A cost-effective method for producing an isotropic pitch-based carbon fiber using the 1-methylnaphthalene (MN) soluble fraction of Hyper-coal (HPC) was newly developed. The extent of MN fractionation ...was controlled by altering the fractionation temperatures. The MN soluble fraction obtained from HPC at 60 °C had excellent spinnability after the removal of volatile matter by thin layer evaporation. Additionally, the fiber that was subsequently derived from the MN soluble fraction had satisfactory mechanical properties with an averaged tensile strength of 1150 MPa after heating to 800 °C for 5 min.
Gastric cancer (GC) is commonly treated by chemotherapy using 5-fluorouracil (5-FU) derivatives and platinum combination, but predictive biomarker remains lacking. We develop patient-derived ...xenografts (PDXs) from 31 GC patients and treat with a combination of 5-FU and oxaliplatin, to determine biomarkers associated with responsiveness. When the PDXs are defined as either responders or non-responders according to tumor volume change after treatment, the responsiveness of PDXs is significantly consistent with the respective clinical outcomes of the patients. An integrative genomic and transcriptomic analysis of PDXs reveals that pathways associated with cell-to-cell and cell-to-extracellular matrix interactions enriched among the non-responders in both cancer cells and the tumor microenvironment (TME). We develop a 30-gene prediction model to determine the responsiveness to 5-FU and oxaliplatin-based chemotherapy and confirm the significant poor survival outcomes among cases classified as non-responder-like in three independent GC cohorts. Our study may inform clinical decision-making when designing treatment strategies.
OBJECTIVE:To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy.
BACKGROUND:Despite a lack of supporting evidence, robotic surgery has been ...increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy.
METHODS:A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis.
RESULTS:A total of 434 patients were enrolled for treatment with either robotic (n = 223) or laparoscopic (n = 211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n = 185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In per-protocol analysis, both group s showed similar overall complication rates (robotic = 11.9% vs laparoscopic = 10.3%) and major complication rates (robotic = 1.1% vs laparoscopic = 1.1%) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic = 221 minutes vs laparoscopic = 178 minutes; P < 0.001) and significantly higher total costs (robotic = US$13,432 vs laparoscopic = US$8090; P < 0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay.
CONCLUSIONS:The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identificationNCT01309256.
Background
Development of high-performance serum biomarkers will likely improve treatment outcomes of patients with gastric cancer (GC). We previously identified the candidate serum markers, anosmin ...1 (ANOS1), dihydropyrimidinase-like 3 (DPYSL3), and melanoma-associated antigen D2 (MAGE-D2) and evaluated their clinical significance through a single-center retrospective analysis. Here we conducted a prospective multicenter observational study aimed at validating the diagnostic performance of these potential markers.
Methods
We analyzed serum levels before and after surgery of the three potential biomarkers in patients with GC and healthy volunteers. Quantification of serum and GC tissue levels was performed using an ELISA.
Results
Area under the curve (AUC) values that discriminated patients with GC from healthy controls were − 0.7058, 0.6188, and 0.5031 for ANOS1, DPYSL3, and MAGED2, respectively. The sensitivity and specificity of the ANOS1 assay were 0.36 and 0.85, respectively. The AUC value of ANOS1 that discriminated patients with stage I GC from healthy controls was 0.7131. Serum ANOS1 levels were significantly elevated in patients with stage I GC compared with those of healthy controls (median 1179 ng/ml and 461 ng/ml, respectively,
P
< 0.0001) and decreased after resection of primary GC lesions (
P
< 0.0001). The combination of serum ANOS1 and DPYSL3 levels increased the AUC value that discriminated patients with GC from healthy controls. Serum levels of ANOS1 did not significantly correlate with those of carcinoembryonic antigen, carbohydrate antigen 19–9, or other markers of inflammation.
Conclusions
Serum levels of ANOS1 may serve as a useful diagnostic tool for managing GC.
Two types of activated carbons have been prepared by H3PO4 activation of lignocellulose and by H3PO4 modification of activated carbon, and then heat-treated at temperatures from 400 to 900 °C in an ...atmosphere of N2 or H2 to investigate the evolution of phosphorus-containing groups. Elemental analysis, X-ray photoelectron spectroscopy, 31P nuclear magnetic resonance, nitrogen adsorption, and scanning electron microscopy have been used to analyze the physicochemical properties of the activated carbons. The results show that C–O–P linkages of phosphorus-containing groups can progressively evolve into C–P–O, C3–PO, C3–P, and eventually elemental phosphorus as a result of heat treatment. Phosphate-like groups are much more thermally stable in an N2 than in an H2 atmosphere. In N2, C–O–P linkages significantly evolve into C–P–O and C3–PO at up to 800 °C, whereas C3–P linkages are not formed even at 900 °C. In H2, the corresponding evolution remarkably occurs at 500 °C, forming C3–P linkages and eventually elemental phosphorus. Moreover, the two activated carbons exhibit different evolution trends, suggesting that the evolution happens more easily for phosphorus-containing groups located on the edges of graphite-like crystallites than those in the lattice. Finally, we propose different evolution pathways of phosphorus-containing groups upon heat treatment in N2 and H2 atmospheres.
BACKGROUND AND AIMS:Guidelines propose different extents of macroscopic proximal margin for gastric cancer and frozen margin investigation in selected cases, but data is lacking. This study was to ...evaluate the necessary extent of macroscopic proximal margin, accuracy of frozen margin investigation, and prognostic impact of tumor-free proximal margin length in pT2-pT4 gastric cancer.
STUDY DESIGN:Proximal and distal frozen margins were routinely investigated intraoperatively in all pT2-pT4 gastric cancers resected between 2011 and 2017. Macroscopic and microscopic proximal margin lengths were correlated. For R0-resections, survival analysis was performed for distal gastrectomy (DG) with microscopic proximal margin length ≤3 cm versus >3 cm.
RESULTS:Overall, 1484 patients were included. Microscopic proximal margin lengths were macroscopically more often misestimated in diffuse histology (P = 0.0004), but extent of underestimation in centimeter was similar to intestinal and mixed/undetermined type (P = 0.134). Fifteen cases (1.0%) resulted in R1-resection, 10 at distal, and 5 at proximal margin but none with macroscopic proximal margin ≥3 cm and negative frozen section. Overall agreement of frozen margin and final pathology was 2951/2968 (99.4%). Proximal margin length in DG did not correlate with survival or recurrence in R0-resected patients.
DISCUSSION:Diffuse histology is at higher risk for underestimation of proximal margin length, but extent of underestimation is similar in other Laurén subtypes. If ≥3 cm macroscopic proximal margin length is applied with intraoperative frozen margin confirmation, R1-resection can be avoided.
CONCLUSION:In pT2-T4a gastric cancer, proximal margin of ≥3 cm plus frozen margin confirmation provides high oncological safety. In DG patients with R0-resection, proximal margin length does not correlate with survival or recurrence.
Background
Stratification of patients who undergo curative resection for early gastric cancer (EGC) is warranted due to the heterogeneity in the risk of developing extragastric recurrence (EGR). ...Therefore, we aimed to stratify the need for postoperative surveillance for EGR detection in patients with EGC by developing a model for predicting EGR-free survival.
Methods
This retrospective cohort study included patients who underwent postoperative surveillance after curative resection of EGC (
n
= 4149). Cox proportional hazard models were used to identify predictors to build a model for predicting EGR-free survival. Bootstrap-corrected c-index and calibration plots were used for internal and external (
n
= 2148) validations.
Results
A risk-scoring system was constructed using variables significantly associated with EGR-free survival: pathologic T stage (pT1bsm1, hazard ratio HR 4.928; pT1bsm2, HR 5.235; pT1bsm3, HR 7.748) and N stage (pN1, HR 4.056; pN2, HR 9.075; pN3, HR 30.659). Patients were dichotomized into a very-low-risk group or a low-or-greater-risk group. The 5-year EGR-free survival rates differed between the two groups (99.9 vs. 97.3%). The discriminative performance of the model was 0.851 (Uno’s c-index) and 0.751 in the internal and external cohorts, respectively. The calibration slope was 0.916 and 1.131 in the internal and external cohorts, respectively.
Conclusions
Our model for predicting EGR-free survival based on the pathologic T and N stages may be useful for stratifying patients who have undergone curative surgery for EGC. The results suggest that patients in the very-low-risk group may be spared from postoperative surveillance considering their extremely high EGR-free survival rate.
•An optimization approach is performed to obtain an efficient and compact shroud profile.•The aerodynamic performance of both the bare rotor and the equipped rotor with an optimized shroud is ...analyzed using CFD approach.•A systematic comparison of CFD results with the corresponding experimental data is implemented.•The power coefficient (Cp) obtained from the Shrouded rotor increased by approximately 66.4% compared to the bare rotor.
In the present work, the influence of a compact diffuser on aerodynamic behavior of small-scale wind turbine is analyzed using both CFD and experimental approaches. The present work aims to obtain a compact diffuser shroud while ensuring high aerodynamic performance in order to reduce the fabricating costs, materials, and structural loads on the mast. In this regard, a unique optimization approach is employed to optimize the geometrical features of the shroud profile including length of both entrance and diffuser sections, radii of both diffuser and entrance area. The shroud profile is mathematically described using second-order polynomial functions. The optimization findings affirmed that the total length of optimized shroud profile is shorter by approximately 6 % than the baseline (Cii) configuration. However, the wind speed obtained from the optimized shroud profile shows an improvement of 1.58% compared to the baseline configuration at the throat area. A high-fidelity CFD simulation of the wind turbine equipped with an optimized shroud profile using commercial software SATR-CCM+ was performed to evaluate the overall aerodynamic performance of the wind lens system. Both conventional and shrouded wind turbines were investigated for two different cases: constant rotor speed, and constant wind speed. Furthermore, an experimental test was implemented for both conventional and shrouded turbines under various environmental conditions using an open-loop wind tunnel. A systematic comparison between CFD results with the corresponding experimental data for both turbines is performed. It is evident that placing an optimized shroud around the rotor improves the aerodynamic performance more than twofold compared to the bare turbine. Moreover, results revealed that Cp obtained from shrouded Wind Turbine increased by approximately 66.4 % compared to the conventional one based on CFD results, whereas, it has increased by 69.3 % according to the experimental data.
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Surgical resection with lymphadenectomy and perioperative chemotherapy is the universal mainstay for curative treatment of gastric cancer (GC) patients with locoregional disease. However, GC survival ...remains asymmetric in West‐ and East‐world regions. We hypothesize that this asymmetry derives from differential clinical management. Therefore, we collected chemo‐naïve GC patients from Portugal and South Korea to explore specific immunophenotypic profiles related to disease aggressiveness and clinicopathological factors potentially explaining associated overall survival (OS) differences. Clinicopathological and survival data were collected from chemo‐naïve surgical cohorts from Portugal (West‐Europe cohort WE‐C; n = 170) and South Korea (East‐Asia cohort EA‐C; n = 367) and correlated with immunohistochemical expression profiles of E‐cadherin and CD44v6 obtained from consecutive tissue microarrays sections. Survival analysis revealed a subset of 12.4% of WE‐C patients, whose tumors concomitantly express E‐cadherin_abnormal and CD44v6_very high, displaying extremely poor OS, even at TNM stages I and II. These WE‐C stage‐I and ‐II patients tumors were particularly aggressive compared to all others, invading deeper into the gastric wall (P = .032) and more often permeating the vasculature (P = .018) and nerves (P = .009). A similar immunophenotypic profile was found in 11.9% of EA‐C patients, but unrelated to survival. Tumours, from stage‐I and ‐II EA‐C patients, that display both biomarkers, also permeated more lymphatic vessels (P = .003), promoting lymph node (LN) metastasis (P = .019), being diagnosed on average 8 years earlier and submitted to more extensive LN dissection than WE‐C. Concomitant E‐cadherin_abnormal/CD44v6_very‐high expression predicts aggressiveness and poor survival of stage‐I and ‐II GC submitted to conservative lymphadenectomy.
What's new?
Surgical resection with lymphadenectomy and perioperative chemotherapy is the mainstay of treatment for loco‐regional gastric cancer. However, while South Korea has the highest gastric cancer incidence rate worldwide, the mortality rate is low compared to Western countries like Portugal. This study shows that the survival disparities between the two regions may be explained by earlier cancer detection and increased removal of lymph nodes. The findings support the assessment of concomitant E‐cadherin and CD44v6 expression in tumour biopsies from stage I and II gastric cancer patients and larger removal of lymph nodes in those patients presenting a high dissemination probability.
Major concerns about donor safety cause controversy and limit the use of living donor liver transplantation to overcome organ shortages. The Korean Organ Transplantation Registry established a ...nationwide organ transplantation registration system in 2014. We reviewed the prospectively collected data of all 832 living liver donors who underwent procedures between April 2014 and December 2015. We allocated the donors to a left lobe group (n = 59) and a right lobe group (n = 773) and analyzed the relations between graft types and remaining liver volumes and complications (graded using the Clavien 5‐tier grading system). The median follow‐up was 19 months (range, 10‐31 months). During the study period, 553 men and 279 women donated livers, and there were no deaths after living liver donation. The overall, biliary, and major complication (grade ≥ III) rates were 9.3%, 1.7%, and 1.9%, respectively. The graft types and remaining liver volume were associated with significantly different overall, biliary, and major complication rates. Of the 16 patients with major complications, 9 (56.3%) involved biliary complications (2 biliary strictures 12.5% and 7 bile leakages 43.8%). Among the 832 donors, the mean aspartate transaminase, alanine aminotransferase, and total bilirubin levels were 23.9 ± 8.1 IU/L, 20.9 ± 11.3 IU/L, and 0.8 ± 0.4 mg/dL, respectively, 6 months after liver donation. In conclusion, biliary complications were the most common types of major morbidity in living liver donors. Donor hepatectomy can be performed successfully with minimal and easily controlled complications. Our study shows that prospective, nationwide cohort data provide an important means of investigating the safety in living liver donation. Liver Transplantation 23 999–1006 2017 AASLD.
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