Search

Background: The splenic hilar lymph node (No. 10 LN) dissection is still controversial for patients with advanced proximal gastric cancer (APGC) not invading the greater curvature. The present study aimed to evaluate the short-term outcomes of laparoscopic spleen-preserving No. 10 lymphadenectomy (LSPL) for APGC not invading the greater curvature and the characteristic of No. 10 LN metastasis. Methods: This single-center, open-label, randomized, phase III clinical trial was done in the Department of Gastric Surgery, Fujian Medical University Union Hospital (FMUUH). Individuals aged 18 to 75 years who had histologically proven gastric adenocarcinoma in proximal stomach with clinical stage cT2-4a/N0-3/M0 not invading the greater curvature were enrolled and randomized (1:1) to receive laparoscopy-assisted total gastrectomy with either D2 lymphadenectomy (D2 group) or D2 lymphadenectomy without No. 10 LN dissection (D2- group). The main outcomes were morbidity and mortality within 30 days after surgery, number of retrieved LNs, and the metastasis rate of No. 10 LN. Analysis was based on modified intention-to-treat. Findings: From Jan 5, 2015, to Dec 10, 2018, 268 participants were randomly assigned to the D2 and D2- groups respectively. The full analysis set consisted of 263 participants in the D2 and D2- groups respectively. There were no significant differences in the intraoperative and postoperative morbidity between the D2 and D2- groups (all P>0.05). And there was no mortality in either group. There were more retrieved LNs in the D2 group than in the D2- group (45.1 vs 40.6, P=0.001). The metastasis rate of the No. 10 LN was 13.3% (35/263): 4.9% (2/41) in the early stage, and 14.9% (18/223) in the advanced stage. Pathological T (pT) stage and pN stage were related to No. 10 LN metastasis. The metastasis rates of No. 10 LN in T3-4a tumors located in the lesser curvature, posterior wall or multiple parts were all higher than 10%. Interpretation: Experienced surgeons can safely perform LSPL for APGC with more retrieved LNs. For APGC located in the lesser curvature, posterior wall or multiple parts with a clinical stage cT3-4a, dissection of the No.10 LN is necessary. Trial Registration: The study is registered with ClinicalTrials.gov, number NCT02333721; the trial has ended and this report represents the final analysis. Funding Statement: This study was supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province (2016Y9031; 2017Y9011). Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171). Fujian Science and Technology Innovation Joint Fund Project (2017Y9004). Joint Funds for the Innovation of Science and Technology of Fujian Province (2018Y9041). Special Fund for Clinical Research of Wu Jieping Medical Foundation (No: 320.6750.17511). Declaration of Interests: There are no conflicts of interest or financial ties to disclose from any authors. Ethics Approval Statement: The trial protocol was approved by the FMUUH Ethics Committee, and all participants provided written informed consent.

Purpose: To develop and validate a delta-radiomics model for predicting a pathologic response after chemotherapy preoperatively in high-grade osteosarcoma (HOS). Materials and Methods: A total of 191 patients with HOS were enrolled retrospectively from November 2013 to November 2017 and received neoadjuvant chemotherapy. A cutoff time of November 2016 was used to divide the training set and validation set. All patients underwent diagnostic CTs before and after chemotherapy. By quantifying the tumor region on the two-phase CT images, 540 delta-radiomics features were calculated. A delta-radiomics signature was constructed using the lasso algorithm based on the training set. A radiomics nomogram was then developed from the multivariate logistic regression model by combining independent clinical factors and the delta-radiomics signature. The prediction accuracy was assessed according to receiver operating characteristic (ROC) and calibration curves. Results: The delta-radiomics signature, consisting of 8 selected features, showed significant differences between the pathologic good response (pGR) (necrosis fraction ≥90%) group and the non-pGR (necrosis fraction

Background: Hepatocellular carcinoma (HCC) has a profound effect on health, and current treatments are of limited effect. Recent advances in immunotherapy have allowed us to view HHC therapy in a new light. Methods: To increase our understanding of immune-related genes (IRGs) in HCC, we combined RNA sequencing data and clinical information to identify HCC-specific IRGs. We developed an IRG-based prognostic index (IRGPI) to estimate the prognosis of HCC patients by using univariate and multivariate Cox regression model. Furthermore, weighted correlation network analysis and assessment of immune cells infiltration levels were conducted to explore the biological understanding of IRGPI. To explore the multidimensional molecular characteristics of IRGs, we also analyzed copy number alterations, transcription factor (TF) regulatory relationships, methylation status and alternative splicing events of IRGs with several bioinformatics tools, including cBioPortal, Cistrome Cancer, MethylMix and SpliceSeq. Connectivity Map (CMAP) combined with molecular docking analysis were conducted to explore and identify certain novel drugs with immunotherapeutic potential for HCC. Findings: A total 35 HCC-specific IRGs could be promising clinical biomarkers for distinguishing among HCC types and monitoring disease progression. A prognostic predictor IRGPI we proposed was excellent in distributing HCC patients into different groups with distinct clinical outcome. This IRGPI was developed by correlating immune cell infiltration levels to functional enrichment analyses which may be associated with T cell activation and chemokine signaling pathways. Exploration into the immune transcription factor (TF) regulatory network uncovered several TFs playing regulatory roles on HCC-specific IRGs that could have significant clinical potential. Furthermore, methylations status and alternative splicing events of IRGs that could also have important implications for the prognostic landscape of HCC. With the help of the CMAP database, we proposed that several molecules (lycorine, amphotericin B, chloroquine, dobutamine, econazole, pralidoxime, and metixene) might be used for HCC immunotherapy. Interpretation: Overall, this study provides a valuable prognostic biomarker resource, novel and multidimensional molecular insights into IRGs, and potential novel drugs for HCC treatment. Funding Statement: This work was supported by the Guangxi Medical University Training Program for Distinguished Young Scholars (2017); Medical Excellence Award Funded by the Creative Research Development Grant from the First Affiliated Hospital of Guangxi Medical University; Innovation Project of Guangxi Graduate Education (YCSW2018104). Declaration of Interests: The authors declare that they have no competing interests.

Traditional Chinese medicine has played a vital role in the well-being of Chinese people for thousands of years. It is a comprehensive system of herb medicine that has been repeatedly practiced and gradually summarized by Chinese people over a long period of time. The current practice related to traditional Chinese medicine has gone beyond the traditional practice. It at least includes mass production of traditional Chinese medicine pills, traditional Chinese medicine herb extract and therapeutic chemicals identified in traditional Chinese medicine materia medica. While traditional practice is in the public domain, the case is less clear for the expansive practice of traditional Chinese medicine, particularly because the public has not practiced such knowledge before. The current intellectual property law is designed to strike a delicate balance between incentives of creation and access to knowledge. It is often construed from a utilitarian perspective. This utilitarian consideration can justify some protection for the new practice. While the current intellectual property law often only recognizes limited defensive rights for traditional knowledge holders, once the rights of non-traditional practitioners are recognized, the rationale of the intellectual property legal regime may justify a stronger package of rights, which would include more than defensive rights for traditional knowledge holders.

This paper examines the productivity effect of the adoption of executive and broad-based stock options. The findings include a positive impact on productivity after the introduction of both executive and broad-based stock options. This productivity effect is maintained over a five-year period after adoption for executive plans but the effect diminishes for broad-based plans. We interpret these findings as evidence of stock option usage as being a benefit to organizations; however, firms may need to distribute broad-based stock options in the same way as for executive plans to maintain the impact.