust explosion. The effect of moisture content on the suppression of the dust explosion was explored.

It is important for the patients to reconstruct the voice phonic function by surgery after total laryngectomy in the developing countries.To investigate the clinical outcomes of voice reconstruction using an infrahyoid musculocutaneous flap for patients after total laryngectomies.Eighteen male patients recruited were laryngectomized. The infrahyoid musculocutaneous flap was designed. After total laryngectomy, the lower edge of the flap was sewed with the upper edge of the tracheostomy opening. Next, the lateral and medial edges of the flap were anastomosed to create a pronunciation tube. Finally, the remaining opening of the tube was sutured with the anterolateral wall of the hypopharynx to establish a communication with the pharyngeal cavity.A total of 17 cases of flaps were survived and only 1 necrosed. There were 17 patients without serious complications, except that 6 cases had mild irritable cough when gulping water. However, it could be relieved through blocking tracheostoma. One year after operation, all patients could more remarkably articulate clear, powerful, and consistent words. The articulatory configuration was existed under rigid laryngoscope and CT.The use of an infrahyoid myocutaneous flap is feasible for the voice restoration in the patients undergoing total laryngectomy.

Near-pure lung adenocarcinoma (ADC) subtypes demonstrate strong stratification of radiomic values, providing basic information for pathological subtyping. We sought to predict the presence of high-grade (micropapillary and solid) components in lung ADCs using quantitative image analysis with near-pure radiomic values. Overall, 103 patients with lung ADCs of various histological subtypes were enrolled for 10-repetition, 3-fold cross-validation (cohort 1); 55 were enrolled for testing (cohort 2). Histogram and textural features on computed tomography (CT) images were assessed based on the “near-pure” pathological subtype data. Patch-wise high-grade likelihood prediction was performed for each voxel within the tumour region. The presence of high-grade components was then determined based on a volume percentage threshold of the high-grade likelihood area. To compare with quantitative approaches, consolidation/tumour (C/T) ratio was evaluated on CT images; we applied radiological invasiveness (C/T ratio > 0.5) for the prediction. In cohort 1, patch-wise prediction, combined model (C/T ratio and patch-wise prediction), whole-lesion-based prediction (using only the “near-pure”-based prediction model), and radiological invasiveness achieved a sensitivity and specificity of 88.00 ± 2.33% and 75.75 ± 2.82%, 90.00 ± 0.00%, and 77.12 ± 2.67%, 66.67% and 90.41%, and 90.00% and 45.21%, respectively. The sensitivity and specificity, respectively, for cohort 2 were 100.0% and 95.35% using patch-wise prediction, 100.0% and 95.35% using combined model, 75.00% and 95.35% using whole-lesion-based prediction, and 100.0% and 69.77% using radiological invasiveness. Using near-pure radiomic features and patch-wise image analysis demonstrated high levels of sensitivity and moderate levels of specificity for high-grade ADC subtype-detecting. • The radiomic values extracted from lung adenocarcinoma with “near-pure” histological subtypes provide useful information for high-grade (micropapillary and solid) components detection. • Using near-pure radiomic features and patch-wise image analysis, high-grade components of lung adenocarcinoma can be predicted with high sensitivity and moderate specificity. • Using near-pure radiomic features and patch-wise image analysis has potential role in facilitating the prediction of the presence of high-grade components in lung adenocarcinoma prior to surgical resection.

The spontaneous combustion of carbonised and oxidised powders has been long considered an intricate physicochemical process, and their combustion is often concealed and difficult to detect. The self-ignition characteristics and parameters of carbonised and oxidised powders were thus explored. The thermokinetic behaviours of carbonised and oxidised powders (303–1073 K) were assessed at four different heating rates (5.0, 10.0, 15.0, and 20.0 K min−1) through thermogravimetry–differential scanning calorimetry (TG–DSC). The variation of the thermogravimetric curve was obtained, and the apparent activation energy (Ea) of the carbonised and oxidised powders was calculated using the Kissinger–Akah–Sunose (KAS) and Flynn–Wall–Ozawa (FWO) methods. The LFA457 laser-flash apparatus was employed to measure thermophysical parameters of experimental samples. The results revealed that the TG–derivative thermogravimetry curve shifted towards high temperatures, and overall, the characteristic temperature increased as the heating rate increased (e.g. at heating rates of 5.0–20.0 K min−1, the critical temperatures were 329–349 and 332–356 K for carbonised and oxidised powders, respectively). The Ea values in the combustion stage obtained using the two calculation methods were similar. The Ea values of the carbonised powders were 148.64 (KAS) and 153.58 (FWO). The Ea values of the oxidised powders were 171.23 (KAS) and 175.68 kJ mol−1 (FWO). The specific heat capacity of carbonised powders was higher than that of oxidised powders, whereas the thermal diffusivity and thermal conductivity were lower than those of oxidised powders.

Expression of cytokines and growth factors have been shown to be highly correlated with the prognosis of esophageal squamous cell carcinoma (ESCC), a deadly disease with poor prognosis. The suppressor of cytokine signaling (SOCS) family of proteins are key factors in regulating cytokines and growth factors. Yet the role of the SOCS proteins in ESCC is hardly investigated. We currently investigated the prognostic role of SOCS5 in ESCC. We analyzed the prognostic effects of 16 single nucleotide polymorphisms (SNPs) within the SOCS genes in 632 ESCC patients. We repeatedly observed that the 3 SNPs in SOCS5, SOCS5:rs3814039, SOCS5:rs3738890, and SOCS5: rs3768720, were significantly correlated with both overall (OS) and progression-free survival (PFS) of ESCC patients (rs3814039, p=0.032 for OS and p=0.009 for PFS; rs3738890, p=0.016 for OS, and p=0.008 for PFS; rs3768720, p=0.005 for OS and p=0.002 for PFS). SOCS5: rs3768720 was also significantly associated with distant metastasis (Ptrend=0.028). The luciferase assay revealed that SOCS5:rs3814039 and SOCS5: rs3768720 might influence the prognosis by regulating SOCS5 expression. Functional analysis demonstrated SOCS5 was able to regulate epidermal growth factor receptor (EGFR) expression and migration activity of ESCC cells. Furthermore, Patients with strong SOCS5 in normal tissues exhibited significantly better PFS (P=0.049) and reduced risk of distant metastasis (P=0.004) compared to those with weak SOCS5 expression. Overall, our study demonstrates the novel function of SOCS5 in ESCC prognosis. The genetic polymorphisms and expression of SOCS5 could serve as a novel therapeutic biomarker for improving the prognosis of ESCC.

SIGNIFICANCE This review summarizes the main factors of refractive error after silicone oil removal combined with cataract surgery.The post-operative refractive results of silicone oil removal combined with cataract surgery are closely related to the patient's future vision quality. This report summarizes the factors that influence the difference between the actual post-operative refractive power and the pre-operatively predicted refractive power after silicone oil removal combined with cataract surgery, including axial length, anterior chamber depth, silicone oil, commonly used tools for measuring intraocular lens power, and intraocular lens power calculation formulas, among others. The aim of the report is to assist clinical and scientific research on the elimination of refractive error after silicone oil removal combined with cataract surgery.

In this letter, the outage performance of a satellite-assisted cooperative non-orthogonal multiple access (NOMA) system is studied, where a terrestrial source communicates with one terrestrial destination directly while the other terrestrial destination is assisted by a regenerative satellite. We consider the satellite channels and the terrestrial channels undergo shadowed-Rician fading and Nakagami- $m$ fading, respectively. Based on this, we derive the exact closed-form expressions for the outage probabilities. In addition, the asymptotic expressions at high signal-to-noise ratio are provided to gain further insights. Simulation results validate the accuracy of the analytical results and show the superiority over other conventional schemes.

Intraductal carcinoma (IC) is a rare salivary gland tumor with low- to intermediate-grade cytological features. It is further classified into intercalated duct type and apocrine type based on its distinct histologic and immunohistochemical expression. Conventional salivary duct carcinoma (SDC) is an aggressive carcinoma with high-grade features and is usually associated with poor prognosis. In this study, immunohistochemistry and mutation analyses (including HRAS/PIK3CA mutations, RET rearrangement, and human epidermal growth factor receptor 2 [HER2] amplification) of 9 ICs (including 3 pure ICs, 6 ICs with invasive carcinoma) and 24 conventional SDCs were performed and the results were compared. Four intercalated duct-type cases were positive for SOX10 and S100 and negative for AR; five apocrine-type cases showed opposite results. All five apocrine-type cases had cysts with relatively circumscribed tumor borders and morphologically mimicking breast low-grade ductal carcinoma in situ or papillary carcinoma. RET fusion is detected in half of the 4 intercalated duct-type IC but not in the apocrine-type or conventional SDC. HER2 amplification was only observed in conventional SDC. The monoclonal antibody (clone RBT-NRAS) against NRAS Q61R is a sensitive and specific marker used for detecting HRAS Q61R mutation in the salivary gland tumors. The apocrine-type IC had different cytological grades, distinct tumor growth patterns, and no evidence of low- to high-grade transition, suggesting that apocrine-type IC should be distinguished from apocrine SDC with an in situ component.

Summary: Background: Preoperative differentiation of follicular thyroid carcinoma (FTC) from follicular adenoma (FA) remains an unsolved puzzle. Patients sometimes undergo unnecessary lobectomy for histology confirmation inevitably. Objective: In this retrospective study, we propose new gray-scale ultrasonographic (US) features that may help to differentiate FTC from FA. Method: Medical charts and US images of follicular thyroid neoplasms were collected prospectively. Gray-scale US features including conventional parameters adding tubercle-in-nodule and trabecular formation were recorded. Results: The histopathologic diagnosis was FA in 139 and FTC in 49 patients. In patients with FTC, minimally invasive follicular carcinoma (MIFC) was seen in 36 patients and widely invasive follicular carcinoma (WIFC) in 13. The incidences of calcifications (p

Although induction chemotherapy improves the resectability of thymic neoplasms, it is unclear whether surgery after induction chemotherapy can improve outcomes. We compared long-term outcomes of surgery with and without induction chemotherapy in patients with thymic neoplasms.We retrospectively investigated the clinical information of patients with thymic neoplasms at the National Taiwan University Hospital between 2005 and 2013.Of 204 patients, 119 underwent direct surgery (group 1), 45 underwent surgery after induction chemotherapy (group 2), and 40 underwent no surgery (group 3). The 5-year overall survival rates of groups 1, 2, and 3 were as follows: for 204 patients, 96.3%, 76.4%, and 35.5% (P .001); for 119 thymoma patients, 96.6%, 88.9%, and 100.0% (P = .835); for 85 thymic carcinoma patients, 94.7%, 69.7%, and 17.7% (P .001); for 36 American Joint Committee on Cancer (AJCC) stage III-IVA thymoma patients, 92.9%, 83.3%, and 100% (P = .833); and for 28 stage III-IVA thymic carcinoma patients, 75.0%, 76.2%, and 62.5%, (P = .160). Univariate analysis showed that for group 2 (P = .0208) and group 3 (P .0001), thymic carcinoma pathology type (P = .0010) and stage IVB disease (P .0001) were poor prognostic factors. Multivariate analysis found thymic carcinoma (P = .0026) and stage IVB disease (P = .0449) to be poor prognostic factors.Up-front surgery leads to best overall survival, and induction chemotherapy followed by surgery may improve resectability and outcomes. Only thymic carcinoma and stage IVB disease were poor prognostic factors in multivariate analysis.

In view of the coal and gas outburst accidents occur frequently caused by blasting in geological structural belt, in order to study the mechanical characteristics of coal rock in tectonic belt disturbance by blasting and blasting vibration effect influenced on the stability of surrounding rock, coal–rock damage and failure characteristics within a reverse fault caused by a blasting stress wave were investigated using numerical analyses and experiments. According to the experimental results, the causes of coal and gas outburst dynamic disasters within a reverse fault during blasting are analyzed. The outcomes indicated that the crushing circle created by the crack propagation near the blasting hole severely damaged the fault plane and floor rocks adjacent to the footwall of the reverse fault. Fractures also extended to the upper and lower coal seams of the reverse fault; this caused the surface of the coal seam to fall off and severe internal damage. According to theoretical analysis, the reflection of the blasting stress wave propagating to the reverse fault intensified the damage to coal and rock. Elastic strain energy accumulation within the reverse fault structural zone was accompanied by high-stress concentration. The reverse fault tectonic region was destroyed by blasting vibration. It increased gas pressure and caused a weak surface, which provided a channel for gas flow and a dynamic basis for the occurrence of coal and gas outburst. The research results have important theoretical value to reveal the mechanism of coal and gas outburst in tectonic belt induced by blasting.

Pulmonary invasive mucinous adenocarcinoma (IMA) has unique histological patterns. This study aimed to comprehensively evaluate the clinicopathological features, prognosis, and survival outcomes of IMAs. We retrospectively identified 77 patients with pulmonary IMA and reviewed their clinical and pathological features. Another 520 patients with non-IMA-type ADC were retrieved for comparison with patients with IMA. A new two-tier grading system (high-grade and low-grade IMAs) modified from the pancreatic intraepithelial neoplasia classification system was used for survival analyses. Compared to patients with non-IMA-type ADC, patients with IMA tended to have never smoked (p = 0.01) and had early-stage IMA at initial diagnosis (p &lt, 0.001). For stage I–II diseases, the five-year overall survival (OS) rates were 76% in IMAs and 50% in non-IMA-type ADCs, and a longer OS was observed in patients with IMA (p = 0.002). KRAS mutations were the most commonly detected driver mutations, which occurred in 12 of the 28 (43%) patients. High-grade IMAs were associated with a shorter recurrence-free survival (RFS) for stage I–IIIA diseases (p = 0.010) than low-grade IMAs but not for OS. In conclusion, patients with stage I and II IMA had better OS than those with non-IMA-type ADC. A new two-tier grading system might be useful for predicting RFS in stage I–IIIA IMAs.

OBJECTIVES Solitary pulmonary capillary haemangioma (SPCH) is a benign lung tumour that presents as ground-glass nodules on computed tomography (CT) images and mimics lepidic-predominant adenocarcinoma. This study aimed to establish a discriminant model using a radiomic feature analysis to distinguish SPCH from lepidic-predominant adenocarcinoma. METHODS In the adenocarcinoma group, all tumours were of the lepidic-predominant subtype with high purity (>70%). A classification model was proposed based on a two-level decision tree and 26 radiomic features extracted from each segmented lesion. For comparison, a baseline model was built with the same 26 features using a support vector machine as the classifier. Both models were assessed by the leave-one-out cross-validation method. RESULTS This study included 13 and 49 patients who underwent complete resection for SPCH and adenocarcinoma, respectively. Two sets of features were identified for discrimination between the 2 different histology types. The first set included 2 principal components corresponding to the 2 largest eigenvalues for the root node of the two-level decision tree. The second set comprised 4 selected radiomic features. The area under the receiver operating characteristic curve, accuracy, sensitivity, specificity were 0.954, 91.9%, 92.3% and 91.8% in the proposed classification model, and were 0.805, 85.5%, 61.5% and 91.8% in the baseline model, respectively. The proposed classification model significantly outperformed the baseline model (P CONCLUSIONS The proposed model could differentiate the 2 different histology types on CT images, and this may help surgeons to preoperatively discriminate SPCH from adenocarcinoma.

The optimal surgical method for cT1N0 lung adenocarcinoma remains controversial. The aim of this study was to evaluate the differences in clinical outcomes of sublobar resection and lobectomy for cT1N0 lung adenocarcinoma patients. We included 1035 consecutive patients with cT1N0 lung adenocarcinoma who underwent surgery at our institute from January 2011 to December 2016. The surgical approach, either sublobar resection or lobectomy, was determined at the discretion of each surgeon. A propensity-matched analysis incorporating total tumor diameter, solid component diameter, consolidation-to-tumor (C/T) ratio, and performance status was used to compare the clinical outcomes of the sublobar resection and lobectomy groups. Sublobar resection and lobectomy were performed for 604 (58.4%; wedge resection/segmentectomy: 470/134) and 431 (41.6%) patients, respectively. Patients in the sublobar resection group had smaller total tumor diameters, smaller solid component diameters, lower C/T ratios, and better performance status. More lymph nodes were dissected in the lobectomy group. Patients in the sublobar resection group had better perioperative outcomes. A multivariable analysis revealed that the solid component diameter and serum carcinoembryonic antigen level are independent risk factors for tumor recurrence. After propensity matching, 284 paired patients in each group were included. No differences in overall survival (OS; p = 0.424) or disease-free survival (DFS; p = 0.296) were noted between the two matched groups. Sublobar resection is not inferior to lobectomy regarding both DFS and OS for cT1N0 lung adenocarcinoma patients. Sublobar resection may be a feasible surgical method for cT1N0 lung adenocarcinoma.

In underground mines, high air temperatures in the summer months lead to an increase in inlet airflow temperatures. This leads to seasonal thermal pollution in the mines. This paper examines the dynamics and effects of seasonal variation in surface air temperatures and surrounding rock temperatures in deep coal mines. It also examines temperature variations in the main ventilation circuit, working face, and surrounding rock. The study results revealed that airflow temperatures were significantly affected by seasonal air temperature variations. The greater the distance was between the inlet and the wellhead of the ventilation shaft, the less the effect was on temperature. Moreover, slight temperature variations (1.0–3.0 °C) were observed between various points on the return route during the summer months. Airflow temperatures along the airflow inlet to the return route of the working face first decreased, but then increased. The temperature field of the surrounding rock increased gradually with increased distance between the mine roadway and inlet, with recorded rock temperatures as high as 40.53 °C. The radius of the heat-adjusting layer was between 28 and 33 m.

Purpose To compare the locations of recurrences and survival outcomes in esophageal squamous cell carcinoma (ESCC) patients with pathological complete response (pCR) after neoadjuvant concurrent chemoradiotherapy (CCRT) with or without preceding induction chemotherapy (IC) followed by esophagectomy. Methods Among 276 patients with locally advanced ESCC undergoing trimodality treatment during 2004–2014, 94 (34.1%) with pCR were eligible. The cohort included 26 patients undergoing IC before CCRT (IC group), and 68 patients who did not receive IC (non-IC group). Results At a median follow-up of 51.4 months (95% confidence interval; 42.9–62.1), 19 patients experienced recurrences. There was a trend toward fewer distant failures in the IC group (0% vs.14.7%, p = 0.057), while locoregional recurrence was similar (7.7% vs. 7.4%). IC was associated with significantly improved survivals with the 5-year RFS and OS rates for the IC group of 85.1% and 90.5%, respectively, compared to of 46.2% and 48.1% for the non-IC group (p = 0.008 for RFS, and p = 0.015 for OS). By multivariable analyses, IC remained the only significant factor associated with survivals (HR:0.18 for RFS, p = 0.020 and HR:0.18 for OS, p = 0.025). The effect of IC in the whole cohort, irrespective of pathological response, was also assessed. Patients with non-pCR in the IC group had a trend toward worse survivals compared to the non-IC group Conclusions In ESCC patients with pCR after trimodality treatment, IC was associated with favorable survivals. The benefits of IC might be a hypothesis generation for adjuvant treatment for patients with pCR.

Aim To assess the relationship between Staphylococcus aureus (S. aureus) strains colonizing the anterior nares and clinical isolate colonizing other, non-nasal infectious sites in children with S. aureus infections. Methods Fifty-six hospitalized children with S. aureus infection were screened and 22 pairs of nasal carrier isolates and non-nasal clinical isolates were characterized by polymerase chain reaction (PCR) assay for the detection of methicillin resistance (mecA) gene, Panton-Valentine leukocidin virulence (PVL) gene, and multilocus sequence typing (MLST) for the purpose of identifying sequence types of S. aureus. Results In this study, Sequence Type (ST) 59 was found to be the predominant clonal type in the nasal carrier isolates, with statistically significant differences in positive mecA and PVL expression compared with other STs. In general, there was consistence between the STs detected in the nose and other, non-nasal sites for each patient (Kappa = 0.950), where 19 pairs (86.4%) of colonization isolates and their corresponding non-nasal clinical isolates were indistinguishable in mecA, PVL, and ST expression. Conclusion ST59 is reported here as a dominant and virulent methicillin-resistant S. aureus (MRSA) clone which may has become a leading sequence type among virulent MRSAs in Sichuan area. Overall there is a strong correlation between colonization and infection in pediatric patients that may be genetically indistinguishable and endogenous. Therefore, nasal swabs as a routine test for children, the elimination of nasal carriage may be considered as a prevention strategy for some systemic S. aureus infections.

Neuropsychiatric symptoms are common in patients with Parkinson's disease (PD) and they are likely to outweigh the motor symptoms and become a major factor affecting the quality of life of PD patients. However, the studies focusing on the non-motor symptoms in Chinese PD patients from different ethnicity are scarce. The aim of this retrospective study was to investigate neuropsychiatric symptoms and cognitive impairment in Chinese PD patients from Han and Hui populations from central China. Seventy-two Han Chinese PD patients (Han PD group) and 71 age-and sex-matched Hui Chinese PD patients (Hui PD group) were enrolled from Zhongnan Hospital of Wuhan University between Sept. 2011 and Aug. 2014 in the study. The neuropsychiatric symptoms and cognitive impairment were assessed using Neuropsychiatric Inventory (NPI) and Mini Mental State Examination (MMSE). We found that the proportion of depression, anxiety, apathy, irritability, euphoria and night time behavior disturbances were higher in the Han PD group than in the Hui PD group (P0.05 or P0.01). But the proportion of delusion, hallucination, agitation, disinhibition, aberrant motor behavior and change in appetite were not significantly different between the Han PD group and the Hui PD group (P0.05). The total mean scores of the MMSE from patients in the Han PD group were similar to those in the Hui PD group (P0.05). However, the subscale scores of recall domain and language domain in the Han PD group were significantly different from those in the Hui PD group (P0.05). No significant difference was noted in the orientation, memory and calculation domains between the two PD groups (P0.05). This study first showed the recall domain and language domain were different between the Han PD patients and the Hui PD patients. Depression, anxiety, apathy, irritability, euphoria and night time behavior disturbances were less presented in the Hui PD patients. All these differences may be related to the different ethnicity, which would be helpful for clinical physicians to recognize the different non-motor symptoms in Chinese PD patients with different ethnicity.

AIM This study explored the gut microbiota of children with hand, foot and mouth disease (HFMD). METHODS We enrolled 15 cases with HFMD admitted to the West China Second Hospital, Sichuan University, China, from July to September 2016 at a median age of three years. The controls were 15 healthy children of a similar age who underwent routine health examinations at the hospital during the same period. Gut microbiota was analysed using high throughput 16S ribosomal deoxyribonucleic acid sequencing. RESULTS The gut microbiota in the HFMD patients was distinct from the controls. Compared with the controls, the composition of gut microbiota in the HFMD cases represented a reduction of two butyrate-producing bacteria, Ruminococcus (0.73 ± 1.28 versus 7.78 ± 20.01, p = 0.026) and Roseburia (0.67 ± 1.69 versus 1.61 ± 3.27, p = 0.024) and an up-regulation of Escherichia (5.26 ± 10.50 versus 1.59 ± 5.90,p

Objective Histologic transformation from adenocarcinoma to small cell lung cancer (SCLC) is one of the mechanisms of acquired resistance after epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment. Furthermore, de novo combined SCLC/non-small cell lung cancer (NSCLC) have occasionally been reported; however, their mutational statuses and clinicopathological features have not yet been elucidated. In this study, we aimed to profile the genetic backgrounds of these 2 different histologic components by investigating patients with de novo combined SCLC/NSCLC as well as those with lung adenocarcinoma who experienced SCLC transformation after TKI treatment. Materials and methods Four patients with de novo combined SCLC/NSCLC were investigated, as were 4 other patients with lung adenocarcinoma who experienced SCLC transformation after TKI treatment. The different histologic components of the tumors in each patient were tested for thyroid transcription factor-1, p40, synaptophysin, chromogranin A, p53, retinoblastoma protein (Rb), and achaete-scute homolog 1 (ASCL1) via immunohistochemistry, and were macroscopically dissected for mutational analysis using next-generation sequencing with the Oncomine Focus Assay and Comprehensive Assay panel. Results The distinct histologic components in patients with de novo combined SCLC/NSCLC and those with adenocarcinoma exhibiting small cell transformation showed high consistency in EGFR/TP53/RB1 mutations, and expression patterns of p53 and Rb. A high frequency of activating mutations involving PI3K/AKT1 signaling pathway was observed in SCLC. Nuclear ASCL1 expression was present in SCLC but absent or barely present in adenocarcinoma in 7 cases. Conclusions Our data imply that inactivation of TP53/RB1 function is a possible early event in the histogenesis of synchronous and metachronous SCLC/NSCLC. Moreover, the non-adenocarcinoma (SCLC) component might arise from the adenocarcinoma (NSCLC) component through a mechanism that involves the activation of the ASCL1 and PI3K/AKT1 signaling pathways.

Activated carbon (AC) prepared by physical activation with steam (named as AC-H2O) was employed for catalytic fast pyrolysis of bagasse in a hydrogen atmosphere to selectively produce 4-ethyl phenol (4-EP), a valuable phenolic compound. Lab-scale fast pyrolysis experiments were conducted to quantitatively determine the pyrolytic products and investigate several factors on the 4-EP production, including pyrolysis atmosphere, AC type, catalytic pyrolysis temperature, and AC-to-bagasse ratio. The results indicated that the AC-H2O (activated by H2O) catalyst exhibited much better performance on 4-EP production than other ACs prepared by different activation methods. Compared with the inert atmosphere, the presence of hydrogen atmosphere could significantly promote the 4-EP formation with the yield increase by over 36%. The maximal 4-EP yield of 3.55 wt% with the selectivity of 17.42% was obtained under AC-to-bagasse ratio of 1.5 at 330 °C. In addition, the gas product produced by the pyrolysis process could be recycled to provide a hydrogen atmosphere without an additional hydrogen supply.

ObjectivesDifferentiating thyroid nodules with a cytological diagnosis of follicular neoplasm remains an issue. The goal of this study was to determine whether ultrasonographic (US) findings obtained preoperatively from the computer-aided detection (CAD) system are sufficient to further stratify the risk of malignancy for this diagnostic cytological category.MethodsFrom September 2016 to September 2018 in our hospital, patients diagnosed with Bethesda category IV (follicular neoplasm or suspicion of follicular neoplasm) thyroid nodules and underwent surgical excisions were include in the study. Quantification and analysis of tumor features were performed using CAD software. The US findings of the region of interest, including index of composition, margin, echogenicity, texture, echogenic dots indicative of calcifications, tall and wide orientation, and margin were calculated into computerized values. The nodules were further classified into American Thyroid Association (ATA) and American College of Radiology Thyroid Imaging Reporting & Data System (TI-RADS) categories.Results92 (10.1%) of 913 patients were diagnosed with Bethesda category IV thyroid nodules. In 65 patients, the histological type of the nodule was identified. The quantitative features between patients with benign and malignant conditions differed significantly. The presence of heterogeneous echotexture, blurred margins, or irregular margins was shown to have the highest diagnostic value. The risks of malignancy for nodules classified as having very low to intermediate suspicion ATA, non-ATA, and high suspicion ATA patterns were 9%, 35.7%, and 51.7%, respectively. Meanwhile, the risks of malignancy were 12.5%, 26.1%, and 53.8% for nodules classified as TIRADS 3, 4, and 5, respectively. When compared to human observers, among whom poor agreement was noticeable, the CAD software has shown a higher average accuracy.ConclusionsFor patients with nodules diagnosed as Bethesda category IV, the software-based characterizations of US features, along with the associated ATA patterns and TIRADS system, were shown helpful in the risk stratification of malignancy.

Objective A meta-analysis to investigate the risk factors for postoperative hypocalcaemia after thyroidectomy in adult patients. Methods A systematic search of publications in the electronic databases (PubMed®, The Cochrane Library, Web of Science, OVID and Embase®) from inception to June 2020 was conducted. Screening of titles, abstracts and full texts and data extraction were independently performed by two authors. The OR was selected as the pooled estimate. Results The analysis included 23 studies. Twelve significant risk factors for postoperative hypocalcaemia were identified: hypoparathyroidism, OR 5.58; total thyroidectomy, OR 3.59; hypomagnesaemia, OR 2.85; preoperative vitamin D deficiency, OR 2.32; female sex, OR 1.49; thyroid malignancy, OR 1.85; thyroiditis, OR 1.48; substernal multinodular goitres, OR 1.70; parathyroidectomy, OR 1.58; central compartment neck dissection, OR 1.17; modified radical neck dissection, OR 1.57; and central neck dissection, OR 1.54. Conclusions This meta-analysis provides moderate-to-high quality evidence that the 12 risk factors were predictive of postoperative hypocalcaemia, which should be monitored closely before thyroidectomy.

Background We aimed to establish a radiomic prediction model for tumor spread through air spaces (STAS) in lung adenocarcinoma using radiomic values from high-grade subtypes (solid and micropapillary). Methods We retrospectively reviewed 327 patients with lung adenocarcinoma from two institutes (Cohort 1: 227 patients; Cohort 2: 100 patients) between March 2017 and March 2019. STAS was identified in 113 (34.6%) patients. A high-grade likelihood prediction model was constructed based on a historical cohort of 82 patients with “near-pure” pathological subtype. The STAS prediction model based on the patch-wise mechanism identified the high-grade likelihood area for each voxel within the internal border of the tumor. STAS presence was indirectly predicted by a volume percentage threshold of the high-grade likelihood area. Performance was evaluated by receiver operating curve analysis with 10-repetition, 3-fold cross-validation in Cohort 1, and was individually tested in Cohort 2. Results Overall, 227 patients (STAS-positive: 77 [33.9%]) were enrolled for cross-validation (Cohort 1) while 100 (STAS-positive: 36 [36.0%]) underwent individual testing (Cohort 2). The gray level co-occurrence matrix (variance) and histogram (75th percentile) features were selected to construct the high-grade likelihood prediction model, which was used as the STAS prediction model. The proposed model achieved good performance in Cohort 1 with an area under the curve, sensitivity, and specificity, of 81.44%, 86.75%, and 62.60%, respectively, and correspondingly, in Cohort 2, they were 83.16%, 83.33%, and 63.90%, respectively. Conclusions The proposed computed tomography-based radiomic prediction model could help guide preoperative prediction of STAS in early-stage lung adenocarcinoma and relevant surgeries.

Esophageal cancer (EC) is a deadly cancer that frequently develops multiple primary cancers (MPCs). However, the risk biomarkers of MPC in EC have hardly been investigated. We retrospectively enrolled 920 subjects with primary EC and analyzed the possible risk factors as well as MPC single-nucleotide polymorphisms (SNPs) from blood DNA. A total of 184 subjects (20.0%) were confirmed to have MPC, 59 (32.8%) had synchronous MPC, and 128 (69.6%) had head and neck cancer. Elderly EC patients have an increased risk of having gastrointestinal cancer (Odds ratio, OR[95% CI]=6.70 [1.49–30.19], p=0.013) and a reduced risk of developing HNC (OR[95% CI]=0.44 [0.24–0.81], p=0.008). MPC risk was also associated with betel nut chewing (OR[95% CI]=1.63, 1.14–2.32], p=0.008), the A allele of ALDH2:rs671 (p=0.074 and 0.030 for GA and AA, respectively), the CC genotype in CISH:rs2239751 (OR[95% CI]=1.99 [1.2–3.32], p=0.008), and the G allele of ERCC5:rs17655 (p=0.001 and 0.090 for GC and CC, respectively). ADH1B:rs1229984 also correlated with MPC risk (p=0.117). Patients carrying four risk SNPs had a 40-fold risk of MPC (OR[95% CI]=40.25 [6.77–239.50], pp=0.039) compared to those without any risk SNPs. In conclusion, hereditary variations in ALDH2, CISH, ERCC5, and ADH1B have great potential in predicting the incidence of MPC in EC patients. An extensive cancer screening program during clinical follow-up would be beneficial for patients with high MPC susceptibility.

The purpose of this study was to explore the damage effects and injury mechanism of free-field explosion shock waves on rabbit lungs. Six free-field explosion experiments, each with 500 g trinitrotoluene (TNT), were conducted as the shock wave overpressure acting on the rabbits was measured. The peak overpressure of the shock wave was 533, 390, 249, 102, and 69 kPa at the respective test points. Damage to the rabbit lungs caused by shock wave overpressure was investigated through observation, anatomical analysis, and hematoxylin-eosin (HE) staining processing. The shock wave overpressure of 69–102 kPa caused mild-to-moderate injury; the shock wave overpressure of 102–249 kPa caused moderate injury; the shock wave overpressure of 249–390 kPa resulted in moderate-to-severe injury; and the shock wave overpressure of 390–533 kPa caused severe injury to the rabbit. Mild, moderate, and severe injuries destroyed some, most, or all alveolar structures, correspondingly, as well as producing partial cell apoptosis. The overpressure damage mechanism primarily involves the collapse and rupture of pulmonary alveolus in the lung tissue. As a novel attempt, the investigation provided here may serve to improve the current shock wave injury mechanism.

Solitary pulmonary capillary hemangioma (SPCH) is a benign lung tumor that presents as ground-glass nodules (GGN) on computed tomography (CT) images, mimicking lepidic-predominant adenocarcinoma (LPA). This study aimed to establish a discriminant model using a radiomic feature analysis to distinguish SPCH from LPA in lung GGNs. This study included 13 and 49 patients who underwent complete resection for lung SPCH and LPA, respectively. An SPCH/LPA classification model was proposed based on a two-level decision tree and 26 radiomic features extracted from each segmented lesion, including 5 and 21 features from the histogram and co-occurrence matrix, respectively. The two-level decision tree was constructed based on the training data with a support vector machine (SVM) as the classifier in each tree node. For comparison, a baseline model was built with the same 26 features using an SVM as the classifier. Both models were assessed by the leave-one-out cross-validation method. The area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity of the proposed SPCH/LPA model were 0.954, 91.9%, 92.3%, and 91.8%. The proposed SPCH/LPA model significantly outperformed the baseline model (p

Introduction Recent studies have identified subtypes of small cell lung carcinoma (SCLC) defined by the RNA expression of ASCL1, NEUROD1, POU2F3, and YAP1 transcriptional regulators. There are only limited data on the distribution of these markers at the protein level and associated pathologic characteristics in clinical SCLC samples. Methods The expression of ASCL1, NEUROD1, POU2F3, and YAP1 was analyzed by immunohistochemistry in 174 patient samples with SCLC. Subtypes defined by these markers were correlated with histologic characteristics, expression of classic neuroendocrine markers (synaptophysin, chromogranin A, CD56, INSM1), and other SCLC markers, including the neuroendocrine phenotype-associated markers TTF-1 and DLL3. Results ASCL1 and NEUROD1 expression had the following distribution: (1) 41% ASCL1+/NEUROD1−; (2) 37% ASCL1+/NEUROD1+; (3) 8% ASCL1−/NEUROD1+; and (4) 14% ASCL1−/NEUROD1−. On the basis of their relative expression, 69% of cases were ASCL1-dominant and 17% were NEUROD1-dominant. POU2F3 was expressed in 7% of SCLC and was mutually exclusive of ASCL1 and NEUROD1. YAP1 was expressed at low levels, primarily in combined SCLC, and was not exclusive of other subtypes. Both ASCL1-dominant and NEUROD1-dominant subtypes were associated with neuroendocrine markerhigh/TTF-1high/DLL3high profile, whereas POU2F3 and other ASCL1/NEUROD1 double-negative tumors were neuroendocrine markerlow/TTF-1low/DLL3low. Conclusions This is the first comprehensive immunohistochemical and histopathologic analysis of novel SCLC subtypes in patient samples. We confirm that ASCL1/NEUROD1 double-negative tumors represent a distinct neuroendocrine-low subtype of SCLC, which is either uniquely associated with POU2F3 or lacks a known dominant regulator. The expression profiles of these markers appear more heterogeneous in native samples than in experimental models, particularly with regard to the high prevalence of ASCL1/NEUROD1 coexpression. These findings may have prognostic and therapeutic implications and warrant further clinical investigation.