The optimal perioperative chemotherapeutic regimen for locally advanced gastric cancer remains undefined. We evaluated the efficacy and safety of perioperative and postoperative S-1 and oxaliplatin ...(SOX) compared with postoperative capecitabine and oxaliplatin (CapOx) in patients with locally advanced gastric cancer undergoing D2 gastrectomy.
We did this open-label, phase 3, superiority and non-inferiority, randomised trial at 27 hospitals in China. We recruited antitumour treatment-naive patients aged 18 years or older with historically confirmed cT4a N+ M0 or cT4b Nany M0 gastric or gastro-oesophageal junction adenocarcinoma, with Karnofsky performance score of 70 or more. Patients undergoing D2 gastrectomy were randomly assigned (1:1:1) via an interactive web response system, stratified by participating centres and Lauren classification, to receive adjuvant CapOx (eight postoperative cycles of intravenous oxaliplatin 130 mg/m2 on day one of each 21 day cycle plus oral capecitabine 1000 mg/m2 twice a day), adjuvant SOX (eight postoperative cycles of intravenous oxaliplatin 130 mg/m2 on day one of each 21 day cycle plus oral S-1 40–60 mg twice a day), or perioperative SOX (intravenous oxaliplatin 130 mg/m2 on day one of each 21 day plus oral S-1 40–60 mg twice a day for three cycles preoperatively and five cycles postoperatively followed by three cycles of S-1 monotherapy). The primary endpoint, assessed in the modified intention-to-treat population, 3-year disease-free survival to assess the superiority of perioperative-SOX compared with adjuvant-SOX and the non-inferiority (hazard ratio non-inferiority margin of 1·33) of adjuvant-SOX compared with adjuvant-CapOx. Safety analysis were done in patients who received at least one dose of the assigned treatment. This study is registered with ClinicalTrials.gov, NCT01534546.
Between Aug 15, 2012, and Feb 28, 2017, 1094 patients were screened and 1022 (93%) were included in the modified intention-to-treat population, of whom 345 (34%) patients were assigned to the adjuvant-CapOx, 340 (33%) patients to the adjuvant-SOX group, and 337 (33%) patients to the perioperative-SOX group. 3-year disease-free survival was 51·1% (95% CI 45·5–56·3) in the adjuvant-CapOx group, 56·5% (51·0–61·7) in the adjuvant-SOX group, and 59·4% (53·8–64·6) in the perioperative-SOX group. The hazard ratio (HR) was 0·77 (95% CI 0·61–0·97; Wald p=0·028) for the perioperative-SOX group compared with the adjuvant-CapOx group and 0·86 (0·68–1·07; Wald p=0·17) for the adjuvant-SOX group compared with the adjuvant-CapOx group. The most common grade 3–4 adverse events was neutropenia (32 12% of 258 patients in the adjuvant-CapOx group, 21 8% of 249 patients in the adjuvant-SOX group, and 30 10% of 310 patients in the perioperative-SOX group). Serious adverse events were reported in seven (3%) of 258 patients in adjuvant-CapOx group, two of which were related to treatment; eight (3%) of 249 patients in adjuvant-SOX group, two of which were related to treatment; and seven (2%) of 310 patients in perioperative-SOX group, four of which were related to treatment. No treatment-related deaths were reported.
Perioperative-SOX showed a clinically meaningful improvement compared with adjuvant-CapOx in patients with locally advanced gastric cancer who had D2 gastrectomy; adjuvant-SOX was non-inferior to adjuvant-CapOx in these patients. Perioperative-SOX could be considered a new treatment option for patients with locally advanced gastric cancer.
National Key Research and Development Program of China, Beijing Scholars Program 2018–2024, Peking University Clinical Scientist Program, Taiho, Sanofi-Aventis, and Hengrui Pharmaceutical.
For the Chinese translation of the abstract see Supplementary Materials section.
The link between depression and anxiety status and cancer outcomes has been well-documented but remains unclear. We comprehensively quantified the association between depression and anxiety defined ...by symptom scales or clinical diagnosis and the risk of cancer incidence, cancer-specific mortality, and all-cause mortality in cancer patients. Pooled estimates of the relative risks (RRs) for cancer incidence and mortality were performed in a meta-analysis by random effects or fixed effects models as appropriate. Associations were tested in subgroups stratified by different study and participant characteristics. Fifty-one eligible cohort studies involving 2,611,907 participants with a mean follow-up period of 10.3 years were identified. Overall, depression and anxiety were associated with a significantly increased risk of cancer incidence (adjusted RR: 1.13, 95% CI: 1.06-1.19), cancer-specific mortality (1.21, 1.16-1.26), and all-cause mortality in cancer patients (1.24, 1.13-1.35). The estimated absolute risk increases (ARIs) associated with depression and anxiety were 34.3 events/100,000 person years (15.8-50.2) for cancer incidence and 28.2 events/100,000 person years (21.5-34.9) for cancer-specific mortality. Subgroup analyses demonstrated that clinically diagnosed depression and anxiety were related to higher cancer incidence, poorer cancer survival, and higher cancer-specific mortality. Psychological distress (symptoms of depression and anxiety) was related to higher cancer-specific mortality and poorer cancer survival but not to increased cancer incidence. Site-specific analyses indicated that overall, depression and anxiety were associated with an increased incidence risks for cancers of the lung, oral cavity, prostate and skin, a higher cancer-specific mortality risk for cancers of the lung, bladder, breast, colorectum, hematopoietic system, kidney and prostate, and an increased all-cause mortality risk in lung cancer patients. These analyses suggest that depression and anxiety may have an etiologic role and prognostic impact on cancer, although there is potential reverse causality; Furthermore, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. Early detection and effective intervention of depression and anxiety in cancer patients and the general population have public health and clinical importance.
Hardware implementation of artificial synaptic devices that emulate the functions of biological synapses is inspired by the biological neuromorphic system and has drawn considerable interest. Here, a ...three‐terminal ferrite synaptic device based on a topotactic phase transition between crystalline phases is presented. The electrolyte‐gating‐controlled topotactic phase transformation between brownmillerite SrFeO2.5 and perovskite SrFeO3−δ is confirmed from the examination of the crystal and electronic structure. A synaptic transistor with electrolyte‐gated ferrite films by harnessing gate‐controllable multilevel conduction states, which originate from many distinct oxygen‐deficient perovskite structures of SrFeOx induced by topotactic phase transformation, is successfully constructed. This three‐terminal artificial synapse can mimic important synaptic functions, such as synaptic plasticity and spike‐timing‐dependent plasticity. Simulations of a neural network consisting of ferrite synaptic transistors indicate that the system offers high classification accuracy. These results provide insight into the potential application of advanced topotactic phase transformation materials for designing artificial synapses with high performance.
A ferrite synaptic transistor with topotactic transformation is presented. The electrolyte‐gating‐controlled topotactic phase transformation between the brownmillerite SrFeO2.5 and perovskite SrFeO3−δ is confirmed by the crystal and electronic structure measurements. This ferrite synaptic transistor can mimic important synaptic functions such as synaptic plasticity and spike‐timing‐dependent plasticity.
Considering that the human brain uses ≈1015 synapses to operate, the development of effective artificial synapses is essential to build brain‐inspired computing systems. In biological synapses, the ...voltage‐gated ion channels are very important for regulating the action‐potential firing. Here, an electrolyte‐gated transistor using WO3 with a unique tunnel structure, which can emulate the ionic modulation process of biological synapses, is proposed. The transistor successfully realizes synaptic functions of both short‐term and long‐term plasticity. Short‐term plasticity is mimicked with the help of electrolyte ion dynamics under low electrical bias, whereas the long‐term plasticity is realized using proton insertion in WO3 under high electrical bias. This is a new working approach to control the transition from short‐term memory to long‐term memory using different gate voltage amplitude for artificial synapses. Other essential synaptic behaviors, such as paired pulse facilitation, the depression and potentiation of synaptic weight, as well as spike‐timing‐dependent plasticity are also implemented in this artificial synapse. These results provide a new recipe for designing synaptic electrolyte‐gated transistors through the electrostatic and electrochemical effects.
An electrolyte‐gated transistor using WO3 with a unique tunnel structure to successfully emulate the synaptic functions of both short‐term and long‐term plasticity is proposed. Short‐term plasticity is mimicked with the help of electrolyte ion dynamics under low gate bias, and the long‐term plasticity is realized via proton insertion in WO3 under high gate bias.
Purpose
To investigate the role of computed tomography (CT) radiomics for the preoperative prediction of lymph node (LN) metastasis in gastric cancer.
Materials and methods
This retrospective study ...included 247 consecutive patients (training cohort, 197 patients; test cohort, 50 patients) with surgically proven gastric cancer. Dedicated radiomics prototype software was used to segment lesions on preoperative arterial phase (AP) CT images and extract features. A radiomics model was constructed to predict the LN metastasis by using a random forest (RF) algorithm. Finally, a nomogram was built incorporating the radiomics scores and selected clinical predictors. Receiver operating characteristic (ROC) curves were used to validate the capability of the radiomics model and nomogram on both the training and test cohorts.
Results
The radiomics model showed a favorable discriminatory ability in the training cohort with an area under the curve (AUC) of 0.844 (95% CI, 0.759 to 0.909), which was confirmed in the test cohort with an AUC of 0.837 (95% CI, 0.705 to 0.926). The nomogram consisted of radiomics scores and the CT-reported LN status showed excellent discrimination in the training and test cohorts with AUCs of 0.886 (95% CI, 0.808 to 0.941) and 0.881 (95% CI, 0.759 to 0.956), respectively.
Conclusions
The CT-based radiomics nomogram holds promise for use as a noninvasive tool in the individual prediction of LN metastasis in gastric cancer.
Key Points
• CT radiomics showed a favorable performance for the prediction of LN metastasis in gastric cancer.
• Radiomics model outperformed the routine CT in predicting LN metastasis in gastric cancer.
• The radiomics nomogram holds potential in the individualized prediction of LN metastasis in gastric cancer.
Since bacterial infections seriously threaten human's health, considerable attention is devoted to the design of nanoscale antibacterial materials. Among them, metal nanoparticles cannot meet the ...requirements of durable antibacterial effects and are harmful to biological environments. In this study, environmentally friendly nanogels with durable antibacterial and antiadhesion properties are prepared by copolymerization of styrene, polycaprolactone‐hydroxyethyl methacrylate, and polyhexamethylene guanidine hydrochloride methacrylate. The resultant nanogels possess regular spherical morphologies with the size of about 200 nm. The nanogels exhibit a strong ability to kill bacteria and the mechanism is different from that of conventional antibacterial agent loaded nanoparticles. In addition, anti‐infection experiments explored by a wound model confirm the nanogels have the capability to prevent infection. Furthermore, the nanogels grafted on the surface of cotton fibers display good thermal stability, which is essential for finishing of fabrics. The cotton fabrics finished with nanogels can prevent the adhesion of bacteria by enhancing the hydrophobicity and the bacteriostatic rate. The antibacterial fabrics against Staphylococcus aureus and Escherichia coli are still more than 86% active after 50 times of mechanical washing. The biocompatible nanogels are unleachable from the antibacterial fabrics which demonstrate that they are ideal candidates for durable and environmental‐friendly nanoscaled antimicrobial materials.
In this study, environmentally friendly nanogels with durable antibacterial and antiadhesion properties are prepared by copolymerization of guanidine groups based monomers. The resultant inherent guanidine spherical nanogels can kill bacteria effectively and have the capability to prevent infection. Furthermore, the nanogels grafted on cotton fibers display good thermal stability. The cotton fabrics finished with nanogels can prevent the adhesion of bacteria permanently.
Nasopharyngeal carcinoma (NPC) has a unique and complex etiology, which is not completely understood. The aim of this study is to investigate the expression patterns of phosphatidylinositol 3‐kinase ...(PI3K), protein kinase B (PKB), and mammalian target of rapamycin (mTOR) proteins in patients with NPC and their relationship with NPC progression and prognosis. Between January 2008 and March 2010, PI3K, PKB, and mTOR protein expressions were detected using immunohistochemistry among 119 patients with NPC and 30 healthy people. A 5‐year follow‐up was conducted for all patients. Correlations of PI3K, PKB, and mTOR proteins with the clinicopathological features and prognosis of NPC were evaluated using Spearman's rank correlation coefficient and Kaplan‐Meier curve. Cox's regression analysis was performed to analyze the risk factors for the prognosis of NPC. First, PI3K, PKB, and mTOR were highly expressed in patients with NPC. The expressions of PI3K, PKB, and mTOR proteins were associated with T stage, N stage, clinical stage, relapse, and distant metastasis. Meanwhile, PI3K is positively correlated with PKB and PKB is positively correlated with mTOR in NPC. Higher PI3K, PKB, and mTOR protein expressions were related to a shorter survival time and a lower survival rate in NPC. Cox regression analysis revealed that age, T stage, N stage, PI3K, PKB, and mTOR were independent risk factors for NPC patient survival. Altogether, our data suggest that overexpression of PI3K, PKB, and mTOR proteins is an important indicator of poor survival in NPC. In addition, inhibition of PI3K‐PKB‐mTOR signaling may also contribute to the development of new therapeutic strategies for NPC.
Overexpression of phosphatidylinositol 3‐kinase (PI3K), protein kinase B (PKB), and mammalian target of rapamycin (mTOR) proteins is an important indicator of poor survival in nasopharyngeal carcinoma (NPC). In addition, inhibition of PI3K‐PKB‐mTOR signaling may also contribute to the development of new therapeutic strategies for NPC.
Artificial synaptic devices are the essential hardware of neuromorphic computing systems, which can simultaneously perform signal processing and information storage between two neighboring artificial ...neurons. Emerging electrolyte‐gated transistors have attracted much attention for efficient synaptic emulation by using an addition gate terminal. Here, an electrolyte‐gated synaptic device based on the SrCoOx (SCO) films is proposed. It is demonstrated that the reversible modulation of SCO phase transforms the brownmillerite SrCoO2.5 and perovskite SrCoO3−δ
, through controlling the insertion and extraction of oxygen ions with electrolyte gating. Nonvolatile multilevel conduction states can be realized in the SCO films following this route. The synaptic functions such as the long‐term potentiation and depression of synaptic weight, spike‐timing‐dependent plasticity, as well as spiking logic operations in the device are successfully mimicked. These results provide an alternative avenue for future neuromorphic devices via electrolyte‐gated transistors with oxygen ions.
An electrolyte‐gated synaptic transistor with oxygen ions is presented. Nonvolatile multilevel conduction states can be realized in the SrCoOx
epitaxial films, through controlling the insertion and extraction of oxygen ions with electrolyte gating. Important synaptic functions such as the long‐term potentiation and depression of synaptic weight, spike‐timing‐dependent plasticity, as well as spiking logic operations are successfully emulated.
Laparoscopic distal gastrectomy and neoadjuvant chemotherapy are increasingly used to treat locally advanced gastric cancer. However, the safety and efficacy of the laparoscopic procedure after ...neoadjuvant chemotherapy remain unclear.
To evaluate the short-term outcomes of patients with locally advanced gastric cancer who received either laparoscopic distal gastrectomy or open distal gastrectomy.
Between April 23, 2015, and November 16, 2017, a phase 2, open-label, noninferiority randomized clinical trial was conducted at the Gastrointestinal Cancer Center of Peking University Cancer Hospital and Institute in Beijing, China. Patients (n = 96) between 18 and 80 years of age with locally advanced gastric cancer (cT2-4aN+M0) who were receiving neoadjuvant chemotherapy were enrolled and randomized. An as-treated population and a modified intention-to-treat (mITT) population were defined for the data analysis.
Patients were randomized to undergo either laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy or open distal gastrectomy (ODG) with D2 lymphadenectomy.
The primary end point was 3-year recurrence-free survival rate. Secondary end points were surgical radicality, 30-day postoperative morbidity and mortality, 2-week postoperative recovery indexes, and adjuvant chemotherapy completion status.
In total, 95 patients were eligible for as-treated analyses (LADG: 45, of whom 13 were female 29%, with a median interquartile range (IQR) age of 59 52-65 years; ODG: 50, of whom 16 were female 32%, with a median IQR age of 61 55-64 years) and mITT analyses (LADG: 47, of whom 14 were female 30%, with a median IQR age of 59 52-65 years; ODG: 48, of whom 15 were female 31%, with a median IQR age of 61 55-64 years). In the as-treated analyses, the LADG group had a significantly lower postoperative complication rate than the ODG group (20% vs 46%; P = .007). The postoperative visual analog scale score for pain was 1.2 units lower on postoperative day 2 only in the LADG group (95% CI, -2.1 to -0.3; P = .008). Patients in the LADG group had better adjuvant chemotherapy completion (adjusted odds ratio, 4.39; 95% CI, 1.63-11.80; P = .003) and were less likely to terminate adjuvant chemotherapy because of adverse effects (10 22% vs 21 42%; P = .04). The mITT analyses showed similar results to as-treated analyses.
This trial found that LADG appears to offer the benefits of better postoperative safety and adjuvant chemotherapy tolerance compared with ODG for patients with locally advanced gastric cancer who received neoadjuvant chemotherapy.
ClinicalTrials.gov identifier: NCT02404753.
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