Search

This study aimed to evaluate the perioperative outcomes of patients undergoing robot-assisted McKeown esophagectomy (RAME) and the learning curves of surgeons performing RAME at a single center.Perioperative outcomes of RAME and video-assisted McKeown esophagectomy (VAME) were compared after eliminating confounding factors by propensity score matching (PSM). The cumulative sum (CUSUM) method was used to evaluate the learning curves of RAME for a single surgical team.In general, a total of 198 patients with esophageal cancer (RAME: 45 patients, VAME: 153 patients) were included in this study, and 43 pairs of patients receiving RAME or VAME were matched using 1:1 PSM analysis. Those in the RAME group had more lymph nodes dissected in the total lymph nodes (median 29.0 vs. 26.0, P = 0.011) and the upper mediastinum (median 8.0 vs. 6.0, P 0.001), especially the left recurrent laryngeal nerve (RLN) lymph node (median 4.0 vs. 2.0, P = 0.001). According to the trend of the CUSUM plot, the learning curve was divided into two stages at the 20th RAME procedure. After mastering the learning curve, RAME harvested a significantly higher number of upper mediastinal lymph nodes (median 9.0 vs. 6.0, P = 0.001), left RLN lymph nodes (median 5.0 vs. 3.5, P = 0.003), and right RLN lymph nodes (median 4.0 vs. 2.0, P = 0.002). Meanwhile, the incidence of postoperative pneumonia in the proficiency phase was significantly lower than that in the learning phase (4.0% vs. 25.0%, P = 0.04).RAME improved left RLN lymph node dissection. Surgeons with extensive VAME experience need at least 20 cases to achieve early proficiency in RAME.

Summary This study aimed to investigate the survival impact of the number of lymph nodes dissection (LND) in patients receiving neoadjuvant chemotherapy (NCT) for esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed the clinical pathological data and survival of 407 ESCC patients who underwent esophagectomy after NCT between January 2015 and December 2016. The relationship between the number of LNDs and 5-year overall survival (OS) or disease-free survival (DFS) was plotted by using restricted cubic spline analysis. A Cox proportional hazards regression model was used to identify prognostic factors of OS and DFS. We observed an obvious non-linear relationship between LND and the hazard ratios (HRs) for OS (P = 0.0015) and DFS (P

Rheumatoid arthritis (RA) is a chronic autoimmune disease that produces synovial membrane inflammation and causes progressive articular damage with function loss. Some controversy exists regarding whether RA is associated with infection and complications after spinal surgery. The present study aimed to determine the effect of RA on spinal surgery infection and complications.A systematic literature search was performed in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. All studies that had compared patients who had undergone spinal surgery with and without RA were included in the analysis.We found significantly greater rates statistically of complications (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.20-1.70; P0.05) and infections (OR, 1.69; 95% CI, 1.46-1.95, P0.05) in those with RA than in those without RA after spinal surgery. When registry data were excluded, the results suggested that the incidence of complications (OR, 2.24; 95% CI, 0.92-5.44; P = 0.08) and infections (OR, 1.76; 95% CI, 1.50-2.07; P0.05) was still greater for the RA group than for the non-RA group.When undergoing spinal surgery, patients with RA have a greater risk of operative complications and infection. Surgeons should be aware of these risks and appropriately plan spinal operation for patients with RA to reduce the risk of complications.

This study aimed to identify all relevant randomized controlled trials (RCT) and prospective non-RCTs to further investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent fractures on unoperated levels. We systematically searched PubMed, EMBASE, Cochrane library, Google Scholar, web of science, and ClinicalTrial.gov from the establishment of the database to January 2020. All eligible studies comparing subsequent fractures after PVA with those after conservative treatment (CT) were incorporated. The pooled risk ratio (RR) with its 95% confidence intervals (95% CIs) was used. Heterogeneity, sensitivity, and publication bias analyses were performed. In all, 32 studies were included in the study: 82/512 patients (16.02%) and 58/433 patients (13.39%) had clinical subsequent fractures in the PVA group and CT group, respectively. No significant differences were observed between the two groups [RR = 1.22, 95% CI 0.70–2.12, P = 0.49]. Further, 175/837 patients (20.91%) in the PVA group and 160/828 patients (19.32%) in the CT group had radiological subsequent fractures. No significant difference was observed between groups [RR = 0.91, 95% CI 0.71–2.12, P = 1.16]. Further, no statistical difference was observed on subgroup analysis between RCTs and non-RCTs or PVP and PKP. Our systematic review revealed that subsequent fractures on unoperated levels were not associated with PVA, regardless of whether they were clinical or radiological subsequent fractures.

Camellia oil (CAO) is a premium edible vegetable oil with medical value and biological activity, but it is susceptible to adulteration. Therefore, the demand for intelligent analysis to decipher the category and proportion of adulterated oil in CAO was the main driver of this work. Excitation-emission matrix fluorescence (EEMF) spectra of 933 vegetable oil samples were characterized by a chemometric method to obtain chemically meaningful information. Authenticity identification models were constructed using four machine learning methods to realize the discrimination of oil species adulterated in CAO mixtures. Meanwhile, quantitative models were established aiming at the fraud of CAO proportion in blended oil. Results showed that the specially constructed CNN obtained the optimal performance when evaluating unseen real-world samples, with a classification accuracy of 95.8% and 92.2%, and mean-absolute quantitative errors between 2.6 and 6.7%. Therefore, EEMF fingerprints coupled with machine learning are expected to provide intelligent and accurate analysis for authenticity detection of CAO.

Objective Long noncoding RNA small nucleolar RNA host gene 1 (SNHG1) has been reported to be aberrantly expressed and plays an important role in human cancers, including esophageal squamous cell cancer. However, the regulatory mechanism underlying SNHG1 in the progression of esophageal squamous cell cancer is poorly defined. Materials and methods Fifty-three esophageal squamous cell cancer patients were recruited and overall survival was analyzed. EC9706 and KYSE150 cells were cultured for study in vitro. The expression levels of SNHG1, microRNA (miR)-204 and homeobox c8 (HOXC8) were detected by quantitative real-time polymerase chain reaction and Western blot. Cell cycle distribution, apoptosis, migration and invasion were determined by flow cytometry and transwell assays, respectively. The target interaction among SNHG1, miR-204 and HOXC8 was validated by luciferase reporter assay and RNA immunoprecipitation. Xenograft model was established to investigate the role of SNHG1 in vivo. Results High expression of SNHG1 was exhibited in esophageal squamous cell cancer and indicated poor outcomes of patients. SNHG1 silence led to cell cycle arrest at G0-G1 phase, inhibition of migration and invasion and increase of apoptosis. miR-204 was validated to sponge by SNHG1 and target HOXC8 in esophageal squamous cell cancer cells. miR-204 knockdown or HOXC8 restoration reversed the inhibitive role of SNHG1 silence in the progression of esophageal squamous cell cancer cells. Furthermore, inhibiting SNHG1 decreased xenograft tumor growth by regulating miR-204 and HOXC8. Conclusion SNHG1 knockdown suppresses migration and invasion but induces apoptosis of esophageal squamous cell cancer cells by increasing miR-204 and decreasing HOXC8.

Quantitation of protoberberine alkaloids is an essential guarantee for efficacy control and medication safety of Coptidis Rhizoma (CR) related medicines. Traditional univariate chromatography faced challenges with co-elution, unknown interferences, and retention time shift when analyzing isomeric analytes in varying sample matrices. We presented a chemometrics-enhanced high-performance liquid chromatography-diode array detection (HPLC-DAD) strategy for simultaneous quantification of six protoberberine alkaloids and processed multi-channels chromatographic-spectral data with four second-order calibration algorithms. Chromatographic conditions were firstly optimized. Four groups of predicted samples were modeled individually with the designed calibration set. Mathematical resolutions were then obtained, and pseudo-univariate regression gave the quantitative concentration of each analyte. Four models were scored on fit, linearity, recovery, and robustness, where alternating trilinear decomposition assisted multivariate curve resolution (ATLD-MCR) exhibited an optimal and stable performance. Besides, the resolved spectra presented high consistency with the actual spectra (r≥0.9993). Limits of quantification (LOQ) fully met the pharmacopoeia stipulation and were 0.17, 0.60, 0.19, 0.74, 0.15, and 0.38 µg mL

A segmented 3-D coupled electromagnetic-thermal solute transportation model, aimed to better understand the macro-segregation formation in the strand during a popular continuous casting (CC) process, has been developed. Based on the model validation by industrial tests, the effect of M-EMS and F-EMS running parameters on the segregation distribution were subsequently carried out. It is shown that the simulated solute segregation profile in the W-shape along the casting thickness direction is in a good agreement with the measured profile. In the initial solidification shell with thickness in 0.020 m, the solute segregation degree changes from a positive value to a negative with the increasing distance from strand surface because of the washing effect induced by the impact flow from the nozzle side port and M-EMS. Here, the minimum degree of carbon segregation decreases from 0.976 to 0.875 with the increasing stirring current from 100A to 550A. As the stirring current of F-EMS decreases from 630A to 200A, the minimum segregation degree locating at 0.109 m distance from strand surface increases from 0.805 to 0.967. The carbon segregation degree at the strand center first decreases from 1.10 to the minimum value of 1.06 at the case of 350 A/4 Hz because of the concentration equilibrium for the local decreasing negative segregation induced by F-EMS, and then increases to 1.16 due to the local poor stirring.

Pulmonary cement embolism (PCE) was a rare but fatal complication for percutaneous vertebral augmentation (PVA). Thus we did a systematic review and meta-analysis of cohort studies to investigate the risk factors for PCE after PVA.We systematically searched PubMed, EMBASE, Cochrane library, Google Scholar, web of science, and ClinicalTrial.gov from the establishment of the database to September 2021. All eligible studies assessing the risk factors for PCE after PVA were incorporated. Dichotomous data was calculated by risk difference (RD) from Mantel-Haenszel method (M - H method); continuous data was analyzed by mean difference (MD) from Inverse-Variance method (I-V method). All variables were taken as measure of effect by fixed effect model. Heterogeneity, sensitivity, and publication bias analyses were also performed.This study totally included 13 studies. According to the Newcastle-Ottawa Scale (NOS), 7 studies were considered as low quality, with NOS6. The others were of relatively high quality, with NOS≥6. 144/6251 patients (2.3%) had PCE after PVA. percutaneous vertebroplasty (PVP) (RD = 0.02, 95%CI: [0.01, 0.04], Z = 3.70, P 0.01), thoracic vertebra (RD = 0.03, 95%CI: [0.01, 0.05], Z = 3.53, P 0.01), higher cement volume injected per level (MD = 0.23, 95%CI: [0.05, 0.42], Z = 2.44, P = 0.01), more than three vertebrae treated per session (MD = -0.05, 95%CI: [-0.08, -0.02], Z = 3.65, P 0.01), venous cement leakage (RD = 0.07, 95%CI: [0.03, 0.11], Z = 3.79, P 0.01) were more likely to cause PCE.This study showed that risk factors for PCE included PVP, thoracic vertebra, higher cement volume injected per level, more than three vertebrae treated per session, venous cement leakage. As a serious complication, PCE should be paid attention and avoided.

Objective To probe the relationship among cement volume/fraction, imaging features of cement distribution, and pain relief and then to evaluate the optimal volume during percutaneous vertebroplasty. Methods From January 2014 to January 2017, a total of 130 patients eligible for inclusion criteria were enrolled in this prospective cohort study. According to the different degrees of pain relief, cement leakage, and cement distribution, all patients were allocated to 2 groups. Clinical and radiologic characteristics were assessed to identify independent factors influencing pain relief, cement leakage, and cement distribution, including age, sex, fracture age, bone mineral density, operation time, fracture level, fracture type, modified semiquantitative severity grade, intravertebral cleft, cortical disruption in the vertebral wall, endplate disruption, type of nutrient foramen, fractured vertebral body volume, intravertebral cement volume, and volume fraction. A receiver operating characteristic curve was used to analyze the diagnostic value of the cement volume/fraction and then to obtain the optional cut-off value. Results The preoperative visual analog scale scores in the responders versus nonresponders patient groups were 7.37 ± 0.61 versus 7.87 ± 0.92 and the postoperative VAS scores in the responders versus nonresponders were 2.04 ± 0.61 versus 4.33 ± 0.49 at 1 week. There were no independent factors influencing pain relief. There were 95 (73.08%) patients who experienced cement leakage, and cortical disruption in the vertebral wall and cement fraction percentage were identified as independent risk factors by binary logistic regression analysis (adjusted odds ratio [OR] 2.935, 95% confidence interval [95% CI] 1.214–7.092, P = 0.017); (adjusted OR 1.134, 95% CI 1.026–1.254, P = 0.014). The area under the receiver-operating characteristic curve of volume fraction (VF%) was 0.658 (95% CI 0.549–0.768, P = 0.006 Conclusions In osteoporotic vertebral compression fracture with mild/moderate fracture severity at the single thoracolumbar level, the intravertebral cement volume of 4–6 mL could relieve pain rapidly. The optimal VF% was 19.78%, which could achieve satisfactory cement distribution. With the increase of VF%, the incidence of cement leakage would also increase.

In the present work, we demonstrated a facile process to prepare graphene/MnO2composites via a simple hydrothermal method at 120 °C using KMnO4and graphene oxide as raw materials followed by reduction with or without hydrazine. The electrochemical performance of the graphene/MnO2composites were investigated in a neutral electrolyte of Na2SO4. Among these samples, the sample rGM3prepared without hydrazine show uniform morphology and the best electrochemical performance. The specific capacitance of rGM3is 169 F g-1at a specific current of 0.2 A g-1. It exhibits a maintenance of 75.5 % of the initial capacitance after 1000 cycles. The results manifest that the graphene/MnO2composites can be potentially applied in supercapacitors.

Objective: Our objective was to evaluate the impact of early oral feeding (EOF) on postoperative cardiac, respiratory, and gastrointestinal (CRG) complications after McKeown minimally invasive esophagectomy for esophageal cancer. Summary Background Data: Nil-by-mouth with enteral tube feeding is routinely practiced after esophagectomy. Methods: Patients were randomly allocated to receive oral feeding on the first postoperative day (EOF group) or late oral feeding (LOF group) 7 days after surgery. The primary endpoint was the occurrence of postoperative CRG complications, and the secondary outcomes included bowel function recovery and short-term quality of life (QOL). Results: Between February 2014 and October 2015, 280 patients were enrolled in this study. There were 140 patients in the EOF group and 140 patients in the LOF group. EOF was noninferior to LOF for CRG complications (30.0% in the EOF group vs. 32.9% in the LOF group; 95% confidence interval of the difference: -13.8% to 8.0%). Compared with the LOF group, the EOF group showed significantly shorter time to first flatus (median of 2 days vs. 3 days, P = 0.001) and bowel movement (median of 3 vs. 4 days, P < 0.001). Two weeks after the operation, patients in the EOF group reported higher global QOL and function scores and lower symptom scores than patients in the LOF group. Conclusions: In patients after McKeown minimally invasive esophagectomy is noninferior to the standard of care with regard to postoperative CRG complications. In addition, patients in the EOF group had a quicker recovery of bowel function and improved short-term QOL.

Although early oral feeding (EOF) is an element often included in enhanced recovery protocols after gastrointestinal surgery, there is no consensus regarding when to resume oral feeding after esophagectomy. Restoration of alimentary continuity following an esophagectomy requires an esophagoenteric anastomosis that is perforce located in the proximal upper gastrointestinal tract. Traditionally, 1 week or longer of nil by mouth is maintained postoperatively for anastomotic healing; during this period a feeding tube (jejunostomy tube or nasointestinal tube) is placed to provide enteral nutrition. At present, there are only five studies, including three randomized clinical trials, that investigate the feasibility and safety of EOF for patients recovering from an esophagectomy. The results of the current studies suggest that EOF protocols do not increase postoperative complications, can shorten the length of postoperative stay, and improve short-term quality of life for patients with esophagectomy. However, evidence from large multi-center randomized controlled clinical trial is still lacking. The ideal route for resuming enteral nutrition in the early post-operative period remains unclear.

This meta-analysis aimed to investigate the value of preoperative sarcopenia in predicting complications after esophagectomy. Clinicopathologic characteristics of sarcopenia patients, which may support sarcopenia management, also were studied.This study searched for articles describing an association between sarcopenia and short-term outcomes after esophagectomy using PubMed, EMBASE, and the Cochrane Library. Mantel-Haenszel and inverse variance models were used for the meta-analyses of end points.The meta-analysis included 14 studies comprising a total of 2387 patients. Sarcopenia was significantly associated with advanced age (weighted mean difference [WMD], 3.48; 95% confidence interval [CI], 2.22-4.74), lower body mass index (WMD - 2.22; 95% CI - 2.65 to - 1.79), squamous cell carcinoma (odds ratio [OR], 2.78; 95% CI 1.72-4.47), advanced clinical tumor stage (OR 1.65; 95% CI 1.28-2.15), and neoadjuvant therapy (OR 1.87; 95% CI 1.38-2.53). The sarcopenia patients showed lower preoperative albumin levels (WMD - 0.11; 95% CI - 0.19 to - 0.04) than the nonsarcopenia patients. Sarcopenia was significantly predictive of pneumonia (OR 2.58; 95% CI 1.75-3.81) and overall complications (OR 1.52; 95% CI 1.07-2.15) after esophagectomy. The sarcopenia patients also showed nonsignificant increases in the risks of anastomotic leakage (OR 1.29; 95% CI 0.99-1.67), vocal cord palsy (OR 2.03; 95% CI 0.89-4.64), and major complications (≥ Clavien-Dindo grade III; OR 1.30; 95% CI 0.95-1.79) but not increased operation time, blood loss, or mortality.Preoperative sarcopenia assessment showed considerable potential for predicting postoperative complications for esophageal cancer patients. To realize this potential, more effective diagnostic criteria and severity classifications for sarcopenia are warranted.

To assess outcomes in obese patients with chronic obstructive pulmonary disease (COPD) who sustained an osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP) in the improved prone position and right lateral position.Between January 2015 and May 2016, a total of 60 patients were enrolled in this randomized controlled study. Patients in group A were placed in the improved prone position for a bilateral transpedicular technique, and those in group B were placed in the right lateral position for a left transverse process-pedicle approach. Clinical and radiologic outcomes were assessed and compared between the 2 groups during the 12-month follow-up period.All operations were successfully completed without any serious sequelae. The operation time, fluoroscopic time, scores for respiratory condition during the operation, intravertebral cement volume, and incidence of cement leakage were significantly greater in group A compared with group B (P0.01). During the follow-up period, all patients in both groups experienced significant improvement in pain relief. Satisfactory functional improvement was obtained at 3 months postoperatively.Treatment of obese patients with COPD suffering from painful OVCF by PVP in both the improved prone position with a bilateral technique and the right lateral position with a unilateral technique was relatively safe and effective. However, unilateral PVP in the right lateral position was associated with a shorter operation time, limited fluoroscopic time, and minimal cement leakage.

To observe the effects of swimming plus medication on the expressions of cytokines in rats with chronic abacterial prostatitis (CAP).Forty healthy adult male SD rats were randomly divided into five groups of equal number, normal control, CAP model control, medication, exercise therapy, and exercise + medication. The CAP model was made by Xiaozhiling injection, and at 7 days after modeling, the rats in the medication and exercise + medication groups were treated intragastrically with Qianlie Shutong Capsules (0.016 g/ml) at 20 ml per kg of the body weight qd, those in the exercise therapy and exercise + medication groups were made swim at a regular time once a day, 35 minutes on the first day and 5 minutes more on the second until 50 minutes once, for 4 successive weeks, and those in the normal control, model control and exercise therapy groups received normal saline only. After 14 and 28 days of treatment, all the rats were killed and their prostates harvested for observation of histopathological changes and determination of the expressions of TNF- α, IL-1β and IL-6 in the prostatic tissue homogenate by ELISA.After 14 days of treatment, the expression levels of TNF-α, IL-1β and IL-6 were significantly elevated in the groups of CAP model control (［183.08±8.07］ pg/ml, ［57.55±3.53］ pg/ml and ［256.15±13.95］ ng/L), medication (［118.49±8.06］ pg/ml, ［42.64±4.64 ］ pg/ml and ［200.74±9.33］ ng/L), exercise therapy (［169.63±10.64］ pg/ml, ［50.45±5.71］ pg/ml and ［245.23±6.49］ ng/L), and exercise + medication (［107.82±7.81］ pg/ml, ［40.35±6.93］ pg/ml and ［187.04±10.85］ ng/L) as compared with those in the normal control (［20.36±1.82］ pg/ml, ［14.64±1.91］ pg/ml and ［70.58±2.09］ ng/L) (P0.05). At 28 days, the levels of TNF- α, IL-1β, IL-6 were remarkably lower in the exercise + medication group (［29.30±3.78］ pg/ml, ［16.91±1.24］ pg/ml and ［ 88.65±6.74］ ng/L) than in the medication group (［39.67±3.19］ pg/ml, ［26.27±3.49］ pg/ml and ［110.26±6.33］ ng/L) (P0.05) and close to those of the normal control group (［19.34±1.76］ pg/ml, ［13.68±1.06］ pg/ml and ［71.34±2.50］ ng/L). During the treatment, no obvious pathological changes were found in the prostate tissue of the normal control rats, while significant chronic prostatic inflammation was observed in the CAP models, and the inflammation was relieved in different degrees after intervention, most significantly in the exercise + medication group.Swimming can relieve prostatic inflammation and swimming plus medication can effectively reduce the expressions of cytokines and alleviate histological damage in the prostatic tissue of CAP rats.目的： 观察游泳运动与药物综合治疗对慢性非细菌性前列腺炎(CAP)大鼠前列腺组织中TNF-α、IL-1β和IL-6水平的影响。 方法： 成年雄性健康 SD大鼠40只，随机分为正常对照组、CAP模型对照组、药物治疗组、运动治疗组及运动与药物综合治疗组，每组8只。注射消痔灵制备CAP大鼠模型，造模期7 d后药物 治疗组和综合治疗组每天给予前列舒通胶囊水溶液(0.016 g/ml)灌胃治疗（剂量为20 ml/kg）；运动治疗组和综合治疗组每天于固定时间进行1次游泳运动,第1天35 min/次，每天递增5 min，直至50 min/次，每周6 d，持续4周；正常对照组、CAP模型对照组及运动治疗组给予无菌生理盐水灌胃（剂量同上）。于治疗过程中的第14 、28天分别处死各组大鼠4只,并提取前列腺，观察组织病理学改变，制作组织匀浆；采用ELISA法检测组织匀浆内TNF-α、IL-1β、IL-6的水平。 结果： 第14天时，正常对照组、CAP模型对照组、药物治疗组、运动治疗组及综合治疗组大鼠前列腺组织匀浆内TNF-α水平依次为（20.36±1.82）、 （183.08±8.07）、（118.49±8.06）、（169.63±10.64）、（107.82±7.81) pg/ml，IL-1β依次为（14.64±1.91）、 （57.55±3.53）、（42.64±4.64）、（50.45±5.71）、（40.35±6.93） pg/ml，IL-6依次为（70.58±2.09）、（256.15±13.95）、 （200.74±9.33）、（245.23±6.49）、（187.04±10.85） ng/L，后面4组的TNF-α、IL-1β和IL-6水平均明显高于正常对照组（P0.05 ）；第28天时，综合治疗组的TNF-α、IL-1β、IL-6水平依次为（29.30±3.78） pg/ml、（16.91±1.24） pg/ml、（88.65±6.74） ng/L， 药物治疗组依次为（39.67±3.19） pg/ml、（26.27±3.49） pg/ml、（110.26±6.33) ng/L，综合治疗组的TNF-α、IL-1β、IL-6水平显著 低于药物治疗组（P0.05），并逐渐接近正常对照组 ［依次为（19.34±1.76） pg/ml、（13.68±1.06） pg/ml、（71.34±2.50） ng/L］ 水平。 在治疗过程的14～28 d，正常对照组大鼠的前列腺病理学检查未见明显变化；模型对照组大鼠前列腺组织表现为明显的慢性炎症的病理变化；各治疗组大鼠前列腺慢 性炎症改变均有不同程度缓解，其中综合治疗组的慢性炎症明显减轻。 结论： 游泳运动能够降低CAP大鼠炎症程度，与药物并用综合治疗可有效降低CAP大鼠TNF- α、IL-1β和IL-6水平，并改善组织学损伤。.

The discordance of epidermal growth factor receptor (EGFR) mutations between primary lung tumors and the corresponding mediastinal nodal metastases has not yet been well elucidated. We investigate the discordance of EGFR mutations between primary tumors and the corresponding mediastinal nodal metastases, and the discordance of EGFR mutations between different mediastinal lymph node stations in patients operated on for stage N2 non-small cell lung cancer (NSCLC). Two hundred and nineteen surgically resected primary tumors and their 553 corresponding mediastinal nodal metastases were evaluated for EGFR mutations in exon 19 or 21 by TaqMan real-time polymerase chain reaction (PCR) analysis. EGFR mutation was detected in 26.0% (57/219) of the primary tumors and 14.8% (82/553) of the corresponding mediastinal nodal metastases. In 162 cases with EGFR wild-type in primary tumors, none of their 402 corresponding mediastinal nodal metastases had EGFR mutation. In 57 cases with EGFR mutations in primary tumors, EGFR mutations were detected in 82 of all 151 metastatic lymph node stations (54.3%), 34 cases had EGFR mutations in mediastinal nodal metastases, and 23 cases had lost the mutations in mediastinal nodal metastases. Among the 219 cases, 196 cases had at least two metastatic lymph node stations, 9.0% (18/196) of cases with multiple metastatic nodal stations exhibited discordance in EGFR mutations between different lymph node stations. The possibility of discordance in EGFR mutations between primary tumors and corresponding mediastinal nodal metastases, and between different mediastinal lymph node stations should be considered whenever these mutations are used for the selection of patients for EGFR-directed tyrosine kinase inhibitor therapy.

To evaluate the effect of actual cooling rate of liquid steel in the ladle on the metallurgical performances of a tundish, a transient and coupled computational model was developed to reveal the flow fields, temperature fields, residence time distribution of the molten steel and the inclusion removal efficiency in a typical single-strand tundish with given geometry and process parameters. The results showed that, with the decrease of the ladle stream cooling rate, the temperature difference of bulk flow at the outlet of tundish over a normal casting period decreased from 11.3 to 2.6 K, and the dead volume fraction of the tundish decreased from 17.58% to 14.35%, while the inclusion removal efficiency was increased especially for the inclusions with the diameter less than 50 μm, whose removal ratio could be increased by 20.62%. When the cooling rate was less than 0.3 K · min −1 , however, the variation rates of the three evaluation criterions above declined significantly, which suggested that a critical value existed for the effect of the cooling rate of ladle stream on the tundish performances. The establishment of the critical ladle stream cooling rate should be very important to achieve persistent metallurgical properties of tundish over the whole casting stage, together with the reasonable ladle insulation design.

Using self-designed 30cm×30cm gas explosion experiment pipe and data acquisition system, we found Fe-Ni foam metal suppresses better gas explosion. We analyzed mechanism of suppressing gas explosion from material characteristics,. The three-dimensional holing-through structure of foam metal can quench exploding flame and decline exploding shock wave. Foam metal material has dual advantages of material and structure which can suppress transmission of fire and shock wave. Effect on different parameters of Fe-Ni foam metal materials was contrasted from declining overpressure and flame temperature, and suitable Fe-Ni form metal was optimized for engineering application.

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) show great efficacy in patients with advanced non-small cell lung cancer (NSCLC) with EGFR mutations. The efficacy and safety of gefitinib following adjuvant chemotherapy in patients with EGFR mutation are unknown. In this open-label, phase II study, patients with resected stage IIIA-N2 NSCLC harbouring EGFR mutations (either exon 19 deletion or L858R point mutation) were assigned randomly to receive pemetrexed (500 mg/m2) and carboplatin (AUC = 5), administered every 21 days for 4 cycles, followed with or without gefitinib (250 mg/day) for 6 months. The primary end point was disease-free survival (DFS). From August 2008 to September 2011, 60 patients were included in our center. DFS was significantly longer among those who received pemetrexed and carboplatin (PC)-gefitinib than among those who received PC alone [hazard ratio (HR), 0.37; 95 % confidence interval (CI) 0.16–0.85; P = 0.014; median, 39.8 vs. 27.0 months]. The rates of 2-year DFS were 78.9 % in the PC-gefitinib group and 54.2 % in the PC alone group. The rates of 2-year overall survival (OS) were 92.4 % in the PC-gefitinib group and 77.4 % in the PC alone group (HR, 0.37; 95 % CI 0.12–1.11, P = 0.076). The most common adverse event was rash (43.3 %, 13/30) in the PC-gefitinib group and the administration of gefitinib following chemotherapy was well tolerated. The administration of gefitinib following PC adjuvant therapy shows significant improvement in DFS in patients with resected stage IIIA-N2 NSCLC harbouring EGFR mutations.

Double perovskite Sr2FeMoO6 film with different thickness was prepared by electrophoresis method on single crystal Si substrate. The post-annealing treatment was carried out at 1100°C with 5% H2/Ar flow. XRD result shows that all the films are of single phase and belong to the I4/m lattice. All the films have no preferred orientation and exhibit typical polycrystal property. Measurement on scanning electron microscope shows that all the three films exhibit similar surface morphology. Different from crystal structure and surface morphology, Curie temperature (TC) shows a non-linear evolution with the thickness of the film. TC of the film increases firstly and then decreases, the highest TC is 300 K. This result indicates that ferromagnetism of the film is strengthened at the thickness about 35μm.

Crystal structure and magnetic properties of hole-doped double perovskite compounds (Sr, Na)2FeMoO6 have been investigated by means of X-ray powder diffraction (XRD) and magnetic measurements. XRD pattern indicates that all the samples are of single phase and belong to the space group I4/m. The degree of cation ordering in the Na-doped Sr2FeMoO6 compounds shows a non-monotonic variation with the doping level, increasing from x=0 to x=0.03 and decreasing slightly with further increase of the doping. However, the Curie temperature of the compound decreases at low doping level and increases at high doping level.

With the help of SolidWorks, the three-dimensional modeling of seedling vegetable harvester was virtually designed based on the harvesting needs for automated seedling vegetable in production, then the parameters of machine parts were determined and the machine was assembled. The prototype is composed of chassis, frame, running device, cutting device, conveyor devices, protecting device, etc., which has the characteristics such as simple structure, high efficiency, low labor intensity, good working quality, safety and reliability, low operating costs, and easy maintenance.

Two-step growth technology to successfully synthesize scallion-root-shaped GaN nanorods was presented in this paper. This growth method is applicable to continuous synthesis a large number of single-crystalline GaN nanorods with a high purity at a low cost. X-ray diffraction (XRD), x-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM) are employed to characterize the structure, composition and morphology of as-grown GaN nanorods. The results show that the obtained nanorods are single-crystal GaN with hexagonal wurtzite structure and have a relatively high purity. The diameter of the nanorods is about 500nm with length up to several tens of micrometers. The representative photoluminescence spectra (PL) measured at room temperature exhibited a strong and broad emission peak at 388nm corresponding to the strong-band-emission in wurtzite GaN, indicating that the nanorods have a good emission property. The growth mechanism is also briefly discussed.

According to the usage of vehicle radar antenna pedestal connection plate, this article analyzes and compares the structure characteristic of welding and casting. We decide to adopt the casting structure and use cast aluminium ZL101A. Based on the connection plate of using conditions, we analyze the deformation and stress of connection plate by the finite element analysis software. The design is in line with the material allowable requirements and to meet the requirements of the system stiffness. (2013) Trans Tech Publications, Switzerland.

The discordance of epidermal growth factor receptor (EGFR) mutations between primary lung tumors and the corresponding mediastinal nodal metastases has not yet been well elucidated. We investigate the discordance of EGFR mutations between primary tumors and the corresponding mediastinal nodal metastases, and the discordance of EGFR mutations between different mediastinal lymph node stations in patients operated on for stage N2 non-small cell lung cancer (NSCLC). Two hundred and nineteen surgically resected primary tumors and their 553 corresponding mediastinal nodal metastases were evaluated for EGFR mutations in exon 19 or 21 by TaqMan real-time polymerase chain reaction (PCR) analysis. EGFR mutation was detected in 26.0% (57/219) of the primary tumors and 14.8% (82/553) of the corresponding mediastinal nodal metastases. In 162 cases with EGFR wild-type in primary tumors, none of their 402 corresponding mediastinal nodal metastases had EGFR mutation. In 57 cases with EGFR mutations in primary tumors, EGFR mutations were detected in 82 of all 151 metastatic lymph node stations (54.3%), 34 cases had EGFR mutations in mediastinal nodal metastases, and 23 cases had lost the mutations in mediastinal nodal metastases. Among the 219 cases, 196 cases had at least two metastatic lymph node stations, 9.0% (18/196) of cases with multiple metastatic nodal stations exhibited discordance in EGFR mutations between different lymph node stations. The possibility of discordance in EGFR mutations between primary tumors and corresponding mediastinal nodal metastases, and between different mediastinal lymph node stations should be considered whenever these mutations are used for the selection of patients for EGFR-directed tyrosine kinase inhibitor therapy.

To protect any person from exposure to the toxic and cancerous particles, welding fumes should be removed from region of respiration. In the present work, displacement ventilation system has been established within a high rise-welding hall, where welding processes cause very high welding fume emissions which flow in a thermal up-current from above the welding point to the ceiling. Numerical simulations on the air flow, thermal flow and pollutants have been conducted, showing that displacement ventilation can effectively remove the airborne pollutants from the respiration region and produce the suitable thermal stratification within the large scale industrial building space. Additionally, the personalized ventilation unit is adopted to deliver fresh air to the breathing zone. The spatial distribution of airborne pollutants is affected by the altitude of personalized ventilation annulus, which is numerically investigated to enhance the overall performance of the displacement ventilation and personalized ventilation units. Finally, on site measurements presented in this paper demonstrate the above mentioned numerical investigations. This research will be significant for the ventilation in high rise industrial buildings.

Microgrids are LV or MV electric networks which utilize various distributed generators (DG) to serve local loads. In this paper, dynamic models of the main distributed generators including photovoltaic (PV) cell, wind turbine, hydro turbine as well as the equivalent power electronic interfaces, battery unit of PV and excitation system of hydro turbine have been made in ElectroMagnetic Transient Program/Alternative Transient Program (EMTP/ATP) software package. Control strategies based on active power/frequency and reactive power/voltage droops for the power control of the inverters have been also developed. Case studies have been carried out in a distribution network to investigate the dynamic behavior of the micro-sources in both steady state and fault scenarios. Simulation results verify the feasibility of the proposed models.

The optimization of the location and height of weir & dam with drain holes in a single-strand continuous casting tundish was carried out from the view of fluid flow characteristics by physical modeling using a 0.4 scaled water model and mathematical modeling study. Considering simultaneously reducing the remaining melt, maximizing the plug flow and avoiding the short circuited flow, the dam with two upwardly inclined drain holes was optimized. The parameters such as location and height of weir & dam Lw/L, Ld/L, Hw/H and Hd/H are important to fluid flow in tundish. Among them, the location and height of dam were more critical to the overall fluid flow in tundish. The gap between weir and dam was also very important, the gap length that smaller than 0.266 will be preferred. The dead region behind the weir was enlarged and the tracer flow through the drain holes of dam was weakened as increasing the gap of weir and dam. In present study, the parameters of the optimized Case7 are Hw/H 0.448 (162/362), Hd/H 0.718 (260/362), Lw/L 0.4 (480/1200) and Ld/L 0.667 (800/1200). For the fluid flow field, the near surface flow which beneficial to inclusions removal existed both above the dam and through the upwardly inclined drain holes. While the case of bottom grooved dam used may lead to short circuited flow through the grooves.

Zn films were prepared on Si (111) substrates by radio frequency magnetron sputtering system, which were subsequently annealed at different temperature in O2 ambient. Their microstructure, morphology, composition and optical properties, particularly as a function of annealing temperature, were studied by XRD, SEM, FTIR, XPS and PL characterizations. All the results show that the crystal quality of ZnO film can be improved by increasing annealing temperature, and the optimum annealing temperature is 800°C in our experiment. The XRD and SEM results show that the ZnO films have a hexagonal structure with cell constants of nm and nm under the optimum experimental conditions. The FTIR and XPS results further confirm hexagonal structure of ZnO. The PL result shows that best UV and green light emission are found in the samples annealed at 800°C.

Optimization of FCD design in a single strand slab tundish producing stainless steel is carried out by physical modelling using a 0.4 scale water model and mathematical modelling study. Reducing the residual metal volume at the end of casting, promoting the near-surface plug flow for inclusions removal and improving the transient slab quality are concerned, the optimized FCD is two dams and an impact pad, among them the dam1 (close to ladle shroud) with two 30 degrees upward inclined drain holes, another dam2 (close to tundish exit) is bottom rectangular-grooved which is beneficial for reducing the residual metal volume. Besides, the height of impact pad and drain holes must be concerned simultaneously, in the present study the height is 20mm and 60mm, respectively. Compared with turbulence inhibitors, impact pad will decrease the melt exposed to air at the steady state of casting. The holes at the higher level of dam may cause slag entrapment during the refilling process of ladle change operation.

Fe3O4 ferrofluids with uniform magnetic particles were prepared via improved chemical coprecipation technique. A narrow distribution of 8.6-10.8 nm particle sizes was obtained from the magnetization curve using the free-form-model based on Bayesian inference theory. The mean particle diameter about 9.8 nm is consistent with the XRD and SEM results. The hydrodynamic properties of ferrofluids were investigated with different applied magnetic field and shear rate. The experimental results show that diluted ferrofluid and concentrated ferrofluid are Newtonian-fluid and Bingham-plastic fluid, respectively.

Microstructural information obtained for silicon-alloyed pyrolytic carbon coatings used for heart valves using X-ray diffraction, scanning electron microscopy and energy dispersive spectroscopy is described. The coatings consist of two phases, pyrolytic carbon and β silicon carbide, whose crystallite sizes are small. The coatings are principally composed of spherical particles that are from 300 to 1000 nm in diameter. These spherical particles, between which there are occasionally pores, are welded by laminar carbons. The silicon, content of which is moderate, disperses uniformly in the coatings.

Background Adjuvant cisplatin-based chemotherapy benefits selected patients with stages II and III non-small cell lung cancer (NSCLC). However, carboplatin being tolerated better than cisplatin, carboplatin-based adjuvant therapy may have better chemotherapy compliance. This study aimed to investigate the feasibility and toxicity of adjuvant carboplatin and docetaxel in patients with completely resected locally advanced NSCLC. Methods Eighty patients with completely resected locally advanced NSCLC were enrolled in this trial. Adjuvant chemotherapy was initiated between 1 and 4 weeks after surgery, and consisted of four cycles of carboplatin (AUC=5), and docetaxel (Taxotere, 75mg/m 2 ) every 3 weeks, after which patients received prophylactic G-CSF supportive therapy. Results Patient demographics were: Median age 55 years (range 34–73): gender ratio was 56.3% male/43.7% female: 72.5% of the patients were at stage IIIA and 27.5% were at stage IIIB. The two most common histologies were adenocarcinoma (62.5%) and squamous cell carcinoma (17.5%). Sixty-six patients (82.5%) received four cycles of therapy over a 12-week period. Fourteen patients (17.5%) did not complete therapy due to: patient refusal ( n =12), severe adverse events ( n =1) and bone metastases during chemotherapy ( n =1). No treatment related deaths were observed and the primary adverse events were hematologic toxicity, alopecia, fatigue and gastointestinal reaction (nausea, vomiting and diarrhea). Conclusion Combination therapy with carboplatin and docetaxel with the use of G-CSF supportive therapy has an acceptable toxicity profile such that the majority of patients completed four cycles of therapy in 12 weeks.

An improved progressive mesh simplification algorithm for 3D real-time level of detail rendering of shearer based on half-collapse was proposed, which has been successfully applied in the rendering of shearer and produced a good result. Virtools with its secondary development technology SDK (Software Development Kit) was applied to establishing a 3DVR(Three Dimensional Virtual Reality) digital information platform for shearer based on real-time archiving of important working parameters. By using the real-time data provided by the remote control and monitoring system for shearer, the virtual 3D model was driven to reappearance the working state and changing trend of the real one instantly. Preliminary experiments carried out in Xi’an Coal Mine Machinery Factory show that the 3DVR Digital Platform can be integrated with the remote control system for shearer well. The ability to real-time display of shearer’s working state is better than that in traditional ways, for the information is displayed in the form of data and curve in traditional control and monitoring system for shearer, which is unrealistic to the operator and unsuitable for remote control and monitoring.

Even though most breast cancers occur in postmenopausal women in western countries, age35 is one of the prognostic factors. This study was to compare the clinicopathologic characteristics and prognosis between premenopausal breast cancer patients aged of35 andor =35 in south China, and to explore the prognostic factors.A total of 905 consecutive premenopausal patients were evaluated, with first diagnosis of breast cancer referred to surgery at the Sun Yat-sen University Cancer Center from October 2003 to December 2006. The clinicopathologic factors and the survival rates between the very young group(aged of35 at diagnosis) and the non-young group(aged ofor =35 at diagnosis) were retrospectively compared.The overall median follow-up time was 27.77 months. The 3-year disease-free survival rate was significantly lower (78.0% vs. 89.1%, P0.001) and the 3-year survival rate relatively lower(94.3% vs. 96.8%, P=0.10) in the very young group than in the non-young group. In addition, the 3-year survival and disease-free survival rates were significantly lower in the very young group with HR (hormone receptor)-positive than in the non-young group (P0.05). The univariate and multivariate analysis of clinicopathologic characteristics between two groups showed that age35 at diagnosis, axillary lymph node involvement, presence of vascular invasion, and high expression of Ki67 were risk factors for recurrence.Compared with non-young premenopausal patients, very young breast patients with HR-positive cancer have a worse outcome.

Background: Hepatocellular carcinoma, a lethal malignant neoplasm with poor prognosis, has dismal results of surgical resection and chemoradiotherapy. Norcantharidin (NCTD), the demethylated analog of cantharidin derived from a traditional Chinese medicine, Mylabris, has been used in the treatment of cancer. However, the detailed mechanisms underlying this process are generally unclear. Purpose: The aim of this study was to investigate the mechanism of NCTD-induced apoptosis in HepG2 cells. Materials and Methods: Human HepG2 cell lines were treated with NCTD at different concentrations (2.50, 5.00, 10.00, 20.00, 40.00 μg/mL) for 24 hours. Cell proliferation was evaluated by measurement of cellular 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). The methylation levels of RASSF1A (Ras-association domain family 1 A) in HepG2 cells were detected by methylation-specific PCR (MSP). The mRNA levels of RASSF1A in HepG2 cells were detected by real-time fluorescent quantitative PCR (RT-PCR). The levels of RASSF1A protein expression of HepG2 cells were detected by Western blotting assay. Results: The inhibition of cell proliferation was observed when treated with NCTD at concentrations (2.5 μg/mL), and as concentration increased, the proliferation of HepG2 cells was markedly inhibited by NCTD in dose-dependent manners. The levels of methylation of RASSF1A decreased at the increasing concentration of 10, 20 and 40 μg/mL. The levels of RASSF1A mRNA and protein were decreased when treated with NCTD at the concentrations of 10, 20 and 40 μg/mL, which were also in a dose-dependent manner. Conclusion: NCTD can reverse the methylation state of RASSF1A gene and induce its re-expression, which will provide the theoretical basis for the clinical practice.

This paper presents a way to deal with the trajectories of some pendulums, such as the simple pendulum, the conical pendulum, and the Foucault pendulum. With a simulator designed by us for displaying the behaviour of the Foucault pendulum, it is simple and convenient to obtain such a trajectory on a piece of paper; this is useful and helpful for students and teachers engaged in college physics courses.