Significant Difference In Survival Rate Research Articles

Usefulness of albumin-globulin ratio as a clinical prognostic factor in patients with thyroid cancer treated with radioiodine.

Albumin-globulin ratio (AGR), which is calculated by dividing serum albumin by serum globulin, is considered as a cancer-related inflammation biomarker. Although the prognosis of many solid cancers has been shown to be associated with AGR, there are no studies to demonstrate the association between the prognosis of thyroid cancer and AGR. The purpose of this study is to reveal the relationship between AGR and overall survival (OS) in patients with thyroid cancer who received radioactive iodine therapy (RIT). Eighty-eight patients with thyroid cancer who had received RIT for the first time in our institution were included. The values before RIT were adopted as initial measurements for serum albumin, globulin, and thyroglobulin (Tg) and used for analysis. Patients were divided into two groups based on the AGR value. We analyzed the relationship between clinical factors and treatment outcome. The median follow-up period was 92.4months (range: 30.1-173.9months). The 5-year OS and progression-free survival (PFS) were 94% and 54%, respectively. Seventeen patients (< 65years, 8; and ≥ 65years, 9) died during the follow-up period. Low AGR was significantly associated with OS in both univariate and multivariate analyses (p = 0.0059 and p = 0.0120, respectively). As the 5-year OS was as high as 94%, there was no significant difference in survival rate between the two groups during the first 5years. However, there seemed to be a remarkable difference in 10years after the first RIT. On the other hand, Tg was significantly associated with PFS in both univariate and multivariate analyses (p = 0.0016 and p = 0.0441, respectively). In patients under the age of 65, the PFS rate was significantly lower in the low AGR group (p < 0.0001), while there was no difference in PFS rate between the two AGR groups in patients aged 65years or older. AGR may be used as a prognostic factor in relatively younger patients with thyroid cancer treated with radioiodine, while it may be less useful in the older. Overall, it may be an independent prognostic factor for long-term survival in those with thyroid cancer.

Therapeutic effects and prognostic factors of 125I brachytherapy for pelvic recurrence after early cervical cancer surgery

To investigate the efficacy of 125I seed implantation in the treatment regimen of pelvic recurrence after early cervical cancer surgery and to analyse prognostic factors. To evaluate efficacy and analyse prognostic factors of 125I seed implantation for pelvic recurrence after early cervical cancer surgery. A prospective study was conducted on 62 patients who experienced pelvic recurrence after early cervical cancer surgery between August 2005 and September 2015. The 62 patients were treated and assessed in 2 groups (n = 30). All 62 patients were randomized into two groups that received two different treatment regimens: the treatment group (n = 30), which received 125I particle implantation therapy, and the control group (n = 32), which received whole-pelvic irradiation using the anteroposterior/posteroanterior field and cisplatin-based concurrent chemoradiation therapy. The efficacy/efficiency of 125I seed implantation and prognostic factors were analysed by logistic regression. Overall survival was determined by Kaplan–Meier analysis. Multivariate analysis results were obtained by the Cox proportional hazards regression model. The effective control rates at 1, 3, 6 and 12 months were 76.7%, 80.0%, 83.3%, and 86.7% in the 125I particle implantation group. The total effective control rates at 1, 3, 6 and 12 months were 65.6%, 65.5%, 62.5%, and 71.9% in the chemoradiotherapy group. Significant differences were observed between the two groups. The overall survival rates at 1, 2, 3, 4, and 5 years and the median overall were 96.7%, 93.3%, 86.7%, 71.9%, 65.6% and 4.34 years, respectively, in the 125I seed implantation group and 81.3%, 71.9%, 62.5%, 56.3%, 53.1% and 3.59 years, respectively, in the control group. There were statistically significant differences in survival rates depending on the diameter of the largest recurrent pelvic tumour (χ2 = 6.611, P = 0.010). The multivariate analysis showed that the survival rates were related to the diameter of the largest recurrent pelvic tumour (χ2 = 4.538, P = 0.033). 125I implantation is an effective, safe, and promising method for the treatment of pelvic recurrence after early cervical cancer surgery. The diameter of the recurrent pelvic tumour was identified as a significant independent prognostic factor in patients who received 125I implantation.

Obesity as a Risk Factor for Failure to Wean from ECMO: A Systematic Review and Meta-Analysis.

Purpose Obesity has been associated with an increased risk of respiratory complications and other systemic illnesses. Respiratory dynamics in an obese patient, combined with modified lung physiology of ARDS, present a significant challenge in managing obese patients with ARDS. Many physicians think of obesity as a relative contraindication to ECMO. We performed a meta-analysis to see the effect of obesity on weaning from ECMO and survival to hospital discharge. Methods We searched online databases for studies on ECMO and obesity. The search yielded 49 citations in total; after extensive review, six studies were assessed and qualified to be included in the final analysis. Patients were stratified into BMI >30 kg/m2 (obese) and BMI < 30 kg/m2 (nonobese). Results In meta-analysis, there was a total sample population of 1285 patients, with 466 in the obese group and 819 in the nonobese group. There was no significant difference in weaning from ECMO when compared between obese and nonobese patients, with a risk ratio of 1.03 and 95% confidence interval (CI) of 0.94–1.13 (heterogeneity: chi2 = 7.44, df = 4 (p=0.11), I2 = 46%). There was no significant difference in survival rates between obese and nonobese patients who were treated with ECMO during hospitalization, with a risk ratio of 1.04 and 95% CI of 0.86–1.25 (heterogeneity: Tau2 0.03, chi2 = 14.61, df = 5 (p=0.01), I2 = 66%). Conclusion Our findings show no significant difference in survival and weaning from ECMO in obese vs. nonobese patients. ECMO therapy should not be withheld from obese patients, as obesity is not a contraindication to ECMO.

Clinical effectiveness of direct resin composite restorations bonded using one-step or two-step self-etch adhesive systems: A three-year multicenter study

The purpose of this multicenter clinical study was to compare the mid-term clinical effectiveness of direct resin composite restorations using one-step or two-step self-etch adhesives (1-SEAs or 2-SEAs). In total, 352 restorations of class I-V cavities and non-carious cervical lesions in vital teeth (1-SEAs; 52 cases, 2-SEAs; 300 cases) were placed at nine university hospitals and evaluated according to the modified USPHS criteria at baseline, and after 1, 2, and 3 years. The recall rates were 86.6% (1 year), 80.1% (2 years), and 62.2% (3 years). Two restorations failed due to fracture during the follow-up, and there was no significant difference in survival rates between 1-SEAs (97.6%) and 2-SEAs (99.4%). However, 2-SEAs exhibited significantly lower occurrences of discoloration, marginal discoloration, fracture, and plaque retention. Moreover, the subjects reported a significantly lower postoperative hypersensitivity and higher overall satisfaction at all evaluation periods if 2-SEAs were used.

Relationship between serum leptin levels, non-cardiovascular risk factors and mortality in hemodialysis patients.

Introduction. Hemodialysis (HD) patients have higher mortality rate than the general population. Recent studies indicate a significant role of non-cardiovascular risk factors in for mortality in HD patients. Leptin is protein hormone and may indicate malnutrition in HD patients. Its role in mortality in these patients is being examined. This study aimed to investigate the correlation between serum leptin levels and non-cardiovascular risk factors and relationship between leptin level and mortality in HD patients.Methods. The prospective study included 93 patients on maintenance HD and follow-up period was 12 months. We measured leptin level and evaluated non-cardiovascular risk factors: nutritional status, anemia, volemia, parameters of mineral and bone disorder.Results. Out of 93 patients 9 died during study and 1 underwent kidney transplantation. Malnutrition and hypervolemia were two main non-cardiovascular risk factors among deceased subjects. Leptin showed a significant direct correlation with nutritional BMI (r = 0.72, P < 0.001), fat tissue index (r = 0.74, P < 0.001) and statistically significant inverse correlation with leantissue index (r = -0.349, P < 0.05) and inverse correlation with volemic parameters (overhydration / extracellular water ratio (r = -0.38, P < 0.001), but no association with anemia and mineral bone parameters was observed. Elevated leptin levels were associated with better survival. However, no statistically significant difference in survival rates was observed between the study groups (Log-Rank P =0.214, Breslow P =0.211, Tarone-Ware P=0.212).Conclusion. Deceased patients had significantly lower leptin values. Leptin was associated with two non-cardiovascular risk factors for mortality: malnutrition and hypervolemia.

Physio-Anatomical Study of Polyploid Watermelon Grafted by Different Methods

Watermelon is one of the most desirable vegetable crops in the world. Recently, grafting is common in watermelons worldwide, but not all grafting methods are compatible with polyploids. In this study, diploid, triploid, and tetraploid from one watermelon variety, “Mi Mei”, were grafted on the “Xijiaqiangsheng” squash rootstock to study the effect of genome duplication on graft compatibility. Three grafting methods (splice, hole, and tongue) were used to determine graft compatibility. Significant differences in survival rates, hormones, antioxidants (AOX), sugars, and starch contents were observed between compatible/incompatible combinations. Compatible combinations with high survival rates showed high levels of hormones, AOX, carbohydrates, and low hydrogen peroxide H2O2 compared to incompatible plants. The hole grafting method was more efficient with diploid, while splice was efficient with a tetraploid, and both methods can be used for triploid. Compatibility is a combined effect of hormone, carbohydrate, and antioxidant activities. We predict that compatibility is a complex process and that further molecular studies must be performed to dig deep into this phenomenon.

Descripción y seguimiento de pacientes COVID-19 en ventilación mecánica en unidades convertidas dirigidas por anestesiólogos: Clínica Alemana de Santiago

Introduction: The high demand for critical care beds and the need for mechanical ventilation generated by the pandemia of COVID-19 led the Ministry of Health of Chile to authorize both the conversion of beds and the use of anesthesia machines to mechanically ventilate COVID-19 patients. At Clínica Alemana de Santiago (CAS), these converted units were managed by non-intensivist anesthesiologists with technical support from the Intensive Care Unit (ICU). The objective of this study was to compare the survival rate of patients managed at converted and traditional ICU units. The secondary objective was to analyze the factors that may affect morbidity and mortality of these patients. Method: This prospective observational study included mechanically ventilated COVID-19 patients in both traditional and converted units. Patients were followed for 90 days starting at intubation day. Survival rate was determined at 30 and 90 days. A survival analysis was then performed. Results: 41 and 42 patients were admitted to CAS trough converted and traditional ICU units, respectively, between May 24 and June 30, 2020. There was not significant difference in survival rate between converted and traditional ICU units. Age (HR 1.1 per year) and SOFA (HR 1.4 per point) were associated with survival. Conclusions: At CAS, the survival of COVID-19 patients who required mechanical ventilation in converted units was not different as in those patients treated in traditional ICU units. Both age and SOFA were variables that can inform about prognosis of these patients.

Extracellular Vesicle Surface Signatures in IPF Patients: A Multiplex Bead-Based Flow Cytometry Approach.

Background: Extracellular vesicles (EVs) are secreted by cells from their membrane within circulation and body fluids. Knowledge of the involvement of EVs in pathogenesis of lung diseases is increasing. The present study aimed to evaluate the expression of exosomal surface epitopes in a cohort of idiopathic pulmonary fibrosis (IPF) patients followed in two Italian Referral Centres for Interstitial Lung Diseases, comparing them with a group of healthy volunteers. Materials and Methods: Ninety IPF patients (median age and interquartile range (IQR) 71 (66–75) years; 69 males) were selected retrospectively. Blood samples were obtained from patients before starting antifibrotic therapy. A MACSPlex Exosome Kit, human, (Miltenyi Biotec, Bergisch-Gladbach, Germany), to detect 37 exosomal surface epitopes, was used. Results: CD19, CD69, CD8, and CD86 were significantly higher in IPF patients than in controls (p = 0.0023, p = 0.0471, p = 0.0082, and p = 0.0143, respectively). CD42a was lower in IPF subjects than in controls (p = 0.0153), while CD209, Cd133/1, MCSP, and ROR1 were higher in IPF patients than in controls (p = 0.0007, p = 0.0050, p = 0.0139, and p = 0.0335, respectively). Kaplan-Meier survival analysis for IPF patients: for median values and a cut-off of 0.48 for CD25, the two subgroups showed a significant difference in survival rate (p = 0.0243, hazard ratio: 0.52 (95%CI 0.29–0.92); the same was true for CD8 (cut-off 1.53, p = 0.0309, hazard ratio: 1.39 (95%CI 0.75–2.53). Conclusion: Our multicenter study showed for the first time the expression of surface epitopes on EVs from IPF patients, providing interesting data on the communication signatures/exosomal profile in serum from IPF patients and new insights into the pathogenesis of the disease and a promising reliability in predicting mid-term survival of IPF patients.

Comparative study on the growth, survival, gonad development and trait segregation of F2 hybrids and their grandparent species (Crassostrea ariakensis and C. hongkongensis)

In previous studies, we showed that F1 hybrids of Crassostrea ariakensis and C. hongkongensis had faster growth and higher survival rates than the parent species. Further intraspecific crossing of F1 hybrids allowed us to further understand the law of trait segregation and indicated a potential direction for breeding of a new strain with high salinity tolerance and fast growth. In this study, we systematically analyzed the growth, survival, fertility and trait segregation of F2 hybrids and their grandparent species (C. ariakensis and C. hongkongensis) at two sites. Our results confirmed that there were no significant differences in fertilization, cleavage, D larval and survival rates among the three groups of larvae, but the shell heights of F2 hybrids and C. ariakensis were significantly higher than those of C. hongkongensis on the 12th and 16th days. At the high salinity site (Zhulin Pond), the shell heights and survival rates of the F2 hybrids were significantly higher than those of C. hongkongensis from the 90th to the 360th day. However, at the low salinity site (Dafeng River), the F2 hybrids consistently had higher shell heights than C. ariakensis, but there was no significant difference in the survival rates among the three groups. F2 hybrids were classified into three types based on size and number of holes on the gill water tubes, and only F2-A (like C. ariakensis) and F2-H/A (intermediate form) were confirmed to survive at the high salinity site. Moreover, three number of ITS-2 gene fragment were identified in the F2 hybrids, and only A (like C. ariakensis) and HA (like F1 hybrids) existed at the high salinity site. Paraffin sections of gonad tissue confirmed that all three types of F2 hybrids were fertile and could produce mature gametes. In summary, through this comprehensive comparative analysis, we confirmed that F2-A and F2-H/A hybrids had clear advantages in terms of high salinity tolerance and fast growth over their grandparent species, and had potential to be used as the foundations of a new strain.

The Diagnostic and Prognostic Roles of Combined Expression of Novel Biomarkers in Lung Adenocarcinoma and Lung Squamous Cell Carcinoma: An Immunohistochemical Study.

Background & Objective:Diagnosis and discrimination of lung adenocarcinoma (LUAD) from lung squamous cell carcinoma (LUSC) is critical to select the appropriate treatment regimen as recently targeted therapies require accurate subtyping of nonsmall-cell lung carcinoma (NSCLCs). There are currently several biomarkers that could be used for differentiation between LUAD and LUSC, but they have less sensitivity, specificity, and clinical applicability. The aim of this study was to assess the diagnostic and prognostic values of CLCA2, SPATS2, ST6GALNAC1, and Adipophilin tissue expression in the tissues retrieved from LUAD and LUSC patients using immunohistochemistry.Methods:The current study was performed on the samples retrieved from sixty primary lung masses that were diagnosed as LUAD and LUSC. Immunohistochemistry was performed by using a panel of CLCA2, SPATS2, and ST6GALNAC1. We assessed the diagnostic roles of the studied markers in the discrimination between LUAD and LUSC and their prognostic values. Results:SPATS2 and CLCA2 were expressed higher in LUSC than LUAD. ST6GALNAC1 and Adipophilin showed higher expression in LUAD than LUSC (P<0.001). The sensitivity and specificity of CLCA2, SPATS2, ST6GALNAC1 and Adipophilin in adequate subtyping and reaching the accurate diagnosis was 100%. We found only significant difference in survival rate between the patients with negative and positive CLCA2 expression (P=0.038 and P=0.019, respectively). Conclusion:The combination of biomarkers of CLCA2, SPATS2, ST6GALNAC1, and Adipophilin may lead to an appropriate subtyping of lung cancer and reaching accurate diagnosis with the highest sensitivity and specificity.

Pediatric Lung Transplantation−Intermediate Outcomes of a Japanese Center

<h3>Purpose</h3> Since 1998 our center has performed not only cadaveric lung transplantation (CLTx) but living-donor lobar lung LTx (LDLLTx), especially recently, including non-standard procedures of middle lobe LTx and segmental LTx in order to save younger children. The aim of this study was to show outcomes of pediatric LTx of a lung transplant center in Japan. <h3>Methods</h3> We retrospectively reviewed 203 consecutive LTx recipients between 1998 and 2020 including 43 pediatric (< 18 years old: CLTx [n = 9], LDLLTx [n = 34]) and 160 adult (≥18 years old: CLTx [n = 99], LDLLTx [n = 60]) recipients. We analyzed pediatric recipients in subgroups divided at the school age (0-6 years old [n = 10] vs 7-17 years old [n = 33]). <h3>Results</h3> The 1-, 5-, and 10-year overall survival (OS) in pediatric vs adult recipients were 93% vs 91%, 84% vs 74% and, 79% vs 61%, respectively (p = 0.11). The 1-, 5-, and 10-year lung-graft survival (GS) in pediatric vs adult recipients were 85% vs 83%,62% vs 62% and 36% vs 48%, respectively (p = 0.26). There was no significant difference in survival rates between pediatric and adult recipients. In pediatric recipients, the 1- and 5-year OS in 0-6 years old vs 7-17 years old were 70% vs 100% and 56% vs 92%, respectively (p = 0.004). The 1- and 5-year GS in 0-6 years old vs 7-17 years old were 60% vs 93% and 24% vs 72%, respectively (p = 0.02). Although the number is small, younger children under 7 years old have poorer OS and GS when compared with older children of 7-17 years old. From patient characteristics, lower height (p < 0.0001), non-standard LTx procedure (p = 0.001),idiopathic interstitial pneumonia (p = 0.004) and on-ventilation at LTx (p = 0.007) might be factors associated with poor outcome. <h3>Conclusion</h3> Outcome of pediatric LTx is comparable with that of adult LTx. However, younger children under 7 years old have poorer OS and GS compared with older children of 7-17 years old.

Relationship between Von Willebrand Factor and Gastrointestinal Bleeding Compared EVAHEART and HeartMate II

Purpose Gastrointestinal (GI) bleeding is crucial issue in long-term management of continuous-flow (CF) left ventricular assist device (LVAD) patients, and it has been reported that lack of high-molecular-weight (HMW) von Willebrand factor (vWF) multimers is one of the most critical cause of GI bleeding. Aim of this study was to investigate a relationship between the prevalence of GI bleeding in LVAD and the effects of vWF activities including the comparison between EVAHEART and HeartMate II. Methods We performed EVAHEART implantation for 36 patients and HeartMate II for 6 patients with advanced heart failure (INTERMACS profile I - IV, eligible for heart transplantation, mean age 43 years old) between March 2011 and December 2017. Laboratory data of factor VIII-antigen (VIII-Ag), vWF ristocetin cofactor (RCo), and the presence of HMW-vWF multimers were measured post-operatively over time. The primary outcome was comparison of VIII-Ag and vWF RCo between two groups. The analysis was performed using Wilcoxon signed-rank test and a two-factor repeated-measures analysis of variance. Results Thirty patients (71%) survived with a mean follow-up period of 1157 (range 14-2255) days, and 25 of them underwent heart transplantation. There was no significant difference of survival rate (75% vs 67%, p=0.67), the loss of HMW-vWF multimers (3% vs 0%, p=0.68), and the incidence of GI bleeding (8% vs 0%, p=0.46). The EVAHEART group showed higher vWF RCo than the HeartMate II (p Conclusion This result suggested that EVAHEART maintained vWF RCo, and there was a possibility that EVAHEART provided low incidence of GI bleeding by means of maintenance the HMW-vWF multimers.

Late Central Airway Toxicity after High-Dose Radiotherapy: Clinical Outcomes and a Proposed Bronchoscopic Classification.

Simple SummaryHigh-dose radiotherapy is frequently used to treat lung cancer, however, it can cause serious central airway toxicity. Although radiation toxicity of the lung parenchyma has been studied extensively, relatively little has been published on bronchoscopic findings in the central airways and no standard classification/reporting system exists. With the growing use of high-dose (chemo)radiotherapy and high-dose hypo-fractionated radiotherapy in close proximity to central airways, as well as potential interactions with new systemic therapies, the risks and incidence of central airway toxicity may increase. In this retrospective study, we analyzed patient characteristics and clinical outcomes of 70 patients with central airway toxicity after high-dose radiotherapy. Furthermore, we analyzed the post-radiotherapy bronchoscopic images to identify main patterns of airway toxicity. We identified luminal stenosis and vascular changes as the two main patterns and have proposed a classification system. Preliminary analysis suggests that the pattern and severity of radiation toxicity may be of prognostic value.The study’s purpose was to identify the bronchoscopic patterns of central airway toxicity following high-dose radiotherapy or chemoradiotherapy, and to look at the consequences of these findings. Our institutional bronchoscopy database was accessed to identify main patterns of airway toxicity observed in a seven-year period. A total of 70 patients were identified with central airway toxicity, and the findings of bronchoscopy were used to derive a classification system. Patient characteristics, time from radiotherapy to toxicity, follow-up and survival were retrospectively analyzed. Results: The main bronchoscopic patterns of airway toxicity were vascular changes (telangiectasia, loss of vascularity, necrosis) and stenosis of the lumen (moderate, severe). Indications for bronchoscopy were airway symptoms (n = 28), assessment post-CRT/surgery (n = 12), (suspected) recurrence (n = 21) or assessment of radiological findings (n = 9). Stenosis was revealed by bronchoscopy at a median time of 10.0 months (IQR: 4–23.5) after radiotherapy and subsequent follow-up after identification was 23 months (IQR: 1.5–55). The corresponding findings for vascular changes were 29 months (IQR: 10.5–48.5), and follow-up after identification was nine months (IQR: 2.5–19.5). There was a statistically significant difference in survival rates between patients with necrosis and telangiectasia (p = 0.002) and loss of vascularity (p = 0.001). Eight out of 10 deceased patients with telangiectasia died of other causes and 4/8 patients with necrosis died of other causes. We identified two main patterns of central airway toxicity visualized with bronchoscopy after high-dose radiotherapy or chemoradiotherapy, and propose a bronchoscopic classification system based on these findings. Preliminary analysis suggests that the pattern and severity of radiation damage might be of prognostic value. Prospective data are required to confirm our findings.

Comparison of gefitinib-induced skin adverse reactions (SAR) in C57BL/6 and FVB/N mice.

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) such as gefitinib, erlotinib, and afatinib, are widely used in clinical practice and remarkably effective in treatment of advanced non-small cell lung cancer. However, there are some adverse effects while taking EGFR-TKIs, among which skin adverse reactions (SAR) are the most common events. At present, the poor outcome of SAR and insufficient research on SAR models need to be addressed. In this study we focused on the SAR models to lay a foundation for mechanism researches. Gefitinib, one of the EGFR-TKIs, was used as SAR inducing agents. We chose C57BL/6 and FVB/N mice as experimental model and they were divided into four groups. The weight and skin moisture of mice were detected every 7days, itching behavior and abnormal eyelids were tested at 35th day after gavage, and survival rate was also recorded. The weight of unit area hair, length of whiskers and inflammatory cells were evaluated after mice sacrificed. C57BL/6 animals treated with gefitinib showed significant differences in survival rate, weight of unit area hair, skin moisture changes, skin dryness, itching behavior, whisker irregular growth, abnormal eyelids, and inflammatory cells; FVB/N animals treated with gefitinib only showed significant differences in survival rate, whisker irregular growth and abnormal eyelids, compared with the control group, respectively. In this study, we compared the similarities and differences of gefitinib-induced SAR between C57BL/6 and FVB/N mice, which illustrated different patients probably showing different symptoms clinically and provided experimental basis for researching mechanism of EGFR-TKIs induced SAR.

Clinical features and outcomes of patients with stage I multiple primary lung cancers.

The number of patients with multiple primary lung cancers (MPLC) is rising. We studied the clinical features and factors related to outcomes of MPLC patients using the database of surgically resected lung cancer (LC) cases compiled by the Japanese Joint Committee of Lung Cancer Registry. From the 18 978 registered cases, 9689 patients with clinical stage I non‐small‐cell lung cancer who achieved complete resection were extracted. Tumors were defined as synchronous MPLC when multiple LC was simultaneously resected or treatment was carried out within 2 years after the initial surgery; metachronous MPLC was defined as second LC treated more than 2 years after the initial surgery. Of these cases, 579 (6.0%) were synchronous MPLC and 477 (5.0%) metachronous MPLC, with 51 overlapping cases. Female sex, nonsmoker, low consolidation‐tumor ratio (CTR), and adenocarcinoma were significantly more frequent in the synchronous MPLC group, whereas patients with metachronous MPLC had higher frequencies of male sex, smoker, chronic obstructive pulmonary disease (COPD), and nonadenocarcinoma. There was no significant difference in survival rate between patients with and without synchronous or metachronous MPLC. Age, gender, CTR for second LC, and histological combination of primary and second LC were prognostic indicators for both types of MPLC. Logistic regression analysis showed that female sex, history of malignant disease other than LC, and COPD were risk factors for MPLC incidence. The present findings could have major implications regarding MPLC diagnosis and identification of independent prognostic factors, and provide valuable information for postoperative management of patients with MPLC.

Early Life Intervention Using Probiotic Clostridium butyricum Improves Intestinal Development, Immune Response, and Gut Microbiota in Large Yellow Croaker (Larimichthys crocea) Larvae.

Marine fish larvae are vulnerable during the early life period. The early intervention using probiotics may be a promising method to improve growth of fish larvae. In this study, a 30-day feeding trial was conducted to evaluate the effects of early life intervention using probiotic Clostridium butyricum (CB) on growth performance, intestinal development, immune response and gut microbiota of large yellow croaker (Larimichthys crocea) larvae. Four isonitrogenous and isolipidic diets were formulated with the supplementation of four different levels of CB (5 × 109 CFU g−1), 0.00% (Control), 0.10% (CB1), 0.20% (CB2), and 0.40% (CB3). Results showed that larvae fed diets with CB had significant higher final length than the control group. Meanwhile, larvae fed the diet with 0.10% CB had significant higher final weight and specific growth rate (SGR) than the control group. However, no significant difference in survival rate was observed among dietary treatments. CB supplementation significantly increased the height of intestinal villus and the length of intestinal enterocyte. Similarly, CB supplementation significantly increased the expression of tight zonula occludens-2 (zo-2) and ornithine decarboxylase (odc) than the control group. Larvae fed the diet with 0.20% CB had significant higher lipase and leucine-aminopeptidase (LAP) activity than the control group. Moreover, CB supplementation significantly improved immune enzyme activities than the control group. Sequencing of bacterial 16S rRNA V4-5 region indicated that dietary CB altered intestinal microbiota profile and decreased intestinal microbial diversities of larvae. CB supplementation could effectively increase the abundance of CB, and decrease the abundance of some potential pathogenic bacteria in larval gut. These results revealed that early life intervention using 0.10–0.20% CB could promote growth of large yellow croaker larvae probably through promoting intestinal development, improving immune enzyme activities and modulating gut microbiota.

P38.01 The Role of Pathology in The Proposed Subdivided N Descriptors of The TNM Staging System For Lung Cancer– A Single Center Experience

IASLC has proposed to subdivide N descriptors of TNM Staging for lung cancer into N1a (single N1 station), N1b (multiple N1 stations), N2a1 (skip metastases), N2a2 (single N2 with N1 involvement) and N2b (multiple N2 stations). The lymph nodes (LNs) on resection specimens have been dissected and reported separately according to their stations in our department over the years. The aim of this study is to evaluate the survival differences between pathologically confirmed subdivided N descriptors and to examine the value of other parameters related to N1 LNs such as the number of metastasis in a single LN station, size of the largest metastasis, extranodal invasion, and metastasis defined by direct infiltration of the primary tumor. The analysis was conducted on data from 630 NSCLC patients who underwent surgical treatment between 2008-2019. The IASLC nodal map and anatomical definitions were used to describe regional lymph node stations. Survival analysis was done with Kaplan Meier method. Among 630 patients, 193 showed pathological nodal involvement (128 N1, 65 N2). The distribution of cases into the subdivided N categories were as follows: 437 were N0, 88 were N1a, 40 were N1b, 13 were N2a1, 42 were N2a2, and 10 were N2b. The mean number of LNs dissected by pathologists was 12.10±7.31, sampled by surgeons was 7.56±5.84. Overall survival (OS) rates of the subdivided N descriptors- regardless of T stage, histologic type, adjuvant therapy- were significantly different: 85.9% for N0, 77.2% for N1a, 66.1% for N1b, 76.2% for N2a1, 33.5% for N2a2 and 44.4% for N2b (p<0.001). Multiple LN station involvement is found to be an unfavorable prognostic sign both for N1 and N2 cases (N1a vs N1b) (N2a1 vs N2a2, N2b). Patients with only single N2 involvement (skip metastasis) had a better OS then multiple N1 involvement (N2a1 vs N1b) (p<0.001). Among N1 cases (n:128) the number of involved LNs in a single station (1 LN/ >1 LN), extracapsular invasion (absent/ present), and the size of the largest metastasis did not show any significant difference in survival rates (p>0.005). Patients having metastases in distally located N1 stations (13, 14), and metastasis defined by direct extension of the primary tumor into the lymph nodes showed a favorable survival; all patients were alive. However, statistical analysis could not be done for these groups due to the limited number of cases. Evaluation of N1 LNs is under the responsibility of pathologists; they should be dissected and reported according to their stations. As proposed by IASLC, single or multiple N1 station involvement shows a survival difference. In contrast, presence of one or more metastatic lymph nodes in a single N1 station does not seem to have a prognostic value. Distal or proximal LN involvements, LN metastasis caused by direct infiltration of the primary tumor may have an effect on survival. Studies in larger multi-institutional series should be conducted. In addition, the favorable prognosis of N2a1 cases in our series is remarkable and should further be evaluated in detail.

Epinephrine Plus Vasopressin vs Epinephrine Plus Placebo in Pediatric Intensive Care Unit Cardiopulmonary Resuscitation: A Randomized Double Blind Controlled Clinical Trial

To compare the efficacy of epinephrine plus vasopressin vs epinephrine plus placebo in the pediatric intensive care unit (PICU) cardiopulmonary resuscitation (CPR). Randomized, double-blind controlled clinical trial. PICU in a tertiary care institute from February, 2019 to May, 2020. Children aged one month to 13 years who required CPR during PICU stay. Patients in whom vascular access was not available or return of spontaneous circulation (ROSC) was achieved by defibrillation without epinephrine were excluded. Patients were randomized to receive vasopressin 0.1 mL per kg (=0.8 unit per kg) or placebo (0.1 mL per kg normal saline) in addition to epinephrine (1:10000) 0.1 mL per kg. The drugs were given as bolus doses every three minutes until the ROSC or up to a maximum of five doses, whichever was earlier. The primary outcome was the proportion of patients who achieved ROSC. The secondary outcomes were survival rate and functional status (at 24-hour, PICU, hospital, and 90-day post-discharge), need for organ supports, length of stay (PICU and hospital), and adverse effect(s) of the study drugs. 90 patients (epinephrine plus vasopressin group, n=45 and epinephrine plus placebo group, n=45) were analyzed on intention-to-treat basis. There was no significant difference in the primary outcome between epinephrine plus vasopressin (n=25, 55.5%) and epinephrine plus placebo groups (n=24, 53.3%) (Relative risk 1.04, 95% CI 0.71 to 1.52). There was no significant difference in survival rate at 24-hour (n=7, 15.6% vs. n=8, 17.8%), at PICU, hospital, and 90-day post-discharge (n=1, 2.2% vs n=1, 2.2%). There was no difference in other secondary outcomes. No trial drug-related serious adverse events were observed. A combination of epinephrine plus vasopressin did not improve the rate of return of spontaneous circulation in the pediatric intensive care unit cardiopulmonary resuscitation as compared with epinephrine plus placebo.

Hepatocellular Carcinoma in Cirrhotic Versus Non-Cirrhotic Patients: A Retrospective Study of 483 Patients

Background and Aim: Although cirrhosis is a classical risk factor for the development of hepatocellular carcinoma (HCC), its absence does not exclude this risk. We aimed to assess the clinical characteristics and outcomes of cirrhotic HCC (C-HCC) and non-cirrhotic HCC (NC-HCC) patients. Methods: Patients consecutively included in a prospective HCC cohort (University Hospital Bern) were analysed. They were categorised into two groups, based on the basis of histology or combined radiological and laboratory characteristics. Results: 20.4% of patients were NC-HCC. This group was characterized by a higher median age and a higher female prevalence compared to the C-HCC group. Non-alcoholic fatty liver disease (NAFLD) (25.7%) and HBV infection (14.9%) were the main risk factors in this group, whereas alcohol abuse (26%) and HCV (21.6%) in C-HCC, P&lt;0.001. 19.4% of them were diagnosed during a screening programme. Resection was performed in 54.5% of NC HCC patients despite the advanced stage (BCLC stage B and C). No statistically significant difference in survival rate was observed between C and NC-HCC patients (24 months vs. 33.9 months, P=0.162). In multivariate analysis, in the NC-HCC group each unit increase in BMI was associated with mortality while liver transplantation and resection were positively associated with survival. In the C-HCC group, the BCLC stage C was negatively associated with survival while all the therapeutic lines were negative factors for mortality. Conclusion: NC-HCC patients were diagnosed more often outside a screening programme. The patients were older, with a higher female prevalence and despite an advanced stage, were often amenable to surgery.

Analysis of ascending aortic diameter and long-term prognosis in patients with ascending aortic dissection.

This study was designed to review the ascending aortic diameter of patients undergoing surgery for AAD in China and its influence on prognosis. In the period between January 2018 and January 2020, 265 patients eligible for analysis of ascending aorta were included in this study. The maximum diameter of the ascending aorta was assessed using preoperative computed tomography (CT) scan for patients. The mean diameter of the ascending aorta of the reference population was 48.16±9.37mm, and the percentage of subjects with an aorta <55mm was 80.38%. In this study, we found that BMI, hypertension, and bicuspid aortic valve are the main factors affecting the widening of the ascending aorta, and the diameter of the ascending aorta in patients with AAD is negatively correlated with the patient's long-term prognosis. However, there is no significant difference in survival rates among patients with different ascending aortic diameter. Ascending aortas with smaller diameter are also prone to dissection, most of which occur at a lower surgical threshold than recommended by current guidelines. Therefore, the diameter of ascending aorta cannot be used as an independent risk factor for high-risk patients with aortic dissection, but it can be used as an important indicator to evaluate the long-term prognosis of patients.