What enlightenment has the development of lung cancer bone metastasis brought in the last 22 years

BACKGROUND Lung cancer bone metastasis(LCBM)is a disease with a poor prognosis,high risk and large patient population.Although considerable scientific output has accumulated on LCBM,problems have emerged,such as confusing research structures.AIM To organize the research frontiers and body of knowledge of the studies on LCBM from the last 22 years according to their basic research and translation,clinical treatment,and clinical diagnosis to provide a reference for the development of new LCBM clinical and basic research.METHODS We used tools,including R,VOSviewer and CiteSpace software,to measure and visualize the keywords and other metrics of 1903 articles from the Web of Science Core Collection.We also performed enrichment and proteinprotein interaction analyses of gene expression datasets from LCBM cases worldwide.RESULTS Research on LCBM has received extensive attention from scholars worldwide over the last 20 years.Targeted therapies and immunotherapies have evolved into the mainstream basic and clinical research directions.The basic aspects of drug resistance mechanisms and parathyroid hormone-related protein may provide new ideas for mechanistic study and improvements in LCBM prognosis.The produced molecular map showed that ribosomes and focal adhesion are possible pathways that promote LCBM occurrence.CONCLUSION Novel therapies for LCBM face animal testing and drug resistance issues.Future focus should centre on advancing clinical therapies and researching drug resistance mechanisms and ribosome-related pathways.

Liver transplantation for biliary atresia: A single-center study from China's Mainland

AIM: To summarize our single-center experience with liver transplantation(LT) for biliary atresia(BA).METHODS: From October 2006 to December 2012, 188 children with BA were analyzed retrospectively. The stage?Ⅰ?group(from October 2006 to December 2010) comprised the first 74 patients, and the stage Ⅱ group(from January 2011 to December 2012) comprised the remaining 114 patients. Finally, 123 liver transplants were performed in 122(64.9%) patients, whereas 66 patients did not undergo LT due to denial by their parents or lack of suitable liver grafts. The selection of graft types depended on the patients' clinical status and whether a suitable living donor was available. The characteristics of patients in stages?Ⅰ?and Ⅱ were described, and the surgical outcomes of LT recipients were compared between the two stages. The KaplanMeier method was used to estimate the cumulative patient and graft survival rates, and the equality of survival distributions was evaluated using the log-rank test.RESULTS: The 188 children consisted of 102 boysand 86 girls. Their ages ranged from 3 to 144 mo with a median of 8 mo. One hundred and fifteen(61.2%) patients were born in rural areas. Comparing stage?Ⅰ?and stage Ⅱ patients, the proportion of patients referred by pediatricians(43.2% vs 71.1%, respectively; P < 0.001) and the proportion of patients who previously received a Kasai procedure(KP)(32.4% vs 44.7%, respectively; P = 0.092) obviously increased, and significantly more parents were willing to treat their children with LT(73% vs 86%, respectively; P = 0.027). Grafts from living donors(102/122, 83.6%) were the most commonly used graft type. Surgical complications(16/25, 64.0%) were the main reason for posttransplant mortality. Among the living donor liver transplantation recipients(n = 102), the incidence of surgical complications was significantly reduced(34.1% vs 15.5%, respectively; P = 0.029) and survival rates of patients and grafts were greatly improved(81.8% vs 89.7%, respectively, at 1 year; 75.0% vs 87.8%, respectively, at 3 years; P = 0.107) from stage?Ⅰ?to stage Ⅱ.CONCLUSION: The status of surgical treatments for BA has been changing in China's Mainland. Favorable midterm outcomes after LT were achieved as centers gained greater technical experience.

High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient.Few studies are available on the management of immunosuppression(IS)treatment in the liver transplant(LT)recipients complicated with infection.The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection(BSI)in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery,Renji Hospital from January 1,2016 through December 31,2017.All recipients diagnosed with BSI after LT were included.Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial(GNB)infection.RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients,including 45 episodes of Gram-positive bacterial(GPB)infections in 42 patients and 29 episodes of GNB infections in 28 patients.Overall,IS reduction(at least 50%dose reduction or cessation of one or more immunosuppressive agent)was made in 28(41.2%)cases,specifically,in 5(11.9%)cases with GPB infections and 23(82.1%)cases with GNB infections.The 180 d all-cause mortality rate was 18.5%(13/70).The mortality rate in GNB group(39.3%,11/28)was significantly higher than that in GPB group(4.8%,2/42)(P=0.001).All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal,but the deaths in GPB group were all due to graft-versus-host disease.GNB group was associated with significantly higher incidence of intra-abdominal infection,IS reduction,and complete IS withdrawal than GPB group(P<0.05).Cox regression showed that rejection(adjusted hazard ratio 7.021,P=0.001)and complete IS withdrawal(adjusted hazard ratio 12.65,P=0.019)were independent risk factors for 30 d mortality in patients with GNB infections after LT.CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients.Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.

Living-donor or deceased-donor liver transplantation for hepatic carcinoma:A case-matched comparison

AIM:To compare the surgical outcomes between living-donor and deceased-donor liver transplantation in patients with hepatic carcinoma.METHODS:From January 2007 to December 2010,257 patients with pathologically confirmed hepatic carcinoma met the eligibility criteria of the study.Forty patients who underwent living-donor liver transplantation(LDLT)constituted the LDLT group,and deceaseddonor liver transplantation(DDLT)was performed in217 patients.Patients in the LDLT group were randomly matched(1:2)to patients who underwent DDLT using a multivariate case-matched method,so 40 patients in the LDLT group and 80 patients in the DDLT group were enrolled into the study.We compared the two groups in terms of clinicopathological characteristics,postoperative complications,long-term cumulative survival and relapse-free survival outcomes.The modified Clavien-Dindo classification system of surgical complications was used to evaluate the severity of perioperative complications.Furthermore,we determined the difference in the overall biliary complication rates in the perioperative and follow-up periods between the LDLT and DDLT groups.RESULTS:The clinicopathological characteristics of the enrolled patients were comparable between the two groups.The duration of operation was significantly longer(553 min vs 445 min,P<0.001)in the LDLT group than in the DDLT group.Estimated blood loss(1188 mL vs 1035 mL,P=0.055)and the proportion of patients with intraoperative transfusion(60.0%vs 43.8%,P=0.093)were slightly but not significantly greater in the LDLT group.In contrast to DDLT,LDLT was associated with a lower rate of perioperative gradeⅡcomplications(45.0%vs 65.0%,P=0.036)but a higher risk of overall biliary complications(27.5%vs 7.5%,P=0.003).Nonetheless,21 patients(52.5%)in the LDLT group and 46 patients(57.5%)in the DDLT group experienced perioperative complications,and overall perioperative complication rates were similar between the two groups(P=0.603).No significant difference was observed in 5-year overall survival(74.1%vs 66.6%,P=0.372)or relapse-free survival(72.9%vs 70.9%,P=0.749)between the LDLT and DDLT groups.CONCLUSION:Although biliary complications were more common in the LDLT group,this group did not show any inferiority in long-term overall survival or relapse-free survival compared with DDLT.

Statistical properties of random clique networks

在这份报纸，模仿大聚类系数和在许多真实建筑群存在的模块化的结构的一个随机的派系网络模型联网，例如社会网络，人工的网络，和蛋白质相互作用网络，吗被联合 Erd 的随机的选择规则介绍? s 和R.愠辀? 辀 吗？？

Expression of programmed death-1 and its ligands in the liver of biliary atresia

Background:An aberrant immune response is the predominant pathogenetic factor in biliary atresia (BA).Programmed death-1 (PD-1) and its two ligands,programmed death ligand-1 and programmed death ligand-2 (PD-L1 and PD-L2,respectively) play an important inhibitory role in immune reactions.We aimed to illustrate the expression of these molecules in BA.Methods:Liver specimens were obtained from infants with BA during the Kasai procedure (early BA) and fiver transplantation (late BA).Intrahepatic expression of PD-1,PD-L1,and PD-L2 were examined by immunostaining and compared with that in patients with neonatal hepatitis syndrome and normal controls.The correlation between the expression levels of these molecules in the liver and clinicopathological parameters was analyzed for each group.Results:Enhanced expression of PD-1 and its ligands occurred in the livers with early BA.In the BA-affected livers,PD-1 was correlated with the degree of peri-bifiary inflammation,while PD-L2 was linked more directly with portal fibrosis.None of the three molecules was correlated with the prognosis of the Kasai procedure in patients with early BA.Conclusion:Only PD-1 and PD-L1 are involved in the immune reactions of early BA.Elucidation of the detailed role of PD-L2 in BA requires further research.