Surgical Strategy for Resecting Hepatocellular Carcinoma in the Caudate Lobe: Isolated or Combined Lobectomy? A Single-Center Study and Meta-Analysis.

BACKGROUND: Resection of hepatocellular carcinoma (HCC) originating in the caudate lobe remains challenging, while the optimal extent of resection is debated. We aimed to evaluate the relative benefits of combined caudate lobectomy (CCL) versus isolated caudate lobectomy (ICL) for caudate HCC. METHODS: Patients who underwent curative-intent resection for caudate HCC between January 2010 and December 2018 were identified from a single-center database. Surgical outcomes of the two strategy groups were analyzed before and after propensity score matching. A systematic review with meta-analysis was also performed to compare outcomes of CCL versus ICL for caudate HCC. RESULTS: A total of 28 patients were included: 11 in the CCL and 17 in the ICL group. Compared with ICL, the CCL group contained patients with larger tumors and a higher incidence of vascular invasion. After propensity score matching, 6 pairs of patients were selected. In the well-matched cohort, CCL demonstrated significantly improved recurrence-free survival (RFS) (P = 0.047) compared with ICL; no significant differences were noted for overall survival (OS), operation time, blood loss and morbidity rate. A total of 227 patients from nine eligible studies and ours were involved in the systematic review. Meta-analysis revealed that CCL provided better RFS (hazard ratio 0.54, 95% confidence interval 0.31-0.92) than ICL; no significant differences were observed in OS, operation time, blood loss and morbidity rate. CONCLUSION: CCL confers superior RFS over ICL without compromise of perioperative outcomes and should be prioritized for patients with caudate HCC when feasible, especially for those with large-sized tumors.

[Panlong acupuncture combined with Xingnao Kaiqiao acupuncture for post-stroke fatigue: a randomized controlled trial].

OBJECTIVE: To observe the clinical effect of Panlong (dragon-like) acupuncture combined with Xingnao Kaiqiao (regaining consciousness and opening orifice) acupuncture on post-stroke fatigue. METHODS: Sixty patients with post-stroke fatigue were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 2 cases dropped off). The patients in the control group were treated with Xingnao Kaiqiao acupuncture at Neiguan (PC 6), Shuigou (GV 26), etc. for 30 min; based on the treatment of the control group, the patients in the observation group were treated with Panlong acupuncture at Jiaji (EX-B 2) of T1 to L5 for 15 min. The two groups were treated once a day, 6 times a week, for a total of 4 weeks. The scores of fatigue assessment instrument (FAI), energy of stroke-specific quality of life (SS-QOL), and modified Barthel index (MBI) in the two groups were compared before and after treatment, and the clinical efficacy was evaluated. RESULTS: Compared before treatment, the total score and each item score of FAI in the observation group were reduced after treatment (P<0.05), while the total score and FAI-1 and FAI-4 scores in the control group were reduced after treatment (P<0.05). The total score of FAI and FAI-1, FAI-2 and FAI-4 scores in the observation group were lower than those in the control group (P<0.05). After treatment, the SS-QOL energy scores and MBI scores of the two groups were increased compared before treatment (P<0.05), and the SS-QOL energy score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 72.4% (21/29) in the observation group, which was better than 46.4% (13/28) in the control group (P<0.05). CONCLUSION: The Panlong acupuncture combined with Xingnao Kaiqiao acupuncture could effectively alleviate the fatigue symptoms and improve quality of life in patients with post-stroke fatigue.

Effect of Electro-acupuncture on Vasomotor Symptoms in Rats with Acute Cerebral Infarction Based on Phosphatidylinositol System.

OBJECTIVE: To investigate the effect of electro-acupuncture (EA) on vasomotor symptoms in rats with acute cerebral infarction, by observing the changes in the expression of factors related to the phosphatidylinositol (PI) system. METHODS: Forty-two Wistar rats were randomly divided into 3 groups by a random number table: the control group (n=6), the model group (n=18) and the EA group (n=18). The EA group was given EA treatment at Shuigou (GV 26) instantly after modeling with middle cerebral artery occlusion (MCAO) method, while the model and control groups were not given any treatment. The degrees of neurological deficiency were evaluated using neurological severity scores (NSS) and the brain blood flow was evaluated by a laser scanning confocal microscope. Western blot analysis was conducted to detect the expression levels of G-protein subtype (Gq) and calmodulin (CaM). Competition for protein binding was conducted to detect the expression level of inositol triphosphate (IP3). Thin layer quantitative analysis was conducted to detect the expression level of diacylglycerol (DAG). The expression level of intracellular concentration of free calcium ion ([Ca2+]i) was detected by flow cytometry. RESULTS: The NSS of the model group was significantly higher than the control group at 3 and 6 h after MCAO (P<0.01), while the EA group was significantly lower than the model group at 6 h (P<0.01). The cerebral blood flow in the model group was significantly lower than the control group at 1, 3 and 6 h after MCAO (P<0.01), while for the EA group it was remarkably higher than the model group at the same time points (P<0.01). The expressions of Gq, CaM, IP3, DAG and [Ca2+]i in the model group were significantly higher than the control group (P<0.05 or P<0.01), and those in the EA group were significantly lower than the model group at the same time points (P<0.05 or P<0.01). CONCLUSION: EA treatment at GV 26 can effectively decrease the over-expression of related factors of PI system in rats with acute cerebral infarction, improve cerebral autonomy movement, and alleviate cerebral vascular spasm.

Machine Learning to Improve Prognosis Prediction of Early Hepatocellular Carcinoma After Surgical Resection.

BACKGROUND: Improved prognostic prediction is needed to stratify patients with early hepatocellular carcinoma (EHCC) to refine selection of adjuvant therapy. We aimed to develop a machine learning (ML)-based model to predict survival after liver resection for EHCC based on readily available clinical data. METHODS: We analyzed data of surgically resected EHCC (tumor≤5 cm without evidence of extrahepatic disease or major vascular invasion) patients from the Surveillance, Epidemiology, and End Results (SEER) Program to train and internally validate a gradient-boosting ML model to predict disease-specific survival (DSS). We externally tested the ML model using data from 2 Chinese institutions. Patients treated with resection were matched by propensity score to those treated with transplantation in the SEER-Medicare database. RESULTS: A total of 2778 EHCC patients treated with resection were enrolled, divided into 1899 for training/validation (SEER) and 879 for test (Chinese). The ML model consisted of 8 covariates (age, race, alpha-fetoprotein, tumor size, multifocality, vascular invasion, histological grade and fibrosis score) and predicted DSS with C-Statistics >0.72, better than proposed staging systems across study cohorts. The ML model could stratify 10-year DSS ranging from 70% in low-risk subset to 5% in high-risk subset. Compared with low-risk subset, no remarkable survival benefits were observed in EHCC patients receiving transplantation before and after propensity score matching. CONCLUSION: An ML model trained on a large-scale dataset has good predictive performance at individual scale. Such a model is readily integrated into clinical practice and will be valuable in discussing treatment strategies.

Novel Bifunctionalization of Activated Methylene: Base-Promoted Trifluoromethylthiolation of ß-Diketones with Trifluoromethanesulfinyl Chloride.

A novel bifunctionalization of activated methylene was achieved successfully through the base-promoted trifluoromethylthiolation of ß-diketones or ß-ketoesters with trifluoromethanesulfinyl chloride. A series of α-trifluoromethylthiolated α-chloro-ß-diketones and α-chloro-ß-ketoesters were obtained in moderate to good yields under mild conditions. When ß-diketones containing a phenyl group with a hydroxyl or amino substituent at the ortho position were used as substrates, intramolecular trifluoromethylthiolation/cyclization reaction took place to give the corresponding cyclic products. Furthermore, the protocol could be extended to perfluoroalkylthiolation with the sodium perfluoroalkanesulfinate/POCl3 system. On the basis of experimental results, plausible mechanisms are proposed.

Indium-Mediated Intramolecular Reaction of N-(2-Iodobenzoyl)azabenzonorbornadienes: A General Access to Dihydrobenzo[c]phenanthridinones.

An efficient synthesis of dihydrobenzo[c]phenanthridinones was achieved by utilizing an indium(0)-mediated intramolecular cyclization reaction under ligand- and base-free conditions. A variety of functional groups were tolerated in the present protocol.

Synthesis, fungicidal activity and structure-activity relationships of 3-benzoyl-4-hydroxylcoumarin derivatives.

BACKGROUND: To develop a coumarin-based fungicide, a series of 3-benzoyl-4-hydroxylcoumarin derivatives were synthesised and their fungicidal activities were evaluated against typical fungi occurring in Chinese agroecosystems. RESULTS: Target compounds were characterised through (1) H NMR, (13) C NMR and high-resolution mass spectrometry. The crystal structure of compound III-21 was determined through X-ray diffraction. Bioassay results indicated that most of the target compounds showed good growth inhibition against all of the fungi tested in vitro. EC50 of the target compounds against Physalospora piricola, Rhizoctonia cerealis, Sclerotinia sclerotiorum and Botrytis cinerea indicated that most of the target compounds displayed comparable activity with that of carbindazim and chlorothalonil in vitro. Among these compounds, the analogue 3-(2-bromo-4-chlorobenzoyl)-4-hydroxylcoumarin (III-21) displayed the optimum growth inhibition against R. cerealis (87.5%) and B. cinerea (82.7%) in vivo at 200 µg mL(-1) concentration; thus, this analogue is a potential inhibitor of pathogenic fungi and a new major compound for further optimisation. The results of analysing the structure-activity relationships demonstrated that changes in substituents on benzene ring A of 3-benzoyl-4-hydroxylcoumarin caused different fungicidal activities and provided original information on the preferential conformation to maintain high activities. CONCLUSION: The present work demonstrated that 3-benzoyl-4-hydroxylcoumarin derivatives can be used as possible major compounds to develop novel fungicides. © 2015 Society of Chemical Industry.

Iridium-catalyzed asymmetric hydrogenation of 2-pyridyl cyclic imines: a highly enantioselective approach to nicotine derivatives.

A highly efficient asymmetric hydrogenation of cyclic imines containing a pyridyl moiety was established by using iridium catalysts with chiral spiro phosphine-oxazoline ligands. This process will facilitate the development of new nicotine-related pharmaceuticals. The introduction of a substituent at the ortho position of the pyridyl ring to reduce its coordinating ability ensures the success of the hydrogenation and excellent enantioselectivity.

[Systematic evaluation of therapeutic effect and safety of acupuncture for treatment of depression].

OBJECTIVE: To assess the therapeutic effect of acupuncture on depression. METHODS: A systematic evaluation of all relevant randomized controlled trials (RCT) about acupuncture and moxibustion treatment of depression was carried out by the study methods of evidence-based medicine. The data were statistically analyzed with a special analysis software RevMan 4.2. RESULTS: Fourteen papers of RCT met the enrolled criteria. Four of the trials used double-blind method. Meta-analysis indicated that the effective rate was no significant difference between the acupuncture treatment and medication, and acupuncture treatment is better than Amitriptyline in improvement of HAMD scores, but no significant differences as compared with other drugs. CONCLUSION: Both acupuncture and medication possibly are effective for depression with good safety. However, because of lower methodological quality of the trials, this conclusion needs further be confirmed.

[Effect of electroacupuncture on inositol triphosphate and diacylglycerol levels in cerebral arteries of cerebral ischemia rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on inositol triphosphate (IP3) and diacylglycerol (DAG) contents in cerebral arteries of the cerebral cortex in rats with cerebral ischemia (CI), so as to explore its effect on intracellular signal transduction pathway. METHODS: Fifty-six Wistar rats wererandomly divided into control (n=8), CI (n=24) and EA (n=24) groups, and the later 2 groups were further separately divided into 1 h, 3 h and 6 h subgroups (CI-1 h, CI-3 h, CI-6 h, EA-CI-1 h, EA-CI-3 h and EA-CI-6 h), with 8 cases in each. CI model was made by occlusion of the middle cerebral artery. EA (15 Hz, 0.1 mA) was applied to "Shuigou" (GV 26) for 20 min. The cerebral arteries in the cerebral shallow layer were collected for assaying intracellular DAG content by thin-layer chromatography (TLC) and IP3 content by competitive protein binding assay (CPBA). RESULTS: Compared with control group,the levels of IP3 and DAG in cerebral vascular smooth muscle were significantly increased in model 1 h, 3 h and 6 h subgroups (P<0.01). Compared with the corresponding model subgroups,the levels of IP3 and DAG were significantly decreased in EA-CI-1 h, EA-CI-3 h and EA-CI-6 h subgroups (P<0.01). CONCLUSION: EA of GV 26 can effectively inhibit CI-induced increase of intracellular IP3 and DAG levels in rat cerebral arteries, which may contribute to its effect in modulating vascular motor to ameliorate cerebral microcirculation.

[Study on modern disease menu of acupuncture and moxibustion therapy in China].

OBJECTIVE: To analyze and summarize the diseases and syndromes treated by acupuncture and moxibustion. METHODS: Using literature researching methods to analyze and summarize the diseases and symptoms treated clinically by acupuncture and moxibustion for observation of therapeutic effects from Chinese Biomedicine Optical Disk Database between 1978-2005, and the frequency-time (number) of reported papers for each disease and syndrome were calculated. RESULTS: The disease menu of acupuncture and moxibustion therapy, 461 kinds in 16 classifications were attained, including 338 diseases of western medicine, 73 symptoms of western medicine and 50 TCM syndromes. CONCLUSION: Acupuncture and moxibustion are an effective therapy with wide indications.