AIM:Our study aimed to compare the results of liver transplantation (LT) and liver resection (LR) in patients with hepatocellular carcinoma (HCC) that met the Milan criteria after successful downstaging therapy. METHO...AIM:Our study aimed to compare the results of liver transplantation (LT) and liver resection (LR) in patients with hepatocellular carcinoma (HCC) that met the Milan criteria after successful downstaging therapy. METHODS:From February 2004 to August 2010, a consecutive series of 102 patients were diagnosed with advanced-stage HCC that met the modified UCSF down-staging protocol inclusion criteria. All of the patients accepted various down-staging therapies. The types and numbers of treatments were tailored to each patient according to the tumor characteristics, location, liver function and response. After various downstaging therapies, 66 patients had tumor characteristics that met the Milan criteria; 31 patients accepted LT in our center, and 35 patients accepted LR. The baseline characteristics, down-staging protocols, postoperative complications, overall survival and tumor free survival rate, and tumor recurrence rate were compared between the two groups. Kaplan-Meier analyses were used to estimate the long-term overall survival and tumor-free survival rate. Meanwhile, a Cox proportional hazards model was used for the multivariate analyses of overall survival and disease-free survival rate. RESULTS:No significant difference was observed between the LT and LR groups with respect to the downstaging protocol, target tumor characteristics, and baseline patient characteristics. Fifteen patients suffered various complications after LT, and 8 patients had complications after LR. The overall complication rate for the LT group was 48.4%, which was significantly higher than the LR group (22.9%) (P = 0.031). The overall in-hospital mortality in hospital for the LT group was 12.9% vs 2.9% for the LR group (P = 0.172). The overall patient survival rates at 1-, 3and 5-years were 87.1%, 80.6% and 77.4%, respectively, after LT and 91.4%, 77.1% and 68.6%, respectively, after LR (P = 0.498). The overall 1-, 3and 5-year tumor recurrencefree rates were also comparable (P = 0.656). Poorer tumor differentiation (P = 0.041) and a higher postdownstage alpha-fetoprotein (AFP) level (> 400 ng/mL) (P = 0.015) were the two independent risk factors for tumor recurrence in the LT and LR patients who accepted successful down-staging therapy. CONCLUSION:Due to the higher postoperative morbidity and similar survival and tumor recurrence-free rates, LR might offer better or similar outcome over LT, but a larger number and further randomized studies may be needed in the future for drawing any positive conclusions.展开更多
Three countries and areas take a leading role in the transaction.The top three are the European Union(EU),the Middle East and the USA,the transaction amounts were respectively US$2.32 billion,US$931 billion and US$927...Three countries and areas take a leading role in the transaction.The top three are the European Union(EU),the Middle East and the USA,the transaction amounts were respectively US$2.32 billion,US$931 billion and US$927 million.展开更多
Hydropower gains increasing importance as a steerable and controllable power source in a renewable energy mix and deregulated markets. Although hydropower produces fossil-free energy, it has a significant impact on th...Hydropower gains increasing importance as a steerable and controllable power source in a renewable energy mix and deregulated markets. Although hydropower produces fossil-free energy, it has a significant impact on the local environment. This review investigates the effects of flow alterations by hydropower on the downstream river system and the possibilities to integrate these effects into hydraulic modeling. The results show that various effects of flow regulation on the ecosystem, but also social and economic effects on related communities were observed in the last decades. The application of hydraulic models for investigations of ecological effects is common. Especially hydraulic effects and effects on fish were extensively modeled with the help of hydraulic 1D- and 2D-simulations. Current applications to investigate social and economic effects integrated into hydraulic modeling are meanwhile limited. Approaches to realizing this integration are presented. Further research on the economic valuation of ecosystems and integration of social and economic effects to hydraulic models is necessary to develop holistic tools to support decision-making on sustainable hydropower.展开更多
基金Supported by Grants from The National Sciences and Technology Major Project of China, No. 2012ZX10002-016 and No. 2012ZX10002-017
文摘AIM:Our study aimed to compare the results of liver transplantation (LT) and liver resection (LR) in patients with hepatocellular carcinoma (HCC) that met the Milan criteria after successful downstaging therapy. METHODS:From February 2004 to August 2010, a consecutive series of 102 patients were diagnosed with advanced-stage HCC that met the modified UCSF down-staging protocol inclusion criteria. All of the patients accepted various down-staging therapies. The types and numbers of treatments were tailored to each patient according to the tumor characteristics, location, liver function and response. After various downstaging therapies, 66 patients had tumor characteristics that met the Milan criteria; 31 patients accepted LT in our center, and 35 patients accepted LR. The baseline characteristics, down-staging protocols, postoperative complications, overall survival and tumor free survival rate, and tumor recurrence rate were compared between the two groups. Kaplan-Meier analyses were used to estimate the long-term overall survival and tumor-free survival rate. Meanwhile, a Cox proportional hazards model was used for the multivariate analyses of overall survival and disease-free survival rate. RESULTS:No significant difference was observed between the LT and LR groups with respect to the downstaging protocol, target tumor characteristics, and baseline patient characteristics. Fifteen patients suffered various complications after LT, and 8 patients had complications after LR. The overall complication rate for the LT group was 48.4%, which was significantly higher than the LR group (22.9%) (P = 0.031). The overall in-hospital mortality in hospital for the LT group was 12.9% vs 2.9% for the LR group (P = 0.172). The overall patient survival rates at 1-, 3and 5-years were 87.1%, 80.6% and 77.4%, respectively, after LT and 91.4%, 77.1% and 68.6%, respectively, after LR (P = 0.498). The overall 1-, 3and 5-year tumor recurrencefree rates were also comparable (P = 0.656). Poorer tumor differentiation (P = 0.041) and a higher postdownstage alpha-fetoprotein (AFP) level (> 400 ng/mL) (P = 0.015) were the two independent risk factors for tumor recurrence in the LT and LR patients who accepted successful down-staging therapy. CONCLUSION:Due to the higher postoperative morbidity and similar survival and tumor recurrence-free rates, LR might offer better or similar outcome over LT, but a larger number and further randomized studies may be needed in the future for drawing any positive conclusions.
文摘Three countries and areas take a leading role in the transaction.The top three are the European Union(EU),the Middle East and the USA,the transaction amounts were respectively US$2.32 billion,US$931 billion and US$927 million.
文摘Hydropower gains increasing importance as a steerable and controllable power source in a renewable energy mix and deregulated markets. Although hydropower produces fossil-free energy, it has a significant impact on the local environment. This review investigates the effects of flow alterations by hydropower on the downstream river system and the possibilities to integrate these effects into hydraulic modeling. The results show that various effects of flow regulation on the ecosystem, but also social and economic effects on related communities were observed in the last decades. The application of hydraulic models for investigations of ecological effects is common. Especially hydraulic effects and effects on fish were extensively modeled with the help of hydraulic 1D- and 2D-simulations. Current applications to investigate social and economic effects integrated into hydraulic modeling are meanwhile limited. Approaches to realizing this integration are presented. Further research on the economic valuation of ecosystems and integration of social and economic effects to hydraulic models is necessary to develop holistic tools to support decision-making on sustainable hydropower.
