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Purpose The aim of this study was to determine the risk of severe postoperative complications (SPCs) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients.Methods We retrospectively analyzed 297 consecutive patients undergoing gastrectomy in this multicenter study. Sarcopenia was diagnosed by preoperative computed tomography of the L3 skeletal muscle area. Nutritional status was assessed according to the Global Leadership Initiative on Malnutrition criteria. According to the Clavien–Dindo classification system, SPCs were classified as C-D Grade ≥ IIIa. A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs.Results Of the 297 patients analyzed in this study, 86 (28.96%) were diagnosed with malnutrition, 55 (18.52%) were diagnosed with sarcopenia, and 24 (8.08%) were diagnosed with SPCs. Patients who developed SPCs had longer hospital stays (SPCs vs. non-SPCs: 23 vs. 11 days, P P P P = 0.017), combined resection (P = 0.028), and duodenostomy (P = 0.001) independently predicted the occurrence of SPCs. The nomogram exhibited good discrimination, with a discriminant consistency index of 0.822, and the calibration was also excellent.Conclusions Sarcopenia, malnutrition, combined resection and duodenostomy are independent predictors of SPCs. Our nomogram exhibited good discrimination and was practical for identifying patients at high risk of SPCs.

Background To evaluate the immune function of gastric cancer patients after single-incision laparoscopic distal gastrectomy (SIDG) or multiport laparoscopic distal gastrectomy (MLDG) guided by enhanced recovery after surgery (ERAS). Methods A retrospective cohort study was performed on 120 patients who underwent laparoscopic distal gastrectomy for gastric cancer. The patients were divided into two groups according to operation method: group A (MLDG) and group B (SIDG), both guided by ERAS concept. The indicators reflecting immune function and inflammation, such as CD3+, CD4+, CD8+ and NK cell count, CD4+/CD8+ cell ratios, IgA, IgM and IgG levels, C-reactive protein (CRP), total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) were tested 3 days and 7 days after surgery. Results The skin incision length of patients in group B was significantly shorter than that in group A, but the operation time was significantly longer in group B than that in group A (P P P > 0.05). On the 7th day after surgery, the immune indexes of both groups recovered somewhat, approaching the preoperative level (P > 0.05). Inflammation indexes increased 3 days after surgery and decreased 7 days after surgery in both groups, among them the CRP level in group A was higher than that in group B (P Conclusion Compared with MLDG guided by ERAS, SIDG under the guidance of the ERAS concept has better cosmetic effect and similar effect on immune function of gastric cancer patients.

Objective Quality assurance is crucial for oncological surgical treatment assessment. For rare diseases, single-quality indicators are not enough. We aim to develop a comprehensive and reproducible measurement, called the “Textbook Outcome” (TO), to assess the quality of surgical treatment and prognosis of gastric neuroendocrine carcinoma (G-NEC) patients. Methods Data from patients with primary diagnosed G-NEC included in 24 high-volume Chinese hospitals from October 2005 to September 2018 were analyzed. TO included receiving a curative resection, ≥15 lymph nodes examined, no severe postoperative complications, hospital stay ≤21 d, and no hospital readmission ≤30 d after discharge. Hospital variation in TO was analyzed using a case mix-adjusted funnel plot. Prognostic factors of survival and risk factors for non-Textbook Outcome (non-TO) were analyzed using Cox and logistic models, respectively. Results TO was achieved in 56.6% of 860 G-NEC patients. TO patients had better overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) than non-TO patients (P200 mL blood loss were independent risk factors for non-TO patients (P

Background The relationship between sarcopenia and the prognoses of patients with gastric neuroendocrine neoplasms (g-NENs) is unclear. This study was designed to explore the effects of sarcopenia on short-term and long-term outcomes of patients with g-NENs after radical gastrectomy. Methods This study retrospectively collected data from 138 patients with g-NENs after radical gastrectomy. The skeletal muscle index (SMI) diagnostic threshold for sarcopenia was determined using X-tile software. Cox regression analyses were performed to determine the independent risk factors for 3-year overall survival (OS) and 3-year recurrence-free survival (RFS). Results In this study, 59 patients (42.8%) were diagnosed with sarcopenia. Among patients in the sarcopenia group and nonsarcopenia group, the incidences of total postoperative complications were 33.9 and 30.4%, incidences of serious postoperative complications were 0 and 3.7%, incidences of postoperative surgical complications were 13.6 and 15.2%, and incidences of postoperative systemic complications were 20.3 and 15.2%, respectively (all p > 0.05). The 3-year OS and RFS rates were significantly worse in the sarcopenia group than in the nonsarcopenia group (OS: 42.37% vs 65.82%, p = 0.004; RFS: 52.54% vs 68.35%, p = 0.036). The multivariate analysis revealed a relation between sarcopenia and the long-term prognoses of patients with g-NENs. A stratified analysis based on the pathological type revealed that the Kaplan-Meier curve was only significantly different in patients with gastric mixed adenoneuroendocrine carcinoma (gMANEC) (OS: 40.00% vs 71.79%, p = 0.007; RFS: 51.43% vs 74.36%, p = 0.026); furthermore, the multivariate analysis identified sarcopenia as an independent risk factor for patients with gMANEC (p Conclusions Sarcopenia is not related to the short-term prognoses of patients with g-NENs. Sarcopenia is an independent risk factor for patients with gMANEC after radical surgery.

Enhanced Recovery after Surgery has been proven effective for patients with gastrointestinal cancer. But radical enhanced recovery could also lead to adverse clinical outcomes. Compared with reports on the estimation of successful implementation of enhanced recovery, studies on risk factors of enhanced recovery failure are still lacking. A retrospective analysis was carried out on 102 patients in ERAS who underwent elective colon cancer surgery. This study included 102 patients with colon cancer between 2015 and 2019, defining enhanced recovery failure as postoperative length of stay over 10 days, stay in ICU over 24 h after surgery, reoperation, death, or unplanned readmission within 30 days after surgery. Univariate and multivariate analyses were performed to explore potential risk factors of failure. Aged ≥ 75, open operation, number of drainage tube over 1, re-urethral catheterization, and Clavien-Dindo grade over 2 were associated with ERAS failure, according to univariate analysis. Multivariate analysis showed that age ≥ 75 [OR 7.231; P = 0.009]; open operation (OR 3.599; P = 0.021); and number of drainage tube over 1 (OR 3.202; P = 0.020) were independent risk factors for ERAS failure. We found age ≥ 75, open operation, and number of drainage tube over 1 are independent risk factors associated with ERAS failure after colon cancer surgery.

Enhanced recovery after surgery programs has been applied extensively in laparoscopic colorectal surgery. However, several studies have found that some patients fail from ERAS programs. It is important to identify these patients so that remedial action can be taken in a timely manner. The aim of this study was to perform a systematic review of ERAS failure and related risk factors following laparoscopic colorectal surgery. A literature search of the PubMed, EMBASE, OVID, and Cochrane databases was performed. The search strategy involved terms related to ERAS, failure, and colorectal surgery. The main outcomes were definitions of ERAS failure and related risk factors. Seven studies including 1463 patients were analyzed. The definition of ERAS failure was mostly associated with a prolonged postoperative length-of-stay (poLOS). Twenty-four kinds of identified risk factors were divided into three parts, the operative part, the pathophysiological part, and the ERAS elements, of which operative factors including more intraoperative blood loss and longer operative duration were the most frequently identified. ERAS failure was mostly related to a prolonged poLOS, and operative factors were the most frequently identified risk factors for ERAS failure following laparoscopic colorectal surgery. These findings will help physicians to take remedial action in a timely manner. Nonetheless, high-quality randomized controlled trials following a standardized framework for evaluating ERAS programs are needed in the future.

Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to conventional laparoscopic sleeve gastrectomy (CLSG) in obese patients. This study aims to compare the surgical outcomes of these two techniques. A meta-analysis of existing literature obtained through a systematic literature search in the PubMed, EMBASE, and Cochrane Library CENTRAL databases from 2009 to 2019 was conducted. Eleven articles including 1168 patients were analyzed. Patients in the SILSG group reported greater satisfaction with cosmetic scar outcomes than those in the CLSG group (SMD = 2.47, 95% CI = 1.10 to 3.83, P = 0.00). There was no significant difference between the SILSG group and the CLSG group regarding operative time, intraoperative estimated blood loss, conversion rate, intraoperative complications, length of hospital stay, postoperative analgesia, postoperative complications, excess weight loss (EWL), and improvements in comorbidities (P > 0.05). Compared to CLSG, SILSG resulted in improved cosmetic satisfaction and showed no disadvantages in terms of surgical outcomes; thus, SILSG can serve as an alternative to CLSG for obese patients. Nonetheless, high-quality randomized controlled trials (RCTs) with large study populations and long follow-up periods are needed.

Purpose: To evaluate whether the European Neuroendocrine Tumor Society (ENETS) system or the 8th American Joint Committee on Cancer (AJCC) staging manual are suitable for gastric neuroendocrine carcinomas and/or mixed adenoneuroendocrine carcinomas (G-NECs/MANECs). Methods: Patients in a multicentric series with G-NEC/MANEC who underwent curative-intent surgical resection for a primary tumor were included. An optimal staging system was proposed base on analysis of the T and N status and validated by the SEER database. Results: Compared with the ENETS system, the survival curves of the T category and N category in the 8th AJCC system were better separated and distributed in a more balanced way, but the survival curves of T2 vs. T3, N0 vs. N1, and N3a vs. N3b overlapped. For the T category, the 8th AJCC T category was modified by combining T2 and T3, which was consistent with the T category in the 6th AJCC manual for GC. For the N category, the optimal cut-off values of metastatic lymph nodes using X-tile were also similar to those of the N category in the 6th AJCC system. The Kaplan-Meier plots of the 6th AJCC system showed statistically significant differences between individual substages. Compared with the other 2 classifications, the 6th AJCC system also showed superior prognostic stratification. Similar results were obtained in both multicentric and SEER validation sets. Conclusions: Compared to the 8th AJCC and ENETS systems, the 6th AJCC staging system for GC is more suitable for G-NEC/MANEC and can be adopted in clinical practice.

The present study was designed to evaluate the dynamic survival and recurrence of remnant gastric cancer (RGC) after radical resection and to provide a reference for the development of personalized follow‐up strategies. A total of 298 patients were analyzed for their 3‐year conditional overall survival (COS3), 3‐year conditional disease‐specific survival (CDSS3), corresponding recurrence and pattern changes, and associated risk factors. The 5‐year overall survival (OS) and the 5‐year disease‐specific survival (DSS) of the entire cohort were 41.2% and 45.8%, respectively. The COS3 and CDDS3 of RGC patients who survived for 5 years were 84.0% and 89.8%, respectively. The conditional survival in patients with unfavorable prognostic characteristics showed greater growth over time than in those with favorable prognostic characteristics (eg, COS3, ≥T3: 46.4%‐83.0%, Δ36.6% vs ≤T2: 82.4%‐85.7%, Δ3.3%; P 0.05). Time‐dependent logistic regression analysis showed that the AJCC stage independently affected recurrence within 2 years after surgery (P, Patients with RGC usually have a high likelihood of death or recurrence within 3 years after radical surgery. We developed a postoperative follow‐up model for RGC patients of different stages.

Key Points Question Are there any differences in prognoses or recurrence patterns associated with gastric neuroendocrine carcinoma, mixed adenoneuroendocrine carcinoma, or adenocarcinoma? Findings This cohort study included 3689 patients with resectable gastric adenocarcinoma, gastric neuroendocrine carcinoma, or gastric mixed adenoneuroendocrine carcinoma. Propensity score matching analysis found that, compared with gastric adenocarcinoma, gastric neuroendocrine carcinoma and gastric mixed adenoneuroendocrine carcinoma were independent risk factors associated with worse disease-free survival, postrecurrence survival, and distant recurrence outcomes. Meaning These findings suggest that different follow-up and treatment strategies should be developed to improve the long-term survival of patients with gastric neuroendocrine carcinoma or gastric mixed adenoneuroendocrine carcinoma, especially for patients with tumors penetrating into the subserosa or deeper layers and with lymph node metastasis., This cohort study examines differences in long-term survival and patterns of recurrence among patients with gastric neuroendocrine carcinoma, gastric mixed adenoneuroendocrine carcinoma, and gastric adenocarcinoma., Importance Gastric neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma are rare pathological types of gastric cancer, and there is a lack of multicenter studies comparing the prognosis and recurrence patterns of gastric neuroendocrine carcinoma, gastric mixed adenoneuroendocrine carcinoma, and gastric adenocarcinoma. Objective To compare the differences in long-term survival and patterns of recurrence among gastric neuroendocrine carcinoma, gastric mixed adenoneuroendocrine carcinoma, and gastric adenocarcinoma. Design, Setting, and Participants This cohort study included patients with resectable gastric neuroendocrine carcinoma and gastric mixed adenoneuroendocrine carcinoma at 23 hospitals in China from January 2006 to December 2016. In addition, patients with gastric adenocarcinoma were selected as controls. Propensity score–matched analysis was used to match pathological stage among the different pathological types, and disease-free survival (DFS), postrecurrence survival (PRS), and patterns of recurrence were examined. Data analysis was conducted from July 15, 2020, to October 21, 2020. Exposures Curative resection for gastric neuroendocrine carcinoma, gastric mixed adenoneuroendocrine carcinoma, and gastric adenocarcinoma. Main Outcomes and Measures The main outcomes were DFS and patterns of recurrence. Results A total of 3689 patients were analyzed (median [interquartile range] age, 62 [55-69] years; 2748 [74.5%] men), including 503 patients (13.6%) with gastric neuroendocrine carcinoma, 401 patients (10.9%) with gastric mixed adenoneuroendocrine carcinoma, and 2785 patients (75.5%) with gastric adenocarcinoma. After propensity score matching, 5-year DFS was 47.6% (95% CI, 42.7%-52.5%) for patients with gastric neuroendocrine carcinoma, compared with 57.6% (95% CI, 55.1%-60.1%) with gastric adenocarcinoma (P

PrécisWe present a valid and reproducible nomogram that combined the TNM stage as well as the Ki-67 index and carcinoembryonic antigen levels; the nomogram may be an indispensable tool to help predict individualized risks of death and help clinicians manage patients with gastric neuroendocrine carcinoma.BackgroundTo analyze the long-term outcomes of patients with grade 3 GNEC who underwent curative surgery and investigated whether the combination of carcinoembryonic antigen (CEA) levels and Ki-67 index can predict the prognosis of patients with gastric neuroendocrine carcinoma (GNEC) and constructed a nomogram to predict patient survival.MethodsIn the training cohort, data were collected from 405 patients with GNEC after radical surgery at seven Chinese centers. A nomogram was constructed to predict long-term prognosis. Data for the validation cohort were collected from 305 patients.ResultsThe 5-year overall survival (OS) was worse in the high CEA group than in the normal CEA group (40.5% vs. 55.2%, p = 0.013). The 5-year OS was significantly worse in the high Ki-67 index group than in the low Ki-67 index group (47.9% vs. 57.2%, p = 0.012). Accordingly, we divided the whole cohort into a KC(-) group (low Ki-67 index and normal CEA) and KC(+) group (high Ki-67 index and/or high CEA). The KC(+) group had a worse prognosis than the KC(-) group (64.6% vs. 46.8%, p < 0.001). KC(+) and the AJCC 8th stage were independent factors for OS. Then, we combined KC status and the AJCC 8th stage to establish a nomogram; the C-index and area under the curve (AUC) were higher for the nomogram than for the AJCC 8th stage (C-index: 0.660 vs. 0.635, p = 0.005; AUC: 0.700 vs. 0.675, p = 0.020). The calibration curve verified that the nomogram had a good predictive value, with similar findings in the validation groups.ConclusionsThe nomogram based on KC status and the AJCC 8th stage predicted the prognosis of patients with GNEC well.

To establish a novel nomogram to predict individual 1, 3, and 5 years disease-free survival (DFS) of patients with gastric neuroendocrine carcinoma/mixed adenoneuroendocrine carcinoma [(MA)NEC]. Among patients undergoing radical resection of gastric (MA)NEC, there is still a high tendency for relapse. A retrospective analysis of 777 patients with gastric (MA)NEC at 23 centers in China from 2004 to 2015 was performed. Based on the established nomogram, which included age, ASA, pT, pN and Ki67, the overall patients were divided into low-risk group (LRG) and high-risk group (HRG). The median follow-up time was 40 months (1–169 months). The C-index, AUC and time-ROC of the nomogram were significantly higher than that of the 8th edition AJCC and ENETS TNM staging systems. The 3-year DFS of patients in HRG generated by the nomogram was significantly lower than that in LRG (all patients: 35% vs 66.9%, p

Background The eighth TNM classification for gastric cancer categorizes N3 as N3a and N3b in the final pathologic stage. The cutoff for N3a/N3b is defined as 15 metastatic lymph nodes, but the rationale for this cutoff remains unclear. This study aimed to determine the optimal N3a/N3b cutoff and evaluate its prognostic significance. Methods An international database was constructed by combining data from patients with N3 gastric cancer and complete five-year follow-up data from the Surveillance, Epidemiology, and End Results program database (n = 1833) and the Fujian Medical University Union Hospital database (n = 920) (total n = 2753). A log-rank test was performed to determine the optimal N3a/N3b cutoff, and its prognostic significance was confirmed in a two-step multivariate analysis and compared to that of the eighth TNM. Results A cut-point analysis performed at each metastatic lymph node number identified the greatest survival difference between N3a and N3b at 13 metastatic lymph nodes (χ2 = 157.671, P = 3.65 × 10− 36). In patients with 14–15 metastatic lymph nodes, prognoses were significantly worse than those in patients with 7–13 metastatic lymph nodes (P 15 metastatic lymph nodes (P = 0.078). Therefore, patients with 14–15 metastatic lymph nodes were incorporated into a modified N3b classification. In the two-step multivariate analysis, the eighth N3 classification fell out of the model, while the modified N3 classification remained intact (HR 1.51, P

Recently, enhanced recovery after surgery (ERAS) was widely used in the perioperative management of gastric cancer. The study aimed to evaluate the safety and effectiveness of ERAS in single-incision laparoscopic distal gastrectomy (SIDG).A total of 90 patients who received laparoscopic gastric cancer resection were divided into 3 groups: group A (n=30), underwent traditional multiport laparoscopic distal gastrectomy with conventional perioperative management; group B (n=30) underwent traditional multiport laparoscopic distal gastrectomy with ERAS concept; and group C (n=30), underwent SIDG with ERAS concept. Clinical data and gut function were assessed in 3 groups.There were no significant differences in terms of postoperative complication, number of resected lymph nodes and blood loss among 3 groups. However, operation time was longer (P=0.003) and treatment cost was higher (P0.001) in group C than that in group A and B. Group C had faster recovery of bowel function (P0.001), shorter postoperative hospital stay (P=0.002), and less postoperative complication (P=0.044) than those in group A. There were no significant differences in terms of recovery of bowel function and postoperative hospital stay between group C and B (all P0.05). The white blood cell counts were lower than group A and B (all P0.05) and C-reactive protein in group C were lower than group A (P0.05) and B (P0.05).The findings suggest that SIDG with ERAS may be a feasible and safe procedure for early gastric cancer because it provides a favorable cosmetic result while not compromising postoperative complications, number of resected lymph nodes, and blood loss.

Based on the Maxwell equation, the electromagnetic model in the coaxial fiber was described. The interaction with electromagnetic wave was analysed and the theoretical formula of axial permeability (μ∥), axial permittivity (e∥), radial permeability (μ⊥) and radial permittivity (e⊥) of Fe-C coaxial fiber were derived, and the demagnetization factor (N) of fibrous material was revised. Calculation results indicate that the composite fiber has stronger anisotropy and better EM dissipation performance than the hollow carbon fiber and solid iron fiber with the same volume content. These properties can be enhanced through increasing aspect ratio and carbon content. The μ‖ is 5.18-4.46i, μ⊥ is 2.58-0.50i, e∥ is 7.63-6.97i, and e⊥ is 1.98-0.15i when the electromagnetic wave frequency is 5 GHz with the outer diameter of 0.866 μm, inner diameter of 0.500 μm, and length of 20 μm. The maximum of the imaginary part of μ∥ and e∥ are much larger than that of μ⊥ and e⊥ when the structural parameters change, and the maximum of μ∥ and e∥ can reach 6.429 and 23.59. Simulation results show that greater conductivity, larger aspect ratio, thin iron shell play important roles to improve the electromagnetic matching ability and microwave attenuation for the Fe-C coaxial fibers.

Mechanically purified raw cotton fiber finds a growing range of applications in support of environmental sustainability, but its unique thermal stability, which is important in processes and utilization, is little known. This study shows that, at low temperatures (

Background and Objective: Few reports address the impact of surgery on the prognosis of rare and heterogeneous gastric neuroendocrine neoplasms (G-NENs). This study analyzed the influence of surgical treatments on prognosis to provide a personalized surgical treatment strategy for G-NEN patients. Methods: The clinicopathological data of 1126 G-NEN patients from 28 Chinese hospitals were analyzed. Cox regression analyses were used to analyze the prognostic factors affecting survival and recurrence, respectively. Results: Cox analysis revealed that in stage I-II but not stage III gastric neuroendocrine carcinoma/mixed adenoneuroendocrine carcinoma (NEC/MANEC) patients, Extended lymph node dissection (ELND) was an independent protective factor for OS and DFS (p 0.05). Furthermore, among patients with stage III disease, the incidence of complications after ELND was significantly greater than that after LLND (28.4% vs. 12.1%, p < 0.001), especially severe complications (Clavien-Dindo grade III-V). Conclusion: ELND may lead to enhanced long-term survival for stage I and II but not stage III NEC/MANEC patients. Our results in multicenter patients do not support the routine use of ELND in stage III NEC/MANEC patients. Funding Statement: This work was supported by National natural science foundation of China (No.81871899); Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031, 2017Y9011); Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171); The second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013). China scholarship council (201908350095). National natural science foundation of China (No.81802312). Declaration of Interests: None of the authors have any competing interests in the manuscript. Ethics Approval Statement: The research proposal was reviewed by the Research Ethics Committee at the university, and all procedures were performed after obtaining written informed consent from the patients following an explanation of the surgical and oncological risks.

The aim of this study was to evaluate whether adjuvant chemotherapy is associated with improved survival in patients with resectable gastric neuroendocrine carcinomas (G-NECs) or mixed adenoneuroendocrine carcinomas (G-MANECs).The study included patients with G-NECs or G-MANECs who underwent surgery in one of 21 centres in China between 2004 and 2016. Propensity score matching analysis was used to reduce selection bias, and overall survival (OS) in different treatment groups was estimated by the Kaplan-Meier method.In total, 804 patients with resectable G-NECs or G-MANECs were included, of whom 490 (60·9 per cent) received adjuvant chemotherapy. After propensity score matching, OS in the chemotherapy group was similar to that in the no-chemotherapy group. Among patients with G-NECs, survival in the fluorouracil (5-FU)-based chemotherapy group and the non-5-FU-based chemotherapy group was similar to that in the no-chemotherapy group. Similarly, etoposide plus cisplatin or irinotecan plus cisplatin was not associated with better OS in patients with G-NECs. Among patients with G-MANECs, OS in the non-5-FU-based chemotherapy group was worse than that in the no-chemotherapy group. Patients with G-MANECs did not have better OS when platinum-based chemotherapy was used.There was no survival benefit in patients who received adjuvant chemotherapy for G-NECs or G-MANECs.El objetivo de este estudio fue evaluar si la quimioterapia adyuvante mejoraba la supervivencia en pacientes con carcinomas gástricos resecables neuroendocrinos (gastric neuroendocrine carcinomas, G-NECs) y carcinomas adenoneuroendocrinos mixtos (mixed adenoneuroendocrine carcinomas, G-MANECs). MÉTODOS: Se incluyeron pacientes con G-NECs y G-MANECs tratados quirúrgicamente en 21 centros en China entre 2004 y 2016. Se utilizó un análisis de emparejamiento por puntaje de propensión para reducir el sesgo de selección y el método de Kaplan-Meier para estimar la supervivencia global (overall survival, OS) de los pacientes en los diferentes grupos de tratamiento.En total, se incluyeron en el estudio 804 pacientes con G-NECs y G-MANECs resecables y 490 pacientes (60,9%) recibieron quimioterapia adyuvante. Después del emparejamiento por puntaje de propensión, la OS del grupo con quimioterapia fue similar a la del grupo sin quimioterapia. En los pacientes con G-NECs, la supervivencia en los grupos con quimioterapia basada en 5-FU (fluorouracilo) y de quimioterapia sin 5-FU fue similar a la del grupo sin quimioterapia. Asimismo, la combinación de etopósido y cisplatino o de irinotecán y cisplatino no se asoció con una mejor OS en pacientes con G-NECs. En pacientes con G-MANECs, la OS del grupo con quimioterapia sin 5-FU fue peor que la del grupo sin quimioterapia. Los pacientes con G-MANECs no presentaron una mejor OS cuando se administró quimioterapia basada en platinos. CONCLUSIÓN: La administración de quimioterapia adyuvante en pacientes con G-NECs y G-MANECs no mejoró la supervivencia.

Background The prognostic values of the AJCC staging system for gastric cancer (GC-AJCC), the AJCC staging system for gastric neuroendocrine tumours (NET-AJCC) and the European Neuroendocrine Tumor Society (ENETS) system for gastric neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma (MA)NEC remain controversial. Methods Data on patients with (MA)NEC from 21 centres in China were analysed. Different staging systems were evaluated by performing Kaplan–Meier survival analysis and calculating the concordance index (C-index) and Akaike information criterion (AIC). Based on three existing systems, a modified staging system (mTNM) was developed. Results A total of 871 patients were included. In the GC-AJCC system, an overlap was noticed for pT2 and pT3 categories. Patients with stage IIIC disease had a similar prognosis to those with stage IV disease. The pT categories of the NET-AJCC system had a lower C-index and higher AIC than those of the other systems. In the ENETS system, there was a low proportion (0·2 per cent) of patients with stage IIIA and a high proportion (67·6 per cent) of stage IIIB disease. The mTNM system adopted the NET-AJCC pT and GC-AJCC pN and pM definitions, and was developed based on the ENETS stage definitions. The proportion of patients in each stage was better distributed and the mTNM system showed improved prognostic performance in predicting overall and disease-free survival. Conclusion The mTNM system offers more accurate prognostic value for gastric (MA)NEC than the AJCC or ENETS staging systems.

Background Myeloperoxidase (MPO) anti-neutrophil cytoplasm autoantibody (ANCA)-associated vasculitis commonly causes life-threatening pulmonary alveolar hemorrhage or fibrosis. Only a limited number of candidate gene variants have been explored, but hitherto, are not widely confirmed. In the present study, we investigated the importance of energy homeostasis associated gene (Enho) mutations and adropin deficiency in the development of MPO-ANCA associated lung injury. Methods We analyzed the peripheral blood mononuclear cells from 152 unrelated patients and 220 population-matched healthy individuals for genetic variations in Enho. Functional studies with adropin knockout (AdrKO) on C57BL/6J mice were also performed. Findings Sequencing revealed six patients with p.Ser43Thr and that five patients shared Cys56Trp amino acid substitution in Enho. Serum concentration of adropin was significantly lower in patients than that of the healthy subjects (P, Graphical Abstract Adropin-deficiency causes ANCA vasculitis. Adropin-deficiency plays a critical role in activating endothelial cells during neutrophil recruitment and neutrophil-endothelium cell interactions under IL-1 and TNF-α-induced vascular inflammation. Neutrophil extracellular trap (NET) formation, also termed as NETosis, has been linked to develop autoantibodies against endothelial cell, such as VCAM-1. Then, VCAM-1 mediates the adhesion of lymphocytes and monocytes to vascular endothelium.Image 1, Highlights • Enho mutations result in adropin deficiency. • Adropin deficiency cause MPO-ANCA-related pulmonary hemorrhage or lung fibrosis. • Adropin knockout (AdrKO) mice exhibit reduced eNOS (Ser1177) and Akt1 (Ser473) phosphorylation and loss of Treg cells in lung tissue. • PR3-AAV and MPO-AAV may be the two independent disease subtypes and have their different susceptibility genes.

Background. Remnant gastric cancer (RGC) is a rare malignant tumor with poor prognosis. There is no universally accepted prognostic model for RGC. Methods. We analyzed data for 253 RGC patients who underwent radical gastrectomy from 6 centers. The prognosis prediction performances of the AJCC7th and AJCC8th TNM staging systems and the TRM staging system for RGC patients were evaluated. Web-based prediction models based on independent prognostic factors were developed to predict the survival of the RGC patients. External validation was performed using a cohort of 49 Chinese patients. Results. The predictive abilities of the AJCC8th and TRM staging systems were no better than those of the AJCC7th staging system (c-index: AJCC7th vs. AJCC8th vs. TRM, 0.743 vs. 0.732 vs. 0.744; P>0.05). Within each staging system, the survival of the two adjacent stages was not well discriminated (P>0.05). Multivariate analysis showed that age, tumor size, T stage, and N stage were independent prognostic factors. Based on the above variables, we developed 3 web-based prediction models, which were superior to the AJCC7th staging system in their discriminatory ability (c-index), predictive homogeneity (likelihood ratio chi-square), predictive accuracy (AIC, BIC), and model stability (time-dependent ROC curves). External validation showed predictable accuracies of 0.780, 0.822, and 0.700, respectively, in predicting overall survival, disease-specific survival, and disease-free survival. Conclusions. The AJCC TNM staging system and the TRM staging system did not enable good distinction among the RGC patients. We have developed and validated visual web-based prediction models that are superior to these staging systems.

Selective self-assembly processes were identified in an aged colloidal dispersion containing CeO2 cube-like and polyhedral nanocrystals as building blocks, resulting in two types of 2D microarrays. The cube-like nanocrystals were hierarchically self-assembled to form cubic nanoblocks with a mesostructure size of ca. 100 nm and a 2D microarray size of over 100 μm. The hierarchical assembly of the cube-like nanocrystals triggered the direct self-assembly of polyhedral nanocrystals, which then formed 2D microarrays. The hierarchical assembly of nanocrystals with a similar morphology was the dominant assembly process in the colloidal dispersion, and the cube-like nanocrystals tend to assemble through an oriented axis; otherwise, the fusion between the oriented nanocrystals is random.

Controlled crystalline structures (α- and γ-phase) and assembly patterns (1-D, 2-D and 3-D) were achieved in the synthesized iron oxide (Fe2O3) nanoparticles (NPs) using polymeric surfactant-polypropylene grafted maleic anhydride (PP-g-MA) with different concentrations. In addition, the change of the crystalline structure from the α- and γ-phase also led to the significantly increased saturation magnetization and coercivity.

The operating conditions such as composition of electrolyte and temperature can greatly influence the formic acid (HCOOH) oxidation reaction (FAOR). Palladium decorated multi-walled carbon nanotubes (Pd/MWNTs) were successfully synthesized and employed as nanocatalysts to explore the effects of formic acid, sulfuric acid (H2SO4) concentration and temperature on FAOR. Both the hydrogen adsorption in low potential range and the oxidation of poisoning species during the high potential range in cyclic voltammetry were demonstrated to contribute to the enhanced electroactivity of Pd/MWNTs. The as-synthesized Pd/MWNTs gave the best performance under a condition with balanced adsorptions of HCOOH and H2SO4 molecules. The dominant dehydrogenation pathway on Pd/MWNTs can be largely depressed by the increased dehydration pathway, leading to an increased charge transfer resistance (Rct ). Increasing HCOOH concentration could directly increase the dehydration process proportion and cause the production of COads species. H2SO4 as donor of H+ greatly facilitated the onset oxidation of HCOOH in the beginning process but it largely depressed the HCOOH oxidation with excess amount of H+. Enhanced ion mobility with increasing the temperature was mainly responsible for the increased current densities, improved tolerance stabilities and reduced Rct values, while dehydration process was also increased simultaneously.

Polyimide (PI) nanocomposite reinforced with Fe3O4 nanoparticles (NPs) at various NPs loadings levels of 5.0, 10.0, 15.0, and 20.0 wt% were prepared. The chemical interactions of the Fe3O4 NPs/PI nanocomposites were characterized using Fourier Transform Infrared (FT-IR) spectroscopy. X-ray Diffraction (XRD) results revealed that the addition of NPs had a significant effect on the crystallization of PI. Scanning electron microscope (SEM) and the atomic force microscope (AFM) were used to characterize the dispersion and surface morphology of the Fe3O4 NPs and the PI nanocomposites. The obtained optical band gap of the nanocomposites characterized using Ultraviolet–Visible Diffuse Reflectance Spectroscopy (UV–Vis DRS) was decreased with increasing the Fe3O4 loading. Differential scanning calorimetry (DSC) results showed a continuous increase of Tg with increasing the Fe3O4 NPs loading. Some differences were observed in the onset decomposition temperature between the pure PI and nanocomposites since the NPs and the PI matrix were physically entangled together to form the nanocomposites. The contact angle of pure PI was larger than that of Fe3O4/PI nanocomposites films, and increased with increasing the loading of Fe3O4. The degree of swelling was increased with increasing the Fe3O4 loading and the swelling time. The dielectric properties of the nanocomposite were strongly related to the Fe3O4 loading levels. The Fe3O4/PI magnetic property also had been improved with increasing the loading of the magnetic nanoparticles.

Eighteen polycyclic aromatic hydrocarbons (PAHs) and crude proteins were recovered by the disintegration of excess sludge (ES) through enzyme hydrolyzed process (EHP), acid hydrolyzed process (AHP) and base hydrolyzed process (BHP) followed by isoelectric precipitation, centrifugation and freeze-drying. The BHP was observed to have the highest total concentrations of PAHs in the crude proteins as compared to AHP and EHP, following: EHP (213.7 ng/g) Zn > Mn > Cu > Pb > Ni > Cr > As > Hg > Cd in the ES samples before treatment. Except Zn, all the metals were in good agreement with the prescribed limits as defined by legal standard. Moreover, the concentration of all metal ions was found to be less or negligible in the EHP recovered proteins as compared to that in the BHP and AHP. The acu...

Imidazole spirocyclic phosphoramidate (ISPA) has been synthesized through one-step reaction between spiralphosphodicholor (SPDPC) and imidazole. The optimal flame-retardant finishing for cotton fabrics process was designed by orthogonal experiment L25 (54) and the finished cotton fabrics with different formulas of aqueous solution containing ISPA, phosphoric acid, and cyanuric acid were prepared. The limiting oxygen index (LOI) to characterize the minimum amount of oxygen needed to sustain a candle like flame revealed that this novel intumescent SPDPC flame system exhibited an excellent flame retardant efficiency on the cotton fabric finished with the optimal formula possessing a high LOI value of 36.6 %. The cotton fabric was investigated by vertical flame test revealing a combustion characteristic of the lowest damaged length (64 mm) without continuing burning and no smoldering. The flame-retardant cotton fabric showed an acceptable decreased tensile strength by 13.3 % and enhanced excellent thermal stability compared with pure cotton fabric. Cone calorimeter test revealed a reduced heat release rate by 57 % and a decreased total heat rate by 60 % for the flame-retardant cotton fabric compared with pure cotton fabric. Scanning electron microscopy (SEM) indicated a solid and tough residue for the burned flame-retardant cotton fabric as compared with the very loose and brittle residue of the burned pure cotton fabric.

Transparent anhydride–bisphenol-A epoxy systems filled with pristine nanosilica were prepared and compared with the counterparts with the nanosilica coated with surface initiated polymerization (SIP) prepared phosphoric acid (H3PO4) doped polyaniline (PANI). The rheological investigation on the bisphenol-A epoxy nanosuspensions demonstrated that the surface coating increased the interaction between the nanosilica and the resin matrix. The tensile strength of anhydride–epoxy (83.79 MPa) was increased to 87.00 and 88.78 MPa for the epoxy with the as-received and functionalized nanosilica, respectively. The real permittivity of the nanocomposites was increased after the introduction of PANI functionalized nanosilica. The H3PO4 doped PANI decreased the heat release rate of epoxy from 563.0 to 508. 3 W g−1, confirming the fire retardancy behavior of the PANI coating. The obtained cured anhydride–epoxy nanocomposites filled with nanosilica are highly transparent in visible light, and have potential applications in the optical field.

Asymmetric supercapacitors (ASCs) with carbon nanotube@nickel hydroxide nanosheet (CNT@Ni(OH)2) core–shell composites as positive electrodes and three-dimensional (3D) graphene networks (3DGNs) as negative electrodes were reported in aqueous KOH electrolyte. The CNT@Ni(OH)2 core–shell composites were prepared through a facile chemical bath deposition method, while 3DGNs were obtained by freeze-drying of graphene hydrogels. By virtue of their unique microstructures, superb electrochemical properties were achieved in a three-electrode system, e.g., 1136 F g−1 at 2 A g−1 for the CNT@Ni(OH)2 electrode within 0–0.5 V and 203 F g−1 at 1 A g−1 for the 3DGN electrode within −1–0 V. Benefiting from these merits, the as-fabricated CNT@Ni(OH)2//3DGN ASC showed a maximum energy density of 44.0 W h kg−1 at a power density of 800 W kg−1 and even retained 19.6 W h kg−1 at 16 000 W kg−1 in the voltage region of 0–1.6 V.

Highly efficient electromagnetic field absorption at gigahertz (GHz) was reported in the novel magnetic polymer nanocomposites (MPNCs) with in-situ synthesized Fe@Fe2O3 core@shell nanoparticles (NPs) or their decorated multiwall carbon nanotubes (MWNTs) dispersed in the polypropylene (PP) matrix through a one-pot bottom-up method. PP grafted maleic anhydride (PP-g-MA) with different molecular weights served as surfactant to stabilize the in-situ-formed NPs and simultaneously as compatibilizer to enhance the bonding at the PP–filler interfaces. Because of the strong magnetization of the PP MPNCs filled with 20.0 wt % Fe@Fe2O3 NPs stabilized by PP-g-MA (Mn = 800), a minimum reflection loss (RL) of −31.5 dB was observed at 18.0 GHz, and the frequency bandwidth with RL lower than −10.0 dB was 3.1 GHz (from 16.9 to 20.0 GHz) in the MPNC sample with a thickness of 5.5 mm. However, due to the lack of magnetic loss, only a weak RL of 4.3 dB was found at frequency of 16.8 GHz for the PP/PP-g-MA (Mn = 800)/1.0 wt %...

The growth mechanism of magnetic nanoparticles (NPs) in the presence of graphite oxide (GO) has been investigated by varying the iron precursor dosage and reaction time (product donated as MP/GO). The synthesized magnetic NPs were anchored on the GO sheets due to the abundant oxygen-containing functionalities on the GO sheets such as carboxyl, hydroxyl and epoxy functional groups. The introduced NPs changed the intrinsic functionalities and lattice structure of the basal GO as indicated by FT-IR, Raman and XRD analysis, and this effect was enhanced by increasing the amount of iron precursor. Uniform distribution of NPs within the basal GO sheets and an increased particle size from 19.5 to 25.4, 31.5 and 85.4 nm were observed using scanning electron microscope (SEM) and transmission electron microscope (TEM) when increasing the weight ratio of GO to iron precursor from 10:1, to 5:1, 1:1 and 1:5, respectively. An aggregation of NPs was observed when increasing the iron precursor dosage or prolonging the reaction time from 1 to 8 h. Most functionalities were removed and the magnetic NPs were partially converted to iron upon thermal treatment under a reducing condition. The GO and MP/GO nanocomposites reacted for one and two hours (denoted as MP/GO1-1 h and MP/GO1-2 h) were converted from insulator to semiconductor after the annealing treatment as annealed GO (A-GO, 8.86 S cm−1), annealed MP/GO1-1 h (A-MP/GO1-1 h, 7.48 × 10−2 S cm−1) and annealed MP/GO1-2 h (A-MP/GO1-2 h, 7.58 × 10−2 S cm−1). The saturation magnetization was also enhanced significantly after the annealing treatment, increased from almost 0 to 26.7 and 83.6 emu g−1 for A-MP/GO1-1 h and A-MP/GO1-2 h, respectively.

Sub-micrometer spheres of poly(glycidyl methacrylate) (PGMA) with a layer of poly(allylamine hydrochloride) (PAH) fi lm are prepared by an easily controlled assembly method. The gold nanoparticles (Au NPs) exhibit a discontinuous structure on the PGMA@PAH particle surface, exhibiting a surface interaction between the PGMA spheres and the Au NPs. PAH not only modifi es the surface of the PGMA particles but also affi rmatively affects the crystallite of the PGMA particles. The real permittivity of the nanocomposite spheres is much higher than that of pure PGMA spheres. An improved thermal stability is observed in the nanocomposite spheres. The calculated bandgap (0.91 eV) of the nanocomposite spheres is observed to be lower than that (4.92 eV) of pure PGMA spheres.

The unusual function of a long known plastic additive in industry, polypropylene-graft-maleic anhydride (PP-g-MA), is reviewed for serving as a polymeric surfactant to synthesize and stabilize magnetic nanoparticles (NPs) with tunable morphology and crystalline structure. The synthesis route employs a solution-based, one-pot, bottom-up method. Specifically, magnetic NPs were synthesized through thermo-decomposing organo-metallic precursors [i.e., Fe(CO)5 or Co2(CO)8] in the presence of PP-g-MA in solvent xylene. By simply changing the backbone length/concentration of PP-g-MA, different morphologies (monodispersed hollow vs. chain-like solid, or chain-like vs. monodispersed polyhedral-shaped NPs) and crystalline structures [α- vs. γ-phase for Fe2O3 NPs, or face-centered cubic (fcc)- vs. e-phase for Co NPs] can be controlled simultaneously. In addition, for the chain-like Fe2O3 NPs, a different chain diameter and building block morphology can be controlled by only varying the molecular weight of PP-g-MA.

Contrary to the observed positive giant magnetoresistance (GMR) in as-received multi-walled carbon nanotubes (MWNTs), pure polyaniline (PANI) synthesized with Cr(vi) as oxidant and MWNTs/PANI nanocomposites with ammonium persulfate (APS) as oxidant, a room temperature negative GMR of around -2% was reported in MWNTs/PANI nanocomposites with Cr(vi) as oxidant. Different from a frequency switch of permittivity from negative to positive in MWNTs/PANI nanocomposites with APS as oxidant, unique negative permittivity was observed in MWNTs/PANI nanocomposites with Cr(vi) as oxidant within the measured frequency range from 20 to 2 × 10(6) Hz. The obtained unique negative permittivity was explained by the plasma frequency from the Drude model, at which the permittivity changes from negative to positive and the material changes from a metamaterial to an ordinary dielectric medium. The observed positive and negative GMR behaviors in these disordered systems as verified by the temperature dependent resistivity exploration were well explained through a wave-function shrinkage model and orbital magnetoconductivity theory by calculating the changed localization length (a0).

Polystyrene (PS)/magnetite (Fe3O4) polymer nanocomposites (PNCs) are successfully synthesized by a solvent extraction method. Scanning electron microscopy reveals that the nanoparticles are well distributed in the PS matrix with 5, 10, and 20 wt% without obvious agglomeration. Fourier transform infrared spectroscopy analysis indicated that the PS/Fe3O4 PNCs are synthesized with strong interaction between PS and nanoparticles. The thermogravimetic analyzer and microscale combustion calorimetry reveal an enhanced thermal stability and reduced flammability. The differential scanning calorimetry demonstrates both glass transition temperature (Tg) and melting temperature (Tm) increased with increasing the Fe3O4 nanoparticle loading. The observed monotonically decreased complex viscosity indicates a strong shear thinning behavior in the PNCs; meanwhile, the percolation takes place in the low frequency range (0.1–1 Hz) when the nanoparticles are introduced in the matrix. The Tg of the PS/Fe3O4 nanocomposites determined from the dynamic mechanical analysis shifts to a higher temperature compared with that of pure PS. Enhanced dielectric properties relate to the Fe3O4 NP loadings. In addition, the PS/Fe3O4 PNCs exhibit superparamagnetic behavior at room temperature.

Epoxy resin nanocomposites reinforced with silica nanoparticles have been prepared at different nanoparticle loading levels. The surface functionality of the silica nanoparticles is manipulated by the phosphoric acid (H3PO4)-doped conductive polyaniline (PANI) via a surface initiated polymerization (SIP) method. The improved glass transition temperature (Tg) and enhanced mechanical properties of the cured epoxy resin nanocomposites filled with the functionalized silica nanoparticles are observed compared with those of the cured pure epoxy resin. The flammability and thermal stability behaviors of these nanocomposites are evaluated using microscale combustion calorimeter (MCC) and thermogravimetric analysis (TGA). The heat release rate (HRR) peak of the epoxy filled with functionalized silica nanoparticles is observed to decrease dramatically with increasing functionalized silica particle loadings, indicating a flame-retardant performance from the phosphoric acid-doped PANI.

Magnetic graphene (Gr) nanocomposites (Gr nanosheets coated with iron core iron oxide shell nanoparticles, named Gr/Fe@Fe 2 O 3 ) have successfully served as nanofillers for obtaining magnetic epoxy resin polymer nanocomposites (PNCs) to be compared with the epoxy nanocomposites with pure graphene. The effects of nanofiller loading levels on the rheological behaviors, thermal stability, thermo-mechanical, tensile mechanical properties, electrical conductivity and magnetic properties were systematically studied. A reduced viscosity was observed in the 1.0 wt% Gr–epoxy resin liquid nanosuspensions and the viscosity was increased with further increasing the Gr loading. In the TGA test, although the introduction of both nanofillers caused lower onset decomposition temperature of the PNCs, the Gr/Fe@Fe 2 O 3 was found to favor the char formation from the epoxy resin. The enhanced char residue was also observed during the flammability tests. The dynamic storage and loss modulii were studied together with the glass transition temperature ( T g ) obtained from the peak of tan δ . The tensile strength observed in the PNCs with 1.0 wt% Gr/Fe@Fe 2 O 3 is 58% higher than that of the pure epoxy, and was attributed to the high stiffness of Gr. Both nanofillers could increase the electrical conductivity of the epoxy matrix. The magnetic properties of the PNCs with Gr/Fe@Fe 2 O 3 are studied and the value of coercivity ( H c) is observed inversely proportional to the loading of Gr/Fe@Fe 2 O 3 in the PNCs due to the decreased interparticle dipolar interaction, which arises from the enlarged nanoparticle spacer distance for the single domain nanoparticles. Finally, the increased real permittivity observed in the PNCs is attributed to the interfacial polarization.

Polypropylene (PP) magnetic polymer nanocomposites (MPNCs) filled with different loadings of cobalt (Co) nanoparticles (NPs) were synthesized through a one-pot bottom-up method, i.e., thermal decomposition of soluble dicobalt octacarbonyl (Co2(CO)8) in the refluxing xylene solution. Maleic anhydride grafted PP (PP-g-MA) served as surfactant to stabilize the in-situ formed Co NPs and control the particle morphology and served as compatibilzier to promote the particle dispersion in the hosting PP matrix. Transmission electron microscopy (TEM) micrographs revealed that the Co core NPs with a Co3O4 shell were well distributed with an average size of 12.6 nm for 5.0 wt % Co loading, while an interconnected network structure was formed when the particle loading reached 10.0 wt %. X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) results indicated that a thin Co3O4 layer was formed on the surface of Co NPs together with chemisorbed hydrolyzed PP-g-MA. Differential scanning calorimetry (DSC) anal...

The phosphoric acid doped conductive polyaniline (PANI) polymer nanocomposites (PNCs) filled with silica nanoparticles (NPs) have been successfully synthesized using a facile surface initiated polymerization method. The chemical structures of the nanocomposites are characterized by Fourier transform infrared (FT-IR) spectroscopy. The enhanced thermal stability of the PNCs compared with that of pure PANI is observed by thermogravimetric analysis (TGA). The dielectric properties of these nanocomposites are strongly related to the silica nanoparticle loading levels. Temperature dependent resistivity analysis reveals a quasi 3-dimensional variable range hopping (VRH) electrical conduction mechanism for the synthesized nanocomposite samples. A positive giant magnetoresistance (GMR) is observed with a maximum value of 95.5% in the PNCs with a silica loading of 20.0 wt % and 65.6% for the pure PANI doped with phosphoric acid. The observed MR is well explained by wave function shrinkage model by calculating the c...