Incomplete surgical resection in Non-Small Cell Lung Cancer: A population-based cohort from the Mid-South region of the United States

Lung cancer accounts for approximately 25% of all cancer deaths in the United States, and most long-term survivors of lung cancer undergo surgical resection. However, the effectiveness of surgical resection is impaired when tumor tissue remains at the margin of the resected specimen after the surgery, known as incomplete resection. The incidence of incomplete resection varies with patient demographic, clinical, surgeon, and institutional characteristics. The anatomic sites of margin involvement may also have impacts on long-term survival. Recommended postoperative treatment options for incomplete resection include re-resection, chemotherapy, and radiation therapy. However, some of these recommendations are not based on high-level evidence. A better understanding of the factors associated with margin positivity is needed to aid preoperative, intraoperative, and postoperative treatment decision making.The Mid-South Quality of Surgical Resection Cohort (MS-QSR) is a population-based dataset including \u3e 95% of surgical resections of lung cancer in the Mid-South from 2009-2019. We evaluated the MS-QSR to disentangle the positive margins preoperative risk factors, the impact of postoperative treatments on positive margin, and survival outcomes.Among 3,414 patients evaluated in this study, 4.9% experienced incomplete resections. Risk factors associated with incomplete resection included male sex, unknown patients residency, advanced clinical stage (II and III), neo-adjuvant treatment, higher surgeon annual case volume, and urban location of hospital. Accurate TN (tumor and node) staging was a protective factor. Margin positivity was independently associated with an increase in the hazard of death (aHR=1.73, 95% CI: 1.40-2.13). Compared to complete resections, the anatomic sites significantly undermined the overall survival.We evaluated a hospital-based surgical quality metric called the risk-adjusted margin positivity (RAMP), which classified hospitals as underperformer, nonoutlier, or outperformer. In our analysis, the outperforming hospitals were more likely to attain quality criteria, had more surgeons with Cardiothoracic board certificate and predominant practice in thoracic or cardiovascular, and were more likely to be affiliated with a teaching program.Future work should focus on better identification of patients at risk for incomplete resection, improving the implementation of current guidelines and quality care at the institutional level, and generating higher level evidence to support postoperative treatment after incomplete resection

Viability of Non-Coplanar VMAT for Liver SBRT as Compared to Coplanar VMAT and Beam Orientation Optimized 4π IMRT.

PurposeThe 4π static non-coplanar radiotherapy delivery technique has demonstrated better normal tissue sparing and dose conformity than the clinically used volumetric modulated arc therapy (VMAT). It is unclear whether this is a fundamental limitation of VMAT delivery or the coplanar nature of its typical clinical plans. The dosimetry and the limits of normal tissue toxicity constrained dose escalation of coplanar VMAT, non-coplanar VMAT and 4π radiotherapy are quantified in this study.Methods and materialsClinical stereotactic body radiation therapy plans for 20 liver patients receiving 30-60 Gy using coplanar VMAT (cVMAT) were re-planned using 3-4 partial non-coplanar arcs (nVMAT) and 4π with 20 intensity-modulated non-coplanar fields. The conformity number (CN), homogeneity index (HI), 50% dose spillage volume (R50), normal liver volume receiving >15 Gy (VL>15), dose to organs at risk (OARs), and tumor control probability (TCP) were compared for all three treatment plans. The maximum tolerable dose (MTD) yielding a normal liver normal tissue control probability (NTCP) below 1%, 5%, and 10% was calculated with the Lyman-Kutcher-Burman model for each plan, as well as the resulting survival fractions at one, two, three, and four years.ResultsCompared to cVMAT, the nVMAT and 4π plans reduced VL>15 by an average of 5 cm3 and 80 cm3, respectively. 4π reduced the 50% dose spillage volume by ~23% compared to both VMAT plans, and either significantly decreased or maintained OAR doses. The 4π MTDs and survival fractions were significantly higher than both cVMAT and nVMAT (p<0.05) for all normal liver NTCP limits used in this study.ConclusionsThe 4π technique provides significantly better OAR sparing than both cVMAT and vMAT and enables more clinically relevant dose escalation for tumor local control. Therefore, despite the current accessibility of nVMAT, it is not a viable alternative to 4π for liver SBRT

Feasibility of Combined UASB-MBR System in Treating PTA Wastewater and Polyimide Membrane for Biogas Purification

Source: ICHE Conference Archive - https://mdi-de.baw.de/icheArchive

Comorbid Mental Disorders in Anxiety Disorders: Genetic Aspects of Bipolar Disorders and of Ethnicity

Anxiety disorder (AD) is commonly comorbid with other mental illness. It could be a state or trait, controversially. Evidence for an association between alcoholism and anxiety has emerged from clinical studies of patients with alcoholism, and those of patients with anxiety disorders. Alcohol dependence (or abuse) as well as bipolar disorder (BP) is usually comorbid with anxiety disorder and/or depressive disorder, which often coexist and are difficult to distinguish from one another. However, in Han Chinese population, the comorbidity rate either with alcoholism or bipolar disorder was not reported as much high as reported in Caucasians, this finding of comorbidity between anxiety/depressive disorders and alcohol dependence (or abuse) or/and bipolar disorders, possibly at the genetic level, makes the differentiation of their categorical diagnoses in the association study vitally important

THE ANTECEDENTS OF AN INDIVIDUAL\u27S COMMITMENTS TOWARD CONTINUOUSLY USING SOCIAL NETWORK SITE

The Social network sites (SNS) has been rapid diffusion around the world. With the increasing importance of SNS, continuance intention also becomes a popular issue in the SNS context. SNS providers have to maintain better relationships with users and make individuals continue to use their sites. Based on this phenomenon, the objective of this study is to gain a better understanding of the continuance intention of SNS through examining the effects of commitments. Specifically, followed Meyer and Allen’s three-component model of commitment, we develop a theoretical model to understand the factors that influence normative, affective and continued commitment and investigate the effects of commitments on continuance intention in the SNS context. Through a survey-based empirical investigation, we anticipate the results to enhance our existing knowledge on continuance intention in the SNS context

2D perovskite stabilized phase-pure formamidinium perovskite solar cells.

Compositional engineering has been used to overcome difficulties in fabricating high-quality phase-pure formamidinium perovskite films together with its ambient instability. However, this comes alongside an undesirable increase in bandgap that sacrifices the device photocurrent. Here we report the fabrication of phase-pure formamidinium-lead tri-iodide perovskite films with excellent optoelectronic quality and stability. Incorporation of 1.67 mol% of 2D phenylethylammonium lead iodide into the precursor solution enables the formation of phase-pure formamidinium perovskite with an order of magnitude enhanced photoluminescence lifetime. The 2D perovskite spontaneously forms at grain boundaries to protect the formamidinium perovskite from moisture and suppress ion migration. A stabilized power conversion efficiency (PCE) of 20.64% (certified stabilized PCE of 19.77%) is achieved with a short-circuit current density exceeding 24 mA cm-2 and an open-circuit voltage of 1.130 V, corresponding to a loss-in-potential of 0.35 V, and significantly enhanced operational stability

An Accelerating 3D Image Reconstruction System Based on the Level-of-Detail Algorithm

This paper proposes a research of An Accelerating 3D Image Reconstruction System Based on the Level-of-Detail Algorithm and combines 3D graphic application interfaces, such as DirectX3D and OpenCV to reconstruct the 3D imaging system for Magnetic Resonance Imaging (MRI), and adds Level of Detail (LOD) algorithm to the system. The system uses the volume rendering method to perform 3D reconstruction for brain imaging. The process, which is based on the level of detail algorithm that converts and formulates functions from differing levels of detail and scope, significantly reduces the complexity of required processing and computation, under the premises of maintaining drawing quality. To validate the system's efficiency enhancement on brain imaging reconstruction, this study operates the system on various computer platforms, and uses multiple sets of data to perform rendering and 3D object imaging reconstruction, the results of which are then verified and compared

Discussion on the Relevance of Old Low-lying Land Reclamation and Soil Liquefaction

Source: ICHE Conference Archive - https://mdi-de.baw.de/icheArchive

On the Quark Mass Dependence of Two Nucleon Observables

We study the implications of lattice QCD determinations of the S-wave nucleon-nucleon scattering lengths at unphysical light quark masses. It is found that with the help of nuclear effective field theory (NEFT), not only the quark mass dependence of the effective range parameters, but also the leading quark mass dependence of all the low energy deuteron matrix elements can be obtained. The quark mass dependence of deuteron charge radius, magnetic moment, polarizability and the deuteron photodisintegration cross section are shown based on the NPLQCD lattice calculation of the scattering lengths at 354 MeV pion mass and the NEFT power counting scheme of Beane, Kaplan and Vuorinen. Further improvement can be obtained by performing the lattice calculation at smaller quark masses. Our result can be used to constrain the time variation of isoscalar combination of u and d quark mass m_q, to help the anthropic principle study to find the m_q range which allows the existence of life, and to provide a weak test of the multiverse conjecture.Comment: 18 pages, 5 figure