Postoperative adjuvant therapy for hepatocellular carcinoma with microvascular invasion

Hepatocellular carcinoma(HCC)is one of the most lethal tumors in the world.Liver resection(LR)and liver transplantation(LT)are widely considered as radical treatments for early HCC.However,the recurrence rates after curative treatment are still high and overall survival is unsatisfactory.Microvascular invasion(MVI)is considered to be one of the important prognostic factors affecting postoperative recurrence and long-term survival.Unfortunately,whether HCC patients with MVI should receive postoperative adjuvant therapy remains unknown.In this review,we summarize the therapeutic effects of transcatheter arterial chemoembolization,hepatic arterial infusion chemotherapy,tyrosine protein kinase inhibitor-based targeted therapy,and immune checkpoint inhibitors in patients with MVI after LR or LT,aiming to provide a reference for the best adjuvant treatment strategy for HCC patients with MVI after LT or LR.

Scientific Hepatectomy for Hepatocellular Carcinoma

With advances in imaging technology and surgical instruments,hepatectomy can be perfectly performed with technical precision for hepatocellular carcinoma(HCC).However,the 5-year tumor recurrence rates remain greater than 70%.Thus,the strategy for hepatectomy needs to be reappraised based on insights of scientific advances.Scientific evidence has suggested that the main causes of recurrence after hepatectomy for HCC are mainly related to underlying cirrhosis and the vascular spread of tumor cells that basically cannot be eradicated by hepatectomy.Liver transplantation and systemic therapy could be the solution to prevent postoperative recurrence in this regard.Therefore,determining the severity of liver cirrhosis for choosing the appropriate surgical modality,such as liver transplantation or hepatectomy,for HCC and integrating newly emerging immune-related adjuvant and/or neoadjuvant therapy into the strategy of hepatectomy for HCC have become new aspects of exploration to optimize the strategy of hepatectomy.In this new area,hepatectomy for HCC has evolved from a pure technical concept emphasizing anatomic resection into a scientific concept embracing technical considerations and scientific advances in underlying liver cirrhosis,vascular invasion,and systemic therapy.By introducing the concept of scientific hepatectomy,the indications,timing,and surgical techniques of hepatectomy will be further scientifically optimized for individual patients,and recurrence rates will be decreased and long-term survival will be further prolonged.

Machine learning predicts portal vein thrombosis after splenectomy in patients with portal hypertension: Comparative analysis of three practical models

BACKGROUND For patients with portal hypertension(PH),portal vein thrombosis(PVT)is a fatal complication after splenectomy.Postoperative platelet elevation is considered the foremost reason for PVT.However,the value of postoperative platelet elevation rate(PPER)in predicting PVT has never been studied.AIM To investigate the predictive value of PPER for PVT and establish PPER-based prediction models to early identify individuals at high risk of PVT after splenectomy.METHODS We retrospectively reviewed 483 patients with PH related to hepatitis B virus who underwent splenectomy between July 2011 and September 2018,and they were randomized into either a training(n=338)or a validation(n=145)cohort.The generalized linear(GL)method,least absolute shrinkage and selection operator(LASSO),and random forest(RF)were used to construct models.The receiver operating characteristic curves(ROC),calibration curve,decision curve analysis(DCA),and clinical impact curve(CIC)were used to evaluate the robustness and clinical practicability of the GL model(GLM),LASSO model(LSM),and RF model(RFM).RESULTS Multivariate analysis exhibited that the first and third days for PPER(PPER1,PPER3)were strongly associated with PVT[odds ratio(OR):1.78,95%confidence interval(CI):1.24-2.62,P=0.002;OR:1.43,95%CI:1.16-1.77,P<0.001,respectively].The areas under the ROC curves of the GLM,LSM,and RFM in the training cohort were 0.83(95%CI:0.79-0.88),0.84(95%CI:0.79-0.88),and 0.84(95%CI:0.79-0.88),respectively;and were 0.77(95%CI:0.69-0.85),0.83(95%CI:0.76-0.90),and 0.78(95%CI:0.70-0.85)in the validation cohort,respectively.The calibration curves showed satisfactory agreement between prediction by models and actual observation.DCA and CIC indicated that all models conferred high clinical net benefits.CONCLUSION PPER1 and PPER3 are effective indicators for postoperative prediction of PVT.We have successfully developed PPER-based practical models to accurately predict PVT,which would conveniently help clinicians rapidly differentiate individuals at high risk of PVT,and thus guide the adoption of timely interventions.

Diagnosis and Treatment of Cholangiocarcinoma: A Consensus from Surgical Specialists of China

Cholangiocarcinoma refers to malignant tumors that develop in epithelial lining of biliary system, and it is divided into two categories according to tumor location, intrahepatic cholangiocarcinoma （ICC） and extrahepatic cholangiocarcinoma （ECC）. ICC occurs from the epithelial cells of the intrahepatic bile duct, its branches and interlobular biliary tree; and ECC is divided into hilar cholangiocarcinoma and distal cholangiocarcinoma by the circumscription at the confluence of cystic duct and the common hepatic duct.

Effect of Quenching Parameters on Mechanical Property of Ultra High Strength Steel BR1500HS Based on Response Surface Methodology

Hot stamping of high strength steels is defined as a process in which blank is heated to the temperature of the austenite stabilization region for a definite time and then formed and quenched simultaneously in a mold with cooling channels. During this process,the processing parameters of austenite temperature and soaking time have strong effects on the mechanical properties such as quenching hardness,tensile strength and elongation. Hence,it is necessary to investigate the relationship between the mechanical properties and the two processing parameters. In this paper,the orthogonal experiment with two factors and five levels was applied, and the experimental data based on the orthogonal experiment was acquired. Based on the data,regression models were set up and the results of the analysis of variance( ANOVA) showed that it is reliable to predict the quenching hardness,tensile strength and elongation by the regression models. Besides,the optimal results of each single object were obtained based on response surface methodology( RSM),and global optimums was gained by employing ideal point method in which the quenching hardness,and tensile strength and elongation were considered simultaneously.

Reconstruction of vector static magnetic field by different axial NV centers using continuous wave optically detected magnetic resonance in diamond

We carried out a proof-of-principle demonstration of the reconstruction of a static vector magnetic field involving adjacent three nitrogen-vacancy(NV) sensors with corresponding different NV symmetry axes in a bulk diamond. By means of optical detection of the magnetic resonance(ODMR) techniques, our experiment employs the continuous wave(CW) to monitor resonance frequencies and it extracts the information of the detected field strength and polar angles with respect to each NV frame of reference. Finally, the detected magnetic field relative to a fixed laboratory reference frame was reconstructed from the information acquired by the multi-NV sensor.

A 3D SiC MOSFET with poly-silicon/SiC heterojunction diode

A three-dimensional(3D)silicon-carbide(SiC)trench metal-oxide-semiconductor field-effect transistor(MOSFET)with a heterojunction diode(HJD-TMOS)is proposed and studied in this work.The SiC MOSFET is characterized by an HJD which is partially embedded on one side of the gate.When the device is in the turn-on state,the body parasitic diode can be effectively controlled by the embedded HJD,the switching loss thus decreases for the device.Moreover,a highly-doped P+layer is encircled the gate oxide on the same side as the HJD and under the gate oxide,which is used to lighten the electric field concentration and improve the reliability of gate oxide layer.Physical mechanism for the HJD-TMOS is analyzed.Comparing with the conventional device with the same level of on-resistance,the breakdown voltage of the HJD-TMOS is improved by 23.4%,and the miller charge and the switching loss decrease by 43.2%and 48.6%,respectively.

Insight into structural degradation of NCMs under extreme fast charging process

Lithium-ion batteries(LIBs)with extreme fast charging(XFC)capability are considered an effective way to alleviate range anxiety for electric vehicle(EV)buyers.Owing to the high ionic and electronic conductivity of LiNi_(x)Co_(y)Mn_zO_(2)(x+y+z=1,NCM)cathodes,the inevitable Li plating of graphite in NCM|graphite cell is usually identified as a key bottleneck for XFC LIBs.However,the capacity decay mechanism of cathode materials under XFC has not been fully investigated.In this work,three typical NCM cathode materials with different Ni fractions were chosen and their electrochemical performances under XFC associated with structural evolution were investigated.A faster capacity decay of NCMs under XFC conditions is observed,especially for Ni-rich NCMs.In-situ X-ray diffraction(XRD)reveals that the multiple caxis parameters appear at the high-voltage regions in Nirich NCMs,which is probably triggered by the larger obstruction of Li(de)intercalation.Particularly,NCMs with moderate Ni fraction also present a similar trend under XFC conditions.This phenomenon is more detrimental to the structural and morphological stability,resulting in a faster capacity decay than that under low current charging.This work provides new insight into the degradation mechanism of NCMs under XFC conditions,which can promote the development of NCM cathode materials with XFC capability.

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

Background:Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma(HCC)patients.The impact of the degrees of cirrhosis on prediction of post-hepatectomy liver failure(PHLF)remains poorly defined.This study aimed to construct and validate a combined pre-and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center’s data.Methods:Consecutive HCC patients who underwent hepatectomy between May 18,2019 and Dec 19,2020 were enrolled at five tertiary hospitals.Preoperative cirrhotic severity scoring(CSS)and intra-operative direct liver stiffness measurement(DSM)were performed to correlate with the Laennec histopathological grading system.The performances of the pre-operative nomogram and combined pre-and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.Results:For 327 patients in this study,histopathological studies showed the rates of HCC patients with no,mild,moderate,and severe cirrhosis were 41.9%,29.1%,22.9%,and 6.1%,respectively.Either CSS or DSM was closely correlated with histopathological stages of cirrhosis.Thirty-three(10.1%)patients developed PHLF.The 30-and 90-day mortality rates were 0.9%.Multivariate regression analysis showed four pre-operative variables[HBV-DNA level,ICG-R15,prothrombin time(PT),and CSS],and one intra-operative variable(DSM)to be independent risk factors of PHLF.The pre-operative nomogram was constructed based on these four pre-operative variables together with total bilirubin.The combined pre-and intra-operative nomogram was constructed by adding the intra-operative DSM.The pre-operative nomogram was better than the conventional models in predicting PHLF.The prediction was further improved with the combined pre-and intra-operative nomogram.Conclusions:The combined pre-and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.

Expert Consensus on Pathological Diagnosis of Intrahepatic Cholangiocarcinoma(2022 version)

Intrahepatic cholangiocarcinoma(iCCA)can originate from the large bile duct group(segment bile ducts and area bile ducts),small bile duct group(septal bile ducts and interlobular bile ducts),and terminal bile duct group(bile ductules and canals of Hering)of the intrahepatic biliary tree,which can be histopathological corresponding to large duct type iCCA,small duct type iCCA and iCCA with ductal plate malformation pattern,and cholangiolocarcinoma,respectively.The challenge in pathological diagnosis of above subtypes of iCCA falls in the distinction of cellular morphologies,tissue structures,growth patterns,invasive behaviors,immunophenotypes,molecular mutations,and surgical prognoses.For these reasons,this expert consensus provides nine recommendations as a reference for standardizing and refining the diagnosis of pathological subtypes of iCCA,mainly based on the 5th edition of the World Health Organization Classification of Tumours of the Digestive System.

Splenectomy may facilitate systemic therapy for advanced hepatocellular carcinoma with hypersplenism

Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related deaths globally and is widely considered to be a serious threat to human health.In clinical settings,more than 70%of HCCs are unresectable at initial diagnosis and are therefore treated with palliative rather than curative treatment,which severely reduces the overall survival of HCC patients(1).

Large margin classification for combatingdisguise attacks on spam filters

This paper addresses the challenge of large margin classification for spare filtering in the presence of an adversary who disguises the spam mails to avoid being detected. In practice, the adversary may strategically add good words indicative of a legitimate message or remove bad words indicative of spam. We assume that the adversary could afford to modify a spam message only to a certain extent, without damaging its utility for the spammer. Under this assumption, we present a large margin approach for classification of spare messages that may be disguised. The proposed classifier is formulated as a second-order cone programming optimization. We performed a group of experiments using the TREC 2006 Spam Corpus. Results showed that the performance of the standard support vector machine （SVM） degrades rapidly when more words are injected or removed by the adversary, while the proposed approach is more stable under the disguise attack.

A voltammetric sensor for simultaneous determination of lead,cadmium and zinc on an activated carbon fiber rod

In this work, a simple, low cost and sensitive voltammetric sensor was developed for the simultaneous detection of lead （Pb2＋）, cadmium （Cd2＋）, and zinc （Zn2＋） ions based on a disposable carbon fiber rod （CFR）. The important factors to enhance the sensing property were creation of a clean surface by dealing with CFR at a high potential and electrochemical deposition of bismuth （Bi） film to improve the accumulation of heavy metal ions. The morphology and conductivity of such activated CFR was characterized by scanning electron microscopy and electrochemical impedance spectroscopy, respectively. In terms of application, differential pulse anodic stripping voltammetry （DPASV） was employed for the simultaneous detection of Pb2＋, Cd2＋, and Zn2＋ on Bi film-coated activated CFR. Experimental parameters, such as the pH value of buffer solution, stirring speed and enrichment factors were optimized. Under optimal conditions, the DPASV peak currents showed good linear relationships with Pb2＋, Cd2＋ and Zn2＋ concentrations in the range of 0.5-2.25 μg/L, 0.5-4.0 μg/L and 1.0- 4.0 μg/L with detection limits of 0.1, 0.3 and 1.0 μg/L （SIN = 3）, respectively. Finally, the proposed analysis system was successfully utilized for the simultaneous detection of Pb2＋, Cd2＋, and Zn2＋ contents in rice samples. This study indicated that Bi film-coated activated CFR based DPASV sensor can be a promising and reliable tool for rapid analysis of emergency Dollution affairs of heavv metal ions in food.

Effects of metallic microstructures on fatigue fracture of Q345 steel

Effects of high-frequency cyclic loading on the banded ferrite-pearlite steel were analyzed through crack initiation and propagation. Interfaces of ferrite and pearlite colony with a small angle deviation from the loading axis were verified to be the most potential sites to fabricate the microcracks caused by the high strain gradient. The initial crack extension inside ferrite grain was driven by shear stress in model II along the direction with a 45° angle to the loading axis. Banded pearlite colony and the high-angle grain boundaries were considered as the dominant factors that promote the fatigue resistance of the material through arousing crack deflection in short crack propagation range and crack branching in long crack propagation range to reduce the crack propagation driving force in the crack tip. P-S-N curves were used to quantify the dispersion of fatigue lifetimes and evaluate the effect of elevated volume content of pearlite colony on the fatigue performance of the material.