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Graphene-based devices have important applications attributed to their superior performance and flexible tunability in practice. In this paper, a new kind of absorber with monolayer graphene sandwiched between two layers of dielectric rings is proposed. Two peaks with almost complete absorption are realized. The mechanism is that the double-layer dielectric rings added to both sides of the graphene layer are equivalent to resonators, whose double-side coupled-cavity effect can make the incident electromagnetic wave highly localized in the upper and lower surfaces of graphene layer simultaneously, leading to significant enhancement in the absorption of graphene. Furthermore, the influence of geometrical parameters on absorption performance is investigated in detail. Also, the device can be actively manipulated after fabrication through varying the chemical potential of graphene. As a result, the frequency shifts of the two absorption peaks can reach as large as 2.82 THz/eV and 3.83 THz/eV, respectively. Such a device could be used as tunable absorbers and other functional devices, such as multichannel filters, chemical/biochemical modulators and sensors. [ABSTRACT FROM AUTHOR]

Background: Whether the change of the pre- and postoperative systemic inflammatory response (SIR) levels will affect the prognosis of gastric cancer (GC) is unclear. We aimed to investigate the dynamic changes in the pre- and postoperative SIR and their prognostic value for GC. Methods: The clinicopathological data from 2257 patients who underwent radical gastrectomy between January 2009 and December 2014 at Fujian Medical University Union Hospital (FMUUH) were analyzed. Perioperative SIR changes were reported as changes in the lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Results: The SIR levels showed different trends from postoperative months 1 to 12. Multivariate analysis showed that preoperative (pre)-LMR was an independent predictor for the prognosis (P = 0.024). The postoperative 12-month (post-12-month) LMR predicted the 5-year overall survival (OS) rate with the highest accuracy (areas under the curve [AUC] 0.717). Patients were divided into four groups according to the optimal cutoff of the preoperative and post-12-month LMR: high pre-LMR to high postoperative (post)-LMR group, high pre-LMR to low post-LMR group, low pre-LMR to high post-LMR group, and low pre-LMR to low post-LMR group. The survival analysis showed 5-year OS rate was significantly higher in patients with high post-12-month LMR than in patients with low post-12-month LMR, regardless of pre-LMR levels (81.6% vs. 44.2%, P < 0.001). The prognostic accuracy was significantly improved by incorporating the post-12-month LMR in the tumor-node-metastasis (TNM) staging system (P = 0.003). Conclusions: The remeasurement of LMR at post-12-month is helpful in predicting the long-term survival of GC. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have shown that the short-term efficacy of three-dimensional (3D) laparoscopic radical gastrectomy (LG) is comparable to that of two-dimensional (2D)-LG. Whether 3D-LG affects the recurrence patterns of gastric cancer (GC) patients has not been investigated. Methods: From January 2015 to April 2016, a total of 419 patients were recruited for a phase III clinical trial (NCT02327481), which compared the short-term outcomes between the 2D and 3D groups. The long-term efficacy including recurrence patterns was compared between the 2D and 3D groups in this retrospective study. Multivariate analyses were performed to determine whether 3D-LG affects the recurrence patterns. Results: Ultimately, 401 patients were analyzed (197 in the 2D-LG group and 204 in the 3D-LG group), and no differences were observed in the clinicopathological data between the two groups. There were no significant differences between the two groups in the recurrence types, first recurrence time or recurrence-free survival (RFS) (all p > 0.05). According to the 7th American Joint Committee on Cancer tumor-node-metastasis (TNM) staging system, both groups were stratified into pathological stages I, II, and III. The stratified analysis showed no significant differences in RFS or overall survival (OS) among patients in each subgroup (all p > 0.05). The multivariate analysis of RFS showed that tumor diameter, pTNM stage, lymphovascular invasion, and adjuvant chemotherapy were independent factors (all p < 0.05). The multivariate analysis of post-recurrence survival (PRS) showed that adjuvant chemotherapy was an independent protective factor (p = 0.043). Conclusions: 3D-LG for GC did not differ significantly from 2D-LG in the effects on 3-year recurrence patterns, RFS and OS, which provides more tumor-related evidence for 3D technology. And due to the technological similarity, it may have certain reference value for robotic-assisted gastrectomy. Further multicenter, large-scale clinical trials are warranted. [ABSTRACT FROM AUTHOR]

Background: Well-designed retrospective studies (RSs) and small-sample prospective studies (PSs) evaluating the efficacy of interventions have received much attention. This study was designed to evaluate the differences between well-designed RSs and small-sample randomized controlled trials based on the efficacy of laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) for advanced gastric cancer (GC).Methods: The clinicopathological data of 1360 patients with GC who underwent DG were analysed. After propensity score matching (1:1), 380 cases (ODG = 190, LDG = 190) were finally selected in a RS. Meanwhile, data from 120 patients (ODG = 60, LDG = 60) who enrolled in a PS were analysed.Results: In the PS, the LDG group had less intraoperative blood loss, shorter time to first flatus, and shorter time to fluid diet than the ODG group. In the RS, the LDG group had less intraoperative blood loss, and a shorter postoperative hospital stay than the ODG group. In the PS, the 3-year overall survival (OS) rate was 83.3% in the LDG group and 83.2% in the ODG group (p = 0.877). In the RS, the 3-year OS rate was 68.7% in the LDG group and 66.6% in the ODG group (p = 0.752). No significant interactions were observed between the two groups and any of the variables examined, either in the PS or RS. The recurrence patterns were similar in the two groups. Furthermore, Cox regression analysis showed that surgical method (LDG/ODG) was not a prognostic factor affecting OS or DFS, either prospectively or retrospectively.Conclusions: The oncologic efficacy of laparoscopic and open distal gastrectomy for advanced GC is comparable. Well-designed RSs can be similar to small sample of PSs in assessing long-term oncologic outcomes of surgical interventions, but the short-term outcomes obtained should be treated with caution. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of three nutritional scoring systems: Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), and Naples Prognostic Score (NPS) on the short- or long-term prognosis of gastric cancer (GC) patients who underwent radical gastrectomy.Methods: The clinicopathological data of 2182 patients who underwent radical gastrectomy at the Fujian Medical University Union Hospital (FMUUH) from 2009 to 2014 were retrospectively analyzed. The effects of the PNI, CONUT, and NPS on the short- or long-term prognosis of GC patients were analyzed.Results: Overall, 359 (16.5%) patients had postoperative complications. There was no significant association between the PNI, CONUT, and NPS and postoperative complications (P > 0.05); however, high CONUT and NPS were significantly associated with severe postoperative complications (P < 0.05). Univariate analysis showed that PNI, CONUT, and NPS were all associated with overall survival (OS) (P < 0.001). However, multivariate analysis showed that only PNI was an independent risk factor for OS (P = 0.004), and the 5-year OS rate in the low PNI group was significantly lower than that in the normal PNI group (55.5% vs 75.4%, P < 0.05). The area under the curve (AUC) and the c-index of PNI were significantly higher than those of CONUT and NPS. The prognostic efficiency of combining PNI and TNM stage was also significantly better than that of TNM staging alone (P < 0.05).Conclusion: The current study demonstrated that CONUT and NPS are important for assessing the risk of severe postoperative complications. However, PNI is an independent risk factor for the long-term prognosis of GC patients who underwent radical gastrectomy and can improve the prognostic efficiency of TNM staging. [ABSTRACT FROM AUTHOR]

Nb self‐doped Bi3Ti1‐xNb1+xO9 (x = 0, 0.02, 0.04, 0.06, 0.08, and 0.1) high‐temperature piezoelectric ceramics were fabricated through the conventional solid‐state sintering method. The effects of different Nb self‐doping levels on the microstructure, piezoelectric activities, and electrical conduction behaviors of these Nb self‐doped Bi3Ti1‐xNb1+xO9 ceramics were studied in detail. Large doping level effects on piezoelectric activity and resistivity were confirmed, which might be ascribed to the evolution of the crystal structure and the variations of the oxygen vacancy concentration and the grain anisotropy induced by Nb doping. An optimized piezoelectric coefficient (d33) of 11.6 pC/N was achieved at x = 0.04 with a Curie temperature of 906°C. Additionally, an improved DC resistivity of 6.18 × 105 Ω·cm at 600°C was acquired in this ceramic. Furthermore, the ceramic exhibited excellent thermal stability with the d33 value maintaining 95% of its initial value after being annealed at 850°C for 2 hours. These results showed that Nb self‐doped Bi3Ti1‐xNb1+xO9 ceramics might have great potentials for high‐temperature piezoelectric applications. [ABSTRACT FROM AUTHOR]

Background: In clinical practice, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most common markers measured before and after surgery for gastric cancer (GC). However, which pre- or post-operative combined tumour markers (CEA and CA19-9) have more prognostic value remains unclear.Methods: Consecutive patients undergoing a resection for GC at the Fujian Medical University Union Hospital were included as a discovery database between January 2011 and December 2014. The prognostic impact of pre- and post-operative tumour markers was evaluated using Kaplan-Meier log-rank survival analysis and multivariable Cox regression analysis. The results were then externally validated.Results: A total of 735 and 400 patients were identified in the discovery cohort and in the validation cohort, respectively. Overall survival rates decreased in a stepwise manner in association with the number of pre- and post-operative positive tumour markers (both P < 0.001). Multivariable analysis revealed that the number of pre-operative positive tumour markers was an independent prognostic factor (P < 0.05). For patients with abnormal pre-operative tumour markers, normalisation of tumour markers after surgery is an independent prognostic protective factor (hazard ratio (HR) = 0.618; 95% confidence interval (CI) = 0.414-0.921), and patients with both positive post-operative tumour markers had double the risk of overall death (HR = 2.338; 95% CI = 1.071-5.101). Similar results were observed in the internal validation and external validation cohorts.Conclusion: Pre-operative tumour markers have a better discriminatory ability for post-operative survival in GC patients than post-operative tumour markers, and the normalisation of tumour markers after surgery was associated with better survival. [ABSTRACT FROM AUTHOR]

Background: BATF2, also known as SARI, has been implicated in tumor progression. However, its role, underlying mechanisms, and prognostic significance in human gastric cancer (GC) are elusive. Methods: We obtained GC tissues and corresponding normal tissues from 8 patients and identified BATF2 as a downregulated gene via RNA-seq. qRT-PCR and western blotting were applied to examine BATF2 levels in normal and GC tissues. The prognostic value of BATF2 was elucidated using tissue microarray and IHC analyses in two independent GC cohorts. The functional roles and mechanistic insights of BATF2 in GC growth and metastasis were evaluated in vitro and in vivo. Results: BATF2 expression was significantly decreased in GC tissues at both the mRNA and protein level. Multivariate Cox regression analysis revealed that BATF2 was an independent prognostic factor and effective predictor in patients with GC. Low BATF2 expression was remarkably associated with peritoneal recurrence after curative gastrectomy. Moreover, elevated BATF2 expression effectively suppressed GC growth and metastasis in vitro and in vivo. Mechanistically, BATF2 binds to p53 and enhances its protein stability, thereby inhibiting the phosphorylation of ERK. Tissue microarray results indicated that the prognostic value of BATF2 was dependent on ERK activity. In addition, the N6-methyladenosine (m6A) modification of BATF2 mRNA by METTL3 repressed its expression in GC. Conclusions: Collectively, our findings indicate the pivotal role of BATF2 in GC and highlight the regulatory function of the METTL3/BATF2/p53/ERK axis in modulating GC progression, which provides potential prognostic and therapeutic targets for GC treatment. [ABSTRACT FROM AUTHOR]

Background: Many studies have found that use of aspirin can lengthen survival in patients with gastrointestinal cancer. The aim of this study was to assess the survival benefit of aspirin use compared with non-aspirin use for patients with esophageal, gastric or colorectal cancer.Methods: We searched online databases, including PubMed, the Cochrane Library, Embase and www.clinicaltrials.gov for studies that were conducted, before April 30th, 2020, to identify relevant studies. Overall survival and cancer-specific survival of esophageal, gastric and colorectal cancers among aspirin users were compared with those among non-aspirin users. Data extraction and quality evaluation were independently conducted by 2 investigators. A meta-analysis was performed to calculate the pooled risk ratios (RRs) for overall survival and cancer-specific survival by using either a fixed-effects model or a random-effects model.Results: A total of 18 studies were included in this meta-analysis, with more than 74,936 patients. There were no significant differences between postdiagnosis aspirin use and overall survival for esophageal and gastric cancers. For colorectal cancer, a benefit that was associated with postdiagnosis aspirin use was observed for overall survival and cancer-specific survival [HR = 0.83, 95%CI(0.75, 0.9.);HR = 0.78, 95%CI(0.66, 0.92), respectively. However, a prediagnosis of aspirin use did not provide a benefit for overall or cancer-specific survival in colorectal cancer. HR values for overall and cancer-specific survival benefits for colorectal cancer associated with both prediagnosis and postdiagnosis aspirin were as follows: HR = 0.75, 95%CI(0.61, 0.92) and HR = 0.78, 95%CI(0.73, 0.85), respectively. In addition, the survival benefit of postdiagnosis aspirin use appeared to be confined to patients with mutated PIK3CA tumors [HR = 0.78, 95%CI(0.50, 0.99)] and was positive for PTGS2 (COX-2) expression [HR = 0.75, 95%CI(0.43, 1.30)].Conclusions: These findings provide further indications that postdiagnosis aspirin use improves overall survival and cancer-specific survival in colorectal cancer, especially for patients who are positive for PTGS2 (COX-2) expression and PIK3CA-mutated tumors. However, aspirin therapy does not improve overall survival in esophageal and gastric cancers, although the meta-analysis was mainly limited to retrospective studies. [ABSTRACT FROM AUTHOR]

Background: Our study investigated the effect of lymph node (LN) noncompliance on the long-term prognosis of patients after laparoscopic total gastrectomy (LTG) and explored the risk factors of LN noncompliance. Methods: The clinicopathological data of gastric cancer (GC) patients who underwent LTG with D2 lymphadenectomy from June 2007 to December 2013 were prospectively collected and retrospectively analyzed. The effects of LN noncompliance on the long-term prognosis of patients with GC after LTG were explored. Results: The overall LN noncompliance rate was 51.9%. The survival rate of patients after LTG with LN compliance was significantly superior to that of patients with LN noncompliance (p = 0.013). The stratified analysis of TNM stage indicated that there was no difference between the OS of stage I patients with LN compliance and those with LN noncompliance; OS of stage II/III patients with LN compliance was significantly better than that of those with LN noncompliance. Cox regression analyses showed that LN noncompliance was an independent risk factor for OS. Logistic regression analysis showed that high BMI (≥ 25 kg/m2) was an independent risk factor for preoperative prediction of LN noncompliance in cStage II/III patients. Patients with a high BMI were more likely to have LN noncompliance during surgery, especially during the dissections of #6, #8a, and #12a LN stations. Conclusions: LN noncompliance was an independent risk factor for poor prognosis in patients with advanced gastric cancer (AGC) after LTG. Patients with high BMI were more likely to have LN noncompliance, especially during the dissections of #6, #8a, and #12a LN stations. LN tracing was recommended for these patients to reduce the rate of LN noncompliance. [ABSTRACT FROM AUTHOR]

Background: We sought to investigate the prognostic value of complete blood count (CBC)-based biomarkers for patients with resectable gastric cancer (GC).Methods: Patients with GC who underwent primary surgical resection between December 2008 and December 2013 were included. The estimated area under the curve (AUC) and multivariate Cox regression models were used to identify the best CBC-based biomarker. Time-dependent receiver operating characteristic (t-ROC) curve analysis was used to predict overall survival and compare the prognostic impact.Results: In the 1810 patients analyzed, the median follow-up period was 51.0 months (range 1-101 months). Based on multivariate analysis, the lymphocyte-monocyte ratio (LMR) and hemoglobin (Hb) level were independent prognostic factors (both P < 0.05). Based on the LMR and Hb level, we established the CBC-based inflammatory score (CBCS). A higher CBCS was associated with older age, female sex, higher American Society of Anesthesiologists (ASA) score, proximal tumor location, larger tumor size, later stage and vascular involvement (all P < 0.05). Univariate analyses showed that a higher CBCS was also associated with worse overall survival (OS), which was consistent in each stage (all P < 0.05). Multivariate analysis revealed that the CBCS was a significant independent biomarker (P < 0.05). The AUC for the CBCS (0.627) was significantly higher than the AUCs for the LMR (0.573) and Hb level (0.605) (both P < 0.05). Furthermore, the t-ROC curve of the CBCS was superior to that of the prognostic nutritional index (PNI), systemic immune-inflammation index (SII), modified Glasgow prognostic score (mGPS) and C-reactive protein/albumin ratio (CRP/Alb) throughout the observation period.Conclusion: The preoperative LMR and Hb level were optimal CBC-based biomarkers for predicting OS in GC patients after curative resection. Based on the LMR and Hb, we developed a novel and easily obtainable prognostic score called the CBCS, which may improve the prediction of clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: To compare the differences in occurrence rates, time intervals, main causes, and management strategies of early unplanned reoperations (EUROs) after gastrectomy for gastric cancer (GC) between laparoscopic and open surgery. Methods: From Jan. 2005 to Dec. 2014, 2608 and 1516 patients underwent laparoscopic-assisted gastrectomy (LAG) and open gastrectomy (OG), respectively. Perioperative outcomes and risk factors for EURO were analyzed. Results: The overall EURO rate was 1.3%, and the rate in LAG and OG groups was 1.1% and 1.6%, respectively. The EURO rate after 24 h postoperatively was significantly lower in LAG group than in OG group (p = 0.019). No significant correlation was identified between laparoscopic surgery and EURO rate (p = 0.157); age > 70 (p = 0.028), body mass index (BMI) > 25 kg/m2 (p = 0.009), and estimated blood loss > 100 ml (p = 0.029) were independent risk factors for EURO. The main cause of EURO was intra-abdominal bleeding, anastomotic bleeding, and anastomotic leakage in LAG group; and intra-abdominal bleeding, anastomotic leakage, and intestinal obstruction in OG group. The proportion of patients with intra-abdominal bleeding requiring EURO was markedly higher in LAG group than in OG group (p = 0.043). Transverse mesocolonic vessels and spleen were the most common bleeding sites necessitating EURO in LAG and OG groups, respectively. Six of 28 (21.4%) patients with EUROs in LAG group underwent laparoscopic procedure (p = 0.025). Mortality in patients requiring EURO was 3.6% and 20.8% in LAG and OG groups, respectively (p = 0.084). Conclusions: Compared to open surgery, laparoscopic surgery does not increase the incidence of EURO in patients undergoing gastrectomy for GC; however, laparoscopic surgery is associated with a lower EURO rate after 24 h postoperatively and a higher proportion of patients with intra-abdominal bleeding requiring EURO than open surgery. Effective and accurate intraoperative hemostasis for intra-abdominal vessels and anastomotic sites will help further reduce the incidence of EURO following LAG within 24 h postoperatively. [ABSTRACT FROM AUTHOR]

Background: Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors.Methods: EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set.Results: In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P <  0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659-0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P <  0.001). The AUC of the validation set was 0.796 (95%CI, 0.662-0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set.Conclusions: The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested. [ABSTRACT FROM AUTHOR]

Background: Three-dimensional (3D) systems for laparoscopy provide surgeons with additional information on spatial depth not found in two-dimensional (2D) systems.Methods: This study enrolled 156 spleen-preserving splenic hilar lymphadenectomy (LSPSHL) patients in a randomized controlled trial (ClinicalTrials.gov Identifier NCT02327481) at the department of gastric surgery at Fujian Medical University Union Hospital between January 2015 and April 2016. The short-term efficacies were compared between the treatment groups. The unedited videos of 80 LSPSHL (40 procedures each for 3D and 2D) were rated for technical performance using the Generic Error Rating Tool.Results: The data for 156 LSPSHL patients indicate that the estimated blood loss (EBL) (3D vs 2D = 66.3 vs. 99.0, P = 0.046) was significantly less in the 3D group. The postoperative recovery and complication rates were similar (P > 0.05). And there were no deaths within 30 days of surgery. Two observers analyzed 80 videos of LSPSHL. The results showed that there were fewer grasping-errors made in the 3D group than in the 2D group when dissecting the inferior pole region of spleen (IPRS) (P = 0.016) and the superior pole region of spleen (SPRS) (P = 0.022). Additionally, the inter-rater reliability was high regarding grasping-errors in the IPRS (intraclass correlation coefficient (ICC) 0.92) and in the SPRS (ICC 0.83). The ICC for the total number of errors was 0.82. The mean of errors in the 3D group (3D vs. 2D = 20.7 vs. 23.5, P = 0.022) was less than the 2D group.Conclusions: Compared with 2D LSPSHL, 3D technology reduces EBL and technical errors during splenic hilar dissection. [ABSTRACT FROM AUTHOR]

Background: The definition and predictors of early recurrence (ER) for gastric cancer (GC) patients after radical gastrectomy are unclear. Methods: A minimum-p value approach was used to evaluate the optimal cutoff value of recurrence-free survival to determine ER and late recurrence (LR). Receiver operating characteristic curves were generated for inflammatory indices. Potential risk factors for ER were assessed with a Cox regression model. A decision curve analysis was performed to evaluate the clinical utility. Results: A total of 401 patients recruited in a clinical trial (NCT02327481) from January 2015 to April 2016 were included in this study. The optimal length of recurrence-free survival to distinguish between ER (n = 44) and LR (n = 52) was 12 months. Factors associated with ER included a preoperative C-reactive protein–albumin ratio (CAR) ≥ 0.131, stage III and postoperative adjuvant chemotherapy (PAC) > 3 cycles. The risk model consisting of both the CAR and TNM stage had a higher predictive ability and better clinical utility than TNM stage alone. Further stratification analysis of the stage III patients found that for the patients with a CAR < 0.131, both PAC with 1–3 cycles (p = 0.029) and > 3 cycles (p < 0.001) could reduce the risk of ER. However, for patients with a CAR ≥ 0.131, a benefit was observed only if they received PAC > 3 cycles (54.2% vs 16.0%, p = 0.004), rather than 1–3 cycles (58.3% vs 54.2%, p = 0.824). Conclusions: A recurrence-free interval of 12 months was found to be the optimal threshold for differentiating between ER and LR. Preoperative CAR was a promising predictor of ER and PAC response. PAC with 1–3 cycles may not exert a protective effect against ER for stage III GC patients with CAR ≥ 0.131. [ABSTRACT FROM AUTHOR]

• The new cathodic peak caused by Brønsted acids is independent of the concentration of quinones. • A new mechanism of voltammetric determination the pK a of Brønsted acids is suggested. • The mechanism is based on the new peak caused by the steep pH increase near the electrode surface. The determination of pK a of Brønsted – Lowry acids in aprotic solvent is a meaningful work. We observed that a small concentration of acids caused a new cathodic peak during quinone reduction in acetonitrile. The new peak is independent of the quinone concentration, but its height increases with increasing acid concentration and its potential is dependent on the pK a of the acids. Moreover, the substituent of quinones strongly affects the potential difference between the new peak and the original peak. The new peak is produced by a sharp increase in pH on the electrode surface. Therefore, the new peak is independent of the concentration of quinone. We suggest a new mechanism of voltammetric determination of pK a of Brønsted acids in acetonitrile. In addition, the pK a values obtained in this work are consistent with those in literature. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Background: The metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC). Methods: The nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n = 4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n = 1800) and Surveillance, Epidemiology, and End Results (SEER) (n = 3227) databases. Results: nTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0% (n = 2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2% (n = 1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P < 0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P < 0.001) compared to the 7th and 8th editions (P = 0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts. Conclusion: Compared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification. [ABSTRACT FROM AUTHOR]

Background: There is a lack of data on the effect of high postoperative body temperature on disease-free survival (DFS) in patients who underwent radical gastrectomy. Methods: Patients who underwent radical gastrectomy from January 2006 to December 2011 were selected. The highest body temperature within 1 week after operation was used to establish diagnostic thresholds for high and low body temperature through X-tile software. Results: A total of 1396 patients were included in the analysis. The diagnostic threshold for high body temperature was defined as 38 °C; 370 patients were allocated to the high-temperature group (HTG), while another 1026 patients were allocated to the low-temperature group (LTG). For all patients, survival analysis showed that 5-year DFS in the HTG was significantly lower than that for the LTG (55.6% vs 63.9%, P = 0.007). Multivariate analysis revealed that high postoperative body temperature was an independent prognostic risk factor for 5-year DFS (HR = 1.288 (1.067–1.555), P = 0.008). For patients without complications, survival analysis showed that the 5-year DFS rate in the HTG was lower than that for the LTG (57.5% vs 64.4%, P = 0.051), especially in patients with stage III gastric cancer (31.3% vs 41.7%, P = 0.037). For patients with complications or infectious complications, there were no significant differences between the HTG and LTG regarding 5-year DFS (49.3% vs 58.2%, P = 0.23 and 49.4% vs 55.1%, P = 0.481, respectively). Conclusion: For stage III gastric cancer patients without complications, high postoperative body temperature can significantly reduce the 5-year DFS. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens. [ABSTRACT FROM AUTHOR]

Background: Whether the tumor‐node‐metastasis (TNM) staging system is appropriate for patients with node‐negative gastric cancer (GC) is still inconclusive. The modified staging system developed by recursive partitioning analysis (RPA) showed good prognostic performance in a variety of cancers. The application of RPA has not been reported in the prognostic prediction of GC. Methods: Node‐negative GC patients who underwent radical resection at Fujian Medical University Union Hospital (n = 862) and Sun Yat‐sen University Cancer Center (n = 311) with at least 5 years of follow‐up were selected as the training set. RPA was used to develop a modified staging system. Patients from the Surveillance, Epidemiology, and End Results database (n = 1415) were selected as the validation set. Results: The 5‐year overall survival (OS) rates of patients with 8th AJCC‐TNM stage IA‐IIIA in the training set were IA 95.2%, IB 87.1%, IIA 78.3%, IIB 75.8%, and IIIA 72.6%. Multivariate analysis (MVA) showed that larger tumor size, elder age, and deeper depth of invasion were independent predictors for OS in patients with node‐negative GC (all P < 0.05). Patients were reclassified into RPA I, RPA II, RPA III, and RPA IV stages based on RPA; the 5‐year OS rates were 96.1%, 87.2%, 81.0%, and 64.3%, respectively, with significant difference (P < 0.05). Two‐step MVA showed that the RPA staging system was an independent predictor of OS (P < 0.05). Compared with the 8th AJCC‐TNM staging system, the RPA staging system had a smaller AIC value (2544.9 vs 2576.2), higher χ2 score (104.2 vs 69.6) and higher Harrell's C‐index (0.697 vs 0.669, P = 0.007). The similar results were found in the validation set. Conclusions: A new prognostic predictive system based on RPA was successfully developed and validated, which may be suggested for staging node‐negative GC in future. [ABSTRACT FROM AUTHOR]

Background: Serum prealbumin (PALB) can predict the prognosis of patients with gastric cancer (GC). However, the prognostic value of combination of C-reactive protein and PALB (CRP/PALB) remains unclear. Methods: A total of 419 gastric cancer patients included in a clinical trial (NCT02327481) were analyzed. The present study is a substudy of the trial. Receiver operating characteristic (ROC) curves were generated, and by calculating the areas under the curve (AUC) and the C-index, the discriminative ability of each inflammatory index was compared, including CRP/PALB, C-reactive protein/albumin, Glasgow prognostic score (GPS), modified GPS, systemic immune-inflammation index, neutrophil–lymphocyte ratio, and platelet–lymphocyte ratio. Results: Ultimately, 401 patients were included in this study. The optimal cutoff value of CRP/PALB was 17.7. According to this cutoff point, the entire sample was divided into a CRP/PALB < 17.7 (LCP) group and a CRP/PALB ≥ 17.7 (HCP) group, comprising 245 and 156 patients, respectively. There were 54 and 22 patients experienced recurrence in the HCP and LCP group, respectively, p < 0.001. Compared with traditional inflammatory indices, CRP/PALB had the highest AUC (0.707) and C-index (0.716), all p < 0.05. The post-recurrence survival (PRS) of patients in the HCP group was significantly shorter than that in the LCP group (p = 0.010), especially for pathological stage III patients (p = 0.015) or patients with distant (p = 0.018) or local (p = 0.023) recurrences. Conclusions: The predictive value of preoperative CRP/PALB for the recurrence of GC is significantly better than traditional inflammatory indices. HCP significantly reduces the PRS, especially for pathological stage III patients or patients with distant or local recurrences. [ABSTRACT FROM AUTHOR]

Background: The objective of the study was to investigate the effects of intra-abdominal infection after curative gastrectomy on the prognosis of patients. Patients and Methods: Data were collected for enrolled patients who underwent curative gastrectomy in two centers; the relationship between intra-abdominal infection and prognosis was analyzed. Results: Of the 5,721 patients in the entire group, intra-abdominal infection occurred in 202 (3.5%) patients. Co-morbidities and duration of surgical procedures ≥240 minutes represented the independent risk factors for intra-abdominal infection. The overall five-year survival of patients with and without intra-abdominal infection was 60.2% and 64.3%, respectively (p = 0.041). After propensity score matching, the five-year overall survival between the two groups was not significantly different (p = 0.909). T staging, N staging, American Society of Anesthesiologists score, and age were independent prognostic factors for the overall survival of patients who underwent curative gastrectomy. The meta-analysis of the random effects model showed that there were no significant differences in the five-year overall survival between patients with and without intra-abdominal infection. Conclusions: The development of intra-abdominal infection after curative gastrectomy is associated closely with co-morbidities and longer operation time, whereas intra-abdominal infection does not lead to reduced long-term survival of patients. [ABSTRACT FROM AUTHOR]

Objective. To investigate the validity of the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer. Methods. The clinicopathologic data of 7371 patients who were diagnosed with gastric cancer and had 16 or more involved lymph nodes (LNs) were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and retrospectively reviewed. Results. Stage migration occurred primarily during stage III between the 7th and 8th edition TNM staging systems. Stages IIIB and IIIC in the 7th edition staging system were divided in the 8th edition and had obvious differences in survival rates (both P<0.001). The 8th edition TNM stages IIIC and IV showed similar survival rates (P=0.101). The prognosis of patients with T4aN3bM0 was not different from that of patients with TxNxM1 (P=0.433), while the prognosis of patients with T4bN3bM0 was significantly poorer than that of patients with TxNxM1 (P=0.008). A revised TNM system with both T4aN3bM0 and T4bN3bM0 incorporated into stage IV was proposed. Multivariable regression analysis showed that the revised TNM system, but not the 7th and 8th editions, was an independent factor for disease-specific survival (DSS) in the third step of the analysis. Further analyses revealed that the revised TNM system had superior discriminatory ability to the 8th edition staging system, which was also an improvement over the 7th edition staging system. Conclusion. The 8th edition of the AJCC TNM staging system is superior to the 7th edition for predicting the DSS rates of gastric cancer patients. However, for better prognostic stratification, it might be more suitable for T4aN3bM0/T4bN3bM0 to be incorporated into stage IV in the 8th edition TNM staging system. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: This study sought to explore whether lymphovascular invasion can affect the prognosis of patients with stage N0 gastric cancer and to evaluate the survival benefit of adjuvant chemotherapy for such patients.Method: From January 2006 to December 2011, a total of 2102 gastric cancer patients undergoing radical gastric resection were enrolled in this study. Homogeneity, discriminatory ability, and monotonicity of gradients in the combination of lymphovascular invasion and the 8th edition of the AJCC staging system and the 8th edition of the AJCC staging system alone were compared using linear trend χ2, likelihood ratio χ2 statistics, and Akaike information criterion (AIC) calculations. The Kaplan-Meier method and the log-rank test were used to analyze between-group differences in survival rate.Result: The median follow-up time of the whole group was 58 months, and the average age of the whole group was 63.9 years (range 21-89 years). The 3-year and 5-year overall survival rates in N0 patients with lymphovascular invasion were lower than those in N0 patients without lymphovascular invasion (3-year OS: 78.3% vs 92.5%, 5-year OS: 70.0% vs 88.3%, p < 0.001). A multivariate analysis showed that age (p < 0.001), lymphovascular invasion (p < 0.001), and pT (p < 0.001) were independent risk factors for the prognosis of N0 patients. Compared with the 8th edition of the AJCC staging system alone, the 8th AJCC staging system combined with lymphovascular invasion demonstrated a better linear trend χ2, likelihood ratio χ2 statistics, and AIC value (68.99 vs 58.58, 70.18 vs 58.36, 1473.38 vs 1485.04). In pT3N0M0 patients with lymphovascular invasion, the 3-year and 5-year overall survival rates of the adjuvant chemotherapy group were higher than those of the surgery alone group (3-year OS: 83.3% vs 68.2%, 5-year OS: 72.3% vs 50.0%, p = 0.048).Conclusion: Lymphovascular invasion is an independent prognostic factor in N0 patients. The 8th AJCC staging system combined with lymphovascular invasion can improve the accuracy of the AJCC staging system for N0 patients. Moreover, adjuvant chemotherapy improves the survival of pT3N0M0 patients with lymphovascular invasion. [ABSTRACT FROM AUTHOR]

Background: The systemic inflammation score (SIS), based on preoperative serum albumin (Alb) level and lymphocyte-to-monocyte ratio (LMR), has been shown to be a novel prognostic score for some tumors. We investigate the prognostic value of the SIS in patients with resectable gastric cancer (GC).Methods: Patients with GC who underwent curative resection between December 2008 and December 2013 were included. Time-dependent receiver operating characteristics analysis (t-ROC), concordance index (C-index) and AUC were used to compare the prognostic impact.Results: Totally, 1786 patients with resectable GC were included in the study. By multivariate analysis, the SIS was not an independent prognostic factor. However, the normal Alb level (≥ 40 g/l) and LMR ≥ 3.4 both remained independent protective factors for GC (both P < 0.05). Due to the similar survival of patients with LMR ≥ 3.4 and LMR < 3.4 in the normal Alb group, we combined the two subgroups to establish the modified SIS (mSIS). Multivariate analysis revealed that the mSIS was the only significant independent biomarker (P < 0.05). The t-ROC curve and C-index for the mSIS were superior to those of the SIS throughout the observation period. Furthermore, the AUC of the mSIS was significantly greater than that of the SIS at 3 and 5 years after operation (both P < 0.05).Conclusion: The preoperative mSIS is a novel, simple and useful prognostic factor for postoperative survival in patients with GC and can be used as a part of the preoperative risk stratification process to improve the prediction of clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: To determine whether laparoscopic surgery can be used in high-risk patients with gastric cancer.Methods: The clinicopathological data of 3743 patients with primary gastric adenocarcinoma, collected from January 2007 to December 2014, were retrospectively analyzed. Patients who had ≥ 1 of the following conditions were defined as high-risk patients: (1) age ≥ 80 years; (2) BMI ≥ 30 kg/m2; (3) ASA (American Society of Anesthesiologists) grade ≥ 3; or (4) clinical T stage 4 (cT4). Propensity score matching (PSM) was used to reduce confounding bias; then, we compared the short-term and long-term efficacy of laparoscopic gastrectomy (LG) with open gastrectomy (OG) in high-risk patients with gastric cancer.Results: A total of 1296 patients were included in PSM. After PSM, no significant difference in clinicopathological data was observed between the LG group (n = 341) and the OG group (n = 341). The operative time (181.70 vs. 266.71 min, p < 0.001) and blood loss during the operation (68.11 vs. 225.54 ml, p < 0.001) in the LG group were significantly lower than those in the OG group. In the LG and OG groups, postoperative complications occurred in 39 (11.4%) and 63 (18.5%) patients, respectively, p = 0.010. Multivariate analysis showed that laparoscopic surgery was an independent protective factor against postoperative complications (p = 0.019). The number of risk factors was an independent risk factor for postoperative complications (p = 0.021). The 5-year overall survival rate in the LG group was comparable to that in the OG group (55.0 vs. 52.0%, p = 0.086). Hierarchical analysis further confirmed that the LG and OG groups exhibited comparable survival rates among patients with stages cI, pI, cII, pII, cIII, and pIII (all p > 0.05).Conclusions: For high-risk patients with gastric cancer, LG not only exhibits better short-term efficacy than OG but also has a comparable 5-year survival rate to OG. [ABSTRACT FROM AUTHOR]

Objective. To investigate the prognostic impact of postoperative complications for patients with gastric cancer. Methods. Postoperative complications of patients undergoing radical gastrectomy for gastric cancer were reviewed. The severity of complications was graded by the CCI and C-D classification. Results. A total of 5327 patients were included in the study. Complications were observed in 767 patients. When the C-D classification system was applied, for patients with grade I–II complications, the length of stay (LOS) of those with high CCI (CCI ≥ 26.2) was significantly longer than that of patients with low CCI (CCI < 26.2) (p<0.001). The 5-year cancer-specific survival rate of patients with complications (52%) was lower than that of patients without complications (61%) (p<0.001). Analysis of the factors associated with prognosis in patients with gastric cancer revealed that complications were independent risk factors for specific survival. When CCI was used to classify complication severity, the 5-year cancer-specific survival rate of the high-CCI group was 46.3%, which was lower than that of the low-CCI group (54.9%, p=0.009). Conclusion. Complication after radical gastrectomy is an independent prognostic factor, and the complication severity as graded by CCI reflects the difference of cancer-specific survival in gastric cancer patients with postoperative complications. [ABSTRACT FROM AUTHOR]

Background: The types of patients with gastric adenocarcinoma (GA) for whom postoperative radiotherapy can improve the disease-specific survival rate (DSS) remain controversial. This study aims to explore the ideal indications.Methods: Patients in the Surveillance, Epidemiology, and End Results (SEER) database with T3-4Nx or TxN+ GA from January 1988 to December 2012 were included and divided into a postoperative chemoradiotherapy group (Group R) and a postoperative chemotherapy group (Group C). We established a nomogram to predict DSS and then divided entire patient cohort into low-risk and high-risk groups based on the DSS predicted by the nomogram.Results: The Cox multiple regression analysis demonstrated that various risk factors affected DSS for Group R. Based on these risk factors, a nomogram for predicting DSS was established. The decision curve indicated that the best clinical effect could be obtained when the threshold probability was 0-58%. The patients were then divided into low-risk (< 69 points) and high-risk (≥ 69 points) groups according to the five-year DSS predicted. DSS was significantly better for Group R than for Group C for high-risk patients (P < 0.001) but was similar for low-risk patients (P = 0.732).Conclusion: At present, the National Comprehensive Cancer Network (NCCN) guidelines may include an overly broad range of indications for postoperative radiotherapy for patients with GA. For intestinal GA patients with a postoperative pathologic stage of T1 N1 who are younger than 65 years, have had more than 15 lymph nodes dissected, and have received postoperative chemotherapy, postoperative radiotherapy should not be recommended. [ABSTRACT FROM AUTHOR]

Background: To assess the prognostic factors and investigate the optimal treatment of gastric mixed adenoneuroendocrine tumors.Methods: We retrospectively analyzed clinical data from 80 patients with gastric mixed adenoneuroendocrine carcinoma that received radical resection in our department from January 2007 to December 2016. Risk factors for relapse and survival were analyzed using a multivariate Cox proportional hazards regression model. Gastric mixed adenoneuroendocrine carcinoma was divided into neuroendocrine carcinoma and adenocarcinoma based on the predominant type in the tumor.Results: The 3-year overall survival was 40% in the neuroendocrine carcinoma group and 75% in the adenocarcinoma group (P = 0.006). The neuroendocrine carcinoma (NEC)-dominant tumors and a Ki-67-positive index ≥60% were independent risk factors for worse overall survival. The 3-year recurrence-free survival was 33% in the neuroendocrine carcinoma group and 68% in the adenocarcinoma group. NEC-dominant tumors and a Ki-67-positive index ≥60% were independent risk factors for gastric mixed adenoneuroendocrine carcinoma recurrence. Patients in the adenocarcinoma group that received adjuvant chemotherapy exhibited significantly better overall survival than patients that did not receive chemotherapy (median survival time 43 months vs. 13 months, P = 0.026).Conclusion: The NEC-dominant tumors and a Ki-67-positive index ≥60% were significantly associated with worse survival and a higher recurrence rate for gastric mixed adenoneuroendocrine carcinoma patients. Patients in the adenocarcinoma group may benefit from gastric adenocarcinoma treatments. [ABSTRACT FROM AUTHOR]

Background: The oncologic outcome of laparoscopic radical gastrectomy (LG) with open radical gastrectomy (OG) for gastric cancer with preoperative enlarged lymph nodes (LNs) remains ambiguous.Methods: The long-term outcomes of LG (n = 855) versus OG (n = 154) in gastric adenocarcinoma patients were analyzed retrospectively. Patients were stratified according to enlarged (> 10 mm) and small (≤ 10 mm) LNs (ELN and SLN) based on the long-axis diameter of the LNs.Results: The violin plot indicates that the distribution of ELN size was similar between two groups. Survival curves demonstrated that the overall survival (OS) in LG is enhanced compared with OG (p = 0.034). A stratified analysis revealed that the OS was better in the LG group compared with the OG group for patients with ELNs (p = 0.038). In a forest map analysis, the actual 3-year OS rate for LG was significantly increased compared with OG in enlarged suprapancreatic LN (ESLNs) patients. Stratified analysis based on different diameters of ESLNs revealed that the actual 3-year OS and cancer-specific survival (CSS)rate for LG was significant increased compared to OG with a diameter from 1.0 to 1.9 cm for pII or pIII stage patients. However, the actual 3-year OS and CSS rate for LG was significantly reduced compared with OG when the size exceeded 2.5 cm.Conclusions: For advanced gastric cancer with an ESLN diameter from 1.0 to 1.9 cm, LG could be chosen preferentially; nevertheless, LG is not safe if ESLN are > 2.5 cm. [ABSTRACT FROM AUTHOR]

By separating two photonic crystals with a distance of 2 3 a , where a is the lattice constant, shifting the positions of some discriminatory air holes in the upper and lower edges, and inserting a defect central row, a specific waveguide is set up, W3 photonic crystal waveguide (W3 PCW). An equivalent transmission line model is given, giving the theoretical basis of for the proposed waveguide to have a wider transmission bandwidth and thus higher normalized delay bandwidth product (NDBP). Slow-light properties and performance are studied by using plane-wave expansion and finite-difference time-domain methods. We obtained ultra-wideband of 65.70 nm with low group-velocity dispersion and at the same time a high NDBP of 0.496 through optimization which is a worthy indicator for slow light device performance. Wider bandwidth can allow shorter duration of pulse waves, causing higher field intensity and stronger nonlinear effect. [ABSTRACT FROM AUTHOR]

Abstract: Skeletal muscle index (SMI) and the controlling nutritional status (CONUT) score are useful for evaluating nutritional status, which is closely associated with cancer prognosis. This study compared the prognostic value of these indicators in patients with gastric cancer (GC) after radical gastrectomy (RG). We retrospectively enrolled 532 patients between 2010 and 2011. SMI was measured via CT images to determine low SMI. The CONUT score was calculated based on serum albumin, total lymphocyte count, and cholesterol. Patients were grouped according to SMI and the CONUT score based on previous research. Spearman's correlation coefficient, the Kaplan‐Meier method, and Cox regression were used. There was no significant correlation between SMI and the CONUT score. Five‐year overall survival (OS) and recurrence‐free survival (RFS) in patients with low SMI were significantly worse than those in patients with high SMI (P < .001). The normal nutrition group had better OS and RFS than did the light and moderate or severe malnutrition groups (P < .05), but the OS and RFS were not significantly different between the light and moderate or severe malnutrition groups (P = .726). Univariate analysis showed that SMI and the CONUT score were associated with OS and RFS, but only SMI remained prognostic in multivariate analysis. Preoperative SMI based on CT images is a more objective predictor than the CONUT score of long‐term survival in GC after RG, but this finding must be confirmed by prospective trials. [ABSTRACT FROM AUTHOR]

In this paper, based on coupled hetero-cavities, multiple Fano resonances are produced and tuned in a plasmonic metal-insulator-metal (MIM) system. The structure comprises a rectangular cavity, a side-coupled waveguide, and an upper-coupled circular cavity with a metal-strip core, used to modulate Fano resonances. Three Fano resonances can be realized, which originate from interference of the cavity modes between the rectangular cavity and the metal-strip-core circular cavity. Due to the different cavity-cavity coupling mechanisms, the three Fano resonances can be divided into two groups, and each group of Fano resonances can be well tuned independently by changing the different cavity parameters, which can allow great flexibility to control multiple Fano resonances in practice. Furthermore, through carefully adjusting the direction angle of the metal-strip core in the circular cavity, the position and lineshape of the Fano resonances can be easily tuned. Notably, reversal asymmetry takes place for one of the Fano resonances. The influence of the direction angle on the figure of merit (FOM) value is also investigated. A maximum FOM of 3436 is obtained. The proposed structure has high transmission, sharp Fano lineshape, and high sensitivity to change in the background refractive index. This research provides effective guidance to tune multiple Fano resonances, which has important applications in nanosensors, filters, modulators, and other related plasmonic devices. [ABSTRACT FROM AUTHOR]

Background. Determining preferences regarding the benefits of adjuvant chemotherapy (AC) for stage I GC is critical. Methods. We retrospectively reviewed 1069 patients with pathologically confirmed stage I GC who underwent R0 gastrectomy between 2006 and 2014. Univariate and multivariate survival analyses were conducted. Systemic inflammation factors were used to develop a scoring system for predicting AC benefits. Results. With a median follow-up of 47 months (range 3–113 months), the 5-year overall survival (OS) rate was 90.5%. The patient score was 1 for either a pretreatment hypoalbuminemia or elevated derived neutrophil-lymphocyte ratio (dNLR) and was 0 otherwise. The SIS served as an independent prognostic factor for reduced OS. AC was delivered to 13.5% (144/1069) of all patients. Compared to surgery alone, AC had no significant effect on survival in both the entire cohort and the IA/IB subgroup. However, in the high-risk group (SIS = 2), patients with AC had a significantly better OS than those undergoing surgery alone. Conclusions. Patients with SIS = 2 may benefit from AC and thus may be considered candidates for adjuvant treatment. However, to confirm our findings, future prospective studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted gastrectomy (RAG) has been rapidly adopted for gastric cancer (GC) treatment. However, whether RAG provides any significant outcome/cost advantages over laparoscopy-assisted gastrectomy (LAG) for the experienced laparoscopist remains unclear.Methods: A retrospective review of a prospectively collected database identified 768 consecutive patients who underwent either RAG (n = 103) or LAG (n = 667) for GC between July 2016 and June 2017 at a large center. A 1:3 matched propensity score analysis was performed. The short-term outcomes and hospital costs between the two groups were compared.Results: A well-balanced cohort of 404 patients was analyzed (RAG:LAG = 1:3 match). The mean operation times were 226.6 ± 36.2 min for the RAG group and 181.8 ± 49.8 min for the LAG group (p < 0.001). The total numbers of retrieved lymph nodes were similar in the RAG and LAG groups (means 38 and 40, respectively, p = 0.115). The overall and major complication rates (RAG, 13.9% vs. LAG, 12.5%, p = 0.732 and RAG, 3.0% vs. LAG, 1.3%, p = 0.373, respectively) were similar. RAG was much more costly than LAG (1.3 times, p < 0.001) mainly due to the amortization and consumables of the robotic system. According to cumulative sum (CUSUM), the learning phases were divided as follows: phase 1 (cases 1-21), phase 2 (cases 22-63), and phase 3 (cases 64-101), in the robotic group. The surgical stress (SS) was higher in the robotic group compared with the laparoscopic group in phase 1 (p < 0.05). However, the SS did not differ significantly between the two groups in phase 3.Conclusions: RAG is a feasible and safe surgical procedure for GC, especially in the post-learning curve period. However, further studies are warranted to evaluate the long-term oncological outcomes and to elucidate whether RAG is cost-effective when compared to LAG. [ABSTRACT FROM AUTHOR]

Abstract: Given the rarity and indolent clinical course of gastroenteropancreatic neuroendocrine tumors (GEP‐NETs), conditional survival might be the most suitable parameter for cancer survivors who wish to receive accurate prognostic information during follow‐up. We have explored the updated incidence trend and the conditional survival of patients with GEP‐NETs. Incidence trends from 2000 to 2014 were determined through an assessment of patients in the SEER cancer registry. Patients diagnosed between 1988 and 2011 were included in the conditional survival analysis, and the 3‐year conditional cancer‐specific survival (CCS3) was computed. The incidence of GEP‐NETs, which is far higher than the incidence of many malignant tumors, is still increasing steadily (annual percentage change = 4.4). The risk of death from NETs is dynamic over time, and most deaths occur in the first 3 years after diagnosis. Patients with gastric, rectal, or appendiceal NETs hardly exhibit any excess mortality (CCS3 > 95%) given that they have already survived until a defined time‐point within 10 years. The initial difference between each age group basically disappeared with an extension of the survival time since the initial diagnosis of gastric, appendiceal, or rectal NETs, but the difference persisted for tumors at other sites. Although patients with advanced‐stage or higher‐grade tumors have a worse survival at diagnosis than patients with early‐stage or lower‐grade tumors, the difference diminishes and might even disappear over time. For GEP‐NETs that are rare but exhibit slow growth, clinically relevant variations in conditional survival were observed based on the time since diagnosis. Therefore, conditional survival can serve as a guideline that can be used by cancer survivors to plan their future and doctors to plan surveillance schedules. [ABSTRACT FROM AUTHOR]

Background: The proportion of elderly patients who undergo surgery has rapidly increased. However, clinical indicators that predict outcomes are limited. Frailty is thought to estimate physiological reserves, although its use has not been evaluated in laparoscopic surgical patients. This study aimed to evaluate the significance of preoperative modified frailty index (PMFI) in octogenarians undergoing a laparoscopic gastrectomy.Methods: We reviewed prospectively collected data from 119 patients with gastric cancer (GC) aged 80 years or older who underwent a radical laparoscopic gastrectomy (RLG) between January 2007 and December 2012. Three baseline frailty traits were measured using routine preoperative laboratory data: albumin < 3.4 g/dL, haematocrit < 35%, and creatinine > 2 mg/dL. Patients were categorized by the number of positive traits as follows: low preoperative modified frailty index (LPMFI): 0-2 traits and high preoperative modified frailty index (HPMFI): 3 traits. We compared patient characteristics, operative outcomes, pathological results, morbidity, and survival.Results: A total of 43 (36.1%) patients were considered HPMFI, and 76 (63.9%) patients were considered LPMFI. HPMFI was associated with an increased risk of postoperative complications (HPMFI group: odds ratio 2.506; 95% CI, 1.113-5.643, P = 0.027). With a median follow-up of 39.0 months, the 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates for the entire cohort were 47.9, 34.3, and 51.7%, respectively. Significant differences were observed in OS (HPMFI group, 37.2%; LPMFI group, 53.9%; P = 0.038) and RFS (HPMFI group, 23.3%; LPMFI group, 40.5%; P = 0.012) between the groups, but no difference was found for CSS (HPMFI group, 43.5%; LPMFI group, 56.4%; P = 0.078).Conclusions: HPMFI based on an easily calculable preoperative measure may be useful for predicting postoperative complications and have a negative impact on 3-year OS and RFS after an RLG in octogenarians. Therefore, HPMFI can serve as a low-cost, simple screen for high-risk individuals who might suffer more than expected during the postoperative period after an RLG. [ABSTRACT FROM AUTHOR]

Aim: To investigate oncologic efficacy of prophylactic laparoscopic superior mesenteric vein (No. 14v) lymph node (LN) dissection for lower-third gastric cancer (LTGC).Methods: We retrospectively collected data from 757 patients who underwent laparoscopic-assisted distal gastrectomy for LTGC. Of these patients, 102 underwent 14v LN dissection (14vD+ group), and the remaining 655 patients did not undergo 14v LN dissection (14vD- group). The outcomes were compared using a 1:1 propensity score matching method.Results: After matching, 93 patients from the 14vD+ group and 93 patients from the 14vD- group with similar clinicopathological characteristics were compared. Before matching, the overall survival (OS) was similar between the two groups (P = 0.742). After matching, the OS was greater in the 14vD+ group (P = 0.025). The status of 14v dissection was not a significant prognostic factor in the survival analyses, both before and after matching. However, a stratified analysis according to the independent factors in the OS showed that the OS in the 14vD+ group was higher than that in the 14vD- group for cT2-3 patients after matching. The forest plot of OS showed that after matching the 14vD+ group had a significantly higher 3-year OS rate than the 14vD- group in cT2-3 patients. The distribution of the therapeutic index demonstrated that the index of 14v LN was similar to those of Nos. 1, 7, 8a, 9, and 11p after matching.Conclusions: Adding laparoscopic 14v dissection for laparoscopic-assisted radical distal gastrectomy was safe and might improve the OS for clinically advanced LTGC without serosal invasion. [ABSTRACT FROM AUTHOR]

Impaired skeletal muscle energy metabolism is linked to the pathogenesis of insulin resistance and glucose intolerance in type 2 diabetes. The contractile and metabolic properties of myofibers exhibit a high degree of heterogeneity and plasticity. The regulatory circuitry underpinning skeletal muscle energy metabolism is critically linked to exercise endurance and systemic homeostasis. Recent work has identified the Baf60 subunits of the SWI/SNF chromatin-remodeling complex as powerful regulators of the metabolic gene programs. However, their role in integrating myofiber energy metabolism with exercise endurance and metabolic physiology remains largely unknown. In this study, we conditionally inactivated Baf60a, Baf60c, or both in mature skeletal myocytes to delineate their contribution to muscle bioenergetics and metabolic physiology. Our work revealed functional redundancy between Baf60a and Baf60c in maintaining oxidative and glycolytic metabolism in skeletal myofibers and exercise endurance. Unexpectedly, mice lacking these two factors in skeletal muscle were protected from diet-induced and age-associated metabolic disorders. Transcriptional profiling analysis identified the muscle thermogenic gene program and myokine secretion as key pathways that integrate myofiber metabolism with systemic energy balance. As such, Baf60 deficiency in skeletal muscle illustrates a surprising disconnect between exercise endurance and systemic metabolic homeostasis. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the short- and long-term outcomes of malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Background: Preoperative malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. However, whether laparoscopic surgery can improve the short- and long-term outcomes of malnourished gastric cancer patients has not been determined. Methods: We reviewed prospectively collected data from 2441 patients with gastric cancer between January 2009 and December 2014 and compared the short- and long-term outcomes in malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Nutritional risk factors included weight loss >10% within 6 months, body mass index <18.5 kg/m, Subjective Global Assessment Grade C, and serum albumin <3.0 g/dL. Results: Overall, 501 patients (20.52%) were classified as malnourished. Patients with gastric stump carcinoma, neoadjuvant chemotherapy, distant metastases, palliative operation, or the presence of other malignancies were excluded. Finally, a total of 412 patients were analyzed; 304 in the laparoscopic group and 108 in the open group. There were no significant differences between the two groups regarding the clinicopathological characteristics. However, the operation time (181 ± 53 vs. 253 ± 81 min), intraoperative blood loss (80 ± 116 vs. 322 ± 502 mL), time to first ambulation (2.21 ± 1.04 vs. 2.55 ± 1.50 days), liquid diet (4.91 ± 1.61 vs. 5.72 ± 2.09 days) and semiliquid diet (7.67 ± 1.56 vs. 9.53 ± 2.09 days) as well as the postoperative hospital stay duration (13.00 ± 6.56 vs. 15.22 ± 6.87 days) were significantly lower in the laparoscopic group than those in the open group ( p < 0.05). The instances of overall complications (laparoscopic vs. open: 18.4 vs. 30.6%, p = 0.008) and pneumonia (laparoscopic vs. open: 10.9 vs. 19.4%, p = 0.023) were significantly lower in the laparoscopic group. With a median follow-up of 31.0 months (range 1.0-88.0), the 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates for the entire cohort were 58.9, 54.0 and 63.0%, respectively. Further analysis showed that the OS (57.5 vs. 59.4%, p = 0.560), RFS (51.8 vs. 54.8%, p = 0.441) and CSS (62.8 vs. 63.0%, p = 0.789) between the laparoscopic and open groups, respectively, were no significantly different. Further analysis showed no significant differences in the OS rates of the two groups of patients stratified by tumor stage ( p > 0.05). Conclusion: Compared with open radical gastrectomy, laparoscopy would reduce the postoperative complications especially pneumonia and shorten the postoperative hospital stay for patients with preoperative malnutrition without affecting their long-term survival. [ABSTRACT FROM AUTHOR]

Few studies have been designed to investigate the incidence of postoperative pneumonia after radical gastrectomy and its effect on prognosis of these patients. Incidences of postoperative pneumonia after radical gastrectomy in our department between January 1996 and December 2014 were summarized. Their effects on prognosis were retrospectively analyzed using survival curves and Cox regression. A total of 5237 patients were included in this study, 767 (14.4%) of them had complications, including 383 cases of postoperative pneumonia (7.2%). The 5-year overall and disease-specific survival of patients with postoperative pneumonia were both lower than those without this complication ( P < 0.001). Stratified analysis demonstrated that this difference existed in all Stage I, II, and III patients (log-rank, P < 0.05). Multivariate analysis revealed that age, neoadjuvant chemotherapy, tumor size, tumor stage, and postoperative pneumonia were independent risk factors for disease-specific survival. Postoperative pneumonia after radical gastrectomy is an independent risk factor for prognosis of gastric cancer patients, especially in stage III. [ABSTRACT FROM AUTHOR]

Background: To evaluate the risk factors affecting unplanned reoperation (URO) after laparoscopic gastrectomy (LAG) for gastric cancer (GC) and establish a model to predict URO preoperatively.Study Design: Between May 2007 and December 2014, we prospectively collected and retrospectively analyzed the data of 2608 GC patients who underwent LAG. Among them, 2580 patients not requiring an URO were defined as the Non-URO group, and 28 patients requiring an URO were defined as the URO group. Univariate, multivariate, and bootstrap analyses were performed to determine the independent predictors for URO, and a nomogram was constructed to preoperatively predict the rate of URO after LAG.Results: Of the 2608 patients, the URO rate was 1.1% (28/2608) within the 30-day hospitalization. The mean URO time interval to first operation was 5.6 ± 5.5 (0.10-18.5) days. The main causes requiring URO were intraabdominal bleeding (57.1%), anastomotic bleeding (17.9%), anastomotic leakage (7.1%), and intraabdominal infection (7.1%). Compared to the Non-URO group, the URO group had a significantly longer hospital stay (p < 0.001) and significantly higher hospital fees (p < 0.001). The morbidity rate was 39.2% in the URO group and 14.5% in the non-URO group (p = 0.001), and mortality was 3.6% in the URO group and 0.2% in the non-URO group (p = 0.063). Multivariate analysis using bootstrap method revealed that age >70 years (odds ratio (OR) = 2.232, 95% confidence interval (CI) = 1.023-4.491, p = 0.028), male gender (OR = 32.983, 95% CI 1.405-25.343 × 106, p = 0.027), and body mass index (BMI) > 25 kg/m2 (OR = 2.550, 95% CI 1.017-5.398, p = 0.012) were independent risk factors for URO. A multivariable nomogram model for predicting URO exhibited a strong optimism-adjusted discrimination (concordance index, 0.687). No significant correlation was noted between the URO rate and operative period by Spearman analysis (r = 0.012, p = 0.548).Conclusions: Age > 70 years, Male, and BMI > 25 kg/m2 were independent risk factors for URO. Based on the three risk factors, we developed a simple and practical nomogram to predict URO preoperatively, which might aid surgeons in reducing the URO rate when planning to perform LAG for GC. [ABSTRACT FROM AUTHOR]

The 8th edition of the TNM was released in 2016 and included major revisions, especially for stage III. We aimed to compare the prognostic value of the 7th and 8th editions of the AJCC TNM classification for stage III gastric cancer. Clinical data from 1557 patients operated on for stage III gastric cancer according to the 7th edition between 2007 and 2014 were analyzed and compared using the 7th and 8th TNM classifications. A proposed staging system was established, and the three systems were compared in terms of prognostic performance. The stage shifted for 669 (42.96%) patients. It shifted from IIIA to IIIB (one patient, 0.06%), IIIB to IIIA (230 patients, 14.8%), IIIB to IIIC (94 patients, 6.0%), and IIIC to IIIB (344 patients, 22.1%). However, the new AJCC subgroupings did not prove distinctive for survival levels between T3N3aM0 (stage IIIB) and T3N3bM0 (stage IIIC) or between T4aN3aM0 (stage IIIB) and T4aN3bM0 (stage IIIC) when <30 lymph nodes ( LNs) were resected. The performance of the 8th edition (c-index, 0.614; 95% confidence interval [ CI], 0.596-0.633) revealed no relevant improvement compared to the 7th edition (c-index, 0.624; 95% CI, 0.605-0.643). The proposed staging system generated the best prognostic stratification. The 8th TNM edition may not provide better accuracy in predicting the prognosis of stage III gastric cancer. The proposed staging system, comprised of a combination of the number of LNs harvested and the 7th and 8th AJCC classifications, may improve predictive capacities for stage III gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the outcomes of laparoscopic-assisted total gastrectomy (LATG) for Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). Thus, aim of this study was to investigate the surgical outcomes of LATG for Siewert type II and III AEG.Methods: Clinical data for 700 Siewert type II and III AEG patients were analyzed retrospectively. The short- and long-term outcomes were compared between the matched groups using a propensity score matching method.Results: Before matching, the comorbidities, Siewert classifications and tumor invasion depths significantly differed between the LATG and open total gastrectomy (OTG) groups. After matching, the clinicopathologic characteristics were well balanced between the two groups. In addition, after matching, decreases in the operative time, amount of blood loss, time to resumption of a semifluid diet, and length of hospital stay and an increased number of lymph nodes (LNs) retrieved were observed in the LATG group compared with the OTG group. Further, a significantly higher 3-year overall survival rate (81.3 vs 66.4%; P = 0.011) and disease-free survival rate (77.5 vs 63.8%; P = 0.040) were observed for the Siewert type II AEG patients in the LATG group compared with those in the OTG group; however, the survival rates were similar for the Siewert type III AEG patients in the two groups (P = 0.853 and P = 0.844, respectively).Conclusions: LATG is associated with better short-term outcomes for Siewert type II and III AEG. In addition, it may result in an increased number of retrieved LNs and better long-term survival for Siewert type II AEG patients in particular. [ABSTRACT FROM AUTHOR]

Objective: In this study, we evaluated the short-term outcomes following three-dimensional (3D) or two-dimensional (2D) laparoscopic surgery for patients with gastric cancer.Background: There is a lack of prospective evidence regarding the safety and efficacy of 3D versus 2D laparoscopic surgery for patients with gastric cancer. Therefore, we conducted a phase III single-center, prospective, randomized, controlled trial to compare 3D and 2D laparoscopic surgery for patients with gastric cancer.Methods: We compared operation time, intraoperative blood loss, number of lymph node dissections, morbidity, and mortality between the 3D and 2D groups following laparoscopic surgery for gastric cancer. The study is registered at ClinicalTrials.gov with ID number NCT02327481.Results: A total of 228 patients were randomized (3D group 115 cases; 2D group 113 cases) between January 1, 2015 and September 1, 2015. Seven patients who underwent exploratory operations were excluded. Finally, a total of 221 patients were analyzed (3D group 109 cases, 2D group 112 cases). There were no significant differences between the two groups regarding the clinical pathological characteristics, operating time (3D vs. 2D, 184 ± 36 vs. 178 ± 37 min, P = 0.288), number of lymph node dissections (36 ± 14 vs. 37 ± 13, P = 0.698), time to first ambulation (2.27 ± 1.60 vs. 2.04 ± 0.84, P = 0.18), flatus (3.89 ± 1.49 vs. 3.69 ± 1.12, P = 0.255), liquid diet (4.88 ± 1.88 vs. 4.79 ± 1.57, P = 0.684), or duration of postoperative hospital stay (12.52 ± 4.83 vs. 12.63 ± 7.32, P = 0.903). The postoperative complication rates of the 3D and 2D groups were 18.3 and 16.1%, respectively, P = 0.723. No patients died during the postoperative hospital stay. However, the intraoperative blood loss in the 3D group was significantly lower than the 2D group (58 ± 75 vs. 78 ± 72 ml, P = 0.047).Conclusion: There was no significant difference in operation time and number of lymph node harvested between the 3D and 2D groups; however, 3D laparoscopic surgery may reduce the intraoperative blood loss compared to 2D procedure. Therefore, we conclude that this trial is safe and is thus ongoing. [ABSTRACT FROM AUTHOR]

Background: Comorbidity is a predictor of postoperative complications in gastrectomy. However, it remains unclear which comorbidities are predictors of postoperative complications in gastric cancer patients who have undergone laparoscopy-assisted total gastrectomy (LATG). The purpose of this study was to evaluate the effect of comorbidities on the surgical outcomes of patients with gastric cancer after LATG.Methods: We retrospectively collected data on 1657 gastric cancer patients who underwent LATG between January 2008 and December 2015. We investigated the incidences, types, and risk factors for postoperative complications after LATG. Patients were enrolled in analysis to evaluate the effects of comorbidities on postoperative complications.Results: The number of postoperative complications was associated with the number of comorbidities in the gastric cancer patients according to the operative period. Of the 1657 patients included in this study, 714 (43.1 %) had one or more comorbidities. Postoperative complications occurred in 283 patients (17.1 %), and 6 patients (0.4 %) died during hospitalization. With an increasing number of comorbidities, the incidence of local and systemic complications also increased. Univariate and multivariate analyses revealed that comorbidity was a predictive risk factor for local complications (OR 1.204, 1.014-1.431) and systemic complications (OR 1.237, 1.039-1.474). Diabetes mellitus, anemia, pulmonary disease, and renal dysfunction were found to be associated with postoperative complications, including abdominal bleeding, anastomotic leakage, and pneumonia.Conclusions: Our study has revealed that comorbidities could be a predictive risk factor for postoperative complications after LATG. Surgeons should carefully assess patients with full perioperative attention to some specific types of comorbidities. [ABSTRACT FROM AUTHOR]

Background: To investigate the incidence of and factors associated with postoperative complications and failure to rescue following laparoscopic and open gastrectomy for gastric cancer.Study Design: We analyzed the records of 4124 patients who underwent a laparoscopic or open gastrectomy for gastric cancer. One-to-one propensity score matching was performed to compare the difference between the two groups.Results: A total of 4124 patients were included in the study, 627 of whom (15.2 %) developed postoperative complications. Postoperative deaths occurred in 23 (0.6 %) patients with serious complications. In the propensity score matching analysis with 1361 pairs, no significant differences in the rates of overall complications (14.2 vs. 16.5 %, p = 0.093) were observed between laparoscopic and open gastrectomy group. In-hospital mortality decreased in patients who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy (0.3 vs. 1.2 %, p = 0.004). Failure to rescue rates were lower in patients who underwent laparoscopic gastrectomy (2.1 vs. 7.6 %, p = 0.008). Multivariate analysis showed that older age, tumor location, TNM stage classification, extent of gastric resection, operative time and intra-operative blood loss were adverse risk factors for postoperative complications. Laparoscopic gastrectomy was found to be a protective factor for failure to rescue. Complications associated with failure to rescue included abdominal bleeding, anastomotic leakage and cardiac events. In-hospital mortality increased as the number of complications per patient increased.Conclusions: Assuming equal competence with open and laparoscopic approaches of a surgeon, the proportion of patients with postoperative complications were similar among those who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy. However, when complications occurred, patients with open gastrectomy were more likely to die. [ABSTRACT FROM AUTHOR]

Background: The therapy for gastrointestinal stromal tumors (GIST) has changed significantly since the use of imatinib mesylate (IM). However, the appropriate duration of receiving adjuvant IM for patients with high-risk GIST who underwent R0 resection is still controversial. Methods: From January 2005 to December 2014, 234 patients who underwent R0 resection and were treated with adjuvant imatinib at our institution were identified from a prospectively collected database. The effect of the medication duration on the long-term outcomes was analyzed. Results: In this study, 140 cases were male and 94 cases were female, and the mean age was 57.5 ± 11.4 years. The most common site was the stomach (103 cases, 44%), followed by the small intestine (81 cases, 34.6%). The 5 year recurrence-free survival (RFS) rate and overall survival (OS) rate in the whole groups were 76.2 and 83.4%, respectively. The patient's prognosis was improved due to the prolongation of the time of receiving the imatinib treatment ( P < 0.05). According to the results of the risk stratification analysis, the outcomes of the moderate-risk patients who received IM adjuvant therapy for 1-year group, 1-3 years group and more than 3 years group showed improvement, but the difference was not statistically significant ( P > 0.05). However, in the high-risk patients, the RFS rates of the 1-year group, 1-3-years group, 3-5-years group and more than 5 years group were 36.5, 68.7, 71.2 and 90.8%, respectively, and the OS rates were 36.7, 76.6, 84.0 and 97.4%, respectively ( P < 0.001). In addition, linear regression analysis showed that the long-term outcomes of patients with high-risk GIST significantly improved due to prolonged adjuvant IM treatment durations ( P < 0.05). The RFS rate of patients receiving IM for more than 5 years was significantly better than those receiving it for less than 5 years. Multivariate COX regression analysis in the patients with high-risk GIST showed that tumor located in small intestine was an independent risk factor, while receiving IM treatment was an independent protective factor for prognosis. Conclusions: The long-term outcomes of patients with high risk GIST improved due to the prolongation of the IM treatment. To reduce the recurrence and improve the long-term survival, we suggest that patients with high-risk GIST receive imatinib treatment for at least 5 years. [ABSTRACT FROM AUTHOR]

Background: In Taiwan, betel quid chewing is a part of social life for chewers. Betel quid itself, with or without tobacco, is a Group 1 human carcinogen. Betel quid chewing has become a severe health threat in Taiwan.Objectives: The aim of the present study was to identify the individual, social, contextual, and cultural factors related to initiation, continuous use, and cessation of betel quid chewing.Methods: Four focus groups and 15 in depth face-to-face interviews were conducted in 2013 with current and former users of betel quid, members of a community organization located in central Taiwan. A thematic analysis identified themes evident across all groups.Results: Study participants (N= 41) were 66% male and 34% female; mean age was 40.34 ± 9.23 years. Participants stated that betel quid initiation usually occurs during childhood and that the most frequent reasons for chewing were: to follow cultural/social traditions, to achieve an energetic feeling, and to avoid boredom. Participants perceived betel quid chewing as an addiction and a risk factor for cancer and other health-related conditions. The most frequently mentioned barriers to quitting betel quid included: peer pressure and selected withdrawal symptoms.Conclusions: For the development of culturally relevant and effective cessation interventions for betel quid in Taiwan, it is critical to understand and address perceptions of betel quid chewing and barriers to cessation. [ABSTRACT FROM PUBLISHER]

Background: The evidence regarding the long-term results of laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) has only been rarely reported. The aim of this study was to investigate the feasibility and oncologic efficacy of LSPL for locally advanced proximal gastric cancer.Methods: From May 2007 to December 2012, we prospectively collected and retrospectively analyzed the data of 548 patients who underwent laparoscopic radical total gastrectomy due to proximal gastric cancer. The patients were grouped according to spleen-preserving splenic hilar lymphadenectomy (200 in the D2 group and 348 in the D2-group). The short- and long-term outcomes were compared between the two groups after propensity score matching.Results: Before matching, TNM stages were significantly different between the D2 and D2-groups. After propensity score matching, the two groups were well balanced in clinicopathologic characteristics. After matching, the time for lymph node dissection was longer in the D2 group, but a greater number of lymph nodes were dissected; the estimated blood loss, time to first flatus and duration of hospital stay were similar in the two groups. Furthermore, no significant differences in morbidity and mortality were found. Before matching, the 3-year overall survival (OS) and disease-free survival (DFS) rates of the D2 group were comparable with those of the D2-group (62.4 vs. 57.7 %, p = 0.076). After matching, the 3-year OS remained comparable, but the D2 group showed significantly longer 3-year DFS (61.6 vs. 53.7 %, p = 0.034). Stratified analysis showed that, in stage III patients, the D2 group had better 3-year DFS. Multivariate Cox regression showed that age (p = 0.003), operation (p = 0.001) and pN stage (p < 0.001) were independent prognostic factors.Conclusions: LSPL is a safe and feasible procedure, and patients with stage III proximal gastric cancer might obtain higher 3-year DFS rates. [ABSTRACT FROM AUTHOR]