Epidemiology and outcome of individuals with intraductal papillary neoplasms of the bile duct.

BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare distinct subtype of precursor lesions of biliary carcinoma. IPNB is considered to originate from luminal biliary epithelial cells, typically displays mucin-hypersecretion or a papillary growth pattern, and results in cystic dilatation[1]. IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts, and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma. IPNBs have similar phenotypic changes in the occurrence and development of all subtypes, and the prognosis is significantly better than that of traditional (non-papillary) cholangiocarcinoma. AIM: To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment. METHODS: Invasive IPNB, invasive intraductal papillary mucinous neoplasm of the pancreas (IPMN), and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Annual percentage changes (APCs) in the incidence and incidence-based (IB) mortality were calculated. We identified the independent predictors of overall survival (OS) and cancer-specific survival (CSS) in individuals with invasive IPNB. RESULTS: The incidence and IB mortality of invasive IPNB showed sustained decreases, with an APC of -4.5% (95%CI: -5.1% to -3.8%) and -3.3% (95%CI: -4.1% to -2.6%) (P < 0.001), respectively. Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma. Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma. A total of 1635 individuals with invasive IPNB were included in our prognosis analysis. The most common tumor sites were the pancreaticobiliary ampulla (47.9%) and perihilar tract (36.7%), but the mucin-related subtype of invasive IPNB was the main type, intrahepatically (approximately 90%). In the univariate and multivariate Cox regression analysis, age, tumor site, grade and stage, subtype, surgery, and chemotherapy were associated with OS and CSS (P < 0.05). CONCLUSION: Incidence and IB mortality of invasive IPNB trended steadily downward. The heterogeneity of IPNB comprises site and the tumor's mucin-producing status.

[Distribution of Biodegradable Dissolved Organic Matter and Its Affecting Factors in a Typical Peri-urban Watershed in Yangtze River Delta].

Dissolved organic matter (DOM) plays key roles in the carbon biogeochemical cycle, and biodegradable dissolved organic matter (BDOM) is one of the key fractions of DOM. Rapid urbanization and intensive human activities substantially influence the distribution of DOM at the watershed scale. Identifying the spatial and temporal variability in BDOM has become an important and urgent issue of water quality control in rapid urbanization areas. However, limited studies have been conducted to explore the role of human activities on the occurrence and distribution of BDOM in peri-urban watersheds. In this study, the spatial and temporal distribution of BDOM and related affecting factors were investigated in a typical peri-urban watershed (Zhangxi watershed) located at Ningbo City in Yangtze River Delta. Water samples were collected in wet and dry seasons in 2019 based on topographic features, land use, and intensity of human activities. The BDOM were characterized by fluorescence excitation-emission matrix and parallel factor analysis (EEM-PARAFAC), and land use patterns were analyzed using the Source-Sink Landscape Model. The results of this study showed that the BDOM concentrations ranged from 0.57 to 6.80 mg·L-1. Obvious spatial and temporal heterogeneities of BDOM were found at the watershed scale, and significantly higher concentrations of BDOM were observed in the wet season than those in the dry season. Furthermore, relatively high concentrations of BDOM were found in areas with relatively higher intensive human activities. Two fluorescent components (a terrestrial humic-like substance and protein-like substance) were observed using the PARAFAC model. The results of spatial analysis showed that terrestrial humic-like fluorescent components were closely positively correlated with anthropogenic parameters (percentages of agricultural and urban land and ratio of source and sink landscapes). The results showed that the occurrence and distribution of BDOM were strongly influenced by human activities, which could provide scientific guidance for water quality control and related land management in peri-urban aquatic ecosystems.

Efficacy and safety of sirolimus early conversion protocol in liver transplant patients with hepatocellular carcinoma: A single-arm, multicenter, prospective study.

Mammalian target of rapamycin (mTOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant (LT) recipients in Western countries. However, the pertinent studies in Eastern world are paucity. Therefore, we designed a clinical trial to test whether sirolimus can improve recurrence-free survival (RFS) in hepatocellular carcinoma (HCC) patients beyond the Milan criteria after LT. This is an open-labeled, single-arm, prospective, multicenter, and real-world study aiming to evaluate the clinical outcomes of early switch to sirolimus-based regimens in HCC patients after LT. Patients with a histologically proven HCC and beyond the Milan criteria will be enrolled. The initial immunosuppressant regimens are center-specific for the first 4-6 weeks. The following regimens integrated sirolimus into the regimens as a combination therapy with reduced calcineurin inhibitors based on the condition of patients and centers. The study is planned for 4 years in total with a 2-year enrollment period and a 2-year follow-up. We predict that sirolimus conversion regimen will provide survival benefits for patients particular in the key indicator RFS as well as better quality of life. If the trial is conducted successfully, we will have a continued monitoring over a longer follow-up time to estimate indicator of overall survival. We hope that the outcome will provide better evidence for clinical decision-making and revising treatment guidelines based on Chinese population data. Trial register: Trial registered at http://www.chictr.org.cn: ChiCTR2100042869.