BACKGROUND Loco-regional therapy for hepatocellular carcinoma(HCC) during the period awaiting liver transplantation(LT) appears to be a logical approach to reduce the risk of tumor progression and dropout in the waitl...BACKGROUND Loco-regional therapy for hepatocellular carcinoma(HCC) during the period awaiting liver transplantation(LT) appears to be a logical approach to reduce the risk of tumor progression and dropout in the waitlist.Living donor LT(LDLT)offers a flexible timing for transplantation providing timeframe for well preparation of transplantation.AIM To investigate outcomes in relation to the intention of pre-transplantation locoregional therapy in LDLT for HCC patients.METHODS A total of 308 consecutive patients undergoing LDLTs for HCC between August2004 and December 2018 were retrospectively analyzed.Patients were grouped according to the intention of loco-regional therapy prior to LT,and outcomes of patients were analyzed and compared between groups.RESULTS Overall,38 patients(12.3%) were detected with HCC recurrence during the follow-up period after LDLT.Patients who were radiologically beyond the University of California at San Francisco criteria and received loco-regional therapy as down-staging therapy had significant inferior outcomes to other groups for both recurrence-free survival(RFS,P < 0.0005) and overall survival(P= 0.046).Moreover,patients with defined profound tumor necrosis(TN) by locoregional therapy had a superior RFS(5-year of 93.8%) as compared with others(P= 0.010).CONCLUSION LDLT features a flexible timely transplantation for patient with HCC.However,the loco-regional therapy prior to LDLT does not seem to provide benefit unless a certain effect in terms of profound TN is noted.展开更多
BACKGROUND No prognostic models specific to hepatocellular carcinoma patients receiving surgical resection have been considered strong and convincing enough for survival prediction thus far,and there are no models inc...BACKGROUND No prognostic models specific to hepatocellular carcinoma patients receiving surgical resection have been considered strong and convincing enough for survival prediction thus far,and there are no models including only preoperative predictors.We derived a nomogram to predict disease-free survival in a previous study.AIM To simplify our score and compare research outcomes among other scoring systems.METHODS We retrospectively reviewed data from 1106 patients with hepatocellular carcinoma who underwent liver resection at the Linkou Chang Gung Memorial Hospital between April 2003 and December 2012.Multivariate analyses were conducted to identify the significant survival predictors.Homogeneity,Harrell’s C-index,and Akaike information criterion were compared between our score,AJCC 8^(th)edition,Tokyo score,and Taipei Integrated Scoring System(TTV-CTPAFP model).RESULTS Among the 1106 patients,731(66.1%)had tumor recurrence at a median followup of 83.9 mo.Five risk factors were identified:platelet count,albumin level,indocyanine green retention rate,multiplicity,and radiologic total tumor volume.Patients were divided into three risk groups,and the 5-year survival rates were 61.7%,39%,and 25.7%,respectively.The C-index was 0.617,which was higher than the Tokyo score(0.613)and the Taipei Integrated Scoring System(0.562)and equal to the value of the AJCC 8th edition(0.617).CONCLUSION The modified score provides an easier method to predict survival.Appropriate treatment can be planned preoperatively by dividing patients into risk groups.展开更多
A steel dual-core self-centering brace （DC-SCB） is an innovative structural member that provides both energy dissipation and self-centering properties to structures, reducing maximum and residual drifts of structure...A steel dual-core self-centering brace （DC-SCB） is an innovative structural member that provides both energy dissipation and self-centering properties to structures, reducing maximum and residual drifts of structures in earthquakes. The axial deformation capacity of the DC-SCB is doubled by a parallel arrangement of two inner cores, one outer box and two sets of tensioning elements. This paper presents cyclic test results of a DC-SCB component and a full- scale one-story, one-bay steel frame with a DC-SCB. The DC-SCB that was near 8 m-long was tested to evaluate its cyclic behavior and durability. The DC-SCB performed well under a total of three increasing cyclic loading tests and 60 low- cycle fatigue loading tests without failure. The maximum axial load of the DC-SCB was near 1700 kN at an interstory drift of 2.5%. Moreover, a three-story dual-core self-centering braced frame （DC-SCBF） with a single-diagonal DC-SCB was designed and its first-story, one-bay DC-SCBF subassembly specimen was tested in multiple earthquake-type loadings. The one-story, one-bay subassembly frame specimen performed well up to an interstory drift of 2% with yielding at the column base and local buckling in the steel beam; no damage of the DC-SCB was found after all tests. The maximum residual drift of the DC-SCBF caused by beam local buckling was 0.5% in 2.0% drift cycles.展开更多
Aim: Sorafenib is a multi-tyrosine kinase inhibitor and the standard therapy for advanced hepatocellular carcinoma (HCC). This retrospective study aimed to observe the anti-fibrotic effect of sorafenib in patients wit...Aim: Sorafenib is a multi-tyrosine kinase inhibitor and the standard therapy for advanced hepatocellular carcinoma (HCC). This retrospective study aimed to observe the anti-fibrotic effect of sorafenib in patients with advanced HCC. Methods: Seventeen patients with advanced HCC were recruited. Shear wave velocity (SWV) using acoustic radiation force impulse elastography and non-invasive serum markers for liver fibrosis, such as the aspartate aminotransferase (AST) to alanine aminotransferase ratio (AAR), the AST to platelet ratio index, the fibrosis-4 index and the Lok index, were recorded at the beginning of sorafenib treatment and 3-6 months after sorafenib treatment in 2014-2015. Results: Nine (52.9%) patients achieved disease control status and 8 had progressive disease after a mean duration of 11.1 months with sorafenib treatment. The mean SWV decreased from 2.37 m/s at the beginning to 1.90 m/s after sorafenib treatment (P < 0.01). This trend was observed in patients with and without liver cirrhosis (from 2.49 to 2.06 m/s, P = 0.06, and from 2.32 to 1.69 m/s, P < 0.05, respectively). Among the non-invasive serum markers, no statistically significant differences were observed except for the AAR in the cirrhotic group. Conclusion: Sorafenib has potential antif-ibrotic effects in patients with advanced HCC.展开更多
文摘BACKGROUND Loco-regional therapy for hepatocellular carcinoma(HCC) during the period awaiting liver transplantation(LT) appears to be a logical approach to reduce the risk of tumor progression and dropout in the waitlist.Living donor LT(LDLT)offers a flexible timing for transplantation providing timeframe for well preparation of transplantation.AIM To investigate outcomes in relation to the intention of pre-transplantation locoregional therapy in LDLT for HCC patients.METHODS A total of 308 consecutive patients undergoing LDLTs for HCC between August2004 and December 2018 were retrospectively analyzed.Patients were grouped according to the intention of loco-regional therapy prior to LT,and outcomes of patients were analyzed and compared between groups.RESULTS Overall,38 patients(12.3%) were detected with HCC recurrence during the follow-up period after LDLT.Patients who were radiologically beyond the University of California at San Francisco criteria and received loco-regional therapy as down-staging therapy had significant inferior outcomes to other groups for both recurrence-free survival(RFS,P < 0.0005) and overall survival(P= 0.046).Moreover,patients with defined profound tumor necrosis(TN) by locoregional therapy had a superior RFS(5-year of 93.8%) as compared with others(P= 0.010).CONCLUSION LDLT features a flexible timely transplantation for patient with HCC.However,the loco-regional therapy prior to LDLT does not seem to provide benefit unless a certain effect in terms of profound TN is noted.
基金This study was approved by the local ethics committee of Chang Gung Memorial Hospital,No.104-3900B.
文摘BACKGROUND No prognostic models specific to hepatocellular carcinoma patients receiving surgical resection have been considered strong and convincing enough for survival prediction thus far,and there are no models including only preoperative predictors.We derived a nomogram to predict disease-free survival in a previous study.AIM To simplify our score and compare research outcomes among other scoring systems.METHODS We retrospectively reviewed data from 1106 patients with hepatocellular carcinoma who underwent liver resection at the Linkou Chang Gung Memorial Hospital between April 2003 and December 2012.Multivariate analyses were conducted to identify the significant survival predictors.Homogeneity,Harrell’s C-index,and Akaike information criterion were compared between our score,AJCC 8^(th)edition,Tokyo score,and Taipei Integrated Scoring System(TTV-CTPAFP model).RESULTS Among the 1106 patients,731(66.1%)had tumor recurrence at a median followup of 83.9 mo.Five risk factors were identified:platelet count,albumin level,indocyanine green retention rate,multiplicity,and radiologic total tumor volume.Patients were divided into three risk groups,and the 5-year survival rates were 61.7%,39%,and 25.7%,respectively.The C-index was 0.617,which was higher than the Tokyo score(0.613)and the Taipei Integrated Scoring System(0.562)and equal to the value of the AJCC 8th edition(0.617).CONCLUSION The modified score provides an easier method to predict survival.Appropriate treatment can be planned preoperatively by dividing patients into risk groups.
文摘A steel dual-core self-centering brace （DC-SCB） is an innovative structural member that provides both energy dissipation and self-centering properties to structures, reducing maximum and residual drifts of structures in earthquakes. The axial deformation capacity of the DC-SCB is doubled by a parallel arrangement of two inner cores, one outer box and two sets of tensioning elements. This paper presents cyclic test results of a DC-SCB component and a full- scale one-story, one-bay steel frame with a DC-SCB. The DC-SCB that was near 8 m-long was tested to evaluate its cyclic behavior and durability. The DC-SCB performed well under a total of three increasing cyclic loading tests and 60 low- cycle fatigue loading tests without failure. The maximum axial load of the DC-SCB was near 1700 kN at an interstory drift of 2.5%. Moreover, a three-story dual-core self-centering braced frame （DC-SCBF） with a single-diagonal DC-SCB was designed and its first-story, one-bay DC-SCBF subassembly specimen was tested in multiple earthquake-type loadings. The one-story, one-bay subassembly frame specimen performed well up to an interstory drift of 2% with yielding at the column base and local buckling in the steel beam; no damage of the DC-SCB was found after all tests. The maximum residual drift of the DC-SCBF caused by beam local buckling was 0.5% in 2.0% drift cycles.
文摘Aim: Sorafenib is a multi-tyrosine kinase inhibitor and the standard therapy for advanced hepatocellular carcinoma (HCC). This retrospective study aimed to observe the anti-fibrotic effect of sorafenib in patients with advanced HCC. Methods: Seventeen patients with advanced HCC were recruited. Shear wave velocity (SWV) using acoustic radiation force impulse elastography and non-invasive serum markers for liver fibrosis, such as the aspartate aminotransferase (AST) to alanine aminotransferase ratio (AAR), the AST to platelet ratio index, the fibrosis-4 index and the Lok index, were recorded at the beginning of sorafenib treatment and 3-6 months after sorafenib treatment in 2014-2015. Results: Nine (52.9%) patients achieved disease control status and 8 had progressive disease after a mean duration of 11.1 months with sorafenib treatment. The mean SWV decreased from 2.37 m/s at the beginning to 1.90 m/s after sorafenib treatment (P < 0.01). This trend was observed in patients with and without liver cirrhosis (from 2.49 to 2.06 m/s, P = 0.06, and from 2.32 to 1.69 m/s, P < 0.05, respectively). Among the non-invasive serum markers, no statistically significant differences were observed except for the AAR in the cirrhotic group. Conclusion: Sorafenib has potential antif-ibrotic effects in patients with advanced HCC.
