Lymph node dissection in small-sized pulmonary metastasectomy: Impact on the long-term survival.

INTRODUCTION: Pulmonary metastasectomy has been clarified in improving long-term survival in most primary malignancies with pulmonary metastasis, while the role of additional lymph node dissection remained controversial. We aimed to investigate the prognosis of lymph node involvement and identify the role of lymph node dissection during pulmonary metastasectomy in a real-world cohort. METHODS: We identified patients diagnosed with pulmonary metastases with ≤3 cm in size and received pulmonary metastasectomy between 2004 and 2017 in the Surveillance, Epidemiology, and End Results database. We compared the survival via Kaplan-Meier analysis and propensity score matching method, and the multivariable analysis was conducted by cox regression analysis. RESULTS: A total of 3452 patients were included, of which 2268(65.7%) received lymph node dissection, and the incidence of node-positive was 11.3%(256/2268). In total, the median overall survival was 62.8 months(interquartile range, 28.6-118.9 months), and the lymph node involvement was referred to an impaired survival compared to node-negative diseases(5-year overall survival rate, 58.0% versus 38.6%), with comparable survival between N1 and N2 diseases(P = 0.774). Lymph node dissection was associated with improved survival(HR = 0.80; 95%CI, 0.71-0.90; P < 0.001), and the survival benefits remained regardless of age, sex, the number of metastases, and surgical procedures, even in those with node-negative diseases. At least eight LNDs might lead to a significant improvement in survival, and additional survival benefits might be limited with additional dissected lymph nodes. CONCLUSIONS: Lymph node involvement was associated with impaired survival, and lymph node dissection during pulmonary metastasectomy could improve long-term survival and more accurate staging.

Temperature-Dependent Biology and Population Performances of the Coffee Berry Borer Hypothenemus hampei (Ferrari) (Coleoptera: Curculionidae: Scolytinae) on Artificial Diet.

At different observation intervals of 1, 5, and 10 days during a trial period of 30 days, the mortality rates of Hypothenemus hampei were 100, 95, and 55%, and the fecundity rates were 0.55, 8.45, and 19.35 eggs/female, respectively. At temperatures of 18, 21, 24, and 27 °C, the development time of the immature stage of H. hampei was significantly shortened with increasing temperature. Furthermore, the lower developmental threshold (T0) and thermal summation (K) of the immature stage were 8.91 °C and 485.44 degree-days, respectively. The greatest longevity of female and male adults reached 115.77 and 26.50 days, respectively, at 18 °C. The highest fecundity was 29.00 eggs/female at 24 °C. The population parameters of H. hampei were analyzed on the basis of the age-stage, two-sex life table theory. According to the data, the parameters were significantly affected by temperature. The highest net reproductive rate (R0) was 13.32 eggs/individual at 24 °C. The highest intrinsic rate of increase (r) and finite rate of increase (λ) were calculated as 0.0401 and 1.0409 day-1, respectively, at a temperature of 27 °C. The shortest mean generation time (T) was 51.34 days at 27 °C. Overall, we provide a discussion on comprehensive biological information regarding H. hampei, thus providing basic knowledge for further research on this pest.

Surgical resection versus radiotherapy for clinical stage IA lung cancer ≤1 cm in size: A population-based study.

OBJECTIVE: With the increasing incidence of stage IA lung cancer ≤1 cm in size, the optimal primary treatment remains to be controversial, and thus, we compared the survival of these patients treated with radiotherapy, wedge resection, segmentectomy, or lobectomy in a large population. METHODS: We identified patients with stage IA lung cancer ≤1 cm in size between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. We compared the overall survival (OS) via Kaplan-Meier analysis and conducted Cox regression analysis via propensity score matching (PSM) method to identify the relative hazard ratio (HR) and difference of OS among these treatments in the subgroup stratified by four variables (age, total number of tumors, pathological grade, and histology). RESULTS: A total of 5435 patients were included with a median age of 68 years (range, 6-94 years), of which 2131 (39.2%) were male, and 3510 (64.6%) were adenocarcinoma. The 5-year OS rate was 67.1%, 34.5%, 61.6%, 72.1%, and 75.0% for the entire study population, radiotherapy, wedge resection, segmentectomy, and lobectomy, respectively. In PSM analysis, wedge resection and segmentectomy were all superior to radiotherapy (P < 0.001), and segmentectomy was superior to wedge resection (P = 0.043), while segmentectomy was comparable with lobectomy (P = 0.058). In patients with multiple tumors, radiotherapy brought similar survival to surgery (wedge resection versus radiotherapy, P = 0.323; segmentectomy versus radiotherapy, P = 0.170; lobectomy versus radiotherapy, P = 0.796). CONCLUSIONS: Among stage IA lung cancer with ≤1 cm, segmentectomy and lobectomy were identified as the potential effective treatments, with segmentectomy more preferred, while radiotherapy would be recommended in those with multiple tumors, which requires further verification.

Initial treatment of early-stage small-sized non-small cell lung cancer for octogenarians: a population-based study.

The objectives of this study is to figure out the appropriate initial treatment and criteria for clinical decision for early-stage small-sized non-small cell lung cancer (NSCLC) among octogenarians. Elderly patients (≥80 years) with stage I NSCLC (<3 cm) were identified between 2004 and 2015 in the Surveillance, Epidemiology, and End Results database. Patients were divided into four cohorts regarding treatment modalities, and overall survival and cancer-specific survival were evaluated via Kaplan-Meier analysis and Cox proportional hazard model. The propensity score matching method was introduced in the subgroup analysis stratified by four clinical characteristics to identify the preferable treatment. A total of 7861 patients were included with a median overall survival of 43 months (range 1-155 months). In younger patients (80-85 years), lobectomy was superior in improving the survival (versus segmentectomy, HR = 0.68, 95%CI 0.55-0.84; versus wedge resection, HR = 0.77; 95%CI 0.67-0.88). While in those over 85 years, lobectomy was superior to wedge resection (HR = 0.72; 95%CI 0.53-0.98), and all other treatments were comparable. As stratified by T stage in those over 85 years, lobectomy was superior to wedge resection (P = 0.023) for T1 disease, and the four treatments were all comparable in overall survival for T2 disease. In conclusions, the favored treatment of early stage NSCLC for octogenarians may be evaluated by age and T stage. Lobectomy might be preferred in patients between 80 and 85 years whenever possible. Among those over 85 years, radiotherapy might lead to a comparable prognosis and could be recommended as the prior treatment, while should surgery be recommended, lobectomy might be preferred for T1 disease and wedge resection for T2 disease.

The complete mitochondrial genome of Philus pallescens Bates, 1866 (Coleoptera: Vesperidae) and its phylogenetic implications.

We sequenced and assembled the complete mitochondrial genome of Philus pallescens from Madou, Tainan County, Taiwan. The complete mitogenome of P. pallescens is 15,750 bp long, and contains 13 protein-coding, 22 tRNA and two rDNA genes. Nucleotide compositions of the mitogenome of P. pallescens are A: 38.08%, T: 32.25%, C: 18.67%, and G: 11.00%. The AT and GC skewness of the mitogenome sequence were 0.0828 and -0.25845 respectively, showing the genome composition skewed toward adenine and cytosine. The phylogenetic position of Chrysomelidae is sister to all the other families in the superfamily Chrysomeloidea. The results indicate that Chrysomeloidea Cerambycidae is not a monophyletic group. Philus is phylogenetically close to Spiniphilus. Vesperidae is monophyletic and sister to Disteniidae. Mitogenomic data from this study will provide useful information for further studies on the population genetics, speciation, and pest management of P. pallescens.

Treatment Modality for Stage IB Peripheral Non-Small Cell Lung Cancer With Visceral Pleural Invasion and ≤3 cm in Size.

Purpose: To compare the survival difference among lobectomy, segmentectomy, and wedge resection and investigate the role of adjuvant chemotherapy for early-stage small-sized non-small cell lung cancer (NSCLC) with visceral pleural invasion (VPI). Methods: Patients diagnosed with stage IB peripheral NSCLC with VPI and ≤3 cm in size in the Surveillance, Epidemiology, and End Results database between 2004 and 2015 were included, and the pleural layer (PL) invasion status was identified to recognize the tumors with VPI, including PL1 and PL2. We conducted Cox proportional hazards model in multivariable analysis and subgroup analysis via propensity score matching (PSM) method and Cox regression method to figure out the optimal therapy for these patients. Results: A total of 1,993 patients were included, all of whom received surgery, and the median follow-up was 33 months (range, 1-83 months). In multivariable analysis, age, gender, histology, pathological grade, lymph node examination, surgical approaches, and radiotherapy were independent prognostic factors for overall survival (OS). Lobectomy was superior to sublobar resection [hazard ratio (HR) = 1.41; 95% CI, 1.08-1.83], and wedge resection was associated with impaired survival compared to lobectomy (HR = 1.64; 95% CI, 1.22-2.20) in PSM analyses. In subgroup analysis, lobectomy was superior to sublobar resection among those aged <70 years (HR = 1.81; 95% CI, 1.13-2.90), female (HR = 1.75; 95% CI, 1.21-2.53), and 1-20 mm in size (HR = 1.61; 95% CI, 1.11-2.33). No survival benefit was observed for adjuvant chemotherapy. Conclusions: Lobectomy was superior to wedge resection and comparable with segmentectomy for stage IB NSCLC (≤3 cm) with VPI, and adjuvant chemotherapy could not benefit these patients, even in those with sublobar resection. The preferred surgical procedure remains to be studied in prospective controlled trials.

Characterization of the complete mitochondrial genome of Euwallacea fornicatus (Eichhoff, 1868) (Coleoptera: Curculionidae: Scolytinae) and its phylogenetic implications.

In the present report, we described the complete mitochondrial genome of Euwallacea fornicatus from Sindien, New Taipei City, Taiwan. The length of the complete mitogenome of E. fornicatus is 15,743 bp and the mitogenome contains 13 protein-coding, 22 tRNA and two rDNA genes. Nucleotide compositions of the whole mitogenome are 39.41% for A, 33.84% for T, 16.64% for C, and 10.11% for G. The AT and GC skewness of mitogenome sequence was 0.076 and -0.244, showing the A-skew and C-skew. The reconstructed phylogenetic relationships of 33 Curculionid species based on 13 mitochondrial protein-coding genes received absolute support (100%). Euwallacea fornicates is sister to the rest species in Xyleborini. The phylogenetic position of Scolytinae is sister to the clade including Cucurlioninae, Molytinae and Cryptorhynchinae. Mitogenomic data from this study will provide useful information for further studies for the population genetics, invasive history and pest control of E. fornicatus in the future.

Temperature-dependent life history of Oligonychus mangiferus (Acari: Tetranychidae) on Mangifera indica.

The mango red spider mite, Oligonychus mangiferus (Rhaman and Sapra), is a major mango pest in Taiwan. This mite damages the leaves of the mango tree and affects the quality of the fruit. This study investigates the life history of the mango red spider mite on Mangifera indica L. cv. Irwin at five constant temperatures (17, 21, 25, 29, and 33 °C), under 80 ± 5 % RH and L12:D12 photoperiod conditions. An increase in temperature significantly decreased the developmental times for each stage and the overall immature period in females and males. The lower developmental thresholds of the immature stage were 12.5 and 12.4 °C for females and males, respectively. The thermal summations for the development of the immature stage were 185.9 and 175.7 degree-days for females and males, respectively. Based on the annual field temperature, an estimated 26 generations can reproduce in a mango orchard annually. The longevity of adults of both sexes decreased as temperature increased, and adult males lived longer than females. The preoviposition periods were shorter than 1 day when the temperature exceeded 25 °C. The development period and the oviposition period were shortest at 29 °C. At this point, daily fecundity was highest, and fecundity was second highest, resulting in the highest intrinsic rate of increase (r m ), 0.182 day(-1). These life history traits are applied to improve the management of O. mangiferus.

Clinical characteristics, treatment and prognostic factors of candidal meningitis in a teaching hospital in Taiwan.

The prognostic factors of candidal meningitis had rarely been studied owing to the rarity of this disease. We identified 17 patients with candidal meningitis at a teaching hospital in Taiwan over a 14-y period and give details of the clinical features, treatment, outcome and prognostic factors of this disease. 10 patients were children (1 was neonate) and 7 were adults. The clinical features and cerebrospinal fluid (CSF) findings were non-specific. The disease was diagnosed > 72 h after hospitalization in 14 (82%) patients. The most frequently isolated species was Candida albicans (65%). Regimens of therapy included intravenous amphotericin B deoxycholate (AmB) or fluconazole alone, or a combination of intravenous AmB with intrathecal AmB, flucytosine or fluconazole. All indwelling central nervous system devices were externalized or removed. Four adults died of the disease. Three of them had malignancy and had received < 48 h of antifungal therapy. For adult patients with malignancy, early diagnosis and alternative treatment modalities with newer antifungal agents may be needed.

Clinical significance of Candida species isolated from cerebrospinal fluid.

Candida species have only rarely been isolated from the cerebrospinal fluid. Some of these isolates are true pathogens with a high morbidity and mortality, while others are only colonizers or contaminants. Spontaneous recovery from Candida meningitis has also been reported. The purpose of this study was to identify factors indicative of patients positive for Candida from cerebrospinal fluid who should receive antifungal therapy. A total of 36 patients with a positive cerebrospinal fluid culture for Candida were included in this retrospective analysis. Seventeen of these patients had received antifungal therapy under the impression of Candida meningitis. The differences in the case fatality rate and the duration of hospitalization between the antifungal treatment and untreated groups were statistically significant (p<0.04 and p<0.005, respectively). Statistical analysis showed a significant difference in the percentage of patients with previous ventricular shunt (14/17 vs 8/19, p<0.05), central venous line in situ (9/17 vs 1/19, p<0.005), multiple positive cerebrospinal fluid culture (11/17 vs 1/19, p<0.0005), isolation of Candida at least 20 days after hospitalization in adults (6/7 vs 1/13, p<0.005), and cerebrospinal fluid white blood cell count (median 77 vs 2 /mm3, p<0.005). These results suggest that antifungal agent should be initiated promptly in patients whose cerebrospinal fluid is positive for Candida and who have one or more of the identified risk factors.