The aim of this study was to develop nomograms for predicting the risk of locoregional recurrence or distant metastasis in esophageal cancer patients who were treated with esophagectomy and regional lymphadenectomy. The clinicopathologic data of 408 esophageal cancer patients after esophagectomy and regional lymphadenectomy were analyzed in this study. Univariate and multivariate COX regression analyses were used to test the association between the clinicopathologic data and the risk of locoregional recurrence or distant metastasis. The nomograms were built from the COX regression model. Univariate analyses revealed that tumor length, tumor width, T-staging and perineural invasion(PNI) were significantly associated with locoregional recurrence, and that tumor length, tumor width, differentiation, T-staging, N-staging, lymph vascular space invasion(LVSI), PNI and adjuvant chemotherapy were significantly associated with distant metastasis. Multivariate analyses revealed that tumor length, tumor width and T-staging were predictors of risk of locoregional recurrence, and that differentiation, N-staging, LVSI and PNI were predictors of risk of distant metastasis. Two nomograms were constructed for a visual explanation of these two COX regression models. The bias-corrected curve showed no significant departure from the ideal curve in these two nomograms. Two nomograms were developed and validated to predict the risk of locoregional recurrence and distant metastasis in esophageal cancer patients after radical esophagectomy. The calculation outcome will help oncologists to choose adjuvant treatment regimens.

Objective: A Phase II study was designed to test the safety and efficacy of concurrent chemoradiotherapy with a modified target volumes delineation method for inoperable oesophageal cancer patients. Methods: All eligible patients were treated with concurrent chemoradiotherapy. The method of delineating target volume is as follows: Planning gross target volume (PGTV) was defined as the primary gross tumour volume (GTV-t) plus a 3 cm margin longitudinally and a 0.5 cm margin circumferentially, and positive lymph nodes(GTV-n) plus a 0.5 cm margin in all directions. Clinical target volume (CTV) was defined as PGTV plus a 0.5 cm margin in all directions and elective nodal region. Planning target volume (PTV) was defined as CTV plus a 0.5 cm margin in all directions. The dose of PGTV is 54–60 Gy in 27–30 fractions(2Gy per fraction). The dose of PTV is 48.6–54 Gy in 27–30 fractions(1.8Gy per fraction). The regimen consists of paclitaxel135 mgm− 2 on 1 day and DDP 25 mgm− 2 on 3 days per 3 weeks. The patients received 2 cycles of chemotherapy during radiotherapy and 2–4 cycles of chemotherapy after radiotherapy. Results: 34 patients were enrolled in this study. The median follow-up time was 20.9 months (range: 3.7–28.4 months) for all patients. The 1- and 2-year survival rates for all patients were 70.5 and 44.1%, respectively. Clinical complete response was observed in 21 patients(61.8%), cPR was observed in 9 patients(26.5%) and cSD was observed in 4 patients(11.7%). Conclusion: This modified method with concurrent chemotherapy could achieve better locoregional control rate. The 1- and 2-year survival rates of this method were close to the survival rates of the current methods widely adopted. Advances in knowledge: The modified target volumes delineation method can enhance locoregional control rate of concurrent chemoradiotherapy.

Purpose: Using data from the National Health and Nutrition Examination Survey (NHANES) and employing Controlled Attenuation Parameter (CAP) measures, this study explores the correlation between vitamin E (VE) intake and hepatic steatosis and its impact on different subsets. Materials and methods: We selected 5757 participants with CAP data from the 2017–2020 NHANES dataset. Daily VE intake was assessed by a 24-hour dietary recall. Hepatic fat content was quantified using transient elastography to measure CAP. Stratified multivariable regression analysis investigated relationships in different subsets, and a generalized additive model identified nonlinear relationships and thresholds. Results: After adjusting for confounders, higher VE intake correlated with lower CAP levels. Subgroup analyses and tests for interaction revealed a significantly stronger negative correlation between VE intake and CAP in obese individuals. Further analysis indicated a curvilinear relationship between VE intake and the severity of liver fat degeneration in both the general study population and the obese subgroup, demonstrating a threshold effect. In the general population, VE intake below the threshold (6.58 mg/day) is positively correlated with CAP levels, whereas intake above this threshold shows a negative correlation. For obese individuals, the threshold is set at 7.37 mg/day, above which the negative correlation with CAP is even more pronounced. Conclusion: Our study revealed a negative correlation between VE intake and hepatic fat content, highlighting the potentially crucial role VE plays in obese fatty liver patients. Importantly, we identified threshold effects of VE intake in both general and obese populations. Our results support clinical nutritional interventions, personalized dietary guidance, and the development of drugs to combat fatty liver.

The incidence of non-alcoholic fatty liver disease (NAFLD) tends to be younger. And the role of theobromine in fatty liver disease remains unclear. The purpose of this study was to investigate the relationship between dietary theobromine intake and degree of hepatic steatosis in individuals aged 45 and below, using data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES) and liver ultrasonography transient elastography. A total of 1796 participants aged below 45 years were included from NHANES 2017–2020 data after applying exclusion criteria. Multivariate regression and subgroup analyses were conducted to examine the associations between theobromine intake and controlled attenuation parameter (CAP), adjusting for potential confounders. Generalized additive models and two-piecewise linear regression were used to analyze nonlinear relationships. In the unadjusted Model 1 and preliminarily adjusted Model 2, there was no significant correlation between theobromine intake and CAP values. However, in Models 3 and 4, which accounted for confounding factors, a higher intake of theobromine was significantly associated with lower CAP values. Subgroup analyses in the fully adjusted Model 4 revealed a significant negative correlation among individuals aged 18–45, women, and white populations. Nonlinear analysis revealed a U-shaped relationship in black Americans, with the lowest CAP values at 44.5 mg/day theobromine. This study provides evidence that higher theobromine intake is correlated with lower degree of hepatic steatosis in young people, especially those aged 18–45 years, women, and whites. For black Americans, maintaining theobromine intake around 44.5 mg/day may help minimize liver steatosis. These findings may help personalize clinical nutritional guidance, prevent the degree of hepatic steatosis, and provide pharmacological approaches to reverse fatty liver disease in young people.

This study investigates the relationship between homocysteine (Hcy) levels and decreased intrinsic capacity (DIC) in older adults over 60 years of age, against the backdrop of rising cognitive decline in aging populations. Elevated Hcy, linked to various diseases, may serve as a biomarker for DIC. A cross-sectional study was conducted on 1311 community-dwelling older adults aged 60–91 years in Hangzhou, China, from March 2023 to June 2023. The primary exposure was Hcy level, with DIC as the outcome, assessed via the World Health Organization Intrinsic Capacity Composite Assessment scale. Covariates included gender, age, education, blood pressure, body mass index, and C-reactive protein. Data were analyzed using logistic regression models. Higher Hcy levels were significantly associated with increased DIC risk (OR = 1.03, 95% CI: 1.00–1.07, P = .0439). A non-linear relationship was observed, with a threshold effect at 14.6 μmol/L. Below this, each 1 μmol/L increase in Hcy corresponded to an 8% rise in DIC risk (95% CI: 1.02–1.15, P = .0137). In the very elderly, a stronger association was noted below 11.8 μmol/L (OR = 1.35, 95% CI: 1.143–1.61, P = .0005). Elevated Hcy levels are positively associated with the risk of DIC, especially among middle-aged and older adults, and exhibit a non-linear threshold effect. These findings suggest the potential of Hcy as a biomarker for DIC, advocating for age-specific management strategies. Further research should explore underlying mechanisms and validate these results across diverse populations.