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This study employed optical microscopy (OM), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS) to investigate the impact of vanadium (V) on the microstructure and mechanical properties of gray cast iron (GCI) HT250. Additionally, Thermo-Calc software was employed to explore the influence of V on the solidification process. The results indicate that adding trace amounts of V in GCI forms a face-centered cubic VC phase, with the precipitation temperature of the VC phase gradually increasing. When the V content reaches 0.28 wt%, the VC phase begins to precipitate during the eutectic reaction. The incorporation of V consumes carbon, reducing the graphite content and promoting the formation of type D graphite. As the V content increases, there is an enlargement in the pearlite area ratio, a decrease in the pearlite layer spacing, and a reduction in the size of eutectic cells. These microstructural alterations lead to enhanced mechanical properties. The tensile strength peaks at 336 MPa with a V content of 0.77 wt%, representing a 29% increase compared to samples without added V. Similarly, the Vickers hardness increases with increasing V content, reaching a peak of 373 HV at 0.92 wt% V, a 27% increase compared to samples without V addition. However, at this point, the tensile strength decreases to 322 MPa.

AimsTo develop and validate an individualized nomogram for differentiating the histologic subtypes (adenocarcinoma and squamous cell carcinoma) of subpleural non-small cell lung cancer (NSCLC) based on ultrasound parameters and clinical data.MethodsThis study was conducted retrospectively between March 2018 and December 2019. Patients were randomly assigned to a development cohort (DC, n=179) and a validation cohort (VC, n=77). A total of 7 clinical parameters and 16 ultrasound parameters were collected. Least absolute shrinkage and selection operator regression analysis was employed to identify the most significant predictors utilizing a 10-fold cross-validation. The multivariate logistic regression model was applied to investigate the relevant factors. An individualized nomogram was then developed. Receiver operating characteristic (ROC) curve, calibration plot and decision curve analysis (DCA) were applied for model validation in both DC and VC.ResultsFollowing the final regression analysis, gender, serum carcinoembryonic antigen, lesion size and perfusion defect in contrast-enhanced ultrasound were entered into the nomogram. The model showed moderate predictive ability, with an area under the ROC curve of 0.867 for DC and 0.838 for VC. The calibration curves of the model showed good agreement between actual and predicted probabilities. The ROC and DCA curves demonstrated that the nomogram exhibited a good predictive performance.ConclusionWe developed a nomogram that can predict the histologic subtypes of subpleural NSCLC. Both internal and external validation revealed optimal discrimination and calibration, indicating that the nomogram may have clinical utility. This model has the potential to assist clinicians in making treatment recommendations.

ABSTRACT Introduction Staged bilateral surgery is widely used to treat synchronous multiple primary lung cancer (SMPLC); however, the prognostic factors for survival outcomes remain unclear. This study aimed to identify prognostic factors and construct a predictive model for overall survival (OS) and recurrence‐free survival (RFS) in patients with SMPLC who underwent staged bilateral surgery. Methods The study included 256 patients diagnosed with SMPLC and treated with staged bilateral surgery at our hospital between January 2010 and July 2017. Multivariate Cox proportional‐hazard regression was used to identify prognostic factors for OS and RFS. Additionally, a predictive model was constructed using time‐dependent receiver operating characteristic curves. Results Among the 256 patients, 10 (3.95%) succumbed to the disease and 24 (9.41%) experienced recurrence. Smoking (hazard ratio [HR]: 5.128; 95% confidence interval [CI]: 1.442–18.233; p = 0.012) and most advanced pathological TNM (pTNM) stage (II + III) (HR: 12.938; 95% CI: 2.650–63.176; p = 0.002) were identified as significant predictors of poor OS. A prognostic model was developed for predicting OS, with a 5‐year area under the curve (AUC) of 0.854. Furthermore, most advanced pTNM stage (II + III) was associated with poor RFS (HR: 5.964; 95% CI: 2.669–13.327; p

Abstract Objectives To develop and validate a nomogram for predicting ≥ 3 metastatic axillary lymph nodes (ALNs) in early breast cancer with no palpable axillary adenopathy by clinicopathologic data, contrast-enhanced (CE) lymphatic ultrasound (US), and grayscale findings of sentinel lymph nodes (SLNs). Materials and methods Women with T1-2N0 invasive breast cancer were consecutively recruited for the CE lymphatic US. Patients from Center 1 were grouped into development and internal validation cohorts at a ratio of 2:1. The external validation cohort was constructed from Center 2. The clinicopathologic data and US findings of SLNs were analyzed. A nomogram was developed to predict women with ≥ 3 metastatic ALNs. Nomogram performance was assessed with the area under the receiver operating characteristic curve (AUC) and calibration curve analysis. Results One hundred seventy-nine from Center 1 were considered the development cohorts. The remaining 90 participants from Center 1 were internal cohorts and 197 participants from Center 2 were external validation cohorts. The US findings of no enhancement (odds ratio (OR), 15.3; p = 0.01), diffuse (OR, 19.1; p = 0.01) or focal eccentric (OR, 27.7; p = 0.003) cortical thickening, and absent hilum (OR, 169.7; p < 0.001) were independently associated with ≥ 3 metastatic ALNs. Compared to grayscale US or CE lymphatic US alone, the nomogram showed the highest AUC of 0.88 (0.85, 0.91). The nomogram showed a calibration slope of 1.0 (p = 0.80–0.81; Brier = 0.066–0.067) in validation cohorts in predicting ≥ 3 metastatic ALNs. Conclusion Patients likely to have ≥ 3 metastatic ALNs were identified by combining the lymphatic and grayscale US findings of SLNs. Our nomogram could aid in multidisciplinary treatment decision-making. Trial registration This trial is registered on www.chictr.org.cn : ChiCTR2000031231. Registered March 25, 2020. Critical relevance statement A nomogram combining lymphatic CEUS and grayscale US findings of SLNs could identify early breast cancer patients with low or high axillary tumor burden preoperatively, which is more applicable to the Z0011 era. Our nomogram could be useful in aiding multidisciplinary treatment decision-making for patients with early breast cancer. Key points • CEUS can help identify and diagnose SLN in early breast cancer preoperatively. • Combining lymphatic and grayscale US findings can predict axillary tumor burden. • The nomogram showed a high diagnostic value in validation cohorts. Graphical Abstract

The 7A04 Al alloy is a commonly used lightweight metal material; however, its low wear resistance limits its application. In this study, the wear resistance of this alloy was improved by preparing micro-arc oxidation (MAO) coatings, MAO/MoS2 composite coatings, and hard-anodized (HA) coatings on its surface. The friction and wear behaviors of these three coatings with diamond-like coated (DLC) rings under oil lubrication conditions were investigated using a ring–block friction tester. The wear rates of the coatings on the block surfaces were determined using laser confocal microscopy, and the wear trajectories of the coatings were examined using scanning electron microscopy. The results indicated that, among the three coatings, the MAO/MoS2 coating had the lowest coefficient of friction of 0.059, whereas the HA coating had the lowest wear rate of 1.47 × 10−6 mm/Nm. The MAO/MoS2 coatings exhibited excellent antifriction properties compared to the other coatings, whereas the HA coatings exhibited excellent anti-wear properties. The porous structure of the MAO coatings stored lubricant and replenished the lubrication film under oil lubrication. Meanwhile, the introduced MoS2 enhanced the densification of the coating and functioned as a solid lubricant. The HA coating exhibited good wear resistance owing to the dense structure of the amorphous-phase aluminum oxide. The mechanisms of abrasive and adhesive wear of the coatings under oil lubrication conditions and the optimization of the tribological properties by the solid–liquid synergistic lubrication effect were investigated. This study provides an effective method for the surface modification of Al alloys with potential applications in the aerospace and automotive industries.

This paper introduces a multi-objective optimization problem (MPO) for the forming process parameters of disc forgings using grey relational analysis (GRA) and the response surface methodology (RSM). Firstly, an experimental design based on the Box–Behnken design (BBD) principle was established, and simulations were performed in Deform to obtain response data. Secondly, GRA was used to transform the MPO into a grey relational degree (GRD) problem, and the entropic weight method was integrated to ascertain the influence weights of each variable on GRD. Then, a quadratic polynomial prediction model based on the RSM was constructed, and its accuracy was ensured through model validation. Finally, the optimal process parameter combination was determined through the particle swarm optimization algorithm, which included a friction coefficient of 0.3, an initial temperature of 1250 °C, and a downward pressing speed of 7.5 mm/s. The results of the experimental investigation indicate that optimized process parameters significantly reduce the forming load, equivalent stress, and damage value, effectively enhancing the overall quality of forged parts.

BackgroundNeuroendocrine breast carcinoma (NECB) is a rare, special histologic type of breast cancer. There are some small sample studies on the clinical outcomes of NECB patients, which are worthy of further discussion.MethodsWe conducted a retrospective case-control study of clinical characteristics and outcomes among patients with primary NECB versus invasive carcinoma of no special type (NST) between November 2004 and November 2017 in the Peking Union Medical College Hospital, Beijing. NST patients were strictly matched 1:4 during the same period based on the TNM stage. Statistical comparisons were performed to determine the differences in survival between NST and NECB patients and to identify clinical factors that correlate with prognosis.ResultsA total of 121 participants affected by primary NECB were included in our analysis from November 2004 to November 2017. Elderly persons (>60 years of age) were more likely to have primary NECB than young persons (p=0.001). In addition, primary NECB patients had significantly higher odds of having tumors 2-5 cm (36.5%) and >5 cm (6.1%) in size than NST patients. Despite a significant difference in tumor size, the proportion of patients with lymph node metastases showed no difference between the two groups (p=0.021). In addition, the rate of patients with ER-negative tumors in the NECB group (4.2%) was significantly lower than that in the primary NST group (29.8%). Significant differences were noted in the PR-negative (13.3% versus 36.6%, P

Background: Primary hepatic lymphoepithelioma-like carcinoma (LELC) is a malignant tumor with a low incidence, but the number of case reports has increased in recent years. The prognosis of hepatic LELC is better than hepatocellular carcinoma (HCC). The differentiation between hepatic LELC and HCC has clinical value during follow-up treatment. The purpose of our study was to compare contrast-enhanced ultrasound (CEUS) imaging features in patients with hepatic LELC and HCC. Methods: Twelve patients with an average age of 60.1±9.5 years and histopathologically confirmed hepatic LELC were included in the study. Forty-three patients with an average age of 57.4±9.0 years and a histopathological diagnosis of HCC were designated as the control group by means of propensity score matching (1:4). The clinical data, B-mode ultrasound (BMUS), and CEUS features were retrospectively analyzed between patients with hepatic LELC and HCC. Results: The serum a-fetoprotein (58.1% [25/43] vs.16.7% [2/12]; p=0.017) and des-gamma-carboxy prothrombin levels (74.4% [32/43] vs.16.7% [2/12]; p=0.001) were not significantly elevated in patients with hepatic LELCs compared to HCCs. LELCs were mainly hypoechoic based on BMUS, while the echogenicity of HCCs varied (p=0.016). A halo sign was less common in patients with hepatic LELCs than HCCs (16.7% [2/12] vs. 58.1% [25/43]; p=0.011). Of hepatic LELCs, 75% (9/12) had homogeneous hyperenhancement based on CEUS, whereas 58.1% (25/43) of HCCs had heterogeneous hyperenhancement (p=0.004). Early washout was noted in 91.7% (11/12) of hepatic LELCs compared to 46.5% (20/43) of HCCs (p=0.005). Furthermore, hepatic LELCs were more likely to exhibit peripheral rim-like hyperenhancement (83.3% [10/12] vs. 11.6% [5/43]; p < 0.001). Conclusion: BMUS and CEUS are helpful in discriminating between hepatic LELC and HCC. A hypoechoic mass, the rare halo sign, homogeneous hyperenhancement in the arterial phase, higher frequencies of early washout, and peripheral rim-like hyperenhancement are useful ultrasound features that can help differentiate hepatic LELCs from HCCs.

Abstract Glioblastoma (GBM) is a lethal cancer characterized by hypervascularity and necrosis associated with hypoxia. Here, it is found that hypoxia preferentially induces the actin‐binding protein, Transgelin (TAGLN), in GBM stem cells (GSCs). Mechanistically, TAGLN regulates HIF1α transcription and stabilizes HDAC2 to deacetylate p53 and maintain GSC self‐renewal. To translate these findings into preclinical therapeutic paradigm, it is found that sodium valproate (VPA) is a specific inhibitor of TAGLN/HDAC2 function, with augmented efficacy when combined with natural borneol (NB) in vivo. Thus, TAGLN promotes cancer stem cell survival in hypoxia and informs a novel therapeutic paradigm.

In this study, scanning electron microscopy (SEM), electron backscatter diffraction analysis (EBSD), and electron probe microanalysis (EPMA) were used to investigate the impact of rare-earth Sc on the interface microstructure and mechanical properties of Al/steel bimetallic composites fabricated by liquid–solid casting. With the addition of 0.3% Sc, the morphology of eutectic Si changed from needle-like to fibrous and granular. The addition of Sc did not change the types of intermetallic compounds in the Al/steel reaction layer, which comprised the Al5Fe2, τ1-Al2Fe3Si3, Al13Fe4, τ5-Al7Fe2Si, and τ6-Al9Fe2Si2 phases. The thickness of the first layer decreased, whereas that of the second layer increased as the Sc content increased to 0.3%. Furthermore, the Al5Fe2 and τ1 phase percentages of the reaction layer decreased, whereas the Al13Fe4, τ5, and τ6 phase percentages increased. Sc was mainly enriched in the front of the ternary compound layer (τ6) near the Al side. The addition of 0.3% Sc reduced the grain size of each phase in the interfacial reaction layer and did not change the preferred orientation of the Al5Fe2, Al13Fe4, τ5, and τ6 phases, but increased the polar density of the Al13Fe4, τ5, and τ6 phases and decreased the polar density of the Al5Fe2 phase. With the addition of 0.3% Sc, the average nanohardness of the reaction layer decreased by 5% and the bonding strength increased by 48%.

Abstract Background Immune checkpoint inhibitors are the most studied forms of immunotherapy for triple-negative breast cancer (TNBC). The Cancer Genome Map (TCGA) and METABRIC project provide large-scale cancer samples that can be used for comprehensive and reliable immunity-related gene research. Methods We analyzed data from TCGA and METABRIC and established an immunity-related gene prognosis model for breast cancer. The SDC1 expression in tumor and cancer associated fibroblasts (CAFs) was then observed in 282 TNBC patients by immunohistochemistry. The effects of SDC1 on MDA-MB-231 proliferation, migration and invasion were evaluated. Qualitative real-time PCR and western blotting were performed to identify mRNA and protein expression, respectively. Results SDC1, as a key immunity-related gene, was significantly correlated with survival in the TCGA and METABRIC databases, while SDC1 was found to be highly expressed in TNBC in the METABRIC database. In the TNBC cohort, patients with high SDC1 expression in tumor cells and low expression in CAFs had significantly lower disease-free survival (DFS) and fewer tumor-infiltrating lymphocytes (TILs). The downregulation of SDC1 decreased the proliferation of MDA-MB-231, while promoting the migration of MDA-MB-231 cells by reducing the gene expression of E-cadherin and TGFb1 and activating p-Smad2 and p-Smad3 expression. Conclusion SDC1 is a key immunity-related gene that is highly expressed TNBC patients. Patients with high SDC1 expression in tumors and low expression in CAFs had poor prognoses and low TILs. Our findings also suggest that SDC1 regulates the migration of MDA-MB-231 breast cancer cells through a TGFb1-Smad and E-cadherin-dependent mechanism.

Abstract Background or Purpose A practical noninvasive method to identify sentinel lymph node (SLN) status in breast cancer patients, who had a suspicious axillary lymph node (ALN) at ultrasound (US), but a negative clinical physical examination is needed. To predict SLN metastasis using a nomogram based on US and biopsy‐based pathological features, this retrospective study investigated associations between clinicopathological features and SLN status. Methods Patients treated with SLN dissection at four centers were apportioned to training, internal, or external validation sets (n = 472, 175, and 81). Lymph node ultrasound and pathological characteristics were compared using chi‐squared and t‐tests. A nomogram predicting SLN metastasis was constructed using multivariate logistic regression models. Results In the training set, statistically significant factors associated with SLN+ were as follows: histology type (p

Abstract Background Few studies have investigated the change in life expectancy (LE) and the healthy lifespan among patients with advanced schistosomiasis. This study was to evaluate the LE and healthy life expectancy (HLE) for patients and assess the mechanism responsible for the LE inequality. Methods We utilized data from a dynamic advanced schistosomiasis cohort (10,362 patients) for the period from January 2008 to December 2019 in Hunan Province, China, to calculate the LEs of patients, and made a comparison with that of general population (19,642 schistosomiasis-free individuals) in the schistosomiasis endemic areas. LEs were estimated from 15 years of age by constructing period life tables. Arriaga’s decomposition method was applied to quantify the influence of the age structure on the difference in LE. HLE for advanced schistosomiasis patients was calculated by using Sullivan method with age-specific disability weight. The LE and HLE were calculated for both males and females to perform further analyses on gender gap. Results The estimated LE for advanced schistosomiasis patients aged 15–19 was 49.51 years (48.86 years for males and 51.07 years for females), which was 20.14 years lower compared with general population (69.65 years), and the LE gap between patients and general population decreased with age. The largest age-specific mortality contribution to the gap (32.06%) occurred at age 80–84 years. Women had a lower LE and HLE than men at age ≥ 60 years (both gender gaps in LE and HLE

Abstract Background The results of halo sign in the differential diagnosis of thyroid nodules were conflicting, and the value of contrast-enhanced ultrasound (CEUS) in characterization of thyroid nodules with halo has not been fully evaluated. This study was therefore designed to investigate the value of contrast-enhanced ultrasound features in the differential diagnosis of thyroid nodules with halo sign on B-mode ultrasound. Material and methods Seventy-four consecutive thyroid nodules with halo sign on B-mode ultrasound were pathologically confirmed by surgery or fine needle aspiration, including 43 benign and 31 malignant lesions. All these lesions underwent pre-operative CEUS examination. The CEUS features, including enhanced time, enhanced intensity and homogeneity, and presence of enhancing ring, were compared between benign and malignant ones. Results Enhanced intensity was significant different between benign and malignant lesions with halo. Hypo-enhancement was more frequently detected in malignant nodules than that in benign ones, compared with iso-enhancement and hyper-enhancement (p = 0.013, and = 0.014, respectively). Detection rate of high-enhancing ring was significantly higher in benign nodules than that in malignant group (p = 0.001). While in nodules > 10 mm, only high-enhancing ring was the distinguishing feature between benign and malignant nodules. Conclusions Enhanced intensity and high-enhancing ring may be helpful in the differential diagnosis of thyroid nodules with halo sign on B-mode ultrasound.

Abstract Tumor-associated macrophages (TAMs) account for 30–50% of glioma microenvironment. The interaction between glioma tumor cells and TAMs can promote tumor progression, but the intrinsic mechanisms remain unclear. Herein, we reported that soluble LRIG3 (sLRIG3) derived from glioma tumor cells can block the M2 polarization of TAMs via interacting with NETO2, thus suppressing GBM malignant progression. The expression or activity of ADAM17 in glioma cells was positively correlated with the expression of sLRIG3 in cell supernatant. Soluble LRIG3 can suppress the M2-like polarity transformation of TAMs and inhibit the growth of tumor. High expression of LRIG3 predicts a good prognosis in patients with glioma. Mass spectrometry and Co-immunoprecipitation showed that sLRIG3 interacts with the CUB1 domain of NETO2 in TAMs. Silencing or knockout of NETO2 could block the effect of sLRIG3, which inhibited the M2-like polarity transformation of TAMs and promoted GBM tumor growth. However, overexpressing His-target NETO2 with CUB1 deletion mutation does not fully recover the suppressive effects of sLRIG3 on the TAM M2-polarization in NETO2-Knockout TAMs. Our study revealed vital molecular crosstalk between GBM tumor cells and TAMs. Glioma cells mediated the M2 polarization of TAM through the sLRIG3-NETO2 pathway and inhibited the progression of GBM, suggesting that sLRIG3-NETO2 may be a potential target for GBM treatment.

BackgroundElderly patients with breast cancer are highly heterogeneous, and tumor load and comorbidities affect patient prognosis. Prediction models can help clinicians to implement tailored treatment plans for elderly patients with breast cancer. This study aimed to establish a prediction model for breast cancer, including comorbidities and tumor characteristics, in elderly patients with breast cancer.MethodsAll patients were ≥65 years old and admitted to the Peking Union Medical College Hospital. The clinical and pathological characteristics, recurrence, and death were observed. Overall survival (OS) was analyzed using the Kaplan–Meier curve and a prediction model was constructed using Cox proportional hazards model regression. The discriminative ability and calibration of the nomograms for predicting OS were tested using concordance (C)-statistics and calibration plots. Clinical utility was demonstrated using decision curve analysis (DCA).ResultsBased on 2,231 patients, the 5- and 10-year OS was 91.3% and 78.4%, respectively. We constructed an OS prediction nomogram for elderly patients with early breast cancer (PEEBC). The C-index for OS in PEEBC in the training and validation cohorts was 0.798 and 0.793, respectively. Calibration of the nomogram revealed a good predictive capability, as indicated by the calibration plot. DCA demonstrated that our model is clinically useful.ConclusionThe nomogram accurately predicted the 3-year, 5-year, and 10-year OS in elderly patients with early breast cancer.

A new study considering data from 7603 households across 28 sites in 22 low- and middle-income countries show that inequality of household water security follows a Development Kuznets Curve.

Abstract Lumbar disc herniation (LDH) can be spontaneously absorbed without surgical treatment. However, the pathogenesis and physiological indications for predicting protrusion reabsorption are still unclear, which prevents clinicians from preferentially choosing conservative treatment options for LDH patients with reabsorption effects. The purpose of this review was to summarize previous reports on LDH reabsorption and to discuss the clinical and imaging features that favor natural absorption. We highlighted the biological mechanisms involved in the phenomenon of LDH reabsorption, including macrophage infiltration, inflammatory responses, matrix remodeling, and neovascularization. In addition, we summarized and discussed potential clinical treatments for promoting reabsorption. Current evidence suggests that macrophage regulation of inflammatory mediators, matrix metalloproteinases, and specific cytokines in intervertebral disc is essential for the spontaneous reabsorption of LDH.

Background: Breast cancer is the most common malignancy in women. Clinical models such as Oncotype DX recurrence score (RS) and Clinical Treatment Score post–5 years (CTS5) model for survival prediction are crucial for clinical practice. However, it remains unclear whether CTS5 or RS would be a more powerful clinical model for recurrence risk evaluation. Therefore, we conducted the present study to compare the performance of CTS5 risk model and RS on different recurrence evaluation. And we further integrated the two models into a novel nomogram to improve the power for prognosis prediction. Methods: Female patients with invasive hormone receptor positive breast cancer in the Surveillance, Epidemiology, and End Results Program (SEER) database with RS data available were included. The clinicopathological data were directly extracted from SEER database. Participants were divided into three subsets according to recurrence timing (60 months) for model evaluation. Survival receiver operating characteristic curve and C-index were calculated to evaluate discrimination. Calibration curve were used to visual inspection for calibration. Model comparison was assessed by net reclassification index (NRI) method. Nomogram prognostic model was developed with the combination of CTS5 score and RS and also included other critical clinicopathological parameters. Results: In total, 64044 breast cancer patients were enrolled for analysis. The number of patients with survival 60 months (late recurrence subset) were 64044, 36878 and 15926, respectively. For model discrimination, CTS5 model was superior to RS for overall survival (OS) prediction (likelihood ratio test P

BackgroundThe high relative mortality rate in elderly breast cancer patients is most likely the result of comorbidities rather than the tumor load. Foregoing axillary lymph node dissection or omitting radiotherapy after breast-conserving surgery (BCS) does not affect the prognosis of elderly breast cancer patients. We sought to assess the safety of breast-conserving surgery without axillary lymph node dissection as well as breast and axillary radiotherapy (BCSNR) in elderly patients with early-stage breast cancer.MethodsWe retrospectively included 541 consecutive breast cancer patients aged over 70 years with clinically negative axillary lymph nodes in one clinical center. Of these patients, 181 underwent mastectomy plus axillary lymph node dissection (MALND) with negative axillary cleaning and 360 underwent BCSNR.ResultsAfter a median follow-up of 5 years, there was no significant difference between the BCSNR and MALND groups in either distant recurrence-free survival (DRFS) (p=0.990) or breast cancer-specific survival (p=0.076). Ipsilateral axillary disease was found in 11 (3.1%) patients in the BCSNR group and 3 (1.7%) patients in the MALND group; this difference was not significant (p=0.334). We did not observe a significant difference in distant recurrence between the groups (p=0.574), with 25 (6.9%) patients in the BCSNR group experiencing distant recurrence compared to 15 (8.3%) patients in the MALND group. Our findings did show a significant difference in ipsilateral breast cancer recurrence (IBTR), with 31 (8.6%) patients in the BCSNR group experiencing IBTR compared to only 2 (1.1%) patients in the MALND group (p=0.003).ConclusionBCSNR is a safe treatment option for elderly breast cancer patients with clinically negative axillary lymph nodes.

With the development of science and technology, digital economy has penetrated into traditional manufacturing industry extensively and deeply, which has motivated the progress of the digital transformation for traditional manufacturing industry. Through comparative analysis of theoretical mechanism of synergetic development, this paper researches the order degree model and the synergy degree model based on the social shaping of technology theory to evaluate the synergetic degree of the digital transformation for China's traditional manufacturing industry. An empirical study is presented based on the proposed models and the spatial analysis method by using the statistical data of Yangtze River Delta in China from 2014 to 2019. The results were consistent with the actual situation and indicated that the model fully reflect the dynamic interaction between systems, which is a sound basis for scientific judgment and effective decision-making when seeking to the digital transformation of traditional manufacturing industry.

Abstract Background The de-escalation treatment in patients with low-risk HER2-positive early breast cancer (eBC) is an attractive strategy to avoid unnecessary treatment and improve the quality of life of patients. Pyrotinib, a novel irreversible pan-HER2 tyrosine kinase inhibitor (TKI), has shown efficacy in patients with advanced HER2-positive breast cancer. Meanwhile, nanoparticle albumin-bound (nab)-paclitaxel reveals survival benefit over solvent-based paclitaxel and eliminates the toxicities associated with the solvent. However, the efficacy and safety of pyrotinib in combination with nab-paclitaxel as adjuvant therapy for low-risk HER2 + eBC patients have not been evaluated. Methods This is a multicenter, open-label, single-arm phase II study. A sample size of 261 patients with tumor ≤ 3 cm, lymph node-negative (N0) or micrometastatic (N1mi), HER2 + breast cancer will be recruited. Eligible patients will receive nab-paclitaxel 260 mg/m2 once every 3 weeks for 12 weeks and pyrotinib 400 mg once daily for one year. The primary endpoint is invasive disease-free survival. A sub-study will be conducted to investigate different prophylactic strategies for diarrhea, which is the most common adverse event of pan-HER TKIs. One hundred and twenty patients from the main study will be randomly (1:1) allocated to receive loperamide either during the first cycle (4 mg tid on days 1–7, then 4 mg bid on days 8–21) or the first 2 cycles (4 mg tid on days 1–7, then 4 mg bid on days 8–42). The primary endpoint of the sub-study is the incidence of grade ≥ 3 diarrhea. Discussion This is the first prospective study of pyrotinib in combination with nab-paclitaxel as adjuvant therapy for patients with low-risk HER2-positive eBC. It would probably provide robust evidence for de-escalating strategy of HER2-positive eBC and appropriate management for pyrotinib-related diarrhea. Trial registration ClinicalTrials.gov Identifier: NCT04659499 . Registered on December 9, 2020.

The sub-micron bimodal grain structure of 301 austenitic stainless steel stripe obtained by phase reversion process, and the relationship between grain size distribution and mechanical properties was described in this study. With the change of annealing heating rate under the industrial condition 10 °C/min, the bimodal grain size of submicron scale was obtained at 750 °C. By analyzing the micrograph of bimodal structure, it was found that the deformed martensite transformed to austenite through diffusion transformation, and the recovery austenite grain had obvious size distribution. It was found that the bimodal structure was easier to form under the condition of slow heating rate, and the ultra-fine grain materials with high performance were obtained by controlling the annealing parameter. The high-density grain boundary of ultrafine grain presents microvoid in the tensile fracture, and the streaks formed by the aggregation of holes can be observed, which is considered to be caused by deformation twinning. The large dimples in the coarse grain are observed, as the strain-induced martensite was formed in the large grain of the bimodal structure.

It is the basic characteristic of pure vortex light that there is a phase singularity at the origin. Such a singularity may be multiple degenerate, which determines the order of vortex light. Singularities splitting phenomenon means that singularities no longer concentrate at the origin but distribute around the space, usually occurring in impure vortex light. In this paper, we demonstrate the singularities splitting phenomenon and propose an analysis method, based on which one may rapidly estimate the modal components of impure vortex light. As two common singularity discrimination methods, the spiral and fork wire interference patterns are compared in distinguishing splitting singularities. The most widely used spiral interference pattern is revealed to be the worst form because of the low resolution. Instead, the fork wire interference pattern is with higher and easily adjusted resolution. 1‰ impurity is still able to be distinguished through fork wire interference patterns in the experiment.

Abstract Grain size is subtly regulated by multiple signaling pathways in rice. Alternative splicing is a general mechanism that regulates gene expression at the post-transcriptional level. However, to our knowledge, the molecular mechanism underlying grain size regulation by alternative splicing is largely unknown. GS3, the first identified QTL for grain size in rice, is regulated at the transcriptional and post-translational level. In this study, we identified that GS3 is subject to alternative splicing. GS3.1 and GS3.2, two dominant isoforms, accounts for about 50% and 40% of total transcripts, respectively. GS3.1 encodes the full-length protein, while GS3.2 generated a truncated proteins only containing OSR domain due to a 14 bp intronic sequence retention. Genetic analysis revealed that GS3.1 overexpressors decreased grain size, but GS3.2 showed no significant effect on grain size. Furthermore, we demonstrated that GS3.2 disrupts GS3.1 signaling by competitive occupation of RGB1. Therefore, we draw a conclusion that the alternative splicing of GS3 decreases the amount of GS3.1 and GS3.2 disrupts the GS3.1 signaling to inhibit the negative effects of GS3.1 to fine-tune grain size. Moreover, the mechanism is conserved in cereals rather than in Cruciferae, which is associated with its effects on grain size. The results provide a novel, conserved and important mechanism underlying grain size regulation at the post-transcriptional level in cereals.

Abstract Understanding the spatial distribution characteristics and formation mechanism of urban facilities (city functional components) constitutes the basis of urban layout optimization. Currently, research on the overall distribution of the various types of city functional components is lacking. In this study, by applying the gradient analysis method common in ecology, we considered 13 types of city functional components (80,214 individuals in total) in large, medium and small Chinese cities (9 cities in total) to carry out quantitative analysis of the distribution of components along urban–rural gradients through density distribution curves. The results indicated that: (1) a higher density of city functional components near the city centre revealed an obvious aggregated distribution; (2) the spatial distribution dynamics of city functional components were related to the city size, providing a reference for the rational distribution of components in cities of different sizes; (3) the distribution of city functional components was affected by their ecosystem services. This study offers a new perspective for the application of ecological methods in the examination of the distribution of city functional components.

BackgroundImmunotherapy plays an important role in the treatment of triple-negative breast cancer (TNBC). This study aimed to identify immune-related genes that are associated with the prognosis of patients with TNBC as possible targets of immunotherapy, alongside their related tumor-infiltrating lymphocytes (TILs).MethodsThe clinical data and gene expression profiles of patients with breast cancer were extracted from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases and divided into training (n = 1,053) and verification (n = 508) groups. CIBERSORT was used to predict the differences in immune cell infiltration in patient subsets that were stratified according to risk. Gene Ontology (GO) enrichment analysis was used to identify pathways associated with immune-related genes in patient subsets that were stratified according to risk. The clinical data and insulin-like growth factor 2 receptor (IGF2R) expression profiles of patients with breast cancer were extracted from METABRIC. The expression of IGF2R and TILs were evaluated in a cohort containing 282 untreated patients with TNBC. The correlations of IGF2R expression, TILs, and clinicopathological parameters with patient prognosis were analyzed in the whole cohort.ResultsThe prognostic model, which was composed of 26 immune-related gene pairs, significantly distinguished between high- and low-risk patients. Univariate and multivariate analyses indicated that the model was an independent prognostic factor for breast cancer. Among the identified genes, the expression of IGF2R significantly distinguished between high- and low-risk patients in TCGA (P = 0.008) and in METABRIC patients (P < 0.001). The expression of IGF2R was significantly associated with clinical risk factors such as TNBC, estrogen receptor (ER)–negative expression, human epidermal growth factor receptor 2 (HER2)–positive expression, and age ≤60 years old in METABRIC patients. In addition, the patients with IGF2R-positive expression had lower disease-free survival (DFS) rates than those with IGF2R-negative expression in the TNBC cohort (67.8% vs. 78.5%, P = 0.023). IGF2R expression also was significantly negatively correlated with TILs, particularly with CD8+ TILs and CD19+ TILs in the cohort of patients with TNBC.ConclusionIGF2R can be used as an indicator of a poor prognosis in patients with TNBC and as a potential target and research direction for TNBC immunotherapy in the future.

Abstract Long noncoding ribonucleic acids (LncRNAs) have been found to be involved in the proliferation, apoptosis, invasion, migration, and other pathological processes of triple-negative breast cancer (TNBC). Expression of the lncRNA actin filament-associated protein 1 antisense RNA1 (AFAP1-AS1) has been found to be significantly higher in TNBC than in other subtypes or in normal tissue samples, but the specific mechanism by which AFAP1-AS1 affects the occurrence and development of TNBC is yet to be revealed. In this study, we used Cell Counting Kit-8 (CCK-8), colony formation, wound healing migration, Transwell invasion, and nude mouse xenograft assays to confirm the role of AFAP1-AS1 in the proliferation, migration of TNBC cells in vitro and in vivo. In addition, we performed bioinformatics analyses, reverse transcriptase quantitative polymerase chain reaction (RT-qPCR), western blot (WB), and dual-luciferase reporter assays (dual-LRA) to confirm interaction among AFAP1-AS1, micro-RNA 2110 (miR-2110), and Sp1 transcription factor (Sp1). We found that silencing AFAP1-AS1 and Sp1 or upregulating miR-2110 suppressed the proliferation, migration, and invasion of MDA–MB-231 and MDA–MB-468 cells in vitro as well as tumor growth in vivo. Mechanistically, the dual-LRA highlighted that miR-2110 was an inhibitory target of AFAP1-AS1, and that AFAP1-AS1 functioned as a miR-2110 sponge to increase Sp1 expression. AFAP1-AS1 silencing led to a reduction in Sp1 mRNA and protein levels, which could be reversed by joint transfection with miR-2110 inhibitor. Our findings demonstrated that AFAP1-AS1 could modulate the progression of breast cancer cells and affect tumorigenesis in mice by acting as a miR-2110 sponge, resulting in regulation of Sp1 expression. Therefore, AFAP1-AS1 could play a pivotal role in the treatment of TNBC.

Abstract Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P

BackgroundThe tightly controlled activity of EGFR is important for the homeostasis of self-renewal of human tissue. Mutations in the extracellular domain of EGFR are frequent and function as a novel mechanism for oncogenic EGFR activation in GBM, and impact the response of patients to small-molecule inhibitors.MethodsWe constructed glioblastoma cell lines stably expressing wild-type EGFR and the mutant of EGFR S645C. We detected cell growth in vitro and in vivo. We evaluated the anti-tumor activity and effectiveness of gefitinib and osimertinib in cells.ResultsIn the present study, we identified an oncogenic substituted mutation of EGFR—S645C. The mutation can promote the proliferation and colony formation of glioblastoma in vitro and in vivo. Mechanistically, the EGFR S645C mutation potentially changes the formation of hydrogen bonds within dimerized EGFR and inhibits the degradation of EGFR to prolong downstream signaling. The mutation induces resistance to gefitinib but presents an opportunity for osimertinib treatment.ConclusionThe study indicated a novel oncogenic mutation and advises on the precise treatment of individual patients with the EGFR S645C mutation.

BackgroundThe prognostic and clinical value of tumor-associated macrophages (TAMs) in patients with breast cancer (BCa) remains unclear. We conducted the current meta-analysis to systematically evaluate the association of CD68+ and CD163+ TAM density with the prognosis and clinicopathologic features of BCa patients.MethodsSearches of Web of Science, PubMed, and EMBASE databases were performed up to January 31, 2022. The meta-analysis was conducted using hazard risks (HRs) and 95% confidence intervals (CIs) for survival data including overall survival (OS), disease-free survival (DFS), and BCa specific survival. Sensitivity and meta-regression analyses were also conducted to identify the robustness of the pooled estimates.ResultsOur literature search identified relevant articles involving a total of 8,496 patients from 32 included studies. Our analysis indicates that a high CD68+ TAM density in the tumor stoma was significantly linked with poor OS (HR 2.46, 95% CI, 1.83–3.31, P

Glioblastoma is the most common primary malignant tumor in the brain and has a dismal prognosis despite patients accepting standard therapies. Alternation of genes and deregulation of proteins, such as receptor tyrosine kinase, PI3K/Akt, PKC, Ras/Raf/MEK, histone deacetylases, poly (ADP-ribose) polymerase (PARP), CDK4/6, branched-chain amino acid transaminase 1 (BCAT1), and Isocitrate dehydrogenase (IDH), play pivotal roles in the pathogenesis and progression of glioma. Simultaneously, the abnormalities change the cellular biological behavior and microenvironment of tumor cells. The differences between tumor cells and normal tissue become the vulnerability of tumor, which can be taken advantage of using targeted therapies. Small molecule inhibitors, as an important part of modern treatment for cancers, have shown significant efficacy in hematologic cancers and some solid tumors. To date, in glioblastoma, there have been more than 200 clinical trials completed or ongoing in which trial designers used small molecules as monotherapy or combination regimens to correct the abnormalities. In this review, we summarize the dysfunctional molecular mechanisms and highlight the outcomes of relevant clinical trials associated with small-molecule targeted therapies. Based on the outcomes, the main findings were that small-molecule inhibitors did not bring more benefit to newly diagnosed glioblastoma, but the clinical studies involving progressive glioblastoma usually claimed “noninferiority” compared with historical results. However, as to the clinical inferiority trial, similar dosing regimens should be avoided in future clinical trials.

Yiqi Huoxue Decoction (abbreviated as YH in this paper) is a well-accepted traditional Chinese medicine formula used for the treatment of lumbar disc herniation (LDH). The main components of YH, such as tetrandrine, astragaloside IV and ferulic acid, have the effects of regulating inflammation and immunity as well as analgesia. Our lab previously reported that YH could promote the accumulation of reactive oxygen species (ROS) in the nucleus pulposus cells. This study was to determine the effect and mechanism of YH on both ruptured and non-ruptured intervertebral disc (IVD). First, we isolated human primary nucleus pulposus cells, then incubated them with 10 μM H2O2 to imitate the condition of oxidative stress in vivo. We found that YH-containing serum could promote the apoptosis and autophagy of nucleus pulposus cells in vitro. Next, we constructed rat models of both ruptured and unruptured disc herniation. The in vivo results showed that YH significantly could promote the number of autophagosomes, proportion of apoptotic cells, and expression levels of autophagy/apoptosis-related proteins in the nucleus pulposus of ruptured IVD. Also, YH could promote the resorption and degeneration of the ruptured IVD. Further, we investigated the molecular mechanism of YH-enhanced resorption of ruptured IVD. The in vitro data suggested that YH could activate ERK/mTOR in nucleus pulposus cells, leading to excessive autophagy and apoptosis while ERK inhibitor U0126 reversed the effect of YH on the ROS content, proportion of apoptotic cells and expression levels of autophagy. Overall, this study has demonstrated that the traditional Chinese medicine Yiqi Huoxue decoction promotes the resorption of herniated IVD via regulating ERK/mTOR-mediated apoptosis/autophagy in the nucleus pulposus cells, which highlights traditional Chinese medicine has a great potential for clinical conservative treatment for lumbar disc herniation.

Taxis are an important component of the transportation system, and empty taxis represent a significant waste of transportation resources. To alleviate the imbalance between supply and demand and relieve traffic congestion, real-time prediction of taxi trajectories is necessary. Most existing trajectory prediction studies focus on extracting time-series information but do not capture spatial information sufficiently. In this paper, we focus on the construction of an urban network and propose an urban topology-encoding spatiotemporal attention network (UTA) to address destination prediction problems. Firstly, this model discretizes the production and attraction units of transportation, combining them with key nodes in the road network to form an urban topological network. Secondly, GPS records are matched to the urban topological map to construct a topological trajectory, which significantly improves trajectory consistency and endpoint certainty, helping to model destination prediction problems. Thirdly, semantic information concerning surrounding space is attached to effectively mine the spatial dependencies of trajectories. Finally, after the topological encoding of city space and trajectories, this algorithm proposes a topological graph neural network to model the attention calculation with the trajectory context, comprehensively considering the spatiotemporal characteristics of the trajectories and improving prediction accuracy. We solve the prediction problems with the UTA model and also compare it with some other classical models, such as the HMM, RNN, LSTM, and transformer. The results suggest that all the models work well in combination with the proposed urban model (with a rough increase of 2%), while the UTA model is less affected by data sparsity.

Steatohepatitic hepatocellular carcinoma (SH-HCC) is a distinctive histologic variant of HCC for the presence of steatohepatitis. This study intended to evaluate the contrast-enhanced imaging features and clinicopathological characteristics of 26 SH-HCCs in comparison with 26 age-and-sex-matched non-SH-HCCs. The frequency of obesity (34.6%, p = 0.048) and type 2 diabetes mellitus (23.1%, p = 0.042) were significantly higher in SH-HCC patients. As seen via B-mode ultrasound (BMUS), SH-HCCs were predominantly hyperechoic (65.4%, p = 0.002) lesions, while non-SH-HCCs were mainly hypo-echoic. As seen via contrast-enhanced ultrasound (CEUS), 96.2% of SH-HCCs exhibited hyperenhancement in the arterial phase. During the portal venous and late phase, 88.5% of SH-HCCs showed late and mild washout. Consequently, most SH-HCCs and all non-SH-HCCs were categorized as LR-4 or LR-5. As seen via magnetic resonance imaging (MRI), a signal drop in the T1WI opposed-phase was observed in 84.6% of SH-HCCs (p = 0.000). Notably, diffuse fat in mass was detected in 57.7% (15/26) SH-HCCs (p < 0.001). As seen via contrast-enhanced MRI (CEMRI), most of the SH-HCCs and non-SH-HCCs exhibited heterogeneous hyperenhancement in the arterial phase (80.8% versus 69.2%, p = 0.337). During the delayed phase, 76.9% SH-HCCs and 88.5% non-SH-HCCs exhibited hypo-enhancement. Histopathologically, the rate of microvascular invasion (MVI) was significantly lower in SH-HCCs than non-SH-HCCs (42.3% versus 73.1%, p = 0.025). The frequency of hepatic steatosis >5% in non-tumoral liver parenchyma of SH-HCCs was significantly higher than in non-SH-HCCs (88.5% versus 26.9%, p = 0.000). Additionally, the fibrotic stages of S0, S1 and S2 in SH-HCCs were significantly higher than in non-SH-HCCs (p = 0.044). During follow-up, although the PFS of SH-HCC patients was significantly longer than non-SH-HCC patients (p = 0.046), for the overall survival rate of SH-HCC and non-SH-HCC patients there was no significant difference (p = 0.162). In conclusion, the frequency of metabolism-related diseases in SH-HCC patients was significantly higher than in non-SH-HCC patients. The imaging features of SH-HCCs combined the fatty change and typical enhancement performance of standard HCC as seen via CEUS/CEMRI.

BackgroundFirst-line surveillance on hepatitis B virus (HBV)-infected populations with B-mode ultrasound is relatively limited to identifying hepatocellular carcinoma (HCC) without elevated α-fetoprotein (AFP). To improve the present HCC surveillance strategy, the state of the art of artificial intelligence (AI), a deep learning (DL) approach, is proposed to assist in the diagnosis of a focal liver lesion (FLL) in HBV-infected liver background.MethodsOur proposed deep learning model was based on B-mode ultrasound images of surgery that proved 209 HCC and 198 focal nodular hyperplasia (FNH) cases with 413 lesions. The model cohort and test cohort were set at a ratio of 3:1, in which the test cohort was composed of AFP-negative HBV-infected cases. Four additional deep learning models (MobileNet, Resnet50, DenseNet121, and InceptionV3) were also constructed as comparative baselines. To evaluate the models in terms of diagnostic power, sensitivity, specificity, accuracy, confusion matrix, F1-score, and area under the receiver operating characteristic curve (AUC) were calculated in the test cohort.ResultsThe AUC of our model, Xception, achieved 93.68% in the test cohort, superior to other baselines (89.06%, 85.67%, 83.94%, and 78.13% respectively for MobileNet, Resnet50, DenseNet121, and InceptionV3). In terms of diagnostic power, our model showed sensitivity, specificity, accuracy, and F1-score of 96.08%, 76.92%, 86.41%, and 87.50%, respectively, and PPV, NPV, FPR, and FNR calculated from the confusion matrix were respectively 80.33%, 95.24%, 23.08%, and 3.92% in identifying AFP-negative HCC from HBV-infected FLL cases. Satisfactory robustness of our proposed model was shown based on 5-fold cross-validation performed among the models above.ConclusionsOur DL approach has great potential to assist B-mode ultrasound in identifying AFP-negative HCC from FLL found in surveillance of HBV-infected patients.

Low temperature germination (LTG) is a key agronomic trait in rice (Oryza sativa L.). However, the genetic basis of natural variation for LTG is largely unknown. Here, a genome-wide association study (GWAS) was performed using 276 accessions from the 3,000 Rice Genomes (3K-RG) project with 497 k single nucleotide polymorphisms (SNPs) to uncover potential genes for LTG in rice. In total, 37 quantitative trait loci (QTLs) from the 6th day (D6) to the 10th day (D10) were detected in the full population, overlapping with 12 previously reported QTLs for LTG. One novel QTL, namely qLTG1-2, was found stably on D7 in both 2019 and 2020. Based on two germination-specific transcriptome datasets, 13 seed-expressed genes were isolated within a 200 kb interval of qLTG1-2. Combining with haplotype analysis, a functional uncharacterized gene, LOC_Os01g23580, and a seed germination-associated gene, LOC_Os01g23620 (OsSar1a), as promising candidate genes, both of which were significantly differentially expressed between high and low LTG accessions. Collectively, the candidate genes with favorable alleles may be useful for the future characterization of the LTG mechanism and the improvement of the LTG trait in rice breeding.

IntroductionAcquired resistance to endocrine therapy (ET) remains a big challenge in the management of metastatic breast cancer (MBC). A novel therapeutic agent, histone deacetylase inhibitors (HDACi), targets the abnormal epigenetic modification and may overcome acquired resistance. However, HDACi efficacy and the safety profile for hormone receptor (HoR)-positive/human epidermal growth factor receptor 2 (HER2)-negative MBC remain controversial.MethodsTwo independent reviewers searched PubMed, Embase, and Cochrane Central Register of Controlled Trials databases for relevant studies on HDACi and HoR+/HER2- MBC. Demographic and clinicopathological parameters were extracted and presented as means and proportions, and between-group differences were assessed by Pearson chi-square test. Fixed- or random-effects models were used for meta-analysis based on inter-study heterogeneity. Pooled results were presented as L’Abbé plot and forest plot. Funnel plot and Egger’s test were employed for evaluation of publication bias.ResultsFour studies with 1,457 patients were included for meta-analysis. The overall objective response rates (ORRs) of HDACi + ET (HE) and placebo + ET (PE) groups were 11.52% and 6.67%, respectively. The HE regimen significantly increased ORR (odds ratio [OR] 1.633, 95% confidence interval [CI] = 1.103–2.418, p < 0.05) and showed higher clinical benefit rate (CBR) than the PE regimen (HE vs. PE groups: 38.82% vs. 30.58%, OR 1.378, 95% CI = 1.020–1.861, p < 0.05). Additionally, the HE regimen was associated with prolonged progression-free survival (PFS) (hazard ratio [HR] 0.761, 95% CI = 0.650–0.872, p < 0.001) and overall survival (OS) (HR 0.849, 95% CI = 0.702–0.996, p < 0.001). Regarding safety profile, the HE regimen had increasing toxicity in terms of higher overall adverse event (AE), Grade ≥3 AE, dose modification, and discontinuation rate.ConclusionsThis meta-analysis validated that the HE regimen had superior efficacy over control in terms of ORR, CBR, PFS, and OS, but was accompanied with increasing toxicity. HDACi plus ET could serve as an important option in managing HoR+/HER2- MBC. Future studies may focus on the clinical difference among different HDACi and AE managements to enhance tolerability.

Sentiment analysis of e-commerce reviews is the hot topic in the e-commerce product quality management, from which manufacturers are able to learn the public sentiment about products being sold on e-commerce websites. Meanwhile, customers can know other people's attitudes about the same products. This paper proposes the deep learning model of Bert-BiGRU-Softmax with hybrid masking, review extraction and attention mechanism, which applies sentiment Bert model as the input layer to extract multi-dimensional product feature from e-commerce reviews, Bidirectional GRU model as the hidden layer to obtain semantic codes and calculate sentiment weights of reviews, and Softmax with attention mechanism as the output layer to classify the positive or negative nuance. A series of experiments are conducted on the large-scale dataset involving over 500 thousand product reviews. The results show that the proposed model outperforms the other deep learning models, including RNN, BiGRU, and Bert-BiLSTM, which can reach over 95.5% of accuracy and retain a lower loss for the e-commerce reviews.

It is well known that different racial groups have significantly different incidence and mortality rates for certain cancers. It has been suggested that biological factors play a major role in these cancer racial disparities. Previous studies on the biological factors contributing to cancer racial disparity have generated a very large number of candidate factors, although there is modest agreement among the results of the different studies. Here, we performed an integrative analysis using genomic data of 21 cancer types from TCGA, GTEx, and the 1000 Genomes Project to identify biological factors contributing to racial disparity in cancer. We also built a companion website with additional results for cancer researchers to freely mine. Our study identified genes, gene families, and pathways displaying similar differential expression patterns between different racial groups across multiple cancer types. Among them, XKR9 gene expression was found to be significantly associated with overall survival for all cancers combined as well as for several individual cancers. Our results point to the interesting hypothesis that XKR9 could be a novel drug target for cancer immunotherapy. Bayesian network modeling showed that XKR9 is linked to important cancer‐related genes, including FOXM1, cyclin B1, and RB1CC1 (RB1 regulator). In addition, metabolic pathways, neural signaling pathways, and several cancer‐related gene families were found to be significantly associated with cancer racial disparities for multiple cancer types. Single nucleotide polymorphisms (SNPs) discovered through integrating data from the TCGA, GTEx, and 1000 Genomes databases provide biologists the opportunity to test highly promising, targeted hypotheses to gain a deeper understanding of the genetic drivers of cancer racial disparity and cancer biology in general.

Abstract Background HER2 dual-blockade combined with aromatase inhibitors (AI) is a promising strategy to improve progression-free survival (PFS) in hormone receptor (HR) positive, metastatic breast cancer (MBC). Pyrotinib is a novel irreversible epidermal growth factor receptor/HER2 dual tyrosine kinase inhibitor. However, there is scarcity of data on the effectiveness and safety of pyrotinib combined with trastuzumab and AI as first-line treatment in a metastatic setting. Methods/design The present study is a prospective, randomized, open-label trial. 198 patients with HER2+/HR+ MBC will be recruited. Eligible patients will be allocated (2:1) to either an experimental group (pyrotinib + trastuzumab + AI) or a control group (trastuzumab + AI). Allocation will be stratified by 1) time since adjuvant hormone therapy (≤ 12 months/> 12 months/no prior hormone therapy); 2) lesion sites (visceral / non-visceral). The primary endpoint is PFS. Discussion To our knowledge, this is the first prospective randomized controlled trial to assess dual HER2-blockade with pyrotinib in the metastatic setting. This study will provide valuable evidence regarding the efficacy and safety of pyrotinib when combined with trastuzumab and an AI as first-line treatment for MBC. Moreover, it will also evaluate the feasibility of endocrine therapy as an alternative to chemotherapy in providing de-escalation therapy with less toxicity for advanced HR+/HER2+ patients. Trial registration ClinicalTrials.gov, ID: NCT03910712 . Registered on 10 Apr. 2019.

The global impact of coronavirus disease 2019 (COVID-19) is unprecedented, and many control and prevention measures have been implemented to test for and trace COVID-19. However, invisible-spreaders, who are associated with nucleic acid detection and asymptomatic infections, have received insufficient attention in the current COVID-19 control efforts. In this paper, we analyze the time series infection data for Italy, Germany, Brazil, India and Sweden since the first wave outbreak to address the following issues through a series of experiments. We conclude that: 1) As of June 1, 2020, the proportion of invisible-spreaders is close to 0.4% in Sweden, 0.8% in early Italy and Germany, and 0.4% in the middle and late stages. However, in Brazil and India, the proportion still shows a gradual upward trend; 2) During the spread of this pandemic, even a slight increase in the proportion of invisible-spreaders could have large implications for the health of the community; and 3) On resuming work, the pandemic intervention measures will be relaxed, and invisible-spreaders will cause a new round of outbreaks.

Objective: This study seeks to evaluate the value of the high-frame-rate vector flow imaging technique in assessing the hemodynamic changes of carotid atherosclerotic stenosis in aging people (>60 years old). Methods: Aging patients diagnosed with carotid atherosclerotic stenosis who underwent carotid high-frame-rate vector flow imaging examination were prospectively enrolled. A Mindray Resona7s ultrasound machine equipped with high-frame-rate vector flow function was used for ultrasound evaluation. First, B mode ultrasound and color Doppler flow imaging were used to evaluate carotid stenosis. Then, the vector arrows and flow streamline detected by V Flow were analyzed and the wall shear stress values (Pa) at the carotid stenosis site were measured. All patients were divided into symptomatic and asymptomatic groups according to whether they had acute/subacute stroke or other clinical symptoms within 2 weeks before ultrasound examination. The results of digital subtraction angiography or computed tomography angiography were used as the gold standard. The stenosis rate was calcified, according to North American Symptomatic Carotid Endarterectomy Trial criteria. The diagnostic values of wall shear stress, conventional ultrasound, and the combined diagnosis in carotid atherosclerotic stenosis were compared. Results: Finally, 88 patients with carotid atherosclerotic plaque were enrolled (71 males (80.7%), mean age 67.6 ± 5.4 years). The success rate of high-frame-rate vector flow imaging was 96.7% (88/91). The WSS value of symptomatic carotid stenosis (1.4 ± 0.15 Pa) was significantly higher than that of asymptomatic carotid stenosis (0.80 ± 0.08 Pa) (p < 0.05). Taking the wall shear stress value > 0.78 Pa as the diagnostic criteria for symptomatic carotid atherosclerotic plaque, the area under receiver operating characteristic curves was 0.79 with 87.1% sensitivity and 69.6% specificity. The area under receiver operating characteristic curves of the combined diagnosis (0.966) for differentiating severe carotid atherosclerotic stenosis was significantly higher than that of conventional ultrasound and WSS value, with 89.7% sensitivity and 93.2% specificity (p < 0.05). Conclusion: As a non-invasive imaging method, the high-frame-rate vector flow imaging technique showed potential value in the preoperative assessment of the symptomatic carotid atherosclerotic stenosis and diagnosing carotid atherosclerotic stenosis in aging patients.

Isolated hepatic malignant melanoma with undetermined origin is relatively rare and the imaging findings vary significantly in published studies. In this report, we described an elderly male patient with pulmonary tuberculosis who was diagnosed with isolated hepatic malignant melanoma with undetermined origin by ultrasound-guided percutaneous coarse needle biopsy (US-CNB). The hepatic melanoma was detected accidentally on chest CT. On contrast-enhanced ultrasound (CEUS), it presented an enhancement pattern of fast washin and slow washout. However, on magnetic resonance imaging (CEMRI), it showed non-rim hyperenhancement in the arterial phase but hypointensity in the late phase, mimicking hepatocellular carcinoma. With inconsistent results, the patient underwent fluorine-18-fluro-2-deoxy-D-glucose-positron emission tomography/computed tomography (18F-FDG-PET/CT). The mass showed mild 18F-FDG uptake with SUVmax of 4.7, and hypermetabolic nodules were observed in the lung, chest wall, thoracic vertebra, and pelvis. Due to the advanced stage of the tumor, US-CNB was performed to acquire a pathological diagnosis. The immunohistochemical staining suggested malignant melanoma. Of note, no primary tumor was revealed. Finally, the patient refused systemic therapy and died from tumor progression seven months later. Hence, CEUS and CEMRI is fundamental in the diagnosis of hepatic melanoma, and PET-CT is helpful in clinical staging. For controversial results, US-CNB is required to establish the pathological diagnosis.

Sequential pattern mining (SPM) is a major class of data mining topics with a wide range of applications. The continuity and uncertain nature of trajectory data make it distinctively different from typical transactional data, which requires additional data transformation to prepare for SPM. However, little research focuses on comparing the performance of SPM algorithms and their applications in the context of trajectory data. This study selected some representative sequential pattern mining algorithms and evaluated them with various parameters to understand the effect of the involved parameters on their performances. We studied the resultant sequential patterns, runtime, and RAM consumption in the context of the taxi trajectory dataset, the T-drive dataset. It was demonstrated in this work that a method to discretize trajectory data and different SPM algorithms were performed on trajectory databases. The results were visualized on actual Beijing road maps, reflecting traffic congestion conditions. Results demonstrated contiguous constraint-based algorithms could provide a concise representation of output sequences and functions at low min_sup with balanced RAM consumption and execution time. This study can be used as a guide for academics and professionals when determining the most suitable SPM algorithm for applications that involve trajectory data.

BackgroundThe presence of anti-HER2 agents, such as trastuzumab, pertuzumab, and trastuzumab emtansine (T-DM1), significantly improved the prognosis of metastatic HER2-positive (HER2+) breast cancers (BC). However, drug resistance and disease progression are still common. In order to further improve the treatment efficacy, new clinical trials about anti-HER2 agents in combination with chemotherapy are growing rapidly. We conducted the network meta-analysis to synthesize evidences of clinical trials to identify the best therapy for metastatic HER2+ BC.MethodsA systematic search of randomized controlled trials regarding anti-HER2 agents in combination with chemotherapy for advanced or metastatic breast cancers up to May 2020 was conducted in Embase, PubMed, and the Cochrane Library. The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), objective response rate (ORR), and safety. Bayesian network meta-analysis was conducted to synthesize the results and rank the therapies.ResultsTwenty-six studies, including 16 studies for first-line treatments and 10 studies for second- or later-line treatments were included in the network meta-analysis. For first-line studies, the THP (taxanes + trastuzumab + pertuzumab) regimen exhibited the highest probability to be the optimal treatment in all efficacy outcomes and moderate safety. For second- or later-line studies, the T-DM1 and XHTuC (capecitabine + trastuzumab + tucatinib) regimens ranked top two in all efficacy outcomes according to the surface under the cumulative ranking (SUCRA) results. T-DM1 ranked first in PFS and OS whereas XHTuC ranked first in ORR. The safety outcomes of T-DM1 and XHTuC were acceptable.ConclusionsTHP was still the optimal first-line treatment for metastatic HER2+ BC. T-DM1 and XHTuC were recommended for second-line treatments.Systematic Review RegistrationINPLASY.com, identifier (INPLASY202090086).

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising approach for the management of peritoneal carcinomatosis, but is associated with significant morbidity and prolonged hospital stay. Herein, we review the impact of Enhanced recovery after surgery (ERAS) protocol on length of stay (LOS) and early complications in patients undergoing CRS and HIPEC for peritoneal carcinomatosis.Methods: PubMed and Embase were searched for studies comparing ERAS protocol with control for CRS + HIPEC. Mean difference (MD) and risk ratios (RR) were calculated for LOS and complications respectively.Results: Six retrospective studies were included. Meta-analysis indicated statistically significant reduction in LOS with ERAS (MD: −2.82 95% CI: −3.79, −1.85 I2 = 29% p < 0.00001). Our results demonstrated significantly reduced risk of Calvien Dindo grade III/IV complications with the use of ERAS protocol as compared to the control group (RR: 0.60 95% CI: 0.41, 0.87 I2 = 0% p = 0.007). Pooled analysis of limited studies demonstrated no statistically significant difference in the risk of reoperation (RR: 1.04 95% CI: 0.54, 2.03 I2 = 50% p = 0.90) readmission (RR: 0.55 95% CI: 0.21, 1.49 I2 = 0% p = 0.24), acute kidney injury (RR: 0.55 95% CI: 0.28, 1.10 I2 = 0% p = 0.09) or mortality (RR: 0.62 95% CI: 0.17, 2.26 I2 = 0% p = 0.46) between the study groups.Conclusion: For CRS + HIPEC, ERAS is associated with significantly reduced LOS along with lower incidence of complications. Limited data suggest that use of ERAS protocol is not associated with increased readmission, reoperation, and mortality rates in these patients. There is a need for randomized controlled trials to corroborate the current evidence.

Abstract Background This preliminary study aimed to examine the feasibility of sentinel lymph node biopsy (SLNB) using contrast-enhanced ultrasound (CEUS) vs. indocyanine green fluorescence (ICG), combined with blue dye in patients with breast cancer. Methods This was a retrospective study of consecutive female patients with invasive stage I-III (based on pre-operative physical examination and imaging) primary breast cancer at the Peking Union Medical College Hospital between 01/2013 and 01/2015 who underwent preoperative SLNB by ICG + blue dye or CEUS + blue dye. The numbers of detected SLNs, detection rates, and recurrence-free survival (RFS) rates were compared between the two groups. Results A total of 443 patients were included. The detection rates of SLNs in the CEUS + blue dye and ICG + blue dye groups were 98.4 and 98.1%, respectively (P = 0.814). The average numbers of SLNs detected per patient showed no significant difference between the two groups (3.06 ± 1.33 and 3.12 ± 1.31 in the CEUS + blue dye and ICG + blue dye groups, respectively; P = 0.659). After a median follow-up of 46 months, five patients in the CEUS + blue dye group and 15 in the ICG + blue dye group had recurrence. RFS rates showed no significant difference (P = 0.55). Conclusion This preliminary study suggests that CEUS + blue dye and ICG + blue dye are both feasible for SLN detection in breast cancer.

As a new multiplexing dimension, spatial modes are catching increasing attentions nowadays. It is a fundamental task to establish an appropriate theoretical model to describe these spatial modes, especially higher-order spatial modes. However, existing theoretical models are only able to explain some special higher-order spatial states in fiber. The basic problem in these models is that their discussed dimensions are not enough. Indeed, to describe a higher-order spatial state, at least four dimensions are needed. In this paper, we present an expanded Jones complex space model, which is four-dimensional when a single higher-order state is discussed. The expanded Jones model is based on the discussion of an arbitrary combination of four degenerated higher-order modes. As a result, arbitrary spatial states are described. Because the number of used dimensions matches that of the problem, the descriptions of higher-order modes are more complete than other models. Also, we have verified the reliability of the expanded Jones model in our experiment. This model has the potential to simplify many analyses related to spatial modes in fiber.

Abstract Background The incidence of bilateral breast cancer (BBC) is increasing nowadays comprising 2%‐11% of all breast cancer (BC). According to the interval time between the first and second cancer, BBC could be divided into synchronous (SBBC) and metachronous (MBBC). However, this interval time is quite different across studies. It remains controversial whether the survival of BBC, SBBC, and MBBC is similar or worse compared to that of unilateral breast cancer (UBC), and whether the survival of SBBC is similar or worse compared to MBBC. To better understand the survival of UBC, BBC, SBBC, and MBBC and how the interval time would influence the prognosis of SBBC and MBBC, we performed this meta‐analysis on studies from recent 10 years (2008‐2018). Methods Databases of PubMed, Embase, and Web of Science were searched for relevant studies within recent 10 years. Hazard ratio (HR) was adopted to evaluate the difference of overall survival (OS) of UBC, BBC, SBBC, and MBBC. HR of OS comparisons were performed between BBC vs UBC, SBBC vs UBC, MBBC vs UBC, and SBBC vs MBBC with 3, 6, 12 months as the interval time, respectively. Results There were 15 studies of 72 302 UBC and 2912 BBC included in the meta‐analysis. The summary HR of OS comparison between BBC vs UBC was 1.68 (95% CI: 1.28‐2.20), SBBC vs UBC was 2.01 (95% CI: 1.14‐3.55), MBBC vs UBC was 3.22 (95% CI: 0.75‐13.78). When 3, 6, 12 months were used as the interval time, the summary HR of the OS comparison between of SBBC vs MBBC were 0.64 (95% CI: 0.44‐0.94), 1.17 (95% CI: 0.84‐1.63) and 1.45 (95% CI: 1.10‐1.92), respectively. Conclusion BBC and SBBC showed worse prognosis in terms of OS compared to UBC while MBBC manifested similar or non‐superior survival as UBC. The OS comparison between SBBC and MBBC changed with different interval time used. The longer the interval time used, the worse the survival of SBBC. SBBC with interval of 3‐12 months between the two cancers had the worst prognosis. When 6 months was used to differentiate SBBC from MBBC, these two clinical entities showed similar OS.