Prediction of the pathological subtypes by intraoperative frozen section for patients with cT1N0M0 invasive lung adenocarcinoma (ECTOP-1015): a prospective multi-center study.

BACKGROUND: The aim of this study is to assess the diagnostic accuracy of intraoperative frozen section (FS) in determining the pathological subtypes among patients diagnosed with cT1N0M0 invasive lung adenocarcinoma. MATERIALS AND METHODS: This was a prospective, multi-center (7 centers in China) clinical trial of Eastern Cooperative Thoracic Oncology Projects (ECTOP-1015). Patients with cT1N0M0 invasive lung adenocarcinoma were enrolled in the study. Pathological images obtained from FS and final pathology (FP) were reviewed by at least two pathologists. The primary endpoint was the concordance between FS and FP diagnoses. The inter-observer agreement for identifying pathological subtypes on FS was evaluated among three pathologists. RESULTS: A total of 935 patients were enrolled. The best sensitivity of diagnosing the predominant subtype was 78.2% in the evaluation of acinar pattern. Presence of acinar pattern diagnosed by FS was an independent factor for the concordance between FS and FP (P=0.007, 95% CI: 2.332-4.736). Patients with tumor size ＞2 cm measured by pathology showed a better concordance rate for the predominant subtype (81.6% vs 74.6%, P=0.023). The presence of radiological ground glass opacity (GGO) component did not affect the diagnosis accuracy of FS for predominant subtype (concordance rate: 76.4% vs 75.2%, P=0.687). Patients with GGO component showed better accuracy of the identification in the presence of LPA (82.1% vs 71.0%, P= 0.026). Substantial agreement between the FS diagnosis from 3 pathologists for the predominant pathological pattern was revealed with κ = 0.846. CONCLUSIONS: This is the largest prospective trial evaluating FS diagnosing pathological subtype in cT1N0M0 invasive lung adenocarcinoma. A favorable concordance in the assessment of the pathological subtypes between FS and FP was observed, indicating the feasibility of utilizing accurate intraoperative pathological diagnoses from FS in guiding surgical strategies. And combination of radiology could improve the precision of FS.

Preventing Subsidence Reoccurrence in Tianjin: New Preconsolidation Head and Safe Pumping Buffer.

Tianjin, a coastal metropolis in north China, has grappled with land subsidence for nearly a century. Yet, emerging evidence suggests a notable decrease in subsidence rates across Tianjin since 2019. This trend is primarily attributed to the importation of surface water from the Yangtze River system via the South-to-North Water Diversion Project, initiated in December 2014. Utilizing Sentinel-1A Interferometric Synthetic Aperture Radar (InSAR) data (2014-2023), this study reveals that one-third of the Tianjin plain has either halted subsidence or experienced land rebound. As a result, the deep aquifer system (~-200 to -450 m) beneath one third of the Tianjin plain has completed a consolidation cycle, leading to the establishment of new, locally specific preconsolidation heads. The identification of the newly established preconsolidation head seeks to answer a crucial question: How can we prevent the reoccurrence of subsidence in areas where it has already ceased? In essence, subsidence will stop when the local hydraulic head elevates to the new preconsolidation head (NPCH), and permanent subsidence will not be reinitiated as long as hydraulic head remains above the NPCH. The difference of the depth between current hydraulic head and the NPCH defines the safe pumping buffer (SPB). This study outlines detailed methods for identifying the NPCHs in the deep aquifer system from long-term InSAR and groundwater-level datasets. Determining NPCHs and ascertaining SPBs are crucial for estimating how much groundwater can be safely extracted without inducing permanent subsidence, and for developing sustainable strategies for long-term groundwater management and conservation.

Coupled processes of groundwater dynamics and land subsidence in the context of active human intervention, a case in Tianjin, China.

To address the crisis of water shortage in the North China Plain, the Chinese government implemented the South-to-North Water Transfer Project (SNWTP). In this context, Tianjin, one of the main beneficiaries of this project, has been relieved from water shortages and begun to implement Groundwater Management Plans (GMP) since 2018, which undoubtedly have a significant effect on the groundwater recovery. Meanwhile, this provides a good case for studying the coupled process of ground settlement and groundwater dynamics, especially the soil deformation pattern driven by groundwater level (GWL) rebound. To analyze these issues in detail, field well data was collected to depict groundwater flow field. Moreover, geodetic data was also collated, including leveling, GPS, and InSAR, so that a vertical deformation field with high spatiotemporal resolution could be generated. The results reveal that the GWL of the third confined aquifer which is the main exploitation layer in Tianjin recovered significantly since 2018 with a rate of 2.1 m/yr. The dynamic deformation patterns indicate that the area of land subsidence cones in Tianjin has reduced significantly, accompanied by a sharply declining subsidence rate (decreased from -32.2 mm/yr to -4.5 mm/yr.). Particularly, a significant poroelastic rebound has occurred in the Wuqing and Beichen districts since 2020. Furthermore, due to the delayed pore pressure dissipation in the aquitard, we find a time delay of 0.3-5.5 years between land subsidence and GWL time series, which is far less than that estimated by hydrogeological parameters, as the latter ignored the recharge and recovery capacity of the aquifer system. Finally, an evolution models in Tianjin was presented to illustrate interactive process among the deformation, pore pressure, and hydraulic head. In general, the SNWDP and the GMP has restored the pore pressure of aquifer, reduced the land subsidence, and alleviated the groundwater storage depletion of Tianjin.