Background: Anastomotic leak is an important cause of morbidity and mortality after esophagectomy for esophageal cancer patients. Calcification of the arteries supplying the gastric tube has been found to be associated with leakage after esophagectomy with cervical anastomosis in Europeans. The purpose of this study is to evaluate the association between calcifications of the supplying arteries of the gastric tube and the occurrence of anastomotic leakage after esophagectomy with cervical anastomosis in Chinese patients with esophageal cancer. Methods:The demographic, clinical, and pathological features as well as the vascular calcification of arteries of 709 esophageal cancer patients who had undergone esophagectomies with cervical anastomosis were analyzed. Univariable and multivariable logistic regression were used to identify the association between the postoperative anastomotic leakage and calcifications of the arteries supplying the gastric tube.Results: Among the 709 patients, 122 (17.2%) had developed anastomotic leakage. Thirty-day mortality and length of hospital stay were higher for patients with anastomotic leakage. Upper digestive tract ulcer, peripheral vascular disease, renal insufficiency, American society of Anesthesiologists (ASA) risk class, and calcifications of aorta and celiac axis were found to be independent risk factors for the anastomotic leakage.Conclusions: Calcification of the aorta and celiac axis that supply the gastric tube is an independent risk factor for cervical anastomotic leakage after esophagectomy in Chinese esophageal cancer patients.

Abstract. The surgical management of patients with malignant biliary and duodenal obstruction is complex. Tumor excision is no longer possible in the majority of patients with malignant obstructive jaundice and duodenal obstruction. The aim of the present study was to evaluate the effectiveness of intraluminal dual stent placement in malignant biliary and duodenal obstruction. In total, 20 patients with malignant obstructive jaundice and duodenal obstruction, including 6 with pancreatic carcinoma, 11 with cholangiocarcinoma, 1 with duodenal carcinoma and 2 with abdominal lymph node metastasis, were treated with intraluminal stent placement. Bile duct obstruction with late occurrence of duodenal obstruction was observed in 16 cases, and duodenal obstruction followed by a late occurrence of bile duct obstruction was observed in 3 cases, while, in 1 case, bile duct obstruction and duodenal obstruction occurred simultaneously. After X-ray fluoroscopy revealed obstruction in the bile duct and duodenum, stents were placed into the respective lumens. Percutaneous transhepatic placement was employed for the biliary stent, while the duodenal stent was placed perioraly. The clinical outcomes, including complications associated with the procedures and patency of the stents, were evaluated. The biliary and duodenal stents were successfully implanted in 18 patients and the technical success rate was 90% (18/20). A total of 39 stents were implanted in 20 patients. In 2 cases, duodenal stent placement failed following biliary stent placement. Duodenal obstruction remitted in 15 patients, and 1 patient succumbed to aspiration pneumonia 5 days after the procedure. No severe complications were observed in any other patient. The survival time of the 18 patients was 5-21 months (median, 9.6 months), and 6 of those patients survived for >12 months. The present study suggests that X-ray fluoroscopy-guided intraluminal stent implantation is an effective procedure for the treatment of malignant biliary and duodenal obstruction. IntroductionBiliary and duodenal obstruction is a common complication in patients with gastroduodenal or pancreatobiliary malignancies. Stent implantation has been widely used in clinical practice, which is the preferred method for palliative management of malignant biliary and duodenal obstruction (1-6). Obstructive jaundice accompanied by duodenal obstruction is mainly caused by periampullary or pancreatic head carcinoma, malignant duodenal tumor and lymph node metastasis. Biliary and duodenal obstruction causes cholestasis and hepatic insufficiency. Patients with malignant obstructive jaundice and duodenal obstruction are in a poor condition or the tumor has already invaded the surrounding tissue or organs, thus tumor excision in no longer possible (7).The most commonly used surgical approach for biliary and duodenal obstruction is palliative cholangioenteric anastomosis, gastroenterostomy or jejunostomy; however, these approaches are not considered safe for patients who are weak, have electrolyte imbalance o...

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machine. They were validated using public DNA methylation data of thyroid tissues. Candidate markers were developed into a targeted sequencing panel and were validated on plasma DNA samples (115 PTC, 102 benign nodules). Best-performing markers were developed into an improved panel to classify additional plasma DNA samples of malignant or benign thyroid nodules.Results: From the MONOD+ data we identified over 1000 DNA methylation markers significantly differential between malignant and benign nodules. We built a classification model by random forest method, which classified DNA methylation profiles of thyroid nodules at a sensitivity of 90.5% and a specificity of 91.9% (95% CI, 0.91-1.0). We produced a targeted sequencing panel using those markers and sequenced plasma DNA of PTC and benign nodules. Two thirds of them were used as a training cohort to build a prediction model, which classified the remaining samples at an accuracy of 72%. We selected the best-performing markers to build an advanced version of panel, which classified additional 300 plasma DNA samples of thyroid nodules with increased sequencing depth to improve the accuracy and consistency in classification.Conclusions: Our study demonstrates that DNA methylation markers can robustly differentiate thyroid nodules based on their malignancy. They are thus promising candidates to develop non-invasive diagnostics for thyroid cancer screening.