The earliest evidence of deep-sea vertebrates.

Vertebrate macroevolution has been punctuated by fundamental habitat transitions from shallow marine origins to terrestrial, freshwater, and aerial environments. Invasion of the deep sea is a less well-known ecological shift because of low fossilization potential and continual loss of abyssal fossil record by ocean floor subduction. Therefore, there has been a lack of convincing evidence of bottom-living vertebrates from pre-Paleogene deep seas. Here, we describe trace fossils from abyssal plain turbidites of the Tethys Ocean, which, combined with nannofossil dating, indicate that fishes have occupied the deep seafloor since at least the Early Cretaceous (Hauterivian-Barremian). These structures are identical to those produced by modern demersal fishes that feed by either scratching the substrate or expose their prey by water flow generated by suction or jetting. The trace fossils suggest activity of at least three fish species exploiting a productive abyssal invertebrate sediment fauna. These observations are consistent with Early Cretaceous vertebrate transition to the deep sea triggered by the availability of new food sources. Our results anticipate the appearance of deep-seafloor fishes in the fossil record by over 80 My while reassessing the mode of vertebrate colonization of the deep sea.

A national experiment reveals where a growth mindset improves achievement.

A global priority for the behavioural sciences is to develop cost-effective, scalable interventions that could improve the academic outcomes of adolescents at a population level, but no such interventions have so far been evaluated in a population-generalizable sample. Here we show that a short (less than one hour), online growth mindset intervention-which teaches that intellectual abilities can be developed-improved grades among lower-achieving students and increased overall enrolment to advanced mathematics courses in a nationally representative sample of students in secondary education in the United States. Notably, the study identified school contexts that sustained the effects of the growth mindset intervention: the intervention changed grades when peer norms aligned with the messages of the intervention. Confidence in the conclusions of this study comes from independent data collection and processing, pre-registration of analyses, and corroboration of results by a blinded Bayesian analysis.

Flower isoforms promote competitive growth in cancer.

In humans, the adaptive immune system uses the exchange of information between cells to detect and eliminate foreign or damaged cells; however, the removal of unwanted cells does not always require an adaptive immune system1,2. For example, cell selection in Drosophila uses a cell selection mechanism based on 'fitness fingerprints', which allow it to delay ageing3, prevent developmental malformations3,4 and replace old tissues during regeneration5. At the molecular level, these fitness fingerprints consist of combinations of Flower membrane proteins3,4,6. Proteins that indicate reduced fitness are called Flower-Lose, because they are expressed in cells marked to be eliminated6. However, the presence of Flower-Lose isoforms at a cell's membrane does not always lead to elimination, because if neighbouring cells have similar levels of Lose proteins, the cell will not be killed4,6,7. Humans could benefit from the capability to recognize unfit cells, because accumulation of damaged but viable cells during development and ageing causes organ dysfunction and disease8-17. However, in Drosophila this mechanism is hijacked by premalignant cells to gain a competitive growth advantage18. This would be undesirable for humans because it might make tumours more aggressive19-21. It is unknown whether a similar mechanism of cell-fitness comparison is present in humans. Here we show that two human Flower isoforms (hFWE1 and hFWE3) behave as Flower-Lose proteins, whereas the other two isoforms (hFWE2 and hFWE4) behave as Flower-Win proteins. The latter give cells a competitive advantage over cells expressing Lose isoforms, but Lose-expressing cells are not eliminated if their neighbours express similar levels of Lose isoforms; these proteins therefore act as fitness fingerprints. Moreover, human cancer cells show increased Win isoform expression and proliferate in the presence of Lose-expressing stroma, which confers a competitive growth advantage on the cancer cells. Inhibition of the expression of Flower proteins reduces tumour growth and metastasis, and induces sensitivity to chemotherapy. Our results show that ancient mechanisms of cell recognition and selection are active in humans and affect oncogenic growth.

Evaluation of quality and quantity of randomized controlled trials in hepatobiliary surgery: A scoping/mapping review.

AIM: To evaluate the quantity and quality of randomized controlled trials (RCTs) in hepatobiliary surgery and for identifying gaps in current evidences. METHODS: A systematic search was conducted in MEDLINE (via PubMed), Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) for RCTs of hepatobiliary surgery published from inception until the end of 2023. The quality of each study was assessed using the Cochrane risk-of-bias (RoB) tool. The associations between risk of bias and the region and publication date were also assessed. Evidence mapping was performed to identify research gaps in the field. RESULTS: The study included 1187 records. The number and proportion of published randomized controlled trials (RCTs) in hepatobiliary surgery increased over time, from 13 RCTs (.0005% of publications) in 1970-1979 to 201 RCTs (.003% of publications) in 2020-2023. There was a significant increase in the number of studies with a low risk of bias in RoB domains (p < .01). The proportion of RCTs with low risk of bias improved significantly after the introduction of CONSORT guidelines (p < .001). The evidence mapping revealed a significant research focus on major and minor hepatectomy and cholecystectomy. However, gaps were identified in liver cyst surgery and hepatobiliary vascular surgery. Additionally, there are gaps in the field of perioperative management and nutrition intervention. CONCLUSION: The quantity and quality of RCTs in hepatobiliary surgery have increased over time, but there is still room for improvement. We have identified gaps in current research that can be addressed in future studies.

Small airways morphological alterations associated with functional impairment in lymphangioleiomyomatosis.

BACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare neoplastic and cystic pulmonary disease characterized by abnormal proliferation of the so-called LAM cells. Despite the functional obstructive pattern observed in most patients, few studies investigated the morphological changes in the small airways, most of them in patients with severe and advanced LAM undergoing lung transplantation. Understanding the morphological changes in the airways that may occur early in the disease can help us understand the pathophysiology of disease progression and understand the rationale for possible therapeutic approaches, such as the use of bronchodilators. Our study aimed to characterize the morphological alterations of the small airways in patients with LAM with different severities compared to controls, and their association with variables at the pulmonary function test and with LAM Histological Score (LHS). METHODS: Thirty-nine women with LAM who had undergone open lung biopsy or lung transplantation, and nine controls were evaluated. The histological severity of the disease was assessed as LHS, based on the percentage of tissue involvement by cysts and infiltration by LAM cells. The following morphometric parameters were obtained: airway thickness, airway closure index, collagen and airway smooth muscle content, airway epithelial TGF-ß expression, and infiltration of LAM cells and inflammatory cells within the small airway walls. RESULTS: The age of patients with LAM was 39 ± 8 years, with FEV1 and DLCO of 62 ± 30% predicted and 62 ± 32% predicted, respectively. Patients with LAM had increased small airway closure index, collagen and smooth muscle content, and epithelial TGF-beta expression compared with controls. Patients with LAM with the more severe LHS and with greater functional severity (FEV1 ≤ 30%) presented higher thicknesses of the airways. Bronchiolar inflammation was mild; infiltration of the small airway walls by LAM cells was rare. LHS was associated with an obstructive pattern, air trapping, and reduced DLCO, whereas small airway wall thickness was associated with FEV1, FVC, and collagen content. CONCLUSION: LAM is associated with small airway remodelling and partial airway closure, with structural alterations observed at different airway compartments. Functional impairment in LAM is associated with airway remodelling and, most importantly, with histological severity (LHS).

Four-week experimental plus 1-week taper period using live high train low does not alter muscle glycogen content.

This study aimed to investigate the effects of a 4-week live high train low (LHTL; FiO2 ~ 13.5%), intervention, followed by a tapering phase, on muscle glycogen concentration. Fourteen physically active males (28 ± 6 years, 81.6 ± 15.4 kg, 179 ± 5.2 cm) were divided into a control group (CON; n = 5), and the group that performed the LHTL, which was exposed to hypoxia (LHTL; n = 9). The subjects trained using a one-legged knee extension exercise, which enabled four experimental conditions: leg training in hypoxia (TLHYP); leg control in hypoxia (CLHYP, n = 9); leg trained in normoxia (TLNOR, n = 5), and leg control in normoxia (CLNOR, n = 5). All participants performed 18 training sessions lasting between 20 and 45 min [80-200% of intensity corresponding to the time to exhaustion (TTE) reached in the graded exercise test]. Additionally, participants spent approximately 10 h day-1 in either a normobaric hypoxic environment (14.5% FiO2; ~ 3000 m) or a control condition (i.e., staying in similar tents on ~ 530 m). Thereafter, participants underwent a taper protocol consisting of six additional training sessions with a reduced training load. SpO2 was lower, and the hypoxic dose was higher in LHTL compared to CON (p < 0.001). After 4 weeks, glycogen had increased significantly only in the TLNOR and TLHYP groups and remained elevated after the taper (p < 0.016). Time to exhaustion in the LHTL increased after both the 4-week training period and the taper compared to the baseline (p < 0.001). Although the 4-week training promoted substantial increases in muscle glycogen content, TTE increased in LHTL condition.

Using training impulse and monotony methods to monitor aerobic training load in rats.

This study is the first to apply training impulse (TRIMP) and Training Monotony (TM) methodologies, within the realm of sport science, in animal model studies. Rats were divided into Sedentary (SED, n=10) and Training (TR, n=13). TR performed a four-week moderate-intensity interval training with load progression. Lactate kinetics, lactate training impulse (TRIMPLac), maximal speed training impulse (TRIMPSmax) and TM were utilized to develop and monitor training protocol. TR showed an 11.9% increase in time to exhaustion at the second maximum incremental test and a 17.5% increase at the third test. External work was increased by 17.8% at the second test and 30.3% at the third. There was a 10.6% increase in external work at the third test compared to the second for TR. No difference in TRIMPLac between the 1st week (94±9 A.U) and 3rdweek (83±10 A.U) were seen. TRIMPSmax was 2400 A.U. in the 1st week, 2760 A.U. in the 2nd and 3rd weeks, and 3120 A.U. in the 4th week. The TM remained at 1.24 A.U throughout the protocol and there was no dropouts. TRIMPLac and TRIMPSmax contributed to the development and monitoring loads, demonstrating their potential to improve the accuracy of training protocols in animal model research.

Reliability of Anaerobic Contributions during a Single Exhaustive Knee-extensor Exercise.

The total anaerobic contribution (AC[La-]+PCr) is a valid and reliable methodology. However, the active muscle mass plays an important role in the AC[La-]+PCr determination, which might influence its reliability. Thus, this study aimed to investigate the effects of two exhaustive intensities on the reliability of the AC[La-]+PCr during a one-legged knee extension (1L-KE) exercise. Thirteen physically active males were submitted to a graded exercise to determine the peak power output (PPO) in the 1L-KE. Then, two constant-load exercises were conducted to task failure at 100% (TTF100) and 110% (TTF110) of PPO, and the exercises were repeated on a third day. The blood lactate accumulation and the oxygen uptake after exercise were used to estimate the anaerobic lactic and alactic contributions, respectively. Higher values of AC[La-]+PCr were found after the TTF100 compared to TTF110 (p=0.042). In addition, no significant differences (p=0.432), low systematic error (80.9 mL), and a significant ICC (0.71; p=0.004) were found for AC[La-]+PCr in the TTF100. However, an elevated coefficient of variation was found (13.7%). In conclusion, we suggest the use of the exhaustive efforts performed at 100% of the PPO with the 1L-KE model, but its elevated individual variability must be carefully considered in future studies.

Volatile Organic Compounds from Offspring of Stingless Bee Sacrificed in Hygienic Behavior Test.

This study shows the profile of volatile organic compounds (VOCs) from pupae and larvae of Melipona quadrifasciata anthidioides Lepeletier subjected to three death induction techniques for hygienic behavior (HB) studies: freezing in liquid nitrogen (LN2), freezing in a freezer (FRZ) and piercing of offspring with an entomological pin (PIN). The VOCs from larvae and pupae were obtained through headspace solid-phase microextraction and characterized using gas chromatography coupled to mass spectrometry. In addition, an HB test was performed on the colonies. The main classes of VOCs were hydrocarbons, terpenes and alcohols. Multivariate analysis was applied and showed that there was a separation in the compound profiles between the different treatments. The HB test in the colonies showed that 24 hours after the application of the techniques, the bees removed more dead larvae in LN2 treatment (83.5 %), while after 48 hours more larvae were removed in the LN2 and FRZ treatments (92.3 %). When compared to pupae removal, larvae removal was significantly faster in LN2.

Implementation and Results of a Dedicated Telemedicine Program (TeleTrachea) for Patients with Tracheal Diseases.

Background: Central airway diseases requiring frequent outpatient visits to a specialized medical center due to tracheal devices. Many of these patients have mobility and cognition restrictions or require specialized transport due to the need for supplemental oxygen. This study describes the implementation and results of a telemedicine program dedicated to patients with central airway diseases based in a Brazilian public health system. Methods: A retrospective study of telemedicine consultation for patients with central airway diseases referred to a public academic hospital between August 1, 2020 and August 1, 2022. The consultations occurred in a telemedicine department using the hospital's proprietary platform. Data retrieved consisted of demographics, disease characteristics, and the treatment modalities of the patients. The analysis included the savings in kilometers not traveled, the carbon footprint based on reducing CO2 emissions, and the cost savings in transportation. Results: A total of 1,153 telemedicine visits conducted in 516 patients (median age of 31.5 years). Two hundred ninety patients (56.2%) had a tracheal device (129 silicone T-Tube, 128 tracheostomy, and 33 endoprosthesis) and 159 patients (30.8%) had difficulties in transportation to the specialized medical center. Patients were served from 147 Brazilian cities from 22 states. The savings in kilometers traveled was 1,224,108.54 km, corresponding to a 250.14 ton reduction in CO2 emissions. The costs savings in transportation for the municipalities was BRL$ 1,272,283.78. Conclusions: Telemedicine consultations for patients with central airway diseases are feasible and safe. Cost savings and the possibility of disseminating specialized care make telemedicine a fundamental tool in current medical practice.

Understanding seasonal variations in As and Pb river fluxes and their regulatory mechanisms through monitoring data.

The Doce River Basin (DRB) suffers with the adverse impacts of mining activities, due to its high level of urbanization and numerous industrial operations. In this study, we present novel insights into contaminant flow dynamics, seasonal variations, and the primary factors driving concentration levels within the region. We conducted an extensive analysis using a database sourced from the literature, which contained data on the contamination of arsenic (As) and lead (Pb) in the Doce River. Our primary aim was to investigate the patterns of As and Pb flow throughout the entire basin, their response to seasonal fluctuations, and the key parameters influencing their concentration levels. The results showed significant seasonal fluctuations in As and Pb fluxes, peaking during the rainy season. The 2015 Fundão dam breach in the DRB led to notable changes, elevating elemental concentrations, particularly As and Pb, which were subsequently transported to the Atlantic Ocean. These increased concentrations were primarily associated with iron and manganese oxides, hydroxides, and sulfates, rather than precipitation, as evidenced by regressions with low R2 values for both As (R2 = 0.07) and Pb (R2 < 0.001), concerning precipitation. The PCA analysis further supports the connection between these elements and the oxides and hydroxides of Fe and Mn. The approach employed in this study has proven to be highly effective in comprehending biogeochemical phenomena by leveraging data from the literature and could be a model for optimizing resources by capitalizing on existing information to provide valuable insights for drainage basin management, particularly during crises.

Experimental Dengue Virus Type 4 Infection Increases the Expression of MicroRNAs-15/16, Triggering a Caspase-Induced Apoptosis Pathway.

The World Health Organization has estimated the annual occurrence of approximately 392 million dengue virus (DENV) infections in more than 100 countries where the virus is endemic, which represents a serious threat to humanity. DENV is a serologic group with four distinct serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) belonging to the genus Flavivirus, in the family Flaviviridae. Dengue is the most widespread mosquito-borne disease in the world. The ~10.7 kb DENV genome encodes three structural proteins (capsid (C), pre-membrane (prM), and envelope (E)) and seven non-structural (NS) proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS5). The NS1 protein is a membrane-associated dimer and a secreted, lipid-associated hexamer. Dimeric NS1 is found on membranes both in cellular compartments and cell surfaces. Secreted NS1 (sNS1) is often present in patient serum at very high levels, which correlates with severe dengue symptoms. This study was conducted to discover how the NS1 protein, microRNAs-15/16 (miRNAs-15/16), and apoptosis are related during DENV-4 infection in human liver cell lines. Huh 7.5 and HepG2 cells were infected with DENV-4, and miRNAs-15/16, viral load, NS1 protein, and caspases-3/7 were quantified after different durations of infection. This study demonstrated that miRNAs-15/16 were overexpressed during the infection of HepG2 and Huh 7.5 cells with DENV-4 and had a relationship with NS1 protein expression, viral load, and the activity of caspases-3/7, thus making these miRNAs potential injury markers during DENV infection in human hepatocytes.

Is self-reported 7-day point prevalence abstinence an useful measure for smoking cessation effectiveness among individuals with mental disorders?

Smoking rates among individuals with mental disorders are higher compared to general population. We aimed to investigate the effectiveness of a smoking cessation treatment among individuals with and without mental disorders. Self-report 7-day point prevalence was used to assess abstinence status among 'intention to treat' (n = 1,213) and 'completers-only' (n = 578) samples. Participants were distributed in (1) ND-only; (2) ND and other substance use disorder (ND-SUD); (3) ND associated with mental disorder but no other SUD (ND-MD); and (4) co-morbid ND, SUD and MD (ND-SUMD). The treatment program was composed by six weeks of group Cognitive Behavioral Therapy (CBT) and medical consultations. Multivariate logistic regression models were applied. Rates of abstinence between ND-only and both ND-MD and ND-SUMD differed in the 'intention-to-treat' sample, with the former group showing the best rate (62.5%, 48% and 45.4% respectively). ND-SUD had the second-best rate of abstinence (56.1%). Differences between groups were not observed among 'completers-only'. Self-report 7-day point prevalence abstinence is economical and reliable to be used in low to middle-income countries. In this study, it showed that the 6-week smoking cessation treatment had a positive effect among completers, which supports the importance of investing in treatment to decrease smoking prevalence in this population.

Effects of Training and Taper on Neuromuscular Fatigue Profile on 100-m Swimming Performance.

This study aimed to investigate the effects of 6-week specific preparatory period and 2-week taper period on neuromuscular fatigue profile in 100-m front crawl swimming performance. Seventeen competitive-level young-adult swimmers performed a 100-m swimming performance at baseline and after 6-week specific preparatory followed by 2-week taper periods. Neuromuscular fatigue profile was assessed through percutaneous electrical stimuli on the femoral nerve during a maximal voluntary contraction performed before and immediately after each 100-m maximal effort. Performance improved (p=0.001) 2.24 and 3.06% after specific and taper, respectively. Potentiated peak force at post-effort condition decreased (p<0.001) 16.26% at baseline, 11.70% at specific, and 12.86% at taper period. Maximal voluntary contraction force also decreased (p<0.001) at post-effort condition by about 6.77 and 9.33% at baseline and specific period, respectively. Both variables did not present significant differences between times. No condition or time effects were observed to superimposed peak force and voluntary activation, both related to central fatigue. In conclusion, neuromuscular fatigue during 100-m swimming performance was exclusively developed by peripheral mechanisms regardless of the training period, and 2-week taper was able to prevent decreases in maximal voluntary contraction induced by 100-m maximal effort.

Can Hypoxia Alter the Anaerobic Capacity Measured by a Single Exhaustive Exercise?

The present study aimed to compare the MAODALT in situations of hypoxia and normoxia to confirm the method validity. Seventeen healthy and physically active men participated in this study, aged 25.2±3.2 years. All participants underwent four days of evaluation. The first day was performed a body composition test, an incremental test to exhaustion to determine the maximum oxygen uptake, familiarizing the hypoxia (H) and normoxia (N) situation and the equipment used. On the second, third and fourth days, supramaximal efforts were performed until exhaustion at 110% of maximum oxygen uptake, in a situation of hypoxia (FIO2=14.0%) and normoxia (FIO2=20.9%). The anaerobic capacity was considered the sum of energy supply of the alactic and lactic systens. The absolute or relative anaerobic capacity values were not different (H=3.9±1.1 L, N=3.8±0.9 L, p=0.69), similarly no differences were found for the alactic contribution (H=1.7±0.5 L, N=1.5±0.5 L, p=0.30) and lactic contribution (H=2.3±0.9 L, N=2.3±0.7 L, p=0.85). It can be concluded that the anaerobic capacity measured by a single exhaustive effort is not altered by hypoxia.

Geochemical soil dynamics on a bimodal post-collisional intrusive complex.

The importance of environmental quality for global social and ecological development, including soil degradation, cannot be overstated. Trace elements dispersed in the environment due to anthropogenic or geogenic activities can result in ecotoxicological impacts, negatively influencing environmental quality. The reference values for soil quality concerning trace elements are primarily based on geological, geomorphological, and pedological patterns. However, intrinsic geological factors may diverge some concentration levels from established norms. Therefore, conducting comprehensive surveys of environmental quality reference values becomes imperative, incorporating geological, geomorphological, and pedological patterns. A deeper understanding of the distribution of these elements is also required. Multivariate analysis proves crucial in compartmentalizing the most relevant factors, particularly in regions marked by bimodal magmatism arising from post-collisional distensional processes, such as the Santa Angélica intrusive suite in southeast Brazil. This study collected soil samples from pastures and natural grasslands with minimal anthropogenic intervention at two depths. These samples underwent various chemical and physical analyses. Statistical techniques such as correlation analysis, principal component analysis, hierarchical clustering, and geostatistics were utilized to interpret the data. The analysis revealed a correlation between the clay fraction and trace elements, demonstrating that clustering is an effective methodology for ascertaining landscape distribution patterns of these components. When compared to quality reference values, it was observed that most soil content levels exceeded both global and local standards. This study suggests that the presence of barium (Ba) in the soil might be due to the isomorphic replacement of feldspathic minerals in acidic and intermediate rocks, whereas molybdenum (Mo) seems to be associated with soils in the domain of porphyritic allanite granite. However, additional research is warranted to determine the concentration factor of Mo in this scenario accurately.

Chemical Characterization of White Lupin (Lupinus albus) Flour Treated by Extrusion Cooking and Aqueous Debittering Processes.

Lupin is a very nutritious legume with high levels of protein and fiber, but it also contains quinolizidine alkaloids which, depending on the species, can accumulate to toxic levels. The objective of this work was to evaluate the white lupin chemical composition, due to the effects of different processes (aqueous debittering, extrusion cooking, and reactive extrusion), aiming at reducing total alkaloids, preserving fibers, and increasing in vitro protein digestibility. Regarding raw material, the aqueous process reduced significantly total alkaloids (-93.87%), increased dietary fiber (+22.03%), and increased protein digestibility (+6.73%), whereas the extrusion processes were inefficient to reduce alkaloids (< -3.70%) and reduced the dietary fiber content, the reduction being more severe during reactive extrusion (-75.36%). Protein digestibility was improved by extrusion cooking (+3.07%), while the reactive extrusion reduced digestibility (-12.50%). Electrophoresis and quantification of soluble proteins and aromatic amino acids confirmed the high digestibility index, staying only the γ-conglutin fraction in the digested samples evaluated by SDS-PAGE. The aqueous process proved to be the best option, as it reduces the alkaloid content to safe levels and improves the protein digestion of white lupin flour.

Impact of whole millet extruded flour on the physicochemical properties and antihyperglycemic activity of gluten free pasta.

Gluten-free pasta was developed from raw whole millet (RMF) and precooked (PCMF) flours by thermoplastic extrusion. The fusilli shape pasta were prepared with RMF (100%) and RMF:PCMF in a ratio of 50:50. The formulations were characterized for texture, cooking loss, antioxidant capacity, antihyperglycemic activity, sensory and color analyses. The RMF:PCMF blend exhibited better integrity while the RMF was less consistent and more brittle after cooking. The optimal cooking time was 8.5 min for RMF:PCMF and 6.5 min for RMF pasta. Concerning texture parameters, pasta with RMF:PCMF presented higher values ​​than those with RMF, approaching commercial pasta. The antioxidant capacity, DPPH and FRAP (78.5% SFR and 247.5 µmol Trolox/g), total phenolics (127.6 µmol gallic acid equivalent/g (GAE/g)) and antihyperglycemic activity (99.5%) were higher for RMF:PCMF than for pasta prepared with RMF alone. The protein, lipid and fiber content of RMF:PCMF pasta was higher than the commercial brown rice pasta. In relation to the instrumental color analysis, dry pasta (RMF:PCMF) showed a browning index (BI) of 31.9. The global acceptance index of the RMF:PCMF pasta was 66%, in which texture was the most highlighted negative parameter reported by the evaluators. Thus, the use of whole millet precooked flours by thermoplastic extrusion can be an alternative in the preparation of gluten-free products with better functional properties.

Repeat liver resection for recurrent intrahepatic cholangiocarcinoma: meta-analysis.

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is a relatively rare malignancy. The aim of this meta-analysis was to evaluate outcomes of repeat liver resection and non-surgical approaches for treatment of recurrent ICC. METHODS: PubMed, Embase, and Web of Science databases were searched from their inception until March 2021 for studies of patients with recurrent ICC. Studies not published in English were excluded. Two meta-analyses were performed: a single-arm meta-analysis of studies reporting pooled short- and long-term outcomes after repeat liver resection for recurrent ICC (meta-analysis A), and a meta-analysis of studies comparing 1-, 3-, and 5-year overall survival (OS) rates after repeat liver resection and non-surgical approaches for recurrent ICC (meta-analysis B). RESULTS: Of 543 articles retrieved in the search, 28 were eligible for inclusion. Twenty-four studies (390 patients) were included in meta-analysis A and nine studies (591 patients) in meta-analysis B. After repeat liver resection, 1-, 3-, and 5-year OS rates were 87 (95 per cent c.i. 81 to 91), 58 (48 to 68), and 39 (29 to 50) per cent respectively. The 1-, 3-, and 5-year OS rates were higher after repeat liver resection than without surgery: odds ratio 2.70 (95 per cent c.i. 1.28 to 5.68), 2.89 (1.15 to 7.27), and 5.91 (1.59, 21.90) respectively. CONCLUSION: Repeat liver resection is a suitable strategy for recurrent ICC in selected patients. It improves short- and long-term outcomes compared with non-surgical treatments.

Statin use is associated with the reduction in hepatocellular carcinoma recurrence after liver surgery.

BACKGROUND: Hepatocellular carcinoma (HCC) is the sixth most common form of cancer worldwide. Although surgical treatments have an acceptable cure rate, tumor recurrence is still a challenging issue. In this meta-analysis, we investigated whether statins prevent HCC recurrence following liver surgery. METHODS: PubMed, Web of Science, EMBASE and Cochrane Central were searched. The Outcome of interest was the HCC recurrence after hepatic surgery. Pooled estimates were represented as hazard ratios (HRs) and odds ratios (ORs) using a random-effects model. Summary effect measures are presented together with their corresponding 95% confidence intervals (CI). The certainty of evidence was evaluated using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach. RESULTS: The literature search retrieved 1362 studies excluding duplicates. Nine retrospective studies including 44,219 patients (2243 in the statin group and 41,976 in the non-statin group) were included in the qualitative analysis. Patients who received statins had a lower rate of recurrence after liver surgery (HR: 0.53; 95% CI: 0.44-0.63; p < 0.001). Moreover, Statins decreased the recurrence 1 year after surgery (OR: 0.27; 95% CI: 0.16-0.47; P < 0.001), 3 years after surgery (OR: 0.22; 95% CI: 0.15-0.33; P < 0.001), and 5 years after surgery (OR: 0.28; 95% CI: 0.19-0.42; P < 0.001). The certainty of evidence for the outcomes was moderate. CONCLUSION: Statins increase the disease-free survival of patients with HCC after liver surgery. These drugs seem to have chemoprevention effects that decrease the probability of HCC recurrence after liver transplantation or liver resection.