Search Results (76)

Background and Objectives: The tumor-node-metastasis (TNM) classification system is the standard for staging gastric cancer and predicting survival. However, its accuracy can be compromised by insufficient lymph node (LN) dissection during surgery or inadequate pathologic examination. Alternative staging systems, such as the lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS), may provide better prognostic value when LN examination is suboptimal. Because the current N staging system was not able to accurately stratify patients relative to their survival outcomes in our series, this study assessed the prognostic impact of LNR and LODDS on overall survival (OS) of patients who underwent radical gastrectomy for cancer. Materials and Methods: Between March 2005 and June 2025, the authors performed gastrectomy for gastric carcinoma in 114 patients. Out of these patients, 39 were excluded (19 had stage IV, while 20 underwent palliative gastrectomy with D1 lymphadenectomy). Thus, the study cohort included 75 patients who underwent curative gastrectomy, with 4 (5.3%) of them dying postoperatively. Potential prognostic factors associated with OS (including age, sex, tumor location, T stage, N stage, TNM stage, LNR, and LODDS) were evaluated by univariate and multivariate analysis. Because the recurrence data were missing in 41 patients, the disease-free survival (DFS) analysis would not be meaningful. Results: The OS analysis was based on the 71 patients surviving postoperatively. Because successive N stage groups could not accurately stratify patients according to their OS, we used X-tile software version 3.6.1 to identify two cut-offs (both for LNR and LODDS) that were able to stratify patients in three subgroups with significantly distinct survival outcomes. Multivariate analysis found that both LODDS and LNR systems were independent prognostic factors for OS. Conclusions: LNR and LODDS provide more detailed insights into lymph node status and have demonstrated potential for enhancing prognostic accuracy compared to N staging, even in patients who underwent curative gastrectomy with D2 lymphadenectomy. Although LNR and LODDS are usually useful in patients who underwent suboptimal lymphadenectomy, the current study demonstrated that these systems could improve prognostic stratification even in patients with more than 15 retrieved LNs. However, due to the small sample size, the current observations and proposed cut-offs of LNR and LODDS have to be validated in larger studies including such patients. Full article

Background: Oral cancer is a major global health burden with heterogeneous survival outcomes. This study aimed to identify clinicopathological factors, particularly lymph node-related parameters, associated with prognosis in patients with oral cancer and to construct a survival model for predicting overall survival (OS). Methods: A total of 174 patients with oral cancer who underwent surgery between January 2018 and November 2021 were retrospectively analyzed. Clinicopathological variables, including age, gender, body mass index (BMI), pathological T, N and overall stage, tumor subsite, perineural invasion (PNI), lymphovascular invasion (LVI), surgical margin status, lymph node yield (LNY), lymph node metastases (LNM), and lymph node ratio (LNR), were evaluated. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors for OS and disease-specific survival (DSS). Results: Univariate analysis showed that older age, lower BMI, advanced pathological stage, presence of PNI or LVI, positive/close margins, LNY < 15, LNM ≥ 3, and LNR ≥ 0.0454 were significantly associated with poorer OS. Multivariate analysis identified age ≥ 63 years, pathological stage 3–4, LNY < 15, LNM ≥ 3, and LNR ≥ 0.0454 as independent predictors of OS. LNR ≥ 0.0454 was the only independent predictor of DSS. A survival model incorporating age, pathological stage, LNY, LNM, and LNR demonstrated good discriminatory ability for OS. Conclusions: Multiple independent prognostic factors for oral cancer survival were identified. The proposed survival model provides a practical tool for risk stratification and may assist personalized treatment planning, with particular emphasis on lymph node-related parameters. Full article

As the rubber constituting laminated rubber isolation bearings is a temperature-sensitive material, its performance is susceptible to temperature disturbances. Firstly, this study systematically analyzed the effects of temperature on the mechanical properties of natural rubber bearings (LNR), lead–rubber bearings (LRB), and high–damping rubber bearings (HDR), including horizontal equivalent stiffness, equivalent damping ratio, and yield load. The variation trends of the mechanical property parameters of the three types of bearings with temperature are basically the same. LNR exhibits a strong linear variation law, while the mechanical properties of HDR bearings are the most sensitive to temperature changes. Secondly, based on the analysis of the temperature characteristics of the mechanical properties of the bearings, the temperature dependence of the seismic mitigation effect of the bearings was further studied. The results show that the displacement response of the isolation layer has the best temperature stability when using LRB bearings, and the displacement response of the superstructure is most susceptible to temperature changes when using HDR bearings. When the temperature is lower than the normal temperature, the displacement responses of isolation systems with different types of bearings all show the characteristic that the lower the temperature, the greater the deviation from the displacement response at normal temperature. Finally, to overcome the influence of temperature, a temperature-controlled isolation rubber bearing integrating laminated rubber isolation bearings with a temperature regulation system was proposed. This can solve the problems that the mechanical properties of rubber bearings deteriorate and the aging rate accelerates in a wide temperature range, which affect their isolation effect and service life. Thus, it endows new theoretical connotations to rubber isolation bearings and has practical application value for engineering seismic resistance. Full article

Background: Morphological subclassification may refine prognosis after curative pancreaticoduodenectomy (PD) for periampullary cancers. Methods: We conducted a single-center retrospective cohort including 120 consecutive PDs performed between 2005 and 2022. Tumors were classified as intestinal (INT), pancreatobiliary (PB), or pancreatic ductal adenocarcinoma (PAN). Clinicopathologic variables included T stage, margin status, lymphovascular and perineural invasion, and lymph node ratio (LNR; cutoff 0.154 determined by ROC/Youden). Overall survival (OS) was the primary endpoint and was analyzed using Kaplan–Meier with log-rank tests and multivariable Cox regression. Results: INT tumors were associated with earlier T stage, fewer adverse histologic features, and higher R0 resection rates compared with PB and PAN. In multivariable analysis, mortality risk was higher for PB (HR 4.41; 95% CI 1.25–15.53) and PAN (HR 13.96; 95% CI 3.99–48.75) relative to INT. LNR ≥ 0.154 independently predicted worse OS (HR 1.93; 95% CI 1.11–3.35). Mean OS was 108.8 months for INT, 62.0 months for PB, and 22.7 months for PAN (log-rank p < 0.001). Conclusions: Morphological subtype and LNR are independent prognostic factors after PD for periampullary malignancies. Integrating morphology and nodal burden into risk models may improve postoperative stratification and guide adjuvant therapy. Full article

Background/Objectives: Papillary cancer is the most common thyroid cancer. The development of lateral cervical lymph node metastases (I–V levels) is considered a major cause of recurrence. The aim of this study is to investigate the potential predictive factors for lateral cervical lymph node metastasis and disease recurrence, in order to tailor the clinical approach to these patients. An ROC (Receiver Operating Characteristic) curve has been set to search out a cut-off value for the lymph node ratio (LNR), a ratio of involved lymph nodes-to-examined lymph nodes, that could serve as an index of tumor recurrence. Methods: This was an observational retrospective study. The clinical charts of 43 patients with histopathological diagnosis of papillary thyroid cancer who underwent thyroidectomy with lateral and central neck dissection have been reviewed. These results have also been compared with those who underwent total thyroidectomy alone that served as a control group. Results: Extrathyroidal extension (p-value < 0.001), tumor size (p-value = 0.015), number of lymph nodes involvement (p-value = 0.022), and LNR (p-value = 0.004) were identified as potential predictors of tumor recurrence. The ROC curve revealed that an LNR value exceeding 0.205 is indicative of disease recurrence, with an Area Under the Curve (AUC) of 0.818, a sensitivity of 82%, and a specificity of 81%. Furthermore, fT4 value (p-value = 0.008), tumor size (p-value = 0.019), and alcohol consumption (p-value < 0.001) may serve as potential predictors of lymph node metastasis. Conclusions: Extrathyroidal extension, vascular invasion, tumor size, number of pathological lymph nodes, and LNR are associated with recurrence of papillary thyroid carcinoma; in particular, the lymph node ratio can be considered an effective indicator of recurrence risk. Full article

Background: Lymph node status is a prognostic factor in Wilms tumor, and adequate lymph node sampling is strongly recommended. This study investigates the impact of lymph node ratio (LNR) (number of positive to examined lymph nodes) on overall survival in children with resected Wilms tumors. Methods: This retrospective National Cancer Database analysis included children (<18 years) who underwent resection with lymph node sampling for unilateral, non-metastatic Wilms tumor. Results: Among 2206 patients, the median age was three years, the median tumor size was 10.5 cm, and the median number of examined nodes was five. A total of 82.1% of patients had an LNR of 0, 5.4% had an LNR < 0.2, and 12.5% had an LNR ≥ 0.2. In multivariable Cox regression, LNR ≥ 0.2 was associated with worse survival (HR = 1.75, 95%CI: 1.03–2.97, p = 0.04), along with increasing age (HR = 1.11, 95%CI: 1.05–1.17, p < 0.001) and tumor size (HR = 1.03, 95%CI: 1.00–1.06, p = 0.03). Conclusions: LNR is an independent prognostic factor in Wilms tumor and may refine risk stratification and guide treatment decisions. Full article

Background/Objectives: The presence of distant metastases is the main cause of death in medullary thyroid carcinoma (MTC). However, due to the rarity of this cancer, few studies have thoroughly analyzed the variables influencing the development of distant metastases. The objective of this study was to evaluate, in patients with MTC, the factors associated with the occurrence of synchronous and metachronous distant metastases. Methods: An analytical, observational, retrospective cohort study was conducted at a tertiary hospital. Patients with histologically confirmed MTC, both sporadic and familial (MEN2 syndrome), were included. The influence of epidemiological variables, heredity, complementary tests, surgical factors, histological features, staging, and disease progression was assessed. A univariate comparative analysis was first performed, followed by a multivariate analysis using logistic regression. Results: This study included 146 patients, of whom 75% (n = 109) had familial MTC. Lymph node involvement at diagnosis was observed in 36% (n = 52). During follow-up, distant metastases developed in 14% (n = 21) of patients, including five cases present at the time of diagnosis. The median follow-up was 214 months (IQR 106–289). The presence of distant metastases was associated with an increased risk of mortality. Factors associated with distant metastases included age, calcitonin level, hereditary status, lymph node involvement, and overall stage. In multivariate analysis, the lymph node ratio (LNR) remained the only significant predictor (OR 29.124). Conclusions: Several variables were related to the presence of distant metastases. Among them, the LNR emerged as the independent predictor of both synchronous and metachronous distant metastases. Full article

Background/Objectives: Older adults with gastric cancer often have poorer prognoses than younger patients. Early recurrence, within two years after curative surgery, is associated with poor outcomes, but its risk factors remain unclear. This study aimed to identify clinicopathological predictors of early recurrence in older patients with stage II/III disease. Methods: We retrospectively reviewed 604 patients with stage II/III gastric cancer who underwent curative surgery from 2009 to 2020. After exclusions, 237 patients aged ≥65 years were analyzed. Clinicopathological variables were compared between those with and without early recurrence, and risk factors were assessed using logistic regression. Results: Among the 237 patients studied, 103 had recurrence following surgery, of whom 72 (69.9%) were categorized as early recurrence. Distant metastasis was the most common pattern (59.7%), followed by peritoneal (45.8%) and locoregional (33.3%) recurrences. Multivariate analysis identified a lymph node ratio (LNR) > 0.17 as an independent risk factor for early recurrence (odds ratio (OR), 5.30; 95% confidence interval (CI), 2.07–13.53; p < 0.001). Conclusions: Early recurrence is frequent among older patients with stage II/III gastric cancer, with distant metastasis as the predominant pattern. An LNR > 0.17 predicts higher recurrence risk. While adjuvant chemotherapy showed a trend toward reduced risk, statistical significance was not reached. Further prospective studies are necessary to confirm these findings. Full article

Targeting and multidrug resistance are the significant problems of current antitumor drugs, and these problems become the key factors in the design of nanomedicine. Herein, Au NRs and OPC-Au NPs were prepared via the hydroquinone seedless growth method and proanthocyanidin (OPC) one-pot method, and then pH-GSH-near-infrared ΙΙ (NIR-ΙΙ)-responsive nano-prodrugs Au/DOX-ss LNRs and OPC-Au/DOX-ss LNPs were designed by the encapsulation of doxorubicin prodrug DOX-ss with Au-S affinity and thermal-sensitive liposomes. Interestingly, OPC endowed OPC-Au NPs with reducibility and excellent performance in terms of particle size, zeta potential, encapsulation rate, and drug loading rate. In particular, the photothermal efficiencies of OPC-Au/DOX-ss LNPs increased to 59.22% under the 1064 nm NIR-ΙΙ irradiation. Compared with free DOX-ss and Lipid DOX-ss, the IC50 of OPC-Au/DOX-ss LNPs was decreased by 91.68% and 97.60%, respectively. Furthermore, the expression of P-gp in MCF-7/ADR was significantly inhibited (decreased by 65%). The potential of proanthocyanidin remodels the pH-GSH-NIR-ΙΙ responsiveness and drug resistance of OPC-Au/DOX-ss LNPs for breast cancer treatment in NIR-ΙΙ photodynamic/photothermal therapy. Full article

Listeria monocytogenes causes listeriosis, a severe foodborne disease with high mortality. Contamination with it poses significant risks to food safety and public health. Notably, genetic characteristic differences exist between strains causing human infections and those found in routine food inspections. This study examined the genotypic factors influencing the pathogenicity of L. monocytogenes, focusing on virulence gene profiles and key integrity genes like inlA to explain these divergences. The dataset included 958 strains isolated from human, food, and environmental samples. Whole-genome sequencing identified virulence genes, and principal component analysis (PCA) examined 92 virulence genes and inlA integrity to uncover potentially pathogenic patterns. The results highlight differences in virulence characteristics between strains of different origins. The integrity of inlA and genes such as inlD, inlG, and inlL were pivotal to pathogenicity. Strains with premature stop codons (PMSCs) in inlA, associated with reduced virulence, accounted for a low percentage of human cases but over 30% of food isolates. Sequence types (STs) like ST121, ST580, and ST199 showed unique profiles, while ST9, dominant in food, occasionally caused human cases, posing risks to vulnerable individuals. This research highlights the complexity of the pathogenicity of L. monocytogenes and emphasizes the importance of genomic surveillance for effective risk assessment. Full article

Background: In non-metastatic deficient mismatch repair (dMMR) colorectal cancer (CRC), traditional prognostic factors, such as pN staging, often fail to distinguish patient outcomes effectively. Methods: This retrospective study included a cohort of 792 dMMR CRC patients who underwent surgical treatment without neoadjuvant chemoradiotherapy or immunotherapy. Traditional prognostic factors were compared with lymph node-based models (NLN, LNR, LOODS) for their ability to predict overall survival (OS) and disease-free survival (DFS). Results: The study demonstrated that traditional factors, such as histologic type, differentiation, and vascular invasion, had limited predictive value in dMMR CRC. Furthermore, the pN stage failed to effectively distinguish between pN1 and pN2 for both OS (p = 0.219) and DFS (p = 0.095). Conversely, LOODS demonstrated superior performance over traditional pN staging in predicting both OS and DFS (p < 0.001). A prognostic model combining LOODS with age exhibited superior predictive performance compared with the traditional TN staging system. Conclusions: LOODS was identified as a more effective independent prognostic factor compared with traditional pN staging, enabling more precise stratification of pN+ patients in non-metastatic dMMR CRC, highlighting its potential utility in guiding postoperative treatment and optimizing therapeutic strategies. Full article

This article introduces an innovative, fully integrated low-dropout (LDO) specifically designed for low-power applications, capable of handling a wide range of load currents. By employing dynamic biasing to enhance noise performance, the LDO shows a noise equal to 14 $\mathsf{\mu }\mathrm{V}/\sqrt{\mathrm{Hz}}$ at f < 1 kHz. The LDO demonstrates remarkable efficiency with a load regulation (LDR) of 3.8 mV/A and a line regulation (LNR) of 0.71 mV/V. It boasts a rapid settling time of 1 $\mathsf{\mu }$s during load transitions up to 100 mA and a minimal quiescent current of 5 $\mathsf{\mu }$A. The regulator consistently provides a 2.6 V output for input voltages between 2.8 V and 4.8 V, with a dropout voltage of 67 mV, supporting load currents from 0 mA to 100 mA over a temperature range of −25 °C to +125 °C. The design is based on a 150 nm CMOS process to ensure high sensitivity and high performance, making it an ideal choice for battery-operated systems. Full article

Background: The LI-RADS classification is widely used for the hepatocellular carcinoma (HCC) risk stratification of liver nodules in cirrhotic patients. The evaluation of nodule enhancement, which is a major criterion, commonly relies on qualitative assessment. This study aims to investigate the potential role of material density (MD) parameters in the iodine maps of spectral computed tomography (SCT) to discriminate between LI-RADS (v2018 CORE) categories in cirrhotic patients. Methods: Dual-energy SCT scans of cirrhotic patients with suspected HCC, taken between March 1st, 2022 and September 30th, 2023, were retrospectively reviewed. All the images were reviewed by trained radiologists to classify nodules as LI-RADS 3, 4, or 5 by consensus. MD maps were generated in the hepatic arterial phase (HAP), portal venous phase (PVP), and equilibrium phase (EP). The iodine concentration density (ICD) values of nodules (ICDnodule) and the non-nodular liver parenchyma (ICDliver) were measured to calculate lesion-to-non-nodular liver ICD ratio (LNR), as well as their differences (ΔICD) and ratios (rLNR). Results were correlated with LI-RADS categories. Results: A total of 69 patients were included and 79 DECT exams were assessed. Overall, 197 nodules (size 24.67 ± 23.11 mm, mean ± SD) were categorized into different LI-RADS classes: 44 were classed as LI-RADS 3 (22.3%), 14 were classed as LI-RADS 4 (7.1%), and 139 were classed as LI-RADS 5 (70.6%). The arterial LNR, arterial ICDnodule, ΔICD, and rLNR between HAP and PVP discriminated between LI-RADS 3 and LI-RADS 4+5 nodules (p < 0.001). All the calculated MD parameters showed high diagnostic accuracy rates (all AUCs = 70–73%). Conclusions: MD parameters of liver nodules measured in SCT scans are viable diagnostic tools that may increase the radiologist’s confidence in LI-RADS class allocation in cirrhotic patients. This preliminary and speculative study can serve as a baseline for the potential quantification of iodine concentrations of focal liver lesions to reduce subjectivity in hepatic nodule assessment and reporting. Future perspectives include the quantification of iodine concentration for prognostic stratification before locoregional and systemic treatments in HCC patients. Full article

Background/Objectives: The Lymph Node Ratio (LNR) index is the proportion of lymph nodes with present metastases to lymph nodes removed and examined. This is an additionally established parameter for predicting the prognosis of gastric cancer patients. The most popular cancer classification, TNM, describes only the number of affected lymph nodes. It can result in a negative overestimation of the prognosis of patients with gastric cancer if the number of nodes examined is relatively limited. Methods: In this study, we retrospectively analyzed 194 patients diagnosed with gastric cancer operated on between 2017 and 2021 at the Clinical Department of Oncological Surgery, University Centre of General and Oncological Surgery of the University Clinical Hospital in Wroclaw. In total, 133 patients underwent gastrectomy with D2 lymphadenectomy and 61 remaining patients had the resection procedure abandoned due to an unresectable lesion. The LNR index was calculated based on histopathological examination, and postoperative complications were assessed using the Clavien–Dindo (C-D) scale. Statistical analysis was performed regarding the dependence of LNR on the following patient characteristics: sex, age, TNM features, tumor stage, tumor location, performed procedure, chemotherapy application, C-D complication rate, and survival rate. Results: The value of the LNR index significantly depends on TNM features (p < 0.05), clinical tumor stage (p < 0.05), and patient survival (p < 0.05), while no statistically significant relationship with C-D complication rate was demonstrated. Conclusions: The LNR index is a relevant parameter in predicting prognosis and survival time in gastric cancer patients, but future studies on larger and differentiated groups of patients could further confirm its usefulness in the development of guidelines. Full article

Background: Lymphadenectomy is a fundamental part of surgical strategy in patients with gastric cancer. Lymph node (LN) status is a key point in assessment of prognosis in gastric cancer. The LN ratio (LNR)—number of positive LNs/number of sampled LNs—offers a new approach for predicting survival. The aim of the study was to find factors affecting LN yield and the impact of LNR on 5-year survival. Methods: Prospective multicenter quality assurance study. Only LN-positive patients were included in the LNR calculations. Results: 4946 patients from 149 hospitals were enrolled. The inclusion criteria were met by 1884 patients. Patients were divided into two groups: Group 1 (<16 LN), 456 patients and Group 2 (≥16 LN), 1428 patients. The multivariate analysis found G2 (OR 1.98; 95%CI 1.11–3.54), G3 (OR 2.15; 95%CI 1.212–3.829), UICC-stage II (OR 1.44; 95%CI 1.01–2.06) and III (OR 1.71; 95%CI 1.14–2.57), age < 70 (OR 1.818 95%CI 1.19–2.78) and female gender (OR 1.37; 95%CI 1.00–1.86) as independent factors of ≥16 LN yield. Patients with a LNR ≥ 0.4 have a lower probability of survival (p = 0.039 and <0.001) than patients with a LNR = 0.1. Patients with UICC-II have a lower probability of survival than UICC-I (p = 0.023). Age 70–80 (p = 0.045) and > 80 years (p = 0.003) were negative prognostic factors for long-term survival. Conclusion: Long-term survival is directly related to adequate lymphadenectomy. LNR could be superior to pN-stage for estimating survival and adds remarkable nuances in prognosis compared to UICC-stage. LNR also appears valid, even in the case of insufficient LN yield. Full article