A consensus treatment strategy for esophageal squamous cell carcinoma (ESCC) patients who recur after definitive radiochemotherapy/radiotherapy has not been established. This study compared the outcomes in ESCC patients who underwent salvage surgery, salvage chemoradiation (CRT) or best supportive care (BSC) for local recurrence. Ninety-five patients with clinical stage I to III ESCC who had completely responded to the initial definitive radiochemotherapy or radiotherapy alone and developed local recurrence were enrolled in this study. Fifty-one of them received salvage esophagectomy, and R0 resection was performed in 41 patients, 36 underwent salvage CRT, and the remaining eight patients received BSC only. The 5-year overall survival was 4.6% for the 87 patients receiving salvage surgery or CRT, while all patients in the BSC group died within 12.0 months, the difference was statistically significant (P = 0.018). The 1-, 3-, 5-year survival rates in the salvage surgery and salvage CRT groups were 45.1%, 20.0%, 6.9% and 51.7%, 12.2%, 3.1%, respectively, there was no difference of overall survival between the two groups (P = 0.697). Patients also presented with lymph node relapse had inferior survival compared to those with isolated local tumor recurrence after salvage therapy. In the salvage surgery group, infections occurred in eight patients, and three developed anastomotic leakage. In the salvage CRT group, grade 2-4 esophagitis and radiation pneumonitis was observed in 19 and 3 patients, respectively. Seven patients (19.4%) developed esophagotracheal fistula or esophageal perforation. This study of salvage CRT versus salvage surgery for recurrent ESCC after definitive radiochemotherapy or radiotherapy alone did not demonstrate a statistically significant survival difference, but the frequency of complications including esophagotracheal fistula and esophageal perforation following salvage CRT was high.
Design and fabrication of alternative proton exchange membrane (PEM) with high proton conductivity is crucial to the commercial application of PEM fuel cell. Inspired by the bioadhesion principle, dopamine‐modified halloysite nanotubes (DHNTs) bearing –NH2 and –NH– groups are facilely synthesized by directly immersing natural halloysite nanotubes (HNTs) into dopamine aqueous solution under mild conditions. DHNTs are then embedded into sulfonated poly(ether ether ketone) (SPEEK) matrix to prepare hybrid membranes. HNTs‐filled hybrid membranes are prepared for comparison. The microstructure and physicochemical properties of the membranes are extensively investigated. Fourier transform infrared analysis implies that ordered acid–base pairs (e.g., –S–O–…+H–HN–, –S–O–…+H–N–) are formed at SPEEK–DHNT interface through strong electrostatic interaction. In such a way, continuous surface‐induced ion‐channels emerge along DHNTs. Although the incorporation of DHNTs reduces the channel size, water uptake, and area swelling of the hybrid membranes, which in turn would reduce the vehicle‐type proton transfer, the acid–base pairs create continuous pathways for fast proton transfer with low energy barrier via Grotthuss mechanism. Consequently, DHNT‐filled hybrid membrane with 15% DHNTs achieves a 30% increase in proton conductivity and a 52% increase in peak power density of single cell when compared with SPEEK control membrane, particularly.
We recommended MIPO as the optimal treatment for humeral shaft fractures after taking all outcomes into consideration; IMN was also recommended for its relatively good performance, but its complication still needed to be noticed.
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