Adjuvant chemotherapy after surgery improves survival of patients with stage II–III, resectable gastric cancer. However, the overall survival benefit observed after adjuvant chemotherapy is moderate, ...suggesting that not all patients with resectable gastric cancer treated with adjuvant chemotherapy benefit from it. We aimed to develop and validate a predictive test for adjuvant chemotherapy response in patients with resectable, stage II–III gastric cancer.
In this multi-cohort, retrospective study, we developed through a multi-step strategy a predictive test consisting of two rule-based classifier algorithms with predictive value for adjuvant chemotherapy response and prognosis. Exploratory bioinformatics analyses identified biologically relevant candidate genes in gastric cancer transcriptome datasets. In the discovery analysis, a four-gene, real-time RT-PCR assay was developed and analytically validated in formalin-fixed, paraffin-embedded (FFPE) tumour tissues from an internal cohort of 307 patients with stage II–III gastric cancer treated at the Yonsei Cancer Center with D2 gastrectomy plus adjuvant fluorouracil-based chemotherapy (n=193) or surgery alone (n=114). The same internal cohort was used to evaluate the prognostic and chemotherapy response predictive value of the single patient classifier genes using associations with 5-year overall survival. The results were validated with a subset (n=625) of FFPE tumour samples from an independent cohort of patients treated in the CLASSIC trial (NCT00411229), who received D2 gastrectomy plus capecitabine and oxaliplatin chemotherapy (n=323) or surgery alone (n=302). The primary endpoint was 5-year overall survival.
We identified four classifier genes related to relevant gastric cancer features (GZMB, WARS, SFRP4, and CDX1) that formed the single patient classifier assay. In the validation cohort, the prognostic single patient classifier (based on the expression of GZMB, WARS, and SFRP4) identified 79 (13%) of 625 patients as low risk, 296 (47%) as intermediate risk, and 250 (40%) as high risk, and 5-year overall survival for these groups was 83·2% (95% CI 75·2–92·0), 74·8% (69·9–80·1), and 66·0% (60·1–72·4), respectively (p=0·012). The predictive single patient classifier (based on the expression of GZMB, WARS, and CDX1) assigned 281 (45%) of 625 patients in the validation cohort to the chemotherapy-benefit group and 344 (55%) to the no-benefit group. In the predicted chemotherapy-benefit group, 5-year overall survival was significantly improved in those patients who had received adjuvant chemotherapy after surgery compared with those who received surgery only (80% 95% CI 73·5–87·1 vs 64·5% 56·8–73·3; univariate hazard ratio 0·47 95% CI 0·30–0·75, p=0·0015), whereas no such improvement in 5-year overall survival was observed in the no-benefit group (72·9% 66·5–79·9 in patients who received chemotherapy plus surgery vs 72·5% 65·8–79·9 in patients who only had surgery; 0·93 0·62–1·38, p=0·71). The predictive single patient classifier groups (chemotherapy benefit vs no-benefit) could predict adjuvant chemotherapy benefit in terms of 5-year overall survival in the validation cohort (pinteraction=0·036 in univariate analysis). Similar results were obtained in the internal evaluation cohort.
The single patient classifiers validated in this study provide clinically important prognostic information independent of standard risk-stratification methods and predicted chemotherapy response after surgery in two independent cohorts of patients with resectable, stage II–III gastric cancer. The single patient classifiers could complement TNM staging to optimise decision making in patients with resectable gastric cancer who are eligible for adjuvant chemotherapy after surgery. Further validation of these results in prospective studies is warranted.
Ministry of ICT and Future Planning; Ministry of Trade, Industry, and Energy; and Ministry of Health and Welfare.
It is unclear whether laparoscopic distal gastrectomy for locally advanced gastric cancer is oncologically equivalent to open distal gastrectomy. The noninferiority of laparoscopic subtotal ...gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer compared with open surgery in terms of 3-year relapse-free survival rate was evaluated.
A phase III, open-label, randomized controlled trial was conducted for patients with histologically proven locally advanced gastric adenocarcinoma suitable for distal subtotal gastrectomy. The primary end point was the 3-year relapse-free survival rate; the upper limit of the hazard ratio (HR) for noninferiority was 1.43 between the laparoscopic and open distal gastrectomy groups.
From November 2011 to April 2015, 1,050 patients were randomly assigned to laparoscopy (n = 524) or open surgery (n = 526). After exclusions, 492 patients underwent laparoscopic surgery and 482 underwent open surgery and were included in the analysis. The laparoscopy group, compared with the open surgery group, suffered fewer early complications (15.7%
23.4%, respectively;
= .0027) and late complications (4.7%
9.5%, respectively;
= .0038), particularly intestinal obstruction (2.0%
4.4%, respectively;
= .0447). The 3-year relapse-free survival rate was 80.3% (95% CI, 76.0% to 85.0%) for the laparoscopy group and 81.3% (95% CI, 77.0% to 85.0%; log-rank
= .726) for the open group. Cox regression analysis after stratification by the surgeon revealed an HR of 1.035 (95% CI, 0.762 to 1.406; log-rank
= .827;
for noninferiority = .039). When stratified by pathologic stage, the HR was 1.020 (95% CI, 0.751 to 1.385; log-rank
= .900;
for noninferiority = .030).
Laparoscopic distal gastrectomy with D2 lymphadenectomy was comparable to open surgery in terms of relapse-free survival for patients with locally advanced gastric cancer. Laparoscopic distal gastrectomy with D2 lymphadenectomy could be a potential standard treatment option for locally advanced gastric cancer.
In recent decades, aerogels have attracted tremendous attention in academia and industry as a class of lightweight and porous multifunctional nanomaterial. Despite their wide application range, the ...low mechanical durability hinders their processing and handling, particularly in applications requiring complex physical structures. “Mechanically strengthened aerogels” have emerged as a potential solution to address this drawback. Since the first report on aerogels in 1931, various modified synthesis processes have been introduced in the last few decades to enhance the aerogel mechanical strength, further advancing their multifunctional scope. This review summarizes the state‐of‐the‐art developments of mechanically strengthened aerogels through multicompositional and multidimensional approaches. Furthermore, new trends and future directions for as prevailed commercialization of aerogels as plastic materials are discussed.
It has already been ≈90 years since the first development of aerogels, and many researchers have devoted tremendous efforts to enhance their mechanical properties, which is yet completely achieved. This review presents multiscale, multicompositional and multidimensional strategies, resulting from flexible synthesis techniques for 0D–1D, 0D–2D, 1D–2D, and 0D–1D–2D combined aerogels.
Plants are one of the best sources to obtain a variety of natural surfactants in the field of green synthesizing material. Sambucus ebulus, which has unique natural properties, has been considered a ...promising material in traditional Asian medicine. In this context, zinc oxide nanoparticles (ZnO NPs) were prepared using S. ebulus leaf extract, and their physicochemical properties were investigated. X-ray diffraction (XRD) results revealed that the prepared ZnO NPs are highly crystalline, having a wurtzite crystal structure. The average crystallite size of prepared NPs was around 17 nm. Green synthesized NPs showed excellent absorption in the UV region as well as strong yellow-orange emission at room temperature. Prepared nanoparticles exhibited good antibacterial activity against various organisms and a passable photocatalytic degradation of methylene blue dye pollutants. The obtained results demonstrated that the biosynthesized ZnO NPs reveal interesting characteristics for various potential applications in the future.
Nanoscale ZnO is one of the best choices for ultraviolet (UV) protection, not only because of its antimicrobial properties but also due to its potential application for UV preservation. However, the ...behavior of nanostructured thin ZnO films and long-term effects of UV-radiation exposure have not been studied yet. In this study, we investigated the UV-protection ability of sol gel-derived thin ZnO films after different exposure times. Scanning electron microscopy, atomic force microscopy, and UV-visible optical spectroscopy were carried out to study the structure and optical properties of the ZnO films as a function of the UV-irradiation time. The results obtained showed that the prepared thin ZnO films were somewhat transparent under the visible wavelength region and protective against UV radiation. The UV-protection factor was 50+ for the prepared samples, indicating that they were excellent UV protectors. The deposited thin ZnO films demonstrated promising antibacterial potential and significant light absorbance in the UV range. The experimental results suggest that the synthesized samples have potential for applications in the health care field.
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•Microflower to sheet evolution observed in Ni3-xCox(PO4)2 with Ni:Co ratio variation.•The optimum composition (∼1:1) of nickel and cobalt delivers highest capacitance.•HAAS device ...delivers 42.3 Wh kg−1 energy density at 1 kW kg−1 power density.•HASS device exhibits energy density of 36.2 Wh kg−1 at 160 W kg−1 power density.
A rational combination of metal cations is necessary to obtain a synergistic effect leading to improved electrochemical energy storage performance of bimetal compounds. So, the effect of concentration variation of reactants (nickel and cobalt ratio) in nickel cobalt phosphate material and their influence on physicochemical properties and electrochemical capacitive performances are investigated. The morphological evolution from microflowers (nickel phosphate) to microsheets (cobalt phosphate) is observed with increasing cobalt content in nickel cobalt phosphate thin films. The optimum nickel and cobalt composition (∼1:1) in nickel cobalt phosphate (Ni1.38Co1.62(PO4)2·8H2O) thin film electrode demonstrate maximum specific capacitance (capacity) of 1116 F g−1 (446 C g−1) at 0.5 A g−1 current density. Also, a fabricated hybrid asymmetric aqueous device consists of nickel cobalt phosphate thin film as cathode and rGO as an anode in 1 M KOH electrolyte delivers a higher specific capacitance of 120 F g−1 with a high energy density of 42.3 Wh kg−1 at a power density of 1 kW kg−1. Moreover, a hybrid asymmetric solid-state device fabricated using PVA-KOH gel electrolyte exhibits a maximum specific capacitance of 102 F g−1 with an energy density of 36.2 Wh kg−1 at 160 W kg−1 power density and 83.7 % initial capacitance retention after 4000 GCD cycles. Such excellent electrochemical capacitive performance of hybrid asymmetric devices is attributed to the synergy between nickel and cobalt species in nickel cobalt phosphate thin film electrodes, suggesting its potential application as a cathode in hybrid energy storage devices.
Ordered mesoporous TiO2 films with increased pore connectivity are introduced in this work. Crack generation was accomplished by thermal shock using rapid thermal annealing to obtain a connected pore ...structure. Due to the increased pore connectivity caused by crack generation, the specific surface area of mesoporous TiO2 films increased by 2.6 times. As specific surface area increased, gas sensing properties of the ordered mesoporous TiO2 film were enhanced, thus, ordered mesoporous TiO2 films with increased pore connectivity are ideal candidates for gas sensor applications.
Zinc oxide (ZnO) nanocrystals (NCs) were synthesized using a modified sol-gel method. Ultraviolet (UV) treatment was performed under various atmospheres on the highly stacked ZnO NCs. The prepared ...NCs were characterized using Fourier transform infrared spectroscopy, scanning electron microscopy, X-ray diffraction, photoluminescence spectroscopy, and atomic force microscopy to investigate their structural, electrical, and electrochemical properties. Through these analyses, the effect of the UV treatment on the chemical and electrical characteristics of ZnO NCs was established. According to the analyses, the organic ligands in the NCs were decomposed, and the particles were densified. The mobility of UV-treated ZnO NCs thin films increased to 1.4 cm
/Vs, almost 2 orders higher than the UV untreated ZnO thin films. It was confirmed that the recombination from oxygen vacancies of ZnO could be controlled by UV irradiation. As decreased oxygen vacancies, the band gap of ZnO NCs was increased from 3.2 eV to 3.27 eV.
The aim of the study was to evaluate the short-term outcomes of KLASS-02-RCT, a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy (LDG) with D2 lymphadenectomy with ...open distal gastrectomy (ODG).
Although several benefits of laparoscopic gastric cancer surgery have been reported, strong evidence is still limited, especially in locally advanced gastric cancer which requires extensive lymph node dissection.
Enrollment criteria included histologically confirmed cT2-4a and N0-1 gastric adenocarcinoma. Thirty-day morbidity, 90-day mortality, postoperative pain, and recovery were compared between LDG and ODG groups.
A total of 1050 patients were randomly assigned to LDG (n = 526) or ODG group (n = 524) between November 2011 and April 2015. After excluding patients who received bypass or no surgery, 1011 patients were analyzed as actual treatment group. Mean number of totally retrieved lymph nodes was similar in both groups (LDG = 46.6 vs ODG = 47.4, P = 0.451). Early morbidity rate was significantly lower after LDG (16.6%) than after ODG (24.1%; P = 0.003). Postoperative analgesics use and patients' reported pain score were significantly lower after LDG. First day of flatus was earlier after LDG (3.5 vs 3.7 d, P = 0.025) and postoperative hospital stay was shorter in LDG group (8.1 vs 9.3 d, P = 0.005). Ninety days' mortality rate was similar in both groups (LDG = 0.4% vs ODG = 0.6%, P = 0.682).
Laparoscopic distal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer shows benefits in terms of lower complication rate, faster recovery, and less pain compared with open surgery.
Turbomachine components used in aerospace and power plant applications preferably require continuous structural health monitoring at various temperatures. The structural health of pristine and ...damaged superalloy compressor blades of a gas turbine engine was monitored using real electro-mechanical impedance of deposited thick film piezoelectric transducers at 20 and 200 °C. IVIUM impedance analyzer was implemented in laboratory conditions for damage detection in superalloy blades, while a custom-architected frequency-domain transceiver circuit was used for semi-field circumstances. Recorded electromechanical impedance signals at 20 and 200 °C acquired from two piezoelectric wafer active sensors bonded to an aluminum plate, near and far from the damage, were initially utilized for accuracy and reliability verification of the transceiver at temperatures >20 °C. Damage formation in both the aluminum plate and blades showed a peak shift in the swept frequency along with an increase in the amplitude and number of impedance peaks. The thermal energy at 200 °C, on the other hand, enforces a further subsequent peak shift in the impedance signal to pristine and damaged parts such that the anti-resonance frequency keeps reducing as the temperature increases. The results obtained from the impedance signals of both piezoelectric wafers and piezo-films, revealed that increasing the temperature somewhat decreased the real impedance amplitude and the number of anti-resonance peaks, which is due to an increase in permittivity and capacitance of piezo-sensors. A trend is also presented for artificial intelligence training purposes to distinguish the effect of the temperature versus damage formation in sample turbine compressor blades. Implementation of such a monitoring system provides a distinct advantage to enhance the safety and functionality of critical aerospace components working at high temperatures subjected to crack, wear, hot-corrosion and erosion.
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