Prognostic Analysis of Limited Resection Versus Lobectomy in Stage IA Small Cell Lung Cancer Patients Based on the Surveillance, Epidemiology, and End Results Registry Database

Objective: The prognostic analysis of limited resection vs. lobectomy in stage IA small cell lung cancer (SCLC) remains scarce.Methods: Using the Surveillance, Epidemiology, and End Results registry (SEER) database, we identified patients who were diagnosed with pathological stage IA (T1a/bN0M0) SCLC from 2004 to 2013. The overall survival (OS) and lung cancer-specific survival (LCSS) rates of patients with different treatment schemes were compared in stratification analyses. Univariable and multivariable analyses were also performed to identify the significant predictors of OS and LCSS.Results: In total, we extracted 491 pathological stage IA SCLC patients, 106 (21.6%) of whom received lobectomy, 70 (14.3%) received sublobar resection and 315 (64.1%) received non-surgical treatment, respectively. There were significant differences among the groups based on different treatment schemes in OS (log-rank p < 0.0001) and LCSS (log-rank p < 0.0001). Furthermore, in subgroup analyses, we did not identify any differences between sublober resection group and lobectomy group in OS (log-rank p = 0.14) or LCSS (log-rank p = 0.4565). Patients with four or more lymph node dissection had better prognosis. Multivariable analyses revealed age, laterality, tumor location, and N number were still significant predictors of OS, whereas age, tumor location, and N number were significant predictors of LCSS.Conclusion: Surgery is an important component of multidisciplinary treatment for stage IA SCLC patients and sublober resection is not inferior to lobectomy for the specific patients

Germline Predisposition and Copy Number Alteration in Pre-stage Lung Adenocarcinomas Presenting as Ground-Glass Nodules

Objective: Synchronous multiple ground-glass nodules (SM-GGNs) are a distinct entity of lung cancer which has been emerging increasingly in recent years in China. The oncogenesis molecular mechanisms of SM-GGNs remain elusive.Methods: We investigated single nucleotide variations (SNV), insertions and deletions (INDEL), somatic copy number variations (CNV), and germline mutations of 69 SM-GGN samples collected from 31 patients, using target sequencing (TRS) and whole exome sequencing (WES).Results: In the entire cohort, many known driver mutations were found, including EGFR (21.7%), BRAF (14.5%), and KRAS (6%). However, only one out of the 31 patients had the same somatic missense or truncated events within SM-GGNs, indicating the independent origins for almost all of these SM-GGNs. Many germline mutations with a low frequency in the Chinese population, and genes harboring both germline and somatic variations, were discovered in these pre-stage GGNs. These GGNs also bore large segments of copy number gains and/or losses. The CNV segment number tended to be positively correlated with the germline mutations (r = 0.57). The CNV sizes were correlated with the somatic mutations (r = 0.55). A moderate correlation (r = 0.54) was also shown between the somatic and germline mutations.Conclusion: Our data suggests that the precancerous unstable CNVs with potentially predisposing genetic backgrounds may foster the onset of driver mutations and the development of independent SM-GGNs during the local stimulation of mutagens

Age-Related Study and Collision Response of Material Properties of Long Bones in Chinese Pedestrian Lower Limbs

In forensic examination cases, lower limb injuries are common, and pedestrians of different ages suffer different injuries when they are hit by vehicles, especially the injuries to the long bones of the lower limbs. Aging remains a challenging issue for the material properties and injury biomechanical properties of pedestrian lower limb long bones. We analyzed the regression relationship between the age of 50 Chinese pedestrians and the material properties of the lower limb long bones (femur, tibia). We compared them with previous studies to propose a regression model suitable for Chinese human long bone material properties. Through the established Human Active Lower Limb (HALL) model that conforms to the Chinese human anatomy, seven pedestrians’ (20/30/40/50/60/70/80 years old (YO)) lower limbs were parameterized to assign long bone material properties. In the finite element analysis, the Hall model was side-impacted by a family car (FCR) at speeds of 30/40/50/60/70 km/h, respectively. The results showed that an increase in age was negatively correlated with a decrease in the material properties of each long bone. Moreover, with an increase in age, the tolerance limit of long bones gradually decreases, but there will be a limit, and there is no obvious positive correlation with age. During a standing side impact, the stress change in the femur was significantly smaller than that of the tibia, and the stress of the femur and tibia decreased with age. Age is a more significant influencing factor for lower limb injuries. Older pedestrians have a higher risk of lower limb injuries. Forensic experts should pay attention to the critical factor of age when encountering lower limb traffic accident injuries in forensic identification work

Effects of Loading Conditions on the Pelvic Fracture Biomechanism and Discrimination of Forensic Injury Manners of Impact and Run-Over Using the Finite Element Pelvic Model

This study aimed to systematically simulate the responses of pelvic fracture under impact and run-over to clarify the effects of boundary and loading conditions on the pelvic fracture mechanism and provide complementary quantitative evidence for forensic practice. Based on the THUMS finite element model, we have validated the simulation performance of the model by a real postmortem human pelvis side impact experiment. A total of 54 simulations with two injury manners (impact and run-over), seven loading directions (0°, 30°, 60°, 90°, 270°, 300°, 330°), and six loading velocities (10, 20, 30, 40, 50, and 60 km/h) were conducted. Criteria of effective strain, Von-Mises stress, contact force, and self-designed normalized eccentricity were used to evaluate the biomechanism of pelvic fracture. Based on our simulation results, it’s challenging to distinguish impact from run-over only rely on certain characteristic fractures. Loads on the front and back were less likely to cause pelvic fractures. In the 30°, 60°, 300° load directions, the overall deformation caused a “diagonal” pelvic fracture. The higher is the velocity (kinetic energy), the more severe is the pelvic fracture. The contact force will predict the risk of fracture. In addition, our self-designed eccentricity will distinguish the injury manner of impact and run-over under the 90° loads. The “biomechanical fingerprints” based on logistic regression of all biomechanical variables have an AUC of 0.941 in discriminating the injury manners. Our study may provide simulation evidence and new methods for the forensic community to improve the forensic identification ability of injury manners

Effects of Loading Conditions on the Pelvic Fracture Biomechanism and Discrimination of Forensic Injury Manners of Impact and Run-Over Using the Finite Element Pelvic Model

This study aimed to systematically simulate the responses of pelvic fracture under impact and run-over to clarify the effects of boundary and loading conditions on the pelvic fracture mechanism and provide complementary quantitative evidence for forensic practice. Based on the THUMS finite element model, we have validated the simulation performance of the model by a real postmortem human pelvis side impact experiment. A total of 54 simulations with two injury manners (impact and run-over), seven loading directions (0°, 30°, 60°, 90°, 270°, 300°, 330°), and six loading velocities (10, 20, 30, 40, 50, and 60 km/h) were conducted. Criteria of effective strain, Von-Mises stress, contact force, and self-designed normalized eccentricity were used to evaluate the biomechanism of pelvic fracture. Based on our simulation results, it’s challenging to distinguish impact from run-over only rely on certain characteristic fractures. Loads on the front and back were less likely to cause pelvic fractures. In the 30°, 60°, 300° load directions, the overall deformation caused a “diagonal” pelvic fracture. The higher is the velocity (kinetic energy), the more severe is the pelvic fracture. The contact force will predict the risk of fracture. In addition, our self-designed eccentricity will distinguish the injury manner of impact and run-over under the 90° loads. The “biomechanical fingerprints” based on logistic regression of all biomechanical variables have an AUC of 0.941 in discriminating the injury manners. Our study may provide simulation evidence and new methods for the forensic community to improve the forensic identification ability of injury manners

A sub-band-aliasing architecture for frequency-interleaved analog-to-digital converters

The frequency-interleaved analog-to-digital converter (FI-ADC) can effectively improve the performance of sampling systems by expanding bandwidth and sampling rate as the number of channels increases. However, this improvement may come with drawbacks such as complex hardware requirements and potential mirror errors resulting from an imbalance between in-phase and quadrature-phase signals within the system. This article proposes an alternative FI-ADC architecture, referred to as the sub-band-aliasing (SA) ADC. In the proposed architecture, the analog input signal is divided into multiple sub-bands, and a mixer modulates the input signal to alias adjacent sub-bands. Subsequently, the modulated signal is fed into a low-pass filter (LPF) and an ADC, after which each sub-band is recovered via a recursive process involving spectrum calculation and shifting. Moreover, potential errors that may arise in practical applications are analyzed and compensated. The simulation results indicate that the proposed architecture demonstrates practical utility and can achieve comparable performance to traditional FI-ADCs while featuring a simpler architecture and a lower hardware cost. Furthermore, the effectiveness of the proposed architecture is also demonstrated by hardware experiments, in which an FI-ADC with a total bandwidth of 6 GHz has been implemented using four channels, each channel having a bandwidth of only 1.5 GHz

Harnessing the power of clinical decision support systems: challenges and opportunities

Clinical decision support systems (CDSSs) are increasingly integrated into healthcare settings to improve patient outcomes, reduce medical errors and enhance clinical efficiency by providing clinicians with evidence-based recommendations at the point of care. However, the adoption and optimisation of these systems remain a challenge. This review aims to provide an overview of the current state of CDSS, discussing their development, implementation, benefits, limitations and future directions. We also explore the potential for enhancing their effectiveness and provide an outlook for future developments in this field. There are several challenges in CDSS implementation, including data privacy concerns, system integration and clinician acceptance. While CDSS have demonstrated significant potential, their adoption and optimisation remain a challenge