Novel model combining contrast-enhanced ultrasound with serology predicts hepatocellular carcinoma recurrence after hepatectomy

BACKGROUND Surgery is the primary curative option in patients with hepatocellular carcinoma(HCC).However,recurrence within 2 years is observed in 30%–50%of patients,being a major cause of mortality.AIM To construct and verify a non-invasive prediction model combining contrastenhanced ultrasound(CEUS)with serology biomarkers to predict the early recurrence of HCC.METHODS Records of 744 consecutive patients undergoing first-line curative surgery for HCC in one institution from 2016–2018 were reviewed,and 292 local patients were selected for analysis.General characteristics including gender and age,CEUS liver imaging reporting and data system(LIRADS)parameters including wash-in time,wash-in type,wash-out time,and wash-out type,and serology biomarkers including alanine aminotransferase,aspartate aminotransferase,platelets,and alpha-fetoprotein(AFP)were collected.Univariate analysis and multivariate Cox proportional hazards regression model were used to evaluate the independent prognostic factors for tumor recurrence.Then a nomogram called CEUS model was constructed.The CEUS model was then used to predict recurrence at 6 mo,12 mo,and 24 mo,the cut-off value was calculate by X-tile,and each C-index was calculated.Then Kaplan-Meier curve was compared by logrank test.The calibration curves of each time were depicted.RESULTS A nomogram predicting early recurrence(ER),named CEUS model,was formulated based on the results of the multivariate Cox regression analysis.This nomogram incorporated tumor diameter,preoperative AFP level,and LIRADS,and the hazard ratio was 1.123(95%confidence interval[CI]:1.041-1.211),1.547(95%CI:1.245-1.922),and 1.428(95%CI:1.059-1.925),respectively.The cut-off value at 6 mo,12 mo,and 24 mo was 100,80,and 50,and the C-index was 0.748(95%CI:0.683-0.813),0.762(95%CI:0.704-0.820),and 0.762(95%CI:0.706-0.819),respectively.The model showed satisfactory results,and the calibration at 6 mo was desirable;however,the calibration at 12 and 24 mo should be improved.CONCLUSION The CEUS model enables the well-calibrated individualized prediction of ER before surgery and may represent a novel tool for biomarker research and individual counseling.

Multiband fitting to three long GRBs with Fermi/LAT data:structured ejecta sweeping up a density-jump medium

We present broadband （radio, optical, X-ray and GeV） fits to the afterglow light curves and spectra of three long-duration gamma-ray bursts （GRBs 080916C, 090902B, and 090926A） detected by the Gamma-Ray Burst Monitor and Large Area Telescope （LAT） instruments on the Fermi satellite. Using the observed broadband data, we study the origin of the high energy emission, and suggest that the early-time GeV emission and the late-time radio, optical, and X-ray afterglows can be under- stood as being due to synchrotron emission from an external forward shock caused by structured ejecta propagating in a wind bubble jumping to a homogeneous density medium. If the ceasing time for a majority of the energy injection is assumed to be close to the deceleration time of the forward shock, the structured ejecta with con- tinuous energy injection towards the forward shock can well explain the early rising feature of the GeV mission from these bursts, and the density-jump medium can ac- count for some particular plateaus or flares in the late afterglows. From our fits, we find that, on one hand, the external shock origin of the GeV photons will make the optical depth not have a significant contribution to the early LAT rising part, which will loosen the strong constraint of lower limits of the Lorentz factor. On the other hand, these Fermi-LAT events preferentially occur in a low-density circumburst environment, in which case the Klein-Nishina cutoff will significantly suppress the Self- Synchrotron Compton radiation. Such an environment might result from superbubbles or low-metallicity progenitor stars （which have a low mass-loss rate at late times of stellar evolution） of type Ib/c supernovae.