Predictive value of computed tomography in identifying extranodal extension in human papillomavirus‐positive versus human papillomavirus‐negative head and neck cancer

Pathologic extranodal extension (pENE) impacts treatment planning and is an important prognostic indicator for patients with head and neck squamous cell carcinoma (HNSCC). Computed tomography (CT) is a commonly used modality for assessment of radiographic ENE (rENE). To determine the predictive value of CT‐identified rENE in predicting pENE, we performed a systematic review through a search of 4 databases (PubMed, Scopus, Cochrane, and OVID). Meta‐analysis of diagnostic performance based on human papillomavirus (HPV) status was conducted. For HPV‐negative HNSCC, pooled sensitivity, specificity, and accuracy were 60.6%, 93.3%, and 82.6%, respectively. Overall positive predictive value (PPV) was 82.7%. For HPV‐positive HNSCC, pooled sensitivity, specificity, and accuracy were 77.7%, 72.2%, and 63.8%, respectively. Overall PPV was 68.6%. Significant differences were observed in diagnostic performance parameters between the two cohorts. The radiographic characteristics of HPV‐positive and HPV‐negative nodal metastases in HNSCC differ and radiographic evaluation of ENE in HPV‐positive nodes is challenging. Development of refined imaging characteristics of HPV‐positive nodes is needed to improve diagnostic performance.     

Impact of positive surgical margins and their locations after radical prostatectomy: comparison of biochemical recurrence according to risk stratification and surgical modality

Purpose

We investigated the influence of positive surgical margins (PSMs) and their locations on biochemical recurrence (BCR) according to risk stratification and surgical modality.

Methods

A total of 1,874 post-radical-prostatectomy (RP) patients of pT2–T3a between 2000 and 2010 at three tertiary centers, and who did not receive neoadjuvant/adjuvant therapy, were included in this study. Patients were stratified according to BCR risk: low risk (PSA <10, pT2a-b, and pGS ≤6), intermediate risk (PSA 10–20 and/or pT2c and/or pGS 7), and high risk (PSA >20 or pT3a or pGS 8–10). The median follow-up was 43 months.

Results

PSMs were a significant predictor of BCR in both the intermediate- and high-risk-disease groups (P = .001, HR 2.1, 95 % CI 1.3–3.4; P < .001, HR 2.8, 95 % CI 2.0–4.1). Positive apical margin was a significant risk factor for BCR in high-risk disease (P = .003, HR 2.0, 95 % CI 1.2–3.3), but not in intermediate-risk disease (P = .06, HR 1.7, 95 % CI 0.9–3.1). Positive bladder neck margin was a significant risk factor for BCR in both intermediate- and high-risk disease (P < .001, HR 5.4, 95 % CI 2.1–13.8; P = .001, HR 4.5, 95 % CI 1.8–11.4). In subgroup analyses, robotic RP provided comparable BCR-free survival regardless of risk stratification. Patients with PSMs showed similar BCR-free survival between open and robotic RP (log-rank, P = .897).

Conclusions

Post-RP PSMs were a significantly independent predictor of disease progression in high-risk disease as well as intermediate-risk disease. Both positive apical and bladder neck margins are also significant risk factors of BCR in high-risk disease. Patients with PSMs showed similar BCR-free survival between open and robotic surgery.     

Comparative effectiveness of cycling of tumor necrosis factor-α (TNF-α) inhibitors versus switching to non-TNF biologics in rheumatoid arthritis patients with inadequate response to TNF-α inhibitor using a Bayesian approach

Alternative tumor necrosis factor-α (TNF-α) inhibitors and non-TNF biologics are available as treatment options for rheumatoid arthritis patients who exhibit inadequate response to TNF-α inhibitor (TNF-IR patients). These agents have considerable efficacy compared with placebo, but head-to-head comparisons among these agents have not been performed. The objective of this study was to use Bayesian approach to compare the effectiveness of cycling TNF-α inhibitors versus switching to non-TNF biologics in TNF-IR patients. A systematic review was conducted using MEDLINE and Cochrane library. Key endpoints were the American College of Rheumatology (ACR) responses of 20/50/70 and the health assessment questionnaire (HAQ) score change at six months. Bayesian outcomes were calculated as the probability that OR is greater than one and HAQ score change difference is less than zero. Compared with TNF-α inhibitors, non-TNF biologics were associated with higher ACR response rates; in ACR20, the OR was 1.639 for abatacept [P(OR > 1) = 90.7 %], 1.871 for rituximab [P(OR > 1) = 96.2 %] and 3.52 for tocilizumab [P(OR > 1) = 99.9 %]. Similar trends were shown in the HAQ change comparison; the median differences (MD) were ?0.259 for abatacept [P(MD < 0) = 100 %], ?0.160 for rituximab [P(MD < 0) = 98.2 %], and ?0.200 for tocilizumab [P(MD < 0) = 99.3 %]. In conclusion, switching to non-TNF biologics was more effective than cycling TNF-α inhibitor in TNF-IR patients.     

Enhanced NO2 Sensing Performance of Graphene with Thermally Induced Defects

This paper demonstrates the enhanced NO₂ sensing performance of graphene with defects generated by rapid thermal annealing (RTA). A high temperature of RTA (300–700 °C) was applied to graphene under an argon atmosphere to form defects on sp² carbon lattices. The density of defects proportionally increased with increasing the RTA temperature. Raman scattering results confirmed significant changes in sp² bonding. After 700 °C RTA, I_D/I_G, I_2D/I_G, and FWHM (full width at half maximum)(G) values, which are used to indirectly investigate carbon-carbon bonds’ chemical and physical properties, were markedly changed compared to the pristine graphene. Further evidence of the thermally-induced defects on graphene was found via electrical resistance measurements. The electrical resistance of the RTA-treated graphene linearly increased with increasing RTA temperature. Meanwhile, the NO₂ response of graphene sensors increased from 0 to 500 °C and reached maximum (R = ~24%) at 500 °C. Then, the response rather decreased at 700 °C (R = ~14%). The results imply that rich defects formed at above a critical temperature (~500 °C) may damage electrical paths of sp² chains and thus deteriorate NO₂ response. Compared to the existing functionalization process, the RTA treatment is very facile and allows precise control of the NO₂ sensing characteristics, contributing to manufacturing commercial low-cost, high-performance, integrated sensors.     

The effect of electron density in furan pendant group on thermal-reversible Diels–Alder reaction based self-healing properties of polymethacrylate derivatives

Herein, we discuss the effect of electron density in a furan pendant group on the thermally reversible Diels–Alder (DA) reaction based self-healing efficiency in polymethacrylate derivatives. First, the furan-functionalized polymethacrylates (rPFMA and dPFMA) having different electron density in the furan pendant groups were prepared through free-radical polymerization. The healing efficiency of rPFMA, which was expected to have high healing efficiency due to the high reactivity of DA reaction originating from the electron density in the furan moiety, was shown to be 95.89% in the first and 69.86% in the second healing process, respectively, where it is higher than that of dPFMA having relatively low electron density in the furan moiety. To illustrate these results, kinetic tests of the DA reaction for rPFMA64 and dPFMA64 were performed, where the reactivity of the DA reaction for rPFMA64 was much higher than that for dPFMA64. This could be explained by the electron density in the furan pendant groups which controls the reactivity of DA reaction having a major effect on the efficiency of self-healing performance in furan-functionalized polymethacrylates.

Herein, we discuss the effect of electron density in a furan pendant group on the thermally reversible Diels–Alder (DA) reaction based self-healing efficiency in polymethacrylate derivatives.