Impact of Surgical Modalities on Long-term Survival Outcomes of Patients with Duodenal Gastrointestinal Stromal Tumor.

BACKGROUND: The optimal surgical modality for duodenal gastrointestinal stromal tumor (GIST) remains undefined. The purpose of this study was to evaluate long-term survival outcomes of patients who underwent radical resection (RR) or limited resection (LR) of duodenal GIST. METHODS: A total of 325 patients identified from the Surveillance, Epidemiology and End Results (SEER) database who underwent surgery for duodenal GIST between 1986 and 2016 were classified into a LR group and a RR group based on the type of surgery received. Propensity score matching (PSM) was performed to minimize the selection bias in comparisons. Disease-specific survival (DSS) and overall survival (OS) were observed, and factors affecting the survival outcome were analyzed. RESULTS: In the entire cohort, 105 patients (32.3%) underwent RR and 220 (67.7%) received LR. Both the 5-year OS and DSS in RR group were significantly better than those in LR group (71.0% vs. 54.1%, P = 0.014; 66.6% vs. 49.1%, P = 0.025). PSM resulted in 95 pairs of patients, with long-term outcomes being comparable between the two groups. After adjusting covariates in the propensity matched cohort, the type of surgery still showed no significant impact on OS (hazard ratio [HR] 1.160; 95% confidence interval [CI] 0.662-2.033) and DSS (HR 1.208; 95% CI 0.686-2.128). CONCLUSIONS: Surgical modalities do not seem to have a significant impact on long-term survival outcomes of patients with duodenal GIST and should mainly depend on the tumor size and location.

Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the gallbladder.

BACKGROUND: Signet ring cell carcinoma (SRC) is a rare histological subtype of gallbladder adenocarcinoma. The current study evaluates the clinicopathologic features and prognosis of SRC. METHODS: Patients with adenocarcinoma of the gallbladder were identified in the Surveillance, Epidemiology, and End Results database from 1973 to 2016. Overall survival (OS) and cancer-specific survival (CSS) of patients who had SRC were compared with those of patients who had non-SRC using Cox regression and propensity score methods. RESULTS: Of 22,781 gallbladder adenocarcinomas retrieved, 377 (1.7%) were SRC and the other 22,404 were non-SRC. SRC was more significantly associated with older age, female gender, poor differentiation, advanced tumor stage, lymph node metastasis, distant metastasis, and advanced AJCC stage. The 5-year OS and CSS in the SRC group were 7.2 and 6.5%, respectively, both of which were significantly worse than the 13.2 and 13.3% seen in the SRC group (P = 0.002 and P = 0.012, respectively). This survival disadvantage persisted in multivariable analyses [hazard ratio (HR) = 1.256, P = 0.021 and HR = 1.211, P = 0.036] and after propensity score matching (OS: HR = 1.341, P = 0.012 and CSS: HR = 1.625, P = 0.005). Surgery in combination with chemotherapy improved OS of gallbladder SRC patients compared with surgery alone (HR = 0.726, P = 0.036) or chemotherapy alone (HR = 0.433, P < 0.001). CONCLUSION: Patients with SRC of the gallbladder have distinct clinicopathological features with poor prognosis. Surgery in combination with chemotherapy can improve survival.

Proposal of a new T-stage classification system for ampullary carcinoma based on Surveillance, Epidemiology and End Result (SEER) database.

BACKGROUND: Tumor size is still considered a useful prognostic factor in currently available tumor-node-metastasis (TNM) classification staging systems for most solid tumors, but the significance of tumor size on the prognosis of ampullary carcinoma remains controversial. The aim of the current study was to propose a new T-stage classification system for ampullary carcinoma to address the impact of tumor size on the prognostic outcome. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 1080 patients with ampullary carcinoma who underwent radical surgical resection between 2004 and 2015. Based on the results obtained from analysis of various clinicopathologic factors, a new T-stage classification system was proposed. RESULTS: Among the 1080 patients, 618 were men and 462 were women, with a median tumor size of 2.3 (range 0.1-12) cm. Using the 7th edition of the American Joint Committee on Cancer (AJCC) staging manual, we noticed significant differences in overall survival (OS) between T2 vs. T3 tumors (P < 0.001) and T3 vs. T4 tumors (P = 0.002), but failed to observe significant differences between T1 vs. T2 tumors (P = 0.498) in our pair-wise comparison. Using the newly developed T-stage classification system, we were able to differentiate significant differences in OS between T1 vs. T2 tumors (P = 0.032), T2 vs. T3 tumors (P < 0.001) and T3 vs. T4 tumor (P = 0.003) in all pair-wise comparisons. The c-index of the new staging system was 0.653 (95% CI: 0.629-0.677), showing a better discriminatory power than the 0.636 of the 7th AJCC staging system (95% CI: 0.612-0.660). CONCLUSIONS: The new T-stage classification system described herein can better differentiate prognostic outcomes after radical resection in patients with ampullary carcinoma by incorporating tumor size and depth of tumor infiltration.

Genotoxicity response of Vicia faba seedlings to cadmium in soils as characterized by direct soil exposure and micronucleus test.

To overcome the drawbacks of the Vicia faba root tip micronucleus test in soil using the solution extract method, we conducted a potting experiment by direct soil exposure. Cadmium was spiked into 3 typical soils (brown soil, red soil, and black soil) to simulate environmental concentrations (0.625, 1.25, 2.5, 5, and 10 mg kg-1). Multiple Vicia faba tissues (primary root tips, secondary root tips, and leaf tips) were sampled, and mitotic index (MI), chromosome aberration frequency (CA), and micronucleus frequency (MN) were used as endpoints after a seedling period of 5 days. The results showed a response between Cd concentrations and multiple sampling tissues of Vicia faba, and the secondary root tips responded to Cd stress the most, followed by primary root tips and leaf tips. Soil physicochemical properties (e.g., pH, total phosphorus, total organic carbon, etc.) influenced the genotoxicity of Cd, and pH was the dominant factor, which resulted in the genetic toxicity response of Cd in soils in the order: red soil > brown soil > black soil. The lowest observable effect concentration (LOEC) of Cd was 1.25 mg kg-1 for both brown soil and red soil and 2.5 mg kg-1 for black soil. In view of this, we suggested that soil properties should be considered in evaluating genotoxicity risk of Cd in soil, especially with soil pH range, and the secondary root tips should be taken as suitable test tissues in the MN test due to its more sensible response feature to Cd stress in soil.

The Prognostic Value of a Pathologic Complete Response After Neoadjuvant Therapy for Digestive Cancer: Systematic Review and Meta-Analysis of 21 Studies.

BACKGROUND: Neoadjuvant therapy (NAT) before radical excision has become the preferred initial option for locally advanced digestive cancers such as esophageal cancer (EC), esophagogastric junction adenocarcinoma (EGJAC), gastric adenocarcinoma (GAC), rectal cancer (RC), and pancreatic cancer (PC). Although some patients reportedly achieve a pathologic complete response (pCR) after neoadjuvant therapy, the published data are inconsistent regarding whether pCR yields a survival benefit. The current meta-analysis was performed to assess the potential prognostic value of pCR after preoperative therapy for patients with digestive cancers. METHODS: An extensive electronic search in PubMed, Web of Science, and the Cochrane Library was performed for relevant articles, from which data relative to independent correlations of pCR with overall survival (OS) and disease-free survival (DFS) were extracted for analysis. A random-effects model was used to calculate the pooled hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs). RESULTS: The study identified 6780 patients who met the inclusion and exclusion criteria. The results showed that pCR was significantly correlated with better OS (HR, 0.50; 95% CI, 0.43-0.58; P < 0.001) and DFS (HR, 0.49; 95% CI, 0.40-0.60; P < 0.001) for the digestive cancer patients who achieved pCR than for those who did not achieve pCR. Subgroup analysis showed that the correlation of pCR with OS was significant in EC (HR, 0.57; 95% CI, 0.47-0.69; P < 0.001), EGJAC/GAC (HR, 0.38; 95% CI, 0.17-0.86; P = 0.02), RC (HR, 0.48; 95% CI, 0.28-0.81; P = 0.006), and PC (HR, 0.41; 95% CI, 0.17-0.97; P = 0.04). In addition, the survival benefit for pCR patients was of similar magnitude, irrespective of the type of study, type of NAT, or ethnicity. CONCLUSIONS: A pCR is correlated with favorable survival outcomes compared with a non-pCR for digestive cancer patients after NAT.

Survival benefits of additional surgery after non-curative endoscopic resection in patients with early gastric cancer: a meta-analysis.

BACKGROUND: The survival benefit of additional surgery after non-curative endoscopic resection of early gastric cancer is a matter of debate. This meta-analysis is intended to draw a convincing conclusion on this issue based on data currently available. METHODS: A systematic review of PubMed/Medline database was performed from 2010 to 2018 for studies comparing survival outcomes of additional surgery versus simple follow-up after non-curative endoscopic resection for early gastric cancer. Differences between groups were calculated using either the fixed effects model or random effects model. RESULTS: Ten retrospective studies with 4225 patients met the inclusion criteria. Additional surgery significantly provided better 5 years overall survival [odds ratios (OR) 3.50, 95% confidence interval (95% CI) 2.89-4.24] and disease-specific survival (OR 3.99, 95% CI 2.50-6.36). CONCLUSIONS: Additional surgery offers survival benefits to patients undergoing non-curative endoscopic resection of early gastric cancer.

Investigation of Listeriosis-Related Knowledge, Attitudes, and Practices Among Medical Staff in Fangshan, Beijing, China.

The aim of this study was to gain insight into the knowledge of, attitude toward, and practical experience with listeriosis among medical staff. In two hospitals in Fangshan, Beijing, 410 medical staff members were randomly selected using a random sampling method. Each selected staff member was invited to participate in a standardized questionnaire interview. In total, 397 valid questionnaires were collected. With regard to the staff members' general knowledge of listeriosis, they answered 65.96% of the items correctly. The knowledge scores among obstetricians and gynecologists were higher than those of other clinical doctors (p < 0.05); however, obstetricians and gynecologists were less knowledgeable about which drugs are effective against listeriosis than the other doctors (p = 0.007). The percentage of participants with a positive attitude about preventing listeriosis was 96.47%, the percentage with practice formation was 52.39%. The medical staff's mean score for knowledge of listeriosis was 4.61 ± 1.83. The mean score for attitude toward listeriosis was 9.71 ± 1.31. There was a significant association between attitude and knowledge of listeriosis (r = 0.221, p < 0.001). Medical staff obtained a mean score of 2.10 ± 1.07 for the practice formation. There was a significant association between practice formation and knowledge of listeriosis (r = 0.502, p < 0.001). The mean knowledge-attitude-practice (KAP) score for listeriosis among medical staff was 16.41 ± 3.19. The KAP scores were significantly correlated with age (r = 0.129, p = 0.011), occupation (r = -0.103, p = 0.041), department (r = -0.168, p = 0.001), and professional title (r = 0.166, p = 0.001). To improve medical outcomes and foodborne disease surveillance, medical staff should receive more training on listeriosis and the content of the training should be adjusted.

Long-term outcomes of combined hepatocellular-cholangiocarcinoma after hepatectomy or liver transplantation: A systematic review and meta-analysis.

BACKGROUND: Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy. We conducted a systematic review and meta-analysis to assess the evidence available on the long-term outcomes of cHCC-CC patients after either hepatectomy or liver transplantation (LT). DATA SOURCES: Relevant studies published between January 2000 and January 2018 were identified by searching PubMed and Embase and reviewed systematically. Data were pooled using a random-effects model. RESULTS: A total of 42 observational studies involving 1691 patients (1390 for partial hepatectomy and 301 for LT) were included in the analysis. The median tumor recurrence and 5-year overall survival (OS) rates were 65% (range 38%-100%) and 29% (range 0-63%) after hepatectomy versus 54% (range 14%-93%) and 41% (range 16%-73%) after LT, respectively. Meta-analysis found no significant difference in OS and tumor recurrence between LT and hepatectomy groups. CONCLUSION: Hepatectomy rather than LT should be considered as the prior treatment option for cHCC-CC.

Survival after repeat hepatectomy for recurrent colorectal liver metastasis: A review and meta-analysis of prognostic factors.

BACKGROUND: Frequent recurrent hepatic metastasis after hepatic metastasectomy is a major obstacle in the treatment of colorectal liver metastasis (CRLM). We performed the present systematic review to evaluate the short- and long-term outcomes after repeat hepatectomy for recurrent CRLM and determine factors associated with survival in these patients. DATA SOURCES: An electronic search of PubMed database was undertaken to identify all relevant peer-reviewed papers published in English between January 2000 and July 2018. Hazard ratios (HR) with 95% confidence interval (95% CI) were calculated for prognostic factors of overall survival (OS). RESULTS: The search yielded 34 studies comprising 3039 patients, with a median overall morbidity of 23% (range 8%-71%), mortality of 0 (range 0-6%), and 5-year OS of 42% (range 17%-73%). Pooled analysis showed that primary T3/T4 stage tumor (HR = 1.94; 95% CI: 1.04-3.63), multiple tumors (HR = 1.49; 95% CI: 1.10-2.01), largest liver lesion ≥5 cm (HR = 1.89; 95% CI: 1.11-3.23) and positive surgical margin (HR = 1.80; 95% CI: 1.09-2.97) at initial hepatectomy, and high serum level of carcinoembryonic antigen (HR = 1.87; 95% CI: 1.27-2.74), disease-free interval ≤12 months (HR = 1.34; 95% CI: 1.10-1.62), multiple tumors (HR = 1.64; 95% CI: 1.32-2.02), largest liver lesion ≥5 cm (HR = 1.85; 95% CI: 1.34-2.56), positive surgical margin (HR = 2.25; 95% CI: 1.39-3.65), presence of bilobar disease (HR = 1.62; 95% CI: 1.19-2.20), and extrahepatic metastases (HR = 1.60; 95% CI: 1.23-2.09) at repeat hepatectomy were significantly associated with poor OS. CONCLUSIONS: Repeat hepatectomy is a safe and effective therapy for recurrent CRLM. Long-term outcome is predicted mainly by factors related to repeat hepatectomy.

Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta-analysis.

BACKGROUND: In this systematic review and meta-analysis, we aimed to determine the risk factors associated with neck hematoma requiring surgical re-intervention after thyroidectomy. METHODS: We systematically searched all articles available in the literature published in PubMed and CNKI databases through May 30, 2017. The quality of these articles was assessed using the Newcastle-Ottawa Quality Assessment Scale, and data were extracted for classification and analysis by focusing on articles related with neck hematoma requiring surgical re-intervention after thyroidectomy. Our meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. RESULTS: Of the 1028 screened articles, 26 met the inclusion criteria and were finally analyzed. The factors associated with a high risk of neck hematoma requiring surgical re-intervention after thyroidectomy included male gender (odds ratio [OR]: 1.86, 95% confidence interval [CI]: 1.60-2.17, P < 0.00001), age (MD: 4.92, 95% CI: 4.28-5.56, P < 0.00001), Graves disease (OR: 1.81, 95% CI: 1.60-2.05, P < 0.00001), hypertension (OR: 2.27, 95% CI: 1.43-3.60, P = 0.0005), antithrombotic drug use (OR: 1.92, 95% CI: 1.51-2.44, P < 0.00001), thyroid procedure in low-volume hospitals (OR: 1.32, 95% CI: 1.12-1.57, P = 0.001), prior thyroid surgery (OR: 1.93, 95% CI: 1.11-3.37, P = 0.02), bilateral thyroidectomy (OR: 1.19, 95% CI: 1.09-1.30, P < 0.0001), and neck dissection (OR: 1.55, 95% CI: 1.23-1.94, P = 0.0002). Smoking status (OR: 1.19, 95% CI: 0.99-1.42, P = 0.06), malignant tumors (OR: 1.00, 95% CI: 0.83-1.20, P = 0.97), and drainage used (OR: 2.02, 95% CI: 0.69-5.89, P = 0.20) were not significantly associated with postoperative neck hematoma. CONCLUSION: We identified certain risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy, including male gender, age, Graves disease, hypertension, antithrombotic agent use, history of thyroid procedures in low-volume hospitals, previous thyroid surgery, bilateral thyroidectomy, and neck dissection. Appropriate intervention measures based on these risk factors may reduce the incidence of postoperative hematoma and yield greater benefits for the patients.

Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis.

BACKGROUND: The impact of tumor size on prognosis for surgically treated patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. A systematic review and meta-analysis was performed to evaluate this issue. METHODS: Relevant studies published from January 2000 to June 2017 were identified through EMBASE and PUBMED. Data were pooled for meta-analysis using Review Manager 5.3. RESULTS: Twenty eight observational studies involving a total of 23,945 patients were included. Tumors > 2 cm was associated with poor prognosis: the pooled hazard ratio (HR) estimate for overall survival was 1.52 (95% confidence interval [CI]: 1.41-1.64; P < 0.0001) by univariate analysis and 1.61 (95% CI: 1.35-1.91; P < 0.0001) by multivariate analysis; the pooled HR estimate for disease-free survival was 1.74 (95% CI: 1.46-2.07; P < 0.0001) by univariate analysis and 1.38 (95% CI: 1.12-1.68; P = 0.002) by multivariate analysis. When compared with patients with tumors ≤2 cm, those with the tumors > 2 cm had higher incidences of lymph node metastasis, poor tumor differentiation, lymph vessel invasion, vascular invasion, perineural invasion, and positive intraoperative peritoneal cytology. CONCLUSION: These data demonstrate that PDAC size > 2 cm is an independent predictive factor for poor prognosis after surgical resection and associated with more aggressive tumor biology.

Braun anastomosis lowers the incidence of delayed gastric emptying following pancreaticoduodenectomy: a meta-analysis.

BACKGROUND: Delayed gastric emptying (DGE) is one of the most frequent complications following pancreaticoduodenectomy. This meta-analysis aimed to evaluate the impact of Braun enteroenterostomy on DGE following pancreaticoduodenectomy. METHODS: A systematic review of the literature was performed to identify relevant studies. Statistical analysis was carried out using Review Manager software 5.3. RESULTS: Eleven studies involving 1672 patients (1005 in Braun group and 667 in non-Braun group) were included in the meta-analysis. Braun enteroenterostomy was associated with a statistically significant reduction in overall DGE (odds ratios [OR] 0.32, 95% confidence intervals [CI] 0.24 to 0.43; P <0.001), clinically significant DGE (OR 0.27, 95% CI 0.15 to 0.51; P <0.001), bile leak (OR 0.50, 95% CI 0.29 to 0.86; P = 0.01), and length of hospital stay (weighted mean difference -1.66, 95% CI -2.95 to 00.37; P = 0.01). CONCLUSIONS: Braun enteroenterostomy minimizes the rate and severity of DGE following pancreaticoduodenectomy.

A pooled analysis of en bloc right hemicolectomy with pancreaticoduodenectomy for locally advanced right-sided colon cancer.

PURPOSE: The aim of this study was to evaluate the safety and efficacy of en bloc right hemicolectomy with pancreaticoduodenectomy (RHCPD) for locally advanced right-sided colon cancer (LARCC). METHOD: A pooled data analysis was performed on individual patients identified from the literature and the authors' institutions. The short- and long-term outcomes were assessed. RESULTS: Recruited in this study were 81 LARCC patients undergoing RHCPD, including 75 patients reported in the literature and 6 patients from our own institutions. R0 resection was achieved in 97.5% cases. Morbidity and the 30-day mortality rate were 53.8 and 3.7%, respectively. The median survival duration was 70.4 months, and the 1-, 3- and 5-year overall survival rates were 77.8, 64.6, and 55.2%, respectively. Multivariable analysis identified only lymph node metastasis (hazard ratio 3.474, 95% confidence interval 1.323-9.120; P = 0.011) as independent predictors of poor survival. CONCLUSION: En bloc RHCPD for LARCC can be performed safely with a high proportion of R0 resection and a good postoperative survival outcome.

Synthesis and Electrochemical Properties of Yb3+-Doped Li1.20Mn0.54Ni0.13Co0.13O2 Cathode Materials Obtained by Sol-Gel Method.

The Li1.20[Mn0.54Ni0.13Co0.13]0.80-xYbxO2 (x = 0, 0.01, 0.02, 0.03) cathode materials have been synthesized by using sol-gel method and characterized by means of XRD, SEM, ICP-OES analysis. The galvanostatic charge-discharge tests results showed the improved electrochemical properties were obtained through the Yb3+ doping modification. With the increase of Yb3+ doping content, the capacity retentions enhanced from 85.6% to 88.9% and then decrease to 86.5% after 100 cycles with x = 0.01, 0.02 and 0.03, respectively, while the un-doped sample delivered the capacity retention of 83.0%. Besides, the discharge capacity of Li1.20 [Mn0.54Ni0.13Co0.13]0.78Yb0.02O2 was about 23.1 mAh g-1 larger than that of un-doped sample at 5C high rate. The electrochemical impedance spectroscopy (EIS) and cyclic voltammetric results indicated that the Yb3+ doping modification could suppress the layered-spinel phase transformation during cycling and maintain a lower value of charge transfer impedance.

Tunable reflective color filters based on asymmetric Fabry-Perot cavities employing ultrathin Ge2Sb2Te5 as a broadband absorber.

We demonstrated a tunable structural color filter based on an asymmetric Fabry-Perot cavity employing germanium antimony tellurium alloy Ge2Sb2Te5 (GST) as a switchable ultrathin lossy layer. The color tunability and switch mechanism of our designed structure were investigated by both simulation and analytical approaches. Both numerical simulations and analytical results show that the tunable reflective colors can be generated through the reversible phase transition of GST from amorphous to crystalline. Additionally, the generated colors possess high brightness, high saturation, and a wide gamut. Our designed structure will inspire phase-transition-based systems' potential applications in colorimetric sensing, smart windows, full-color printing and displays, anti-counterfeiting, and data encryption.

A pooled analysis of treatment and prognosis of hepatic angiosarcoma in adults.

BACKGROUND: Hepatic angiosarcoma is a rare malignant vascular tumor presenting unique treatment challenges. The aim of the present study was to determine the treatment and prognosis of this entity. DATA SOURCES: A systematic literature search was conducted using PubMed, Embase and Chinese Biomedical Literature database, to identify articles published from January 1980 to July 2017. Search terms were "hepatic angiosarcoma" and "liver angiosarcoma". Additional articles were retrieved through manual search of bibliographies of the relevant articles. Pooled individual data concerning the prognosis following various therapeutic modalities were analyzed. RESULTS: A total of 75 articles involving 186 patients were eligible for inclusion. The median overall survival (OS) was 8 months, with 1-, 3-, and 5-year OS rates of 36.6%, 22.3%, and 12.0%, respectively. The median OS after partial hepatectomy (n = 86), chemotherapy (n = 36), liver transplantation (n = 17), and supportive care (n = 46) were 15, 10, 5 and 1.3 months, respectively. Small tumor size (<10 cm) was the only significant favorable factor for OS after partial hepatectomy (P = 0.012). CONCLUSIONS: Despite the dismal prognosis, partial hepatectomy could prolong the survival of hepatic angiosarcoma patients, particularly those with tumors <10 cm. Chemotherapy could be an option for unresectable disease. Liver transplantation is not a recommendable option for the management of this malignancy.

An evidence-based approach to the surgical interventions for severe pancreatic fistula after pancreatoduodenectomy.

BACKGROUND AND OBJECTIVE: To assess the safety and therapeutic outcome of different surgical interventions for severe pancreatic fistula after pancreatoduodenectomy. METHODS: A systematic literature search was performed in PubMed database for relevant articles published between 1990 and March 2017. Descriptive statistics were performed and data are expressed as mean. RESULTS: Twenty-four studies involving 370 patients undergoing surgical interventions for severe pancreatic fistula after pancreatoduodenectomy were included. Rates of further relaparotomy, in-hospital mortality, and long-term endocrine insufficiency were reported for completion pancreatectomy (31.8%, 42% and 100% respectively), disconnection of anastomosis with preservation of a pancreatic remnant (25%, 21.3% and 17.8% respectively), internal or external wirsungostomy (10.4%, 14.9%, and 12.3% respectively), salvage pancreaticogastrostomy (12.5%, 0% and 25%, respectively), and simple peripancreatic drainage (30%, 47.9% and 12.5%, respectively). CONCLUSIONS: The pancreas-preserving strategy of disconnection of anastomosis with preservation of a pancreatic remnant, internal or external wirsungostomy, and salvage pancreatogastrostomy seems to be the preferred option for the treatment of severe pancreatic fistula after pancreatoduodenectomy. As completion pancreatectomy is a very aggressive treatment, it should only be reserved for specific instances in which organ-preserving resection is technically unfeasible.

Dynamic Color Displays Using Stepwise Cavity Resonators.

High-resolution multicolor printing based on pixelated optical nanostructures is of great importance for promoting advances in color display science. So far, most of the work in this field has been focused on achieving static colors, limiting many potential applications. This inevitably calls for the development of dynamic color displays with advanced and innovative functionalities. In this Letter, we demonstrate a novel dynamic color printing scheme using magnesium-based pixelated Fabry-Pérot cavities by gray scale nanolithography. With controlled hydrogenation and dehydrogenation, magnesium undergoes unique metal and dielectric transitions, enabling distinct blank and color states from the pixelated Fabry-Pérot resonators. Following such a scheme, we first demonstrate dynamic Ishihara plates, in which the encrypted images can only be read out using hydrogen as information decoding key. We also demonstrate a new type of dynamic color generation, which enables fascinating transformations between black/white printing and color printing with fine tonal tuning. Our work will find wide-ranging applications in full-color printing and displays, colorimetric sensing, information encryption and anticounterfeiting.

The histopathologic type predicts survival of patients with ampullary carcinoma after resection: A meta-analysis.

OBJECTIVES: The results of studies on the prognostic value of histopathologic differentiation of the intestinal and pancreatobiliary types of ampullary carcinoma after resection are conflicting. A meta-analysis was undertaken to investigate this issue. METHODS: A systematic literature search was performed to identify articles published from January 2000 to August 2016. Data were pooled for meta-analysis using Review Manager 5.3. RESULTS: Twenty three retrospective studies involving a total of 2234 patients were identified for inclusion, of whom 1021 (45.7%) had intestinal type tumors and 899 (40.2%) had pancreaticobiliary type tumors. Patients with the pancreaticobiliary type had high rates of poor tumor differentiation (P < 0.001), lymph node metastasis (P < 0.001), vascular invasion (P < 0.001), perineural invasion (P < 0.001), and positive resection margins (P = 0.004), as compared with those with the intestinal type. The pancreaticobiliary type predicted a worse overall survival (hazard ratio [HR] 1.84, 95% CI 1.49-2.27; P < 0.001) and disease-free survival (HR 1.93, 95% CI 1.23-3.01; P = 0.004). CONCLUSION: The histopathologic type has major impact on survival in patients with ampullary carcinoma after resection, and the pancreaticobiliary type reflects a more aggressive tumor biology and is associated with worse survival.

Influence of cirrhosis on long-term prognosis after surgery in patients with combined hepatocellular-cholangiocarcinoma.

BACKGROUND: Little is known about the prognostic impact of cirrhosis on long-term survival of patients with combined hepatocellular-cholangiocarcinoma (cHCC-CC) after hepatic resection. The aim of this study was to elucidate the long-term outcome of hepatectomy in cHCC-CC patients with cirrhosis. METHODS: A total of 144 patients who underwent curative hepatectomy for cHCC-CC were divided into two groups: cirrhotic group (n = 91) and noncirrhotic group (n = 53). Long-term postoperative outcomes were compared between the two groups. RESULTS: Patients with cirrhosis had worse preoperative liver function, higher frequency of HBV infection, and smaller tumor size in comparison to those without cirrhosis. The 5-year overall survival rate in cirrhotic group was significantly lower than that in non-cirrhotic group (34.5% versus 54.1%, P = 0.032). The cancer recurrence-related death rate was similar between the two groups (46.2% versus 39.6%, P = 0.446), while the hepatic insufficiency-related death rate was higher in cirrhotic group (12.1% versus 1.9%, P = 0.033). Multivariate analysis indicated that cirrhosis was an independent prognostic factor of poor overall survival (hazard ratio 2.072, 95% confidence interval 1.041-4.123; P = 0.038). CONCLUSIONS: The presence of cirrhosis is significantly associated with poor prognosis in cHCC-CC patietns after surgical resection, possibly due to decreased liver function.