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Background Retrospective studies have shown that adjuvant treatment improves survival of patients with stage IIB–III esophageal squamous cell carcinoma, but there is no evidence from prospective trials so far. Materials and Methods Patients with pathological stage IIB–III esophageal squamous cell carcinoma were randomly assigned to receive surgery alone (SA), postoperative radiotherapy (PORT), or postoperative concurrent chemoradiotherapy (POCRT). PORT patients received 54 Gy in 27 fractions; the POCRT group received 50.4 Gy in 28 fractions, plus concurrent chemotherapy with paclitaxel (135–150 mg/m2) and cisplatin or nedaplatin (50–75 mg/m2) every 28 days. The primary endpoint was disease-free survival (DFS), and the secondary endpoint was overall survival (OS). Results A total of 172 patients were enrolled (SA, n = 54; PORT, n = 54; POCRT, n = 64). The 3-year DFS was significantly better in PORT/POCRT patients than in SA patients (53.8% vs. 36.7%; p = .020); the 3-year OS was also better in PORT/POCRT patients (63.9% vs. 48.0%; p = .025). The 3-year DFS for SA, PORT, and POCRT patients were 36.7%, 50.0%, 57.3%, respectively (p = .048). The 3-year OS for SA, PORT, and POCRT patients were 48.0%, 60.8%, 66.5%, respectively (p = .048). Conclusion PORT/POCRT (especially POCRT) may significantly improve DFS and OS in stage IIB–III esophageal squamous cell carcinoma. Implications for Practice The results of this phase III study indicated that postoperative radiotherapy/postoperative concurrent chemoradiotherapy (PORT/POCRT) could significantly improve disease-free survival and overall survival in stage IIB–III esophageal squamous cell carcinoma compared with surgery alone with acceptable toxicities. In-field and out-of-field recurrences were comparable between the POCRT and PORT groups, which demonstrates the rationality and safety of the radiation field used in this study. The postoperative regimens in this trial might be accepted as standard treatment options for pathological stage IIB–III esophageal cancer. Larger sample size prospective randomized trials to identify the value are warranted.

To meet the changing real-time edge engineering application requirements of CNN, aiming at the lack of universality and flexibility of CNN hardware acceleration architecture based on ARM+FPGA, a general low-power all pipelined CNN hardware acceleration architecture is proposed to cope with the continuously updated CNN algorithm and accelerate in hardware platforms with different resource constraints. In the framework of the general hardware architecture, a basic instruction set belonging to the architecture is proposed, which can be used to calculate and configure different versions of CNN algorithms. Based on the instruction set, the configurable computing subsystem, memory management subsystem, on-chip cache subsystem, and instruction execution subsystem are designed and implemented. In addition, in the processing of convolution results, the on-chip storage unit is used to preprocess the convolution results, to speed up the activation and pooling calculation process in parallel. Finally, the accelerator is modeled at the RTL level and deployed on the XC7Z100 heterogeneous device. The lightweight networks YOLOv2-tiny and YOLOv3-tiny commonly used in engineering applications are verified on the accelerator. The results show that the peak performance of the accelerator reaches 198.37 GOP/s, the clock frequency reaches 210 MHz, and the power consumption is 4.52 w under 16-bit width.

Background Surveillance was recommended for patients after R0 esophagectomy by National Comprehensive Cancer Network (NCCN) guidelines. However, local failure was high in locally advanced patients (48–78%). The present study aimed to determine whether adjuvant treatment improved survival for stage IIb-III thoracic esophageal squamous cell carcinoma (TESCC). Methods A retrospective review of patients diagnosed as esophageal carcinoma at the Chinese Academy of Medical Sciences Cancer hospital, between January 2004 and December 2011, was performed. A database compiling 975 patents with node positive or stage III thoracic esophageal carcinoma after R0 surgery with or without postoperative radiation/chemoradiation was created. A 1:1 matched study group was generated by the Greedy method after propensity score matching (PSM) analysis. Survival curves were calculated by the Kaplan–Meier method and compared with the log-rank test. Univariate and multivariate analyses were using the Cox proportional hazards regression model. Results 975 patients were enrolled in the study, 510 patients (52.3%) did not receive any postoperative treatment after R0 surgery and 465 patients had either postoperative chemoradiation or radiotherapy. Median follow-up was 69.2 months. After PSM, 222 well-balanced patients in each group demonstrated the same results. The 3-year, 5-year survival rates and median survival in surgery group (33.0%, 26.4%, 24.3 months) were inferior to those in postoperative treatment group (48.3%, 37.1% and 34.3 months), ( P = 0.002). Compared with radiotherapy, postoperative chemoradiation did not improve DFS and OS ( P = 0.692; P = 0.368). N stage and adjuvant treatment are independent prognostic factors. Conclusions Adjuvant treatment could improve survival for patients with stage IIb-III TESCC.

Background: Lung cancer is one of the most common malignant tumors in the world and mainly occurs in elderly patients, but rarely in young patients. The purpose of this retrospective study was to examine the clinicopathological features and prognosis of lung cancer patients aged 30 years and younger. Methods: Patients aged 30 years and younger with lung cancer admitted to our center from November 2013 to October 2018 were retrospectively identified. Data included sex, age, smoking history, family history of cancer, high resolution computed tomography results, size and location of tumors, histology of tumors, lymph node status, stage of tumors, treatment methods and prognosis of patients. Results: The patient group included more females (56.3%) than males (43.7%) among lung cancer patients aged 30 and younger. Some patients had a history of tobacco inhalation and family cancer (17.5% and 22.3%, respectively). The most common tumors were in the left lower lobe (27.2%). Nearly half (49.5%) of the patients had pathological adenocarcinomas and 59.3% of the patients were showed early clinical stage and had no lymph node metastasis. All patients received surgical treatment; 47.1% received lobectomy and only 17.9% received adjuvant therapy such as radiotherapy, chemotherapy or targeted therapy after operation. Only seven (7.4%) of the successful follow-up patients died. Local recurrence occurred in two cases and distant metastasis in six cases. Conclusions: The main clinicopathological type of lung cancer in young lung cancer patients aged 30 years and younger is adenocarcinoma, and most cases were at the early stage. Surgical treatment based on lobectomy is still the main treatment method and the prognosis of these patients is very good. Early screening of lung cancer should be actively promoted for young people.

In practical application of underwater wireless optical communication (UWOC), the transmitter should have a larger divergence angle to make it easier to establish a communication link, besides high modulated rate and high optical power. Laser diodes (LD) are suitable to design such transmitter, thanks to their simpler structure and much faster switching speed. However, it is difficult to implement for widespread use in ocean engineering because of its quite small divergence angle. For this, we present a simple way to enlarge the divergence angle for an LD transmitter based on an engineered diffuser in this paper. First, we design a blue LD transmitter that has 476 mW output power, 50 Mbps rate, and 50° divergence angle. Then, using such transmitter, we establish a UWOC system in a large experimental tank with 13.3 m communication distance and about 0.26 m − 1 attenuation coefficient of water. The results show that if the deviation of the transmitting direction is up to ± 25 ∘ , the communication system is workable. Emission light from the transmitter could cover a 42.5% solid angle of the hemisphere space. The combination performances of speed, angular coverage, and optical power are suitable for ocean engineering. Also, it implies that a light field could be designed by using a suitable engineered diffuser for UWOC. The method presented in this paper is simple and pragmatic, which is useful to reduce the difficulty in establishing communication links and is easy to popularize.

Background: Esophageal cancer is one of the most prevalent malignancies with a high incidence and mortality in China, the main treatment for esophageal cancer at present is still surgery-based multimodality treatment, and surgery is still the most effective measure. However, the modes of surgical treatment for esophageal cancer have been diverse. The surgical approaches can be mainly divided into the left thoracic approach and right thoracic approach in China. The long-term survival of the patients treated through right approach was reported better than that through left thoracic approach, but until now no statistically significant difference was found between two approaches, especially, for those with middle and lower thoracic esophageal cancer without suspected upper mediastinal lymph node metastasis in preoperative examinations, no definite conclusion have been made on selection of the approach, therefore, this studies try to compare the long-term survival between two approaches . Methods: The data of 402 cases with complete resection and two-field lymph node dissection from January, 2011 to December, 2011 in the Cancer Hospital, Chinese Academy of Medical Sciences was retrospectively reviewed and analyzed. Propensity score matching (PSM) analysis and life-table in SPSS 22.0 and Stata 14.0 were used to analyze the survival. Results: Totally, 402 cases were surgically treated either via left or right thoracic approach. The overall 5-year survival rate of this series was 38%, it was 37% in 281 cases surgically treated through left approach, and 39% in 121 cases through right approach (P=0.908). The 5-year survival of 256 patients without suspected lymph node metastasis in the upper mediastinum based on the preoperative examinations surgically treated through left approach was 38% versus 43% of 88 cases through right approach (P=0.404). After PSM, the 5-year survival of 110 cases surgically treated through left approach was 32% versus 40% of another matched 110 cases through right approach (P=0.146). for the patients without suspected lymph node metastasis in the upper mediastinum based on preoperative examinations, the 5-year survival of 88 surgically treated through left approach was 33% versus 44% of another matched 88 cases through right approach (P=0.239). Conclusions: For the middle and lower thoracic esophageal cancer patients, whether or not who has suspected lymph node metastasis in the upper mediastinum based on preoperative CT and EUS, the surgical treatment through right thoracic approach can achieve better but not significantly better overall survival than that through left thoracic approach. Further prospective randomized clinical trials are still needed to verify this disputed issue on approach selection.

Colorectal cancer (CRC) is the third most common cancer and the second cause of cancer-related deaths worldwide. Despite early diagnosis and treatment improvement, the majority of patients will still suffer from metastatic disease (mCRC), which has a poor prognosis. Molecular diversity of CRC requires personalized targeted approach for improving patient outcomes. Antiangiogenic agents proved to be beneficial in the continuum of mCRC treatment. For efficient epidermal growth factor receptor (EGFR) directed therapy, subtle molecular selection and better strategies to overcome resistance are needed. BRAF mutant and HER-2 positive mCRC will soon be provided with approved targeted treatments and check-point inhibitors demonstrated effectiveness in microsatellite instability (MSI) - high mCRC. Moreover, numeorous promising agents are entering clinical trial arena. This review summarizes actual and possible targets and current and promising agents for mCRC treatment. With broader accessibility of liquid biopsy we could track molecular evolution of CRC and target genetic alterations as they emerge.

In underwater wireless optical communication (UWOC), one of the key technologies is to generate high-speed communication signal for transmitter. In this paper, we designed such transmitter based on laser diode (LD) arrays, which is composed of three LDs with central wavelength 450nm. The modulation format is non-return-to-zero on-off keying (NRZ-OOK) with data rate up to 50Mbps. Using such transmitter, we established a point-to-point underwater wireless optical communication link in an experimental tank with 20m length, 20m width and 14 depth. The experimental results show that the maximum error-free data rate of the system can reach 50Mbps with 10.7m transmission distance, while the maximum error-free transmission rate is 30Mbps with 14.7m transmission distance. These results verify the feasibility of the LD-based modulation scheme for high-speed UWOC applications.

Background The role of postoperative radiotherapy in pathological T2-3N0M0 esophageal squamous cell carcinoma is unknown. We aimed to evaluate the efficacy and safety of postoperative radiotherapy in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma. Materials and methods Patients aged 18-72 years with pathological stage T2-3N0M0 esophageal squamous cell carcinoma after radical surgery and without neoadjuvant therapy were eligible. Patients were randomly assigned to surgery alone or to receive postoperative radiotherapy of 50.4 Gy in supraclavicular field and 56 Gy in mediastinal field in 28 fractions over 6 weeks. The primary endpoint was disease-free survival. The secondary endpoints were local-regional recurrence rate, overall survival, and radiation-related toxicities. Results From October 2012 to February 2018, 167 patients were enrolled in this study. We analyzed 157 patients whose follow-up time was more than 1 year or who had died. The median follow-up time was 45.6 months. The 3-year disease-free survival rates were 75.1% (95% confidence interval [CI] 65.9-85.5) in the postoperative radiotherapy group and 58.7% (95% CI 48.2-71.5) in the surgery group (hazard ratio 0.53, 95% CI 0.30-0.94, p = .030). Local-regional recurrence rate decreased significantly in the radiotherapy group (10.0% vs. 32.5% in the surgery group, p = .001). The overall survival and distant metastasis rates were not significantly different between two groups. Grade 3 toxicity rate related to radiotherapy was 12.5%. Conclusion Postoperative radiotherapy significantly increased disease-free survival and decreased local regional recurrence rate in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma with acceptable toxicities in this interim analysis. Further enrollment and follow-up are warranted to validate these findings in this ongoing trial. Implications for practice The value of adjuvant radiotherapy for patients with node-negative esophageal cancer is not clear. The interim results of this phase III study indicated that postoperative radiotherapy significantly improved disease-free survival and decreased local-regional recurrence rate in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma compared with surgery alone with acceptable toxicities. The distant metastasis rates and overall survival rates were not different between the two groups. Adjuvant radiotherapy should be considered for pathologic T2-3N0M0 thoracic esophageal squamous cell carcinoma. Prospective trials to identify high-risk subgroups are needed.

Background: It was reported in the literatures that the incidence of anastomotic leakage in patients with esophagogastric junction cancer decreased due to application of staplers and closure devices as well as gastric conduit technique in recent years, however, it increased slightly at our center since widely using the above devices and gastric conduit techniques from 2009. The objective of this study was to summarize our experiences in the management of anastomotic leakages and analyze the factors affecting leakage healing in the patients with esophagogastric junction cancer after surgical resection in recent 6 years. Methods: All patients who received surgical resections for esophagogastric junction cancer and diagnosed anastomotic leak at our center between January 2009 and December 2014 were retrospectively analyzed, we also enrolled the patients who had a longer hospital stay (>30 days) as they may develop anastomotic leak. The binary logistic regression in SPSS 16.0 was applied to analyze the factors that may affect leakage healing. Results: Of the 1,815 surgically treated esophagogastric junction cancer patients, 91 cases were diagnosed anastomotic leakage postoperatively. The patients were divided into two groups based on the median leakage healing time (40 days) in this series: fast healing group (37 cases) and slowly healing group (54 cases). All factors that may affect the leakage healing were put into analysis by using binary logistic regression. The results of the analysis showed that leakage size (OR =1.073, P=0.004), thoracic drainage (OR =12.937, P=0.037) and smoking index ≤400 (OR =1.001, P=0.04) significantly affected the healing time, while drinking history (P=0.177), duration of fever after anastomotic leak developed (P=0.084), and hypoproteinemia after leak (P=0.169) also apparently but not significantly affect the healing time. Conclusions: Though many factors may affect leakage healing in the esophagogastric junction carcinoma patients, leakage size, thoracic drainage and smoking index (≤400) are the most important factors affecting the leakage healing. Placement of a chest tube beside the anastomosis area during operation for early identification and control of an anastomotic leak to minimize contamination of the mediastinum is the most important way to promote leakage healing. A chest tube placing into the purulent cavities after the patients experienced leaks is also important for the cure of leakage. More attention should be paid perioperatively to the patients who had a smoking index (≥400) and the patients who suffered fever or hypoproteinemia.

Primary malignant melanoma of esophagus (PMME) is a rare malignant tumor of esophagus. This study aimed to investigate the clinic pathologic characteristics and analyze the factors that might affect the prognosis of PMME patients. A total of 20 PMME patients who underwent surgical treatment in our hospital from 1975 to 2017 were analyzed. The clinical data, surgical and pathologic features of all patients were collected. For 20 PMME patients, the average age was 57.3 ± 10.7 years, and the male patients account for 75%. Most of the tumors (95%) were located in the middle and lower of the esophagus. There were 7 patients with primary tumor invasion beyond the muscular layer (T3 + T4) and 10 patients with lymph node metastasis (LNM). The median survival time of 20 patients was 12 months, and the 1-year and 5-year survival rates were 50% and 16.9%, respectively. The probability of LNM in tumors confined to submucosa (T1) and myometrium (T2) was lower than that in tumors with deeper invasion (T3, T4) (P = .035). Multivariate analysis showed that tumor node metastasis (TNM) staging was the independent prognostic factor for survival of PMME patients (hazard ratio [95% confidence interval], 4.15 [1.36–12.67]; P = .012). For PMME patients, tumors with deeper invasion were more likely to have LNM, and TNM staging was an independent predictor of prognosis for survival. Early detection of the disease and radical resection of the tumor are critical for better survival of the PMME patients.

Effective tools evaluating the prognosis for patients with esophageal cancer undergoing surgery is lacking. The current study aimed to develop a nomogram to predict overall survival (OS) and provide evidence for adjuvant therapy for patients with esophageal carcinoma after esophagectomy. The study retrospectively reviewed patients with pathologic T1N +/T2-4aN0-3, M0 thoracic esophageal squamous cell carcinoma after radical esophagectomy, with or without adjuvant therapy, in one institution as the training cohort (n = 2281). A nomogram was established using Cox proportional hazard regression to identify prognostic factors for OS, which were validated in an independent validation cohort (n = 1437). Area under curve (AUC) values of receiver operating characteristic curves were calculated to evaluate prognostic efficacy. In the training cohort, the median OS was 50.46 months, and the 5-year OS rate was 47.08%. Adjuvant therapy, sex, tumor location, grade, lymphovascular invasion, removed lymph nodes, and T and N categories were identified as predictive factors for OS. The nomogram showed favorable prognostic efficacy in the training and validation cohorts (5-year OS AUC: 0.685 and 0.744, respectively), which was significantly higher than that of the American Joint Committee on Cancer (AJCC) staging system. The nomogram distinguished OS rates among six risk groups, whereas AJCC could not separate the OS of 2A and 1B, 3C and 3B, or 3A and 2B. Patients with a nomogram score of 72 to 227 were predicted to achieve a 5-year OS increase of 10% or more from adjuvant therapy. The nomogram could effectively predict OS and aided decision making in adjuvant therapy for patients with thoracic esophageal squamous cell carcinoma after esophagectomy.

Background: Increased level of serum macrophage inhibitory cytokine-1 (MIC-1), a member of transforming growth factor-β superfamily, was found in patients with epithelial tumors. This study aimed to evaluate whether serum level of MIC-1 can be a candidate diagnostic and prognostic indicator for early-stage nonsmall cell lung cancer (NSCLC). Methods: A prospective study enrolled 152 patients with Stage I–II NSCLC, who were followed up after surgical resection. Forty-eight patients with benign pulmonary disease (BPD) and 105 healthy controls were also included in the study. Serum MIC-1 levels were measured using an enzyme-linked immunosorbent assay, and the association with clinical and prognostic features was analyzed. Results: In patients with NSCLC, serum protein levels of MIC-1 were significantly increased compared with healthy controls and BPD patients (all P < 0.001). A threshold of 1000 pg/ml of MIC-1 was found in patients with early-stage (Stage I and II) NSCLC, with sensitivity and specificity of 70.4% and 99.0%, respectively. The serum levels of MIC-1 were associated with age (P = 0.001), gender (P = 0.030), and T stage (P = 0.022). Serum MIC-1 threshold of 1465 pg/ml was found in patients with poor early outcome, with sensitivity and specificity of 72.2% and 66.1%, respectively. The overall 3-year survival rate of NSCLC patients with high serum levels of MIC-1 (≥1465 pg/ml) was lower than that of NSCLC patients with low serum MIC-1 levels (77.6% vs. 94.8%). Multivariate Cox regression survival analysis showed that a high serum level of MIC-1 was an independent risk factor for reduced overall survival (hazard ratio = 3.37, 95% confidential interval: 1.09–10.42, P = 0.035). Conclusion: The present study suggested that serum MIC-1 may be a potential diagnostic and prognostic biomarker for patients with early-stage NSCLC.

Our previous study indicated the survival rate for esophageal squamous cell cancer (ESCC) patients in stage III and positive lymph node groups with postoperative radiation therapy was significantly increased compared with surgery alone. But a predictive biomarker was needed to identify the patients who would benefit from postoperative radiotherapy. This study aims to evaluate epidermal growth factor receptor (EGFR) as an indicator to predict the prognosis of ESCC and to identify the patients who would benefit from postoperative radiotherapy.Tissue samples were collected from our previous randomized study: 243 in the surgery alone group and 198 in the surgery plus radiotherapy group. Expression of EGFR was analyzed by immunohistochemical staining.The expression of EGFR is correlated with depth of tumor invasion (p=0.005), lymph node metastasis (p0.001), and pathologic stage (p0.001). The survival rate of patients with high EGFR expression is significantly lower than that of patients with low EGFR expression (p=0.000). Notably, in stage IIA cases, the 5-year survival rate is 57.6% in the low EGFR expression group and 36.6% in the high expression group (p=0.020). EGFR is one of the independent variants that influence the prognosis. Moreover, for high EGFR expression patients the survival rate of the surgery plus radiotherapy group is higher than that of the surgery alone group (p=0.034).Expression of EGFR can be a prognostic predictor for ESCC. Patients with high expression of EGFR may benefit from postoperative radiation therapy.

Combretastatin A4 phosphate (CA4P) is a prodrug that selectively destroys tumor blood vessels, and has shown efficacy as a targeted anticancer drug in both animal models and clinical trials. The aims of this single-center, open label, phase I clinical trial were to investigate the safety and tolerability of CA4P administered intravenously to patients aged 18-65 years with advanced solid tumors. Using a dose-escalation protocol, patients were assigned to five groups that received injections with 20 (n=3), 33 (n=3), 50 (n=11), 65 (n=6), or 85 (n=2) mg/m² CA4P. Patients in the 20 and 85 mg/m² groups received a single dose and the other groups received multiple doses. Adverse events (AE), cardiovascular parameters, and biochemical investigations were studied, and the maximum tolerated dose was determined. Of twenty-five patients enrolled, eight were withdrawn/excluded (not because of AE). There were no deaths. A total of 394 AE occurred in the 25 patients, with 89.3% considered related/possibly related to the drug. AE included headache and dizziness (19.8%), tumor-induced pain (14.2%), vascular vagal excitation (10.7%), and vomiting (9.4%). Ninety-five percent of AE were mild (grades 0-II), with only 5% being grade III-IV. Drug administration was associated with biphasic changes in heart rate and blood pressure, and only limited abnormalities in the laboratory investigations performed. The maximum tolerated dose was 65 mg/m². We conclude that CA4P is generally well tolerated, with the vast majority of AE that occurred being of mild severity. Further studies will establish the role of CA4P in cancer therapy.

Introduction The role of conformal radiotherapy (cRT) in thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed in adjuvant settings. The aim of this study was to investigate whether postoperative radiotherapy using cRT after an R0 resection improves outcomes in pT3N0M0 TESCC compared with resection alone. Methods This study included 678 patients with pT3N0M0 TESCC who were treated at the Cancer Hospital, Chinese Academy of Medical Sciences, from January 2004 to December 2011. The patients were divided into two groups: a surgery plus cRT group (S+cRT group) comprising patients who underwent cRT after an R0 resection and a surgery group (S group), comprising a control group of patients who underwent an R0 resection alone. Propensity score matching was used to create patient groups that were balanced across several covariates (n = 83 in each group). Outcome measures included overall survival (OS), disease-free survival (DFS), and recurrence. Results In the overall study cohort, 5-year OS (75.2% versus 58.5%, p = 0.004) and DFS (71.8% versus 49.2%, p = 0.001) rates were significantly higher in the S+cRT group than in the S group. These data were confirmed in the matched samples (5-year OS, 75.7% versus 58.8% [ p = 0.017]; DFS, 71.7% versus 50.3% [ p = 0.009]). The overall ( p = 0.001) and locoregional ( p = 0.004) recurrence rates in the S+cRT group were significantly lower than in the S group. Multivariate Cox analyses in the matched samples revealed that surgery and postoperative cRT were independently associated with longer OS (hazard ratio = 0.505, 95% confidence interval: 0.291–0.876, p = 0.015) and longer DFS (hazard ratio = 0.513, 95% confidence interval: 0.309–0.854, p = 0.010) than resection alone. Conclusions Postoperative radiotherapy using cRT is strongly associated with improved OS and DFS in patients with pT3N0M0 TESCC. A multicenter, randomized phase III clinical trial is warranted to confirm these findings.

It is a challenging task to build efficient and robust model for aircraft detection. In our object recognition system, aircraft detection is a main task, which faces various problems, such as blur, occlusion, and shape variation and so on. Existing approaches always require a set of complex classification model and a large number of training samples, which is inefficient and costly. In order to deal with these problems, we employ location based informative features to reduce the complexity of training data. With the employment of location based informative features, simple classifiers will manifest high performance instead of complex classifier which requires more complicated strategy for training. Further, our system needs to update the model frequently which is similar to online learning method, in order to reducing computational complexity, a very sparse measurement matrix is applied to extract features from feature space. The construction of this sparse matrix is based on the theory of sparse representation and compressed sensing. From the experimental results, the detection rate and cost of our proposed method is better than other traditional method.

Background Primary small cell carcinoma of the esophagus is rare.Although surgery is successful in eradicating local tumor,the five-year survival rate of patients with primary small cell carcinoma of the esophagus after resection is lower than that of patients with primary squamous cell carcinoma of the esophagus.The purpose of this study was to analyze the clinical manifestations,pathological features and treatment of primary small cell carcinoma of the esophagus. Methods A total of 73 patients with primary small cell carcinoma of the esophagus who had been treated by surgery from 1984 to 2003 were analyzed retrospectively. Results In this series,the overall resection rate was 94.5% (69/73),the radical resection rate 89.0% (65/73) and the operative mortality 1.4% (1/73).The 1-,3-and 5-year survival rates of patients were 50.7%,13.7% and 8.2%, respectively. Conclusions Primary small cell carcinoma of the esophagus is rare with a poor prognosis.Surgical resection is the leading method for patients with stage Ⅰ or Ⅱ primary small cell carcinoma of the esophagus.Postoperative chemotherapy is beneficial to these patients.The patients of stage Ⅲ or Ⅳ should be given chemotherapy and radiation therapy. Chin Med J 2007;120(5):355-358

Video-assisted thoracoscopic (VATS) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node (LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not.The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1, 2009 to July 30, 2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy.One hundred and twenty-nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another part 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 (P0.001). The average dissected LN stations was 3.2 vs. 3.6 (P = 0.038). The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 (P = 0.012). The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P = 0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41.1% in the VATS group versus 42.6% in the conventional group (P = 0.801). The cardiopulmonary complication rate was 25.6% vs. 27.1% (P = 0.777). The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P = 0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P = 0.049) but longer operating time (161.3 min vs. 127.8 min, P0.01).In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to un-skillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.

Objective To evaluate the prognostic factors affecting survival in esophageal squamous cell Carcinoma (ESCC) patients with pathologic T0 (ypT0) underwent preoperative radiotherapy. Patients and methods Two hundred and ninety-six patients with ESCC who had received preoperative radiotherapy from 1980 to 2007 were retrospectively analyzed. One hundred patients were ypT0 after preoperative radiotherapy. Univariate and multivariate analyses were performed to evaluate the predictive impact of residual lymph node status on overall survival (OS) and progression-free survival (PFS). Results Among the originally analyzed 296 patients, 100 (33.7 %) patients had ypT0, including 78 patients (78 %) with ypT0N0, and 22 patients (22 %) with ypT0N1. The 5-year OS of the total patients was 42.4 %. Patients with ypT0N0 have significant improved 5-year OS and PFS than ypT0N1 patients (OS: 50.7 % vs 13.6 %, P = 0.004; PFS: 49.6 % vs 13.6 %, P = 0.003). In multivariate analysis, residual lymph node status was also an independent prognostic factors for OS (HR: 0.406, 95 % CI: 0.240–0.686, P = 0.001) and PFS (HR: 0.427, 95 % CI: 0.248–0.734, P = 0.002). Conclusion Our results indicate that patients with ypT0N0 after preoperative radiotherapy had significantly better OS and PFS than patients with ypT0N1 in ESCC. Residual nodal metastasis of ESCC patients with pathological complete response of the primary tumor after neoadjuvant radiotherapy does influence prognosis.

To analyze the significance of the number of metastatic lymph nodes on survival with and without the addition of prophylactic postoperative radiotherapy (RT) after radical resection of thoracic esophageal carcinoma.A total of 549 thoracic esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery-alone group (S, n = 275) and a surgery plus RT group (S+R, n = 274). We performed a retrospective review of all patients according to the extent of metastasis. The patients were classified into three groups: Group 1, 269 patients (49.0%) without lymph node involvement; Group 2, 159 patients (29.0%) with one to two positive nodes; and Group 3, 121 patients (22.0%) with three or more positive lymph nodes.For the same T stage (T3), the 5-year survival rate for Groups 1, 2, and 3 was 50.6%, 29.3%, and 11.7%, respectively (p = 0.0000). For patients with Stage III, the 5-year survival rate for Groups 1 (T4N0M0), 2 (T3-T4N1M0), and 3 (T3-T4N2M0) was 58.1%, 30.6%, and 14.4%, respectively (p = 0.0092). The 5-year survival rate of the S and S+R groups with positive lymph nodes (Groups 2 and 3) was 17.6% and 34.1% (p = 0.0378). In the positive lymph node groups, the incidence of failure by intrathoracic lymph node metastasis and supraclavicular lymph node metastasis in the S+R group (21.5% and 4.6%, respectively) was lower than in the S group (35.9% and 19.7%, respectively; p0.012). In the negative lymph node group, the incidence of failure by intrathoracic lymph node metastasis in the S and S+R groups was 27.8% and 13.3%, respectively (p = 0.006). Hematogenous metastasis was the greatest (27.5%) in Group 3 (three or more positive lymph nodes).The number of metastatic lymph nodes is one of the important factors affecting the survival of patients with thoracic esophageal carcinoma. In our study, postoperative RT improved the survival of patients with positive lymph nodes. Additionally, postoperative RT reduced the incidence of intrathoracic recurrence and supraclavicular lymph node metastasis for all patients.

Optoelectronic hybrid system is widely used in military field and civilian field. Target recognition is one of the important functions of optoelectronic hybrid system. In order to improve the system's flexibility and intelligence, expert system is involved into optoelectronic hybrid system. This paper presents a model of target recognition based on CBR (case-based reasoning) expert system in optoelectronic hybrid system. And this paper processes an experiment about target recognition to recognize the vehicles. In this experiment, the KNN (K-nearest neighbors), a classical algorithm of CBR and one UCI data-set is employed. Results demonstrate that CBR expert system can be used to recognize the target in optoelectronic hybrid system, and the accuracy and efficiency can be improved by selecting features.

Background: The aim of this study was to retrospectively analyze the effect of postoperative intensity-modulated radiotherapy (IMRT) on recurrence and survival in lymph node-positive or stage III thoracic esophageal squamous cell carcinoma (TESCC) patients, and evaluate its role in TESCC therapy. Methods: We enrolled 538 patients who underwent radical resection with (S + R) or without (S) postoperative IMRT. The median total postoperative IMRT dose was 60 Gy. The Kaplan-Meier method, log-rank test, and chi-square test were used for survival rate calculation, univariate analysis, and sites of failure analysis, respectively. Results: The 5-year overall survival (OS) and disease-free survival rates were 32.7 and 27.3%, respectively. The 5-year OS rates of lymph node-positive S and S + R patients were 28.4 and 38.8%, respectively (p < 0.001). The 5-year OS rates of stage III S and S + R patients were 24.0 and 38.0%, respectively (p = 0.001). Postoperative IMRT resulted in significantly decreased intrathoracic and supraclavicular recurrence, and obviously delayed median local recurrence and systemic metastases. Systemic metastases increased following postoperative IMRT. Conclusion: Postoperative IMRT reduces local recurrence and improves survival in lymph node-positive or stage III TESCC patients, providing a rationale for selection criteria for postoperative IMRT in TESCC.

The aim of this study was to detect the plasma concentration of OLC1 (overexpressed in lung cancer 1) protein as a potential cancer biomarker, and evaluating its clinical application value in the diagnosis of non-small cell lung cancer (NSCLC).We prepared OLC1 antibody with OLC1 full length protein, in 5-6-week old Bal B/c mice. Each mouse was immunized four times at a dose of 15-30 µg antigen protein, and the interval between two consecutive immunizations was two weeks. Antibody screening was made by ELISA and Western blot, and a double antibody sandwich ELISA kit was developed. We used this established ELISA kit to detect the plasma concentration of OLC1 protein in 281 NSCLC patients and 92 gender- and age-matched healthy controls. Area under the receiver operating characteristic curve (AUC) was used to evaluate the detection efficacy of OLC1.We obtained 11 OLC1 monoclonal antibodies and successfully established the ELISA kit to detect the plasma concentration of OLC1 with a detection range from 1.95 ng/ml to 62.50 ng/ml. OLC1 concentration in the case group (124.69 ng/ml) was significantly higher than that in the control group (67.07 ng/ml, P0.001). In the scenario of distinguishing NSCLC from control group, AUC result was 0.69. When the cut-off was set at 67.72 ng/ml, the sensitivity and specificity was 84.4% and 51.1%, respectively. In term of distinguishing early lung cancer (IA) from normal controls, the AUC, sensitivity and specificity were 0.68, 77.8% and 54.4%, respectively.The plasma concentration of OLC1 protein is significantly elevated in NSCLC patients. OLC1 may be as a potential cancer biomarker applied in clinical diagnosis.

To evaluate and compare the value of stair climbing tests and conventional pulmonary function tests in the prediction of postoperative cardiopulmonary complications in non-small cell lung cancer patients underwent surgery.From April 1, 2010 to Jan. 30, 2012, a total of 162 patients with thoracic carcinoma underwent stair climbing test (SCT) and conventional pulmonary function tests (PFT) preoperatively. The correlation of postoperative cardiopulmonary complications with the SCT and PFT parameters were analyzed retrospectively using chi-square test, independent sample t test and binary logistic regression analysis.Of the 162 patients, 19 without operation were excluded, due to an advanced stage (9 cases), poor cardiopulmonary function (5 cases), rejecting operation (4 cases) and exploration alone (1 case). 143 cases were eligible and evaluated eventually. Forty-one of the 143 patients (28.7%) had postoperative cardiopulmonary complications, but no death occurred. The patients were stratified into groups based on the time of stair climbing 5 stories (18.36 m, t,92 s, ≥ 92 s). Exercise oxygen desaturation (EOD) during the stair climbing test (5%, ≥ 5%) and the difference between the pulse at resting state and the pulse at end of stair climbing test (ΔP,55 beats/min, ≥ 55 beats/min), respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with t ≥ 92 s, EOD ≥ 5% and ΔP55 beats/min (38.5%, 42.0% and 35.1%, respectively) than that in the group with t92 s, EOD5% and ΔP ≥ 55 beats/min (16.9%, 21.5% and 18.2%, respectively). Binary logistic regression analysis showed that postoperative cardiopulmonary complications were independently correlated with EOD and lung function which did not meet the requirement of the lung resection operation mode.A symptom-limited stair climbing test is a safe, simple and low-cost method to evaluate the cardiopulmonary function preoperatively. It can predict the occurrence of postoperative cardiopulmonary complications in non-small cell lung cancer patients. Conventional pulmonary function tests and stair-climbing test can be recommended to be routinely performed in all patients with non-small cell lung cancer before thoracic surgery.

Objective: To study the blocharacteristics of primary esophageal adenocarcinoma (PEAC) and factors influencing patients' prognosis and to find rational surgical indications and combined therapy. Methods: To analyze the clinical material of 106 patients with PEAC and compared with that of patients with esophageal squamous-cell carcinoma (ESCC). Results: The overall resectability, morbidity and 30-day mortality rates of PEAC were 92.5%, 23.5% and 2.8% respectively, similar to those of ESCC. The TNM staging, lymph node metastasis, extraesophageal invasion and the nature of operation were major determinants influencing longterm prognosis. The 5-year survival rate of PEAC was 21.0%, which was lower than that of ESCC (P

To evaluate the clinical application of a right-thoracic approach with or without laparotomy for mid-upper esophageal cancer. We retrospectively reviewed the data of 34 esophageal cancer patients who received Belsey surgery or a modified Ivor-Lewis surgery from November 1992 to April 2007. Twenty of the patients underwent a Belsey prodecdure (Group A) from November 1992 to January 2001 and 14 underwent a modified Ivor-Lewis prodecdure (Group B) from May 2001 to April 2007. Twenty patients with esophageal cancer received an esophagectomy through an exclusive right-thoracic approach (Belsey surgery), and 14 patients received an esophagectomy through a right-thoracic approach combined with a laparotomy (modified Ivor-Lewis surgery). The complication rate was 15% (3/20) and 7.1% (1/14) respectively. The survival rate was 42.9% (5-year survival) and 38.7% (5-year survival) respectively for these two groups. An exclusive right-thoracic approach (Belsey surgery) is associated with more complications. It is not a routine surgery for cancer of the mid-upper thorax of the esophagus, but can be selectively used as palliative esophagectomy for esophageal cancer patients with poor pulmonary function. Modified Ivor-Lewis surgery can simultaneously be utilized to resect the primary tumor and dissect lymph nodes of the thorax and abdomen. With a shorter time period of surgery and postoperative recovery period, modified Ivor-Lewis surgery can achieve better effects with patients who have mid-upper esophagus cancer.

In order to minimize the injury reaction during the surgery and reduce the morbidity rate, hence reducing the mortality rate of esophagectomy, minimally invasive esophagectomy (MIE) was introduced. The aim of this study was to compare the postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing minimally invasive or open esophagectomy (OE).The medical records of 176 consecutive patients, who underwent minimally invasive esophagectomy (MIE) between January 2009 and August 2013 in Cancer InstituteHospital, Chinese Academy of Medical Sciences, were retrospectively reviewed. In the same period, 142 patients who underwent OE, either Ivor Lewis or McKeown approach, were selected randomly as controls. The clinical variables of paired groups were compared, including age, sex, Charlson score, tumor location, duration of surgery, number of harvested lymph nodes, morbidity rate, the rate of leak, pulmonary morbidity rate, mortality rate, and hospital length of stay (LOS).The number of harvested lymph nodes was not significantly different between MIE group and OE group (median 20 vs. 16, P = 0.740). However, patients who underwent MIE had longer operation time than the OE group (375 vs. 300 minutes, P0.001). Overall morbidity, pulmonary morbidity, the rate of leak, in-hospital death, and hospital LOS were not significantly different between MIE and OE groups. Morbidities including anastomotic leak and pulmonary morbidity, inhospital death, hospital LOS, and hospital expenses were not significantly different between MIE and OE groups as well.MIE and OE appear equivalent with regard to early oncological outcomes. There is a trend that hospital LOS and hospital expenses are reduced in the MIE group than the OE group.

Background The overall survival of patients with esophageal squamous cell carcinoma (ESCC) remains poor. Prognostic predictions in ESCC are usually based on histological assessment of tumor invasion and lymph node metastasis, but a biomarker with better predictive accuracy could be more useful. Because overexpression of epidermal growth factor receptor (EGFR) has been associated with poor prognosis, this study investigated whether EGFR is an independent prognostic factor for overall survival and disease-free survival of ESCC patients. Methods ESCC tissue specimens from 243 patients obtained during surgical resection between 1980 and 1997 were retrieved for immunohistochemical analysis of EGFR expression. Results The data showed that EGFR protein was overexpressed in 187 of 243 (77%) ESCC tissues. Elevated expression was associated with higher pathologic tumor stages (P = 0.001), lymph node metastasis (P = 0.002), and higher Union for International Cancer Control (UICC) stage (P P P = 0.003) and overall survival (P = 0.001) of these patients. Subgroup analysis of patients with stage IIA (UICC 2002) showed that EGFR overexpression was associated with poorer disease-free survival (P = 0.007) and overall survival (P = 0.010) of the patients in univariate analyses. Conclusions The current study demonstrated that EGFR overexpression was an independent prognostic factor for overall survival and disease-free survival of ESCC patients. However, targeting of EGFR activity using gefitinib or erlotinib could be useful for clinical treatment of ESCC patients.

Background Attenuated total reflection–Fourier transform infrared (ATR–FTIR) spectroscopy could serve as a diagnostic tool for detecting and discriminating different diseases. The aim of this preliminary study was to distinguish malignant and nonmalignant lung tissues with ATR–FTIR spectroscopy. Methods Sixty lung tissue samples were obtained from 30 patients who underwent pulmonary lobectomy. Samples were examined with ATR–FTIR spectroscopy before histologic diagnosis. Peak positions, intensities, and full width at half maximum of each absorbent band were measured, and the relative intensity ratios were calculated. Canonical discriminant analysis was performed to discriminate malignant and nonmalignant groups. Results Twenty-two parameters were significantly different between malignant and nonmalignant groups. Peak intensity at 1546/cm, intensity ratio at 1120/cm, and full width at half maximum at 1303 and 1240/cm were selected as independent factors to form discriminant functions. The sensitivity and specificity of the discriminants were all 96.7%. Conclusions ATR–FTIR spectroscopy is a promising method for the detection of malignant lung tissue and could be proved useful in lung tumor surgery.

Lung wedge resections and biopsies are frequently needed to diagnose and treat benign or malignant lung lesions. This study aims to compare thoracoscopy with thoracotomy for lung biopsy and wedge resection in solitary pulmonary nodule (SPN).A controlled retrospective study was performed in this hospital. Patients with clinical diagnosis of SPN were undergone thoracoscopy or thoracotomy. Data of operation time, hours of stay in recover room, duration and volume of chest tube drainage, accuracy of biopsies, days of hospitalization and the whole cost of hospitalization were evaluated.All patients were received lung biopsies and wedge resections (thoracoscopy 26,thoracotomy 47), and they were diagnosed pathologically. The days of hospitalization were similar in the two groups. The minutes of operation had no significant difference (thoracoscopy: 103.9±29.4 minutes, thoracotomy: 94.7±33.9 minutes). Both groups had equivalent duration of chest tube drainage (thoracoscopy: 60.3±25.0 hours, thoracotomy: 62.5±20.1 hours, P =0.687) . The total volume of chest tube drainage showed no difference in both groups. The hours of stay in recover room (thoracoscopy: 75.4±21.6 hours, thoracotomy: 80.4±17.7 hours, P =0.287) and days of hospitalization after operation (thoracoscopy: 11.3±3.4 days, thoracotomy: 10.6±2.4 days, P = 0.304 ) were not different significantly. The whole cost of thoracoscopy was 17 800.2±6 038.9 CNY and thoracotomy was 17 677.4±6 327.8 CNY ( P = 0.936 ).There is no significant difference in outcomes for thoracoscopy and thoracotomy approaches. Both thoracoscopy and thoracotomy are acceptable procedures for lung biopsy and wedge resection in solitary pulmonary nodules.

With the improvement of the surgical and anesthetic techniques, there are increasing numbers of elderly surgical patients with lung cancer. The purpose of this study is to examine the prognostic factors of surgical resection in patients more than 70 years of age.Data were retrospectively analyzed from 192 patients aged ≥70 years who underwent lung cancer surgery. Of these patients, 48.4% were in stage I, 20.8% in stage II, 19.3% in stage III, and 2.1% in stage IV. Patient demographics were the following: 79.2% male and 20.8% female; 21.9% ≥75 years older; and 11.5% had significant co-morbidities. Tumor characteristics: squamous cell carcinoma 49.0%, adenocarcinoma 35.9%, adenosquamous carcinoma 8.3%, small cell lung cancer 4.7%, others 2.1%.exploration 2.1%, wedge resection 8.3%, lobectomy 72.4%, more than lobectomy 12.5%, pneumonectomy 4.7%. Of these operations, 91.1% were radical surgery. The significance of prognostic factors was assessed by univariate and multivariate COX regression analyses.The total 5-year survival rate was 33.5% in this series. Age, sex, symptom and co-morbidity had no impact on survival. Multivariable COX analysis demonstrated that incomplete resection (P=0.003), advanced surgical-pathological stage (P0.001) and other type of the tumor (P=0.016) were significant, independent, unfavorable prognostic determinants in patients.Thoracic surgery is a safe and feasible approach in elderly patients with lung cancer. Every effort should be made to detect early stage patients who might benefit from surgical treatment. Lobectomy is still the ideal surgical option for elderly patients who are able to tolerate the procedure. More limited lung surgery may be an adequate alternative in patients with associated co-morbidities.