Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment

AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma (HCC) patients undergoing radiofrequency ablation (RFA) as a first-line treatment.METHODS: From 2000 to 2013, 316 consecutive patients with 404 HCC (1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years (24-87 years). Patients were followed for 1 year to > 10 years after RFA (234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model.RESULTS: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions (1.8%). Local tumor progression and/or new tumor development were observed in 43.3% (132/305) of the patients during the follow-up period. Overall 5- and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification (HR = 4.054, P < 0.001), portal vein hypertension (HR = 2.743, P = 0.002), and tumor number (HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions (HR = 1.550, P = 0.002) was associated with local progression-free survival.CONCLUSION: RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.

Lipoprotein metabolism in nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease （NAFLD）, an pathologies characterized by fatty accumulation in escalating health problem worldwide, covers a spectrum of hepatocytes in early stages, with potential progression to liver inflammation, fibrosis, and failure. A close, yet poorly understood link exists between NAFLD and dyslipidemia, a constellation of abnormalities in plasma lipoproteins including triglyceride-rich very low density lipoproteins. Apolipoproteins are a group of primarily liver-derived proteins found in serum lipoproteins; they not only play an extracellular role in lipid transport between vital organs through circulation, but also play an important intracellu- lar role in hepatic lipoprotein assembly and secretion. The liver functions as the central hub for lipoprotein metab- olism, as it dictates lipoprotein production and to a significant extent modulates lipoprotein clearance. Lipoprotein metabolism is an integral component of hepatocellular lipid homeostasis and is implicated in the pathogenesis, potential diagnosis, and treatment of NAFLD.

Percutaneous devices for left atrial appendage occlusion: A contemporary review

Patient with atrial fibrillation(AF) are at risk of developing stroke with the left atrial appendage(LAA) being the most common site for thrombus formation. If left untreated, AF is associated with 4 to 5 folds increase in the risk of ischemic stroke in all age groups. About 5% to 15% of AF patients have atrial thrombi on transesophageal echocardiography, and 91% of those thrombi are located in the LAA in patient with nonrheumatic AF. Although oral anticoagulants are the gold-standard treatment for stroke prevention in patients with non-valvular AF,some patients are at high risk of bleeding and deemed not candidates for anticoagulation. Therefore, LAA occlusion(LAAO) has emerged as alternative approach for stroke prevention in those patients. Surgical LAAO is associated with high rate of unsuccessful closure and recommended only in patients with AF and undergoing cardiac surgery. Percutaneous LAAO uses transvenous access with trans-septal puncture and was first tested using the PLAATO device.Watchman is the most common and only Food and Drug Administration(FDA)approved device for LAAO. LAAO using Watchman device is non-inferior to warfarin therapy in preventing ischemic stroke/systemic thromboembolism.However, it is associated with lower rates of hemorrhagic stroke, bleeding and death. Amplatzer is another successful LAAO device that has CE mark and is waiting for FDA approval. Optimal antithrombotic therapy post LAAO is still under debate and highly patient-specific. The aim of this paper is to systematically review the current literature to evaluate the efficacy and safety of different LAAO devices.

Utility of liver biopsy in predicting clinical outcomes after percutaneous angioplasty for hepatic venous obstruction in liver transplant patients

AIM: To determine utility of transplant liver biopsy in evaluating efficacy of percutaneous transluminal angioplasty(PTA) for hepatic venous obstruction(HVOO). METHODS: Adult liver transplant patients treated with PTA for HVOO(2003-2013) at a single institution were reviewed for pre/post-PTA imaging findings, manometry(gradient with right atrium), presence of HVOO on prePTA and post-PTA early and late biopsy(EB and LB, < or > 60 d after PTA), and clinical outcome, defined as good(no clinical issues, non-HVOO-related death) or poor(surgical correction, recurrent HVOO, or HVOOrelated death). RESULTS: Fifteen patients meeting inclusion criteria underwent 21 PTA, 658 ± 1293 d after transplant.In procedures with pre-PTA biopsy(n = 19), no difference was seen between pre-PTA gradient in 13/19 procedures with HVOO on biopsy and 6/19 procedures without HVOO(8 ± 2.4 mm Hg vs 6.8 ± 4.3 mm Hg; P = 0.35). Post-PTA, 10/21 livers had EB(29 ± 21 d) and 9/21 livers had LB(153 ± 81 d). On clinical follow-up(392 ± 773 d), HVOO on LB resulted in poor outcomes and absence of HVOO on LB resulted good outcomes. Patients with HVOO on EB(3/7 good, 4/7 poor) and no HVOO on EB(2/3 good, 1/3 poor) had mixed outcomes. CONCLUSION: Negative liver biopsy greater than 60 d after PTA accurately identifies patients with good clinical outcomes.

ADAM10 facilitates rapid neural stem cell cycling and proper positioning within the subventricular zone niche via JAMC/RAP1Gap signaling

The mechanisms that regulate neural stem cell(NSC)lineage progression and maintain NSCs within diffe rent domains of the adult neural stem cell niche,the subventricular zone are not well defined.Quiescent NSCs are arranged at the apical ventricular wall,while mitotically activated NSCs are found in the basal,vascular region of the subventricular zone.Here,we found that ADAM 10(a disintegrin and metalloproteinase 10)is essential in NSC association with the ventricular wall,and via this adhesion to the apical domain,ADAM10 regulates the switch from quiescent and undiffe rentiated NSC to an actively prolife rative and differentiating cell state.Processing of JAMC(junctional adhesion molecule C)by ADAM 10 increases Rap1 GAP activity.This molecular machinery promotes NSC transit from the apical to the basal compartment and subsequent lineage progression.Understanding the molecular mechanisms responsible for regulating the proper positioning of NSCs within the subventricular zone niche and lineage progression of NSCs could provide new targets for drug development to enhance the regenerative prope rties of neural tissue.

Portal vein thrombosis following percutaneous transhepatic cholangiography-An unusual presentation of Prothrombin (Factor Ⅱ) gene mutation

Portal vein thrombosis is an uncommonly reported complication of percutaneous transhepatic cholangiography (PTC). A thorough review of the available literature shows no reported cases. In this case, a 29 year old female presented on two separate occasions with portal vein thrombosis following PTC without drain placement. This unusual complication of image guided percutaneous biliary access is unreported in the literature and prompted evaluation of the patient's coagulation parameters. A thrombophilia screen demonstrated a mutation in the Prothrombin (Factor Ⅱ) gene. A thorough literature review shows no reported cases of portal vein thrombosis following percutaneous biliary access, is an unusual complication, and should raise suspicion of an underlying pro-coagulant state.

Chemotherapy predictors and a time-dependent chemotherapy effect in metastatic esophageal cancer

BACKGROUND Chemotherapy has long been shown to confer a survival benefit in patients with metastatic esophageal cancer.However,not all patients with metastatic disease receive chemotherapy.AIM To evaluate a large cancer database of metastatic esophageal cancer cases to identify predictors of receipt to chemotherapy and survival.METHODS We interrogated the National Cancer Database(NCDB)between 2004-2015 and included patients with M1 disease who had received or did not receive chemotherapy.A logistic regression model was used to examine the associations between chemotherapy and potential confounders and a Cox proportional hazards model was employed to examine the effect of chemotherapy on overall survival(OS).Propensity score analyses were further performed to balance measurable confounders between patients treated with and without chemotherapy.RESULTS A total of 29182 patients met criteria for inclusion in this analysis,with 21911(75%)receiving chemotherapy and 7271(25%)not receiving chemotherapy.The median follow-up was 69.45 mo.The median OS for patients receiving chemotherapy was 9.53 mo(9.33-9.72)vs 2.43 mo(2.27-2.60)with no chemotherapy.Year of diagnosis 2010-2014[odds ratio(OR):1.29,95%confidence interval(CI):1.17-1.43,P value<0.001],median income>$46000(OR:1.49,95%CI:1.27-1.75,P value<0.001),and node-positivity(OR:1.35,95%CI:1.20-1.52,P<0.001)were independent predictors of receiving chemotherapy,while female gender(OR:0.86,95%CI:0.76-0.98,P=0.019),black race(OR:0.76,95%CI:0.67-0.93,P=0.005),uninsured status(OR:0.41,95%CI:0.33-0.52,P<0.001),and high Charlson Comorbidity Index(CCI)(OR for CCI≥2:0.61,95%CI:0.50-0.74,P<0.001)predicted for lower odds of receiving chemotherapy.Modeling the effect of chemotherapy on OS using a time-dependent coefficient showed that chemotherapy was associated with improved OS up to 10 mo,after which there is no significant effect on OS.Moreover,uninsured status[hazard ratio(HR):1.20,95%CI:1.09-1.31,P<0.001],being from the geographic Midwest(HR:1.07,95%CI:1.01-1.14,P=0.032),high CCI(HR for CCI≥2:1.16,95%CI:1.07-1.26,P<0.001),and higher tumor grade(HR for grade 3 vs grade 1:1.28,95%CI:1.14-1.44,P<0.001)and higher T stage(HR for T1 vs T4:0.89,95%CI:0.84-0.95,P<0.001)were independent predictors of worse OS on multivariable analyses.CONCLUSION In this large,retrospective NCDB analysis,we identified several socioeconomic and clinicopathologic predictors for receiving chemotherapy and OS in patients with metastatic esophageal cancer.The benefit of chemotherapy on OS is timedependent and favors early initiation.Focused outreach in lower income and underinsured patients is critical as receipt of chemotherapy is associated with improved OS.

大鼠肿瘤模型行经皮肿瘤射频消融治疗中脂质体凋亡增强子能够促进肿瘤凝固和延长生存终点吗?

目的探讨射频(RF)消融术配合静脉注射包裹紫杉醇和多柔比星的促凋亡脂质体对肿瘤灭活、细胞凋亡、热休克蛋白(HSP)分泌、瘤内药物蓄积以及生存终点的影响。

Internet of things (IoT) imbedded point-of-care SARS-CoV-2 testing in the pandemic and post-pandemic era

The outbreaks of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant in China have revealed a high rate of asymptomatic cases,making isolation and quarantine measures exceedingly difficult.Public health surveillance and intervention measures will require rapid and accurate testing preferably on-site using point-of-care tests(POCTs)technology for SARS-CoV-2 variants.However,delayed and/or inaccurate surveillance data is a major obstacle blocking the large-scale implementation of POCTs in curbing spread of infectious pathogens and reducing mortality during an outbreak.To determine levels of community transmission and timely strategies accordingly,highly sensitive and specific POCT embedded with the internet of things(IoT)technology could enable on-site screening and real-time data collection.A new Rapid Amplification with Sensitivity And Portability point-of-care test(RASAP-POCT)system based on thermal convection PCR is the first IoT-based isothermal nucleic acid amplification POCT,which can provide test results within 20-30 min using saliva and/or nasopharyngeal swab samples without nucleic acid extraction.With the IoT-imbedded feature,the RASAP-POCT system can be integrated easily and smoothly with China’s existing mobile-phone-based contact tracing system,which has previously proved to be highly effective in maintaining the dynamic zero-COVID policy.Current regulatory guidelines and rules should be modified to accelerate the adoption of new technologies under an emergency use authorization(EUA).

Comparing microsurgical breast reconstruction outcomes following postoperative monitoring techniques:a systematic review and meta-analysis of 2529 patients

Aims:This paper aims to assess the existing evidence regarding oximetry and thermography by comparing postoperative rates of complications following microsurgical breast reconstruction.Methods:A systematic review of PubMed,Web of Science,and Cochrane was completed.A qualitative and quantitative analysis of all included studies was then performed.Results:Fourteen studies were included with a total population of 2,529 female patients who underwent microvascular breast reconstruction,ultimately totaling 3,289 flaps.The mean age for the cohorts included in this study ranged from 48.9 to 57 years of age.A total of 15 complete flap losses were reported.Furthermore,this meta-analysis of proportion showed that total flap loss experienced was 0%(95%CI 0%-100%)for patients monitored with thermography compared to 0%(95%CI 0%-1%)for those monitored with oximetry.Partial flap loss occurred at a frequency of 1%[95%confidence interval(CI)0%-73%]for patients monitored with thermography compared to 1%(95%CI 0%-2%)for those monitored with oximetry.Furthermore,the results of this study showed that thermography prompted a return to the operating room(OR)in 1%(95%CI 0%-73%)of the patients compared to 5%(95%CI 3%-9%)for oximetry.Lastly,the overall complication rate was 12%(95%CI 1%-54%)for patients monitored with thermography compared to 10%(95%CI 4%-21%)for those monitored with oximetry.Conclusion:Ultimately,this meta-analysis concludes that while oximetry monitoring currently has strong evidence for improving flap outcomes,trends in the current data indicate that further studies may demonstrate that thermography may be comparable to oximetry in achieving similar patient outcomes.