The “No-touch” technique improves the survival of patients with advanced hepatocellular carcinomas treated by liver transplantation: A single-center prospective randomized controlled trial

Background:Liver transplantation(LT)is the best treatment for patients with hepatocellular carcinoma(HCC).However,the surgical technique needs to be improved.The present study aimed to evaluate the“no-touch”technique in LT.Methods:From January 2018 to December 2019,we performed a prospective randomized controlled trial on HCC patients who underwent LT.The patients were randomized into two groups:a no-touch technique LT group(NT group,n=38)and a conventional LT technique group(CT group,n=46).Operative outcomes and survival in the two groups were analyzed.Results:The perioperative parameters were comparable between the two groups(P>0.05).There was no significant difference between the two groups in disease-free survival(DFS)(P=0.732)or overall survival(OS)(P=0.891).Of 36 patients who were beyond the Hangzhou criteria for LT,the DFS of the patients in the NT group was significantly longer than that in the CT group(median 402 vs.126 days,P=0.025).In 31 patients who had portal vein tumor thrombosis(PVTT),DFS and OS in the NT group were significantly better than those in the CT group(median DFS 420 vs.167 days,P=0.022;2-year OS rate 93.8%vs.66.7%,P=0.043).In 14 patients who had diffuse-type HCCs,DFS and OS were significantly better in the NT group than those in the CT group(median DFS 141 vs.56 days,P=0.008;2-year OS rate 75.0%vs.33.3%,P=0.034).Multivariate analysis showed that for patients with PVTT and diffusetype HCCs,the no-touch technique was an independent favorable factor for OS(PVTT:HR=0.018,95%CI:0.001-0.408,P=0.012;diffuse-type HCCs:HR=0.034,95%CI:0.002-0.634,P=0.024).Conclusions:The no-touch technique improved the survival of patients with advanced HCC compared with the conventional technique.The no-touch technique may provide a new and effective LT technique for advanced HCCs.

Inflammatory myofibroblastic tumor of the pancreatic neck:A case report and review of literature

BACKGROUND Pancreatic inflammatory myofibroblastic tumor(IMT)is a relatively rare disease that is often confused with pancreatic cancer or pancreatic neuroendocrine tumors.The histological features of IMTs show that tissue from this type of tumor contains an intermingling of fibroblast and myofibroblast proliferation,accompanied by a varying degree of inflammatory cell infiltration.CASE SUMMARY The management of an IMT occurring at the neck of the pancreas is presented in this paper.A 66-year-old female patient was diagnosed with a pancreatic neck mass after a series of tests.The patient underwent enucleation of the pancreatic neck tumor after a pathological diagnosis of IMT.Previous research on the clinical features,pathological diagnosis and treatment of pancreatic IMTs was reviewed.Compared with previous reports,this is a unique case of enucleation of a pancreatic IMT.CONCLUSION The enucleation of pancreatic IMTs may be a safe and efficient surgical method for managing such tumors with a better prognosis.Further cases are required to explore surgical measures for pancreatic IMTs.

Combination of renoportal anastomosis and inferior mesenteric vein-portal anastomosis in liver transplantation:A new portal reconstruction technique

Liver transplantation (LT) is the only way to cure end-stage liver disease with or without tumors in the last few decades [1].However,critical issues such as how to rebuild portal flow in patients with portal vein thrombosis (PVT) or superior mesenteric vein (SMV) thrombosis have been challenging for surgeons.Adequate portal flow is critical in LT because more than 75%of the liver’s blood supply comes from the portal vein and the rest comes from the hepatic artery.PVT is a universal problem in LT.

Survival comparison between primary hepatic neuroendocrine neoplasms and primary pancreatic neuroendocrine neoplasms and the analysis on prognosis-related factors

Background:Primary hepatic neuroendocrine neoplasms(PHNENs)are extremely rare and few articles have compared the prognosis of PHNENs with other neuroendocrine neoplasms(NENs).This study aimed to investigate the different prognosis between PHNENs and pancreatic NEN(Pan NENs)and evaluate the relevant prognosis-related factors.Methods:From January 2012 to October 2016,a total of 44 NENs patients were enrolled and divided into two groups according to the primary tumor location which were named group PHNENs(liver;n=12)and group Pan NENs(pancreas;n=32).Demographic,clinical characteristics and survival data were compared between the two groups with Kaplan-Meier method and log-rank tests.Prognostic factors were analyzed using the Cox regression model.Results:The overall survival of group PHNENs and group Pan NENs were 25.4±6.7 months and 39.8±3.7 months,respectively(P=0.037).The cumulative survival of group Pan NENs was significantly higher than that of group PHNENs(P=0.029).Univariate analysis revealed that sex,albumin,total bilirubin,total bile acid,aspartate aminotransferase,alkaline phosphatase,α-fetoprotein and carbohydrate antigen 19-9,histological types,treatments and primary tumor site were the prognostic factors.Further multivariate analysis indicated that albumin(P=0.008),histological types NEC(P=0.035)and treatments(P=0.005)were the independent prognostic factors.Based on the histological types,the cumulative survival of patients with well-differentiated neuroendocrine tumor was significant higher than that of patients with poorly differentiated neuroendocrine carcinoma in group PHNENs(P=0.022),but not in group Pan NENs(P>0.05).According to the different treatments,patients who received surgery had significantly higher cumulative survival than those with conservative treatment in both groups(P<0.05).Conclusions:PHNENs have lower survival compared to Pan NENs.Histological types and treatments affect the prognosis.Surgical resection still remains the first line of treatment for resectable lesions and can significantly improve the survival.

A comparison study of atmospheric circulations and potential vorticity anomaly between the two rapid-intensified typhoons

For two rapid-intensification typhoons-Mujigae(2015)and Vicente(2012)-the atmospheric circulation conditions and potential vorticity(PV)anomaly are compared.Although similar in their rapid-intensification(RI)rate,their atmospheric circulation conditions differ considerably,with the absence or presence of an upper-tropospheric inverted trough(IT)being their main difference.The IT provides useful clues for the onset of RI,by estimating the interaction between the environmental upper-tropospheric IT and the typhoon based on eddy momentum flux convergence calculation.The trough–typhoon interaction is examined by comparing the PV transport process for the two cases.An isolated positive PV column develops vertically near Mujigae’s onset of RI,which is not influenced by synoptic-scale PV advection.However,for Vicente,another source-advection from a high-latitude PV reservoir along the upper-tropospheric IT-joins the built-up high-PV anomaly in favor of RI.

Association of handgrip strength with the prevalence of hypertension in a Chinese Han population

Objective: Handgrip strength (HGS) exercise has been reported to reduce blood pressure in both hypertensive and normotensive patients. In this study, we evaluated the association of HGS with hypertension in a Chinese Han Population. Methods: A total of 11,151 subjects mainly consisting of a rural population were recruited with a multi-stage sampling method in Jurong city, Jiangsu Province, China. Besides hypertension and diabetes, major chronic diseases were excluded. HGS was categorized into tertiles by age and gender. Logistic regression was used to estimate the association of HGS and hypertension with the odds ratio (OR) and 95% confidence interval (Cl). Results: From low to high tertiles of HGS, diastolic blood pressure (DBP) was significantly increased (74.52 ± 7.39,74.70 ± 7.03, and 75.54 ± 7.01 mmHg, respectively;Ptrend=0.001), as well as in females (Ptrend=0.003). The differences in DBP among the tertiles of HGS were still significant in females even after adjusting for covariates (Ptrend=0.048). No significant differences in systolic blood pressure (SBP) were observed among the tertiles of HGS (P>0.05). Compared to low HGS, high HGS was significantly associated with hypertension after adjustment for age and gender (adjusted OR,1.19;95% CI, 1.06-1.34;P=0.004). A stratified analysis showed that the significant association of high HGS and hypertension was also observed with the following factors even after adjusting for age and gender: female gender (adjusted OR, 1.25;95% CI, 1.08-1.46;P=0.004), ages of 60-69 years (adjusted OR, 1.29;95% CI, 1.06-1.57;P=O.O11), and married (adjusted OR,1.20;95% CI, 1.06-1.37;P=0.005). However, no significant associations were found after adjusting for age, gender, smoking status, drinking status, body mass index, physical activity level, glucose, high-and low-density lipoprotein cholesterol, total cholesterol, and triglyceride (P>0.05).Conclusion: The findings of the current study suggest that HGS was positively correlated with DBP in a rural population, and high HGS was associated with hypertension in females;however, the association may be modified by smoking status, drinking status, body mass index, physical activity, cholesterol level, and glucose level. Further utilization of HGS exercises to intervene in the development and prognosis of hypertension should be verified in the future.