Laparoscopic anatomical liver resection of segment 7 using a sandwich approach to the right hepatic vein (with video)

Full laparoscopic liver resection has been performed widely since it was introduced in the early 1990s.It has been expanded from initial for partial resection of the anterolateral segments to non-restriction of area of the liver[1–3].Anatomical liver resec-tion is considered to have potential superiority than non-anatomic resection in terms of tumor prognosis,thus it is more often rec-ommended in the treatment of hepatocellular carcinoma[4,5].Recently,laparoscopic segmental liver resection according to the Couinaud classification has been widely performed due to its ad-vantages in minimal invasiveness and tumor prognosis.

Association between ADIPOQ gene polymorphisms and the risk of new-onset diabetes mellitus after liver transplantation

BACKGROUND:New-onset diabetes after transplantation(NODAT) has become one of the major factors that affect the overall survival and long-term life quality in liver transplantation(LT) recipients. Previous studies found that the serum adiponectin concentration of diabetic patients is significantly lower than that of healthy subjects. Adiponectin regulates the blood glucose level by increasing body sensitivity to insulin through various mechanisms. In this study, we aimed to investigate the impact of diabetes related gene polymorphisms on the development of NODAT in liver recipients.METHODS:A total of 256 LT patients in a single-center were selected retrospectively for the study. Genomic DNA was extracted from explanted liver tissues, and tested for twelve diabetes mellitus associated single nucleotide polymorphisms by Sequenom Mass ARRAY. Modified clinical models in predicting NODAT were established and evaluated.RESULTS:The GG genotype of ADIPOQ rs1501299 gene polymorphism was significantly more frequent in NODAT than non-NODAT LT patients(56% vs 39%, P=0.014). Dominant model(GG vs GT+TT, P=0.030) and recessive model(GT+GG vs TT, P=0.005) also confirmed the genotype distribution difference between NODAT and non-NODAT groups. Age(OR=1.048, P=0.004), BMI(OR=1.107, P=0.041), and blood tacrolimus level at 1-month LT(OR=1.170, P=0.003) were clinical independent risk factors of NODAT. Furthermore, rs1501299 could improve the ability of clinical model in predicting NODAT(AUROC=0.743, P<0.001).CONCLUSION:ADIPOQ rs1501299 gene polymorphism is associated with an increased risk of NODAT, which should be added to the clinical models in predicting the occurrence of NODAT in LT recipients.

Role of [18F] fludeoxyglucose positron emission tomography in the selection of liver transplantation candidates in patients with hepatocellular carcinoma

BACKGROUND： The Milan criteria are widely accepted among many centers. However, patients with hepatocellular carcinoma beyond the Milan criteria might still benefit from liver transplantation （LT） when tumor itself is not aggressive. [18F] fluorodeoxyglucose positron emission tomography/computed tomography imaging could provide useful information of tumor behaviors, which is helpful to predict the prognosis for many tumors. METHOD： In order to determine its role in candidate selection for LT, we therefore retrospectively analyzed 103 recipients with preoperative positron emission tomography （PET） findings. RESULTS： Positive PET findings （PET＋） were significantly associated with tumor nodule numbers （P=0.013）, tumor grade （P=0.025）, macro- （P=0.002） and micro-vascular invasion （P=0.002）, as well as the Milan criteria （P=0.018）. PET＋ patients had significantly increased risk of tumor recurrence post-LT compared to PET negative （PET-） patients （P=0.007）. The 1-, 3-, and 5-year overall survival rate of PET- patients were 96.0%, 87.2% and 76.2%, compared to 74.7%, 55.4% and 49.9% in PET＋ patients, respectively （P〈0.05）. The 1-, 3-, and 5-year recurrence-free survival rate of PET- patients were 91.8%,81.9% and 76.0%, compared to 70.1%, 39.3% and 21.9% in PET＋ patients, respectively （P〈0.05）. Recipients within the Milan criteria showed comparable 1-, 3-, and 5-year survival rates in comparison with those beyond the Milan criteria with a PET- findings （1-, 3-, and 5-year overall survival rates, 97.5%, 83.3%, and 83.3% vs 90.0%, 80.0%, and 66.7%, P= 0.123; 1-, 3-, and 5-year recurrence-free survival rates, 95.1%, 73.1%, and 73.1% vs 90.0%, 78.8%, and 65.6%, P=0.148）. CONCLUSIONS： Certain patients with hepatocellular carcinoma and negative PET findings, who have exceeded the Milan criteria, are also eligible candidates for LT. Preoperative PET/CT imaging is an important marker, which should be incorporated in extended candidate selection criteria for LT.

Risk factors of choledocholithiasis formation after liver transplantation

Systematic study of risk factors for biliary stone post-liver transplantation is rarely performed. To investigate the risk factor of choledocholithiasis formation after liver transplantation, we c onducted a case-control study. Fourteen patients were selected into a study group. The stones of the bile duct of the patients were confirmed and treated successfully by endoscopic retrograde cholangiopancreatography. For univariate analysis, we selected carefully some potential risk factors such as cold ischemia time, warm ischemia time, and biliary stricture. The results revealed that cold ischemia time and biliary stenosis were significant predictors. But multivariate analysis revealed that only biliary stenosis was a significant risk factor. In conclusion, biliary stenosis is a risk factor of bile duct stones formation after liver transplantation. Endoscopic retrograde cholangiopancreatography is effective and safe in the diagnosis or treatment of bile duct stones after liver transplantation.

Comparison and development of advanced machine learning tools to predict nonalcoholic fatty liver disease:An extended study

Background:Nonalcoholic fatty liver disease(NAFLD)is a public health challenge and significant cause of morbidity and mortality worldwide.Early identification is crucial for disease intervention.We recently proposed a nomogram-based NAFLD prediction model from a large population cohort.We aimed to explore machine learning tools in predicting NAFLD.Methods:A retrospective cross-sectional study was performed on 15315 Chinese subjects(10373 training and 4942 testing sets).Selected clinical and biochemical factors were evaluated by different types of machine learning algorithms to develop and validate seven predictive models.Nine evaluation indicators including area under the receiver operating characteristic curve(AUROC),area under the precision-recall curve(AUPRC),accuracy,positive predictive value,sensitivity,F1 score,Matthews correlation coefficient(MCC),specificity and negative prognostic value were applied to compare the performance among the models.The selected clinical and biochemical factors were ranked according to the importance in prediction ability.Results:Totally 4018/10373(38.74%)and 1860/4942(37.64%)subjects had ultrasound-proven NAFLD in the training and testing sets,respectively.Seven machine learning based models were developed and demonstrated good performance in predicting NAFLD.Among these models,the XGBoost model revealed the highest AUROC(0.873),AUPRC(0.810),accuracy(0.795),positive predictive value(0.806),F1 score(0.695),MCC(0.557),specificity(0.909),demonstrating the best prediction ability among the built models.Body mass index was the most valuable indicator to predict NAFLD according to the feature ranking scores.Conclusions:The XGBoost model has the best overall prediction ability for diagnosing NAFLD.The novel machine learning tools provide considerable beneficial potential in NAFLD screening.