Comprehensive analysis of genomic mutation signature and tumor mutation burden for prognosis of intrahepatic cholangiocarcinoma.

BACKGROUND: Intrahepatic cholangiocarcinoma (iCCA) is a highly lethal malignancy of the biliary tract. Analysis of somatic mutational profiling can reveal new prognostic markers and actionable treatment targets. In this study, we explored the utility of genomic mutation signature and tumor mutation burden (TMB) in predicting prognosis in iCCA patients. METHODS: Whole-exome sequencing and corresponding clinical data were collected from the ICGC portal and cBioPortal database to detect the prognostic mutated genes and determine TMB values. To identify the hub prognostic mutant signature, we used Cox regression and Lasso feature selection. Mutation-related signature (MRS) was constructed using multivariate Cox regression. The predictive performances of MRS and TMB were assessed using Kaplan-Meier (KM) analysis and receiver operating characteristic (ROC). We performed a functional enrichment pathway analysis using gene set enrichment analysis (GSEA) for mutated genes. Based on the MRS, TMB, and the TNM stage, a nomogram was constructed to visualize prognosis in iCCA patients. RESULTS: The mutation landscape illustrated distributions of mutation frequencies and types in iCCA, and generated a list of most frequently mutated genes (such as Tp53, KRAS, ARID1A, and IDH1). Thirty-two mutated genes associated with overall survival (OS) were identified in iCCA patients. We obtained a six-gene signature using the Lasso and Cox method. AUCs for the MRS in the prediction of 1-, 3-, and 5-year OS were 0.759, 0.732, and 0.728, respectively. Kaplan-Meier analysis showed a significant difference in prognosis for patients with iCCA having a high and low MRS score (P < 0.001). GSEA was used to show that several signaling pathways, including MAPK, PI3K-AKT, and proteoglycan, were involved in cancer. Conversely, survival analysis indicated that TMB was significantly associated with prognosis. GSEA indicated that samples with high MRS or TMB also showed an upregulated expression of pathways involved in tumor signaling and the immune response. Finally, the predictive nomogram (that included MRS, TMB, and the TNM stage) demonstrated satisfactory performance in predicting survival in patients with iCCA. CONCLUSIONS: Mutation-related signature and TMB were associated with prognosis in patients with iCCA. Our study provides a valuable prognostic predictor for determining outcomes in patients with iCCA.

Optimal number of harvested lymph nodes for curatively resected gallbladder adenocarcinoma based on a Bayesian network model.

BACKGROUND AND OBJECTIVES: To identify the optimal range and the minimum number of lymph nodes (LNs) to be examined to maximize survival time of patients with curatively resected gallbladder adenocarcinoma (GBAC). METHODS: Data were collected from the surveillance, epidemiology, and end results database on patients with GBAC who underwent curative resection between 2004 and 2015. A Bayesian network (BN) model was constructed to identify the optimal range of harvested LNs. Model accuracy was evaluated using the confusion matrix and receiver operating characteristic (ROC) curve. RESULTS: A total of 1268 patients were enrolled in this study. Accuracy of the BN model was 72.82%, and the area under the curve of the ROC for the testing dataset was 78.49%. We found that at least seven LNs should be harvested to maximize survival time, and that the optimal count of harvested LNs was in the range of 7 to 10 overall, with an optimal range of 10 to 11 for N+ patients, 7 to 10 for stage T1-T2 patients, and 7 to 11 for stage T3-T4 patients. CONCLUSIONS: According to a BN model, at least seven LNs should be retrieved for GBAC with curative resection, with an overall optimal range of 7 to 10 harvested LNs.

Transient Absorption Microscopy of Layered Crystal AsSbS3.

We introduce getchellite as a new layered material for fabrication of two-dimensional van der Waals materials and heterostructures. Nanofilms of AsSbS3 were fabricated by mechanical exfoliation. Transient absorption spectroscopy measurements identified a direct bandgap at about 710 nm, which is close to the ideal single-junction photovoltaic bandgap. Transient absorption microscopy measurements with high spatial and temporal resolution were performed to reveal the spatiotemporal dynamics of photocarriers in AsSbS3. We obtained a photocarrier lifetime of about 200 ps, a diffusion coefficient of about 5 cm2 s-1, a diffusion length of about 320 nm, and a carrier mobility of about 200 cm2 V-1 s-1. These results establish AsSbS3 as a promising two-dimensional semiconductor for optoelectronic applications as an individual material or in heterostructures.

Non-stapled, total laparoscopic Roux-en-Y anastomosis: A safe and effective procedure for radical pediatric choledochal cyst excision.

Background: Laparoscopic or robot-assisted surgery has become the main pediatric minimal invasive surgery for a choledochal cyst (CDC). However, the Roux-en-Y jejunal limb was created extracorporeally in most reports and intracorporeally in a few reports using an endoscopic stapler. Objectives/methods: To investigate the safety and feasibility of non-stapled laparoscopic Roux-en-Y reconstruction in the radical treatment of congenital choledochal cysts (CDC). Between January 2019 and February 2023, 40 patients diagnosed with CDC underwent non-stapled laparoscopic Roux-en-Y reconstruction (non-stapled totally laparoscopic radical treatment, NTLR), 40 patients underwent conventional reconstruction (conventional laparoscopic radical treatment, CLR) included as control. Their clinical data such as intraoperative blood loss, proportion of transit laparotomy, length of operation, postoperative fasting times, postoperative drainage time, postoperative hospital stay, hospitalization cost, and postoperative complications were retrospectively analyzed. Conclusion: non-stapled laparoscopic Roux-en-Y reconstruction is feasible and safe in total laparoscopic radical treatment of CDC. It may have the following advantages: rapid recovery of postoperative gastrointestinal function, short hospitalization, no age limit on the patient and no additional hospitalization costs, which is worthy of promotion and application.

Preoperative Fibrinogen Albumin Ratio is an Effective Biomarker for Prognostic Evaluation of Gallbladder Carcinoma After Radical Resection: A 10-Year Retrospective Study at a Single Center.

Background: To explore and screen preoperative serum immune response level-related biomarkers with better prognostic ability and developed a prognostic model for decision-making in clinical practice for gallbladder carcinoma (GBC) patients. Methods: A total of 427 patients who underwent radical resection for GBC in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed. Time-dependent receiver operating characteristic (time-ROC) was performed to determine the prognostic predictive power of preoperative biomarkers. A nomogram survival model was established and validated. Results: Time-ROC indicated that the preoperative fibrinogen-to-albumin ratio (FAR) had a better predictive ability for overall survival among preoperative serum immune response level-related biomarkers. Multivariate analysis indicated that FAR was an independent risk factor (P<0.05). The proportion of clinicopathological characteristics of poor prognosis (such as advanced T stage, and N1-2 stage) was significantly higher in high FAR group (P<0.05). Subgroup analyses indicate the prognostic discrimination ability of FAR depended on CA19-9, CA125, liver involvement, major vascular invasion, perineural invasion, T stage, N stage, and TNM stage (all P <0.05). A nomogram model was established based on the prognostic independent risk factors with the C-index of 0.803 (95% CI:0.771~0.835) and 0.774 (95% CI:0.696~0.852) in the training and testing sets, respectively. The decision curve analysis indicated the nomogram model had a better predictive ability than the FAR and TNM staging system in the training and testing sets. Conclusion: Preoperative serum FAR has a better predictive ability for overall survival among preoperative serum immune response level-related biomarkers, and it can be used for survival assessment of GBC and guide clinical decision-making.

Textbook outcome in gallbladder carcinoma after curative-intent resection: a 10-year retrospective single-center study.

BACKGROUND: Textbook outcome (TO) can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement. We explored the factors associated with achieving a TO for gallbladder carcinoma (GBC) after curative-intent resection and analyzed the effect of adjuvant chemotherapy (ACT) on TO and non-TO patients. METHODS: A total of 540 patients who underwent curative-intent resection for GBC at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed. Multivariable logistic regression was used to investigate the factors associated with TO. RESULTS: Among 540 patients with GBC who underwent curative-intent resection, 223 patients (41.3%) achieved a TO. The incidence of TO ranged from 19.0% to 51.0% across the study period, with a slightly increasing trend over the study period. The multivariate analysis showed that non-TO was an independent risk factor for prognosis among GBC patients after resection ( P = 0.003). Age ≤60 years ( P = 0.016), total bilirubin (TBIL) level ≤34.1 µmol/L ( P <0.001), well-differentiated tumor ( P = 0.008), no liver involvement ( P <0.001), and T1-2 stage disease ( P = 0.006) were independently associated with achieving a TO for GBC after resection. Before and after propensity score matching (PSM), the overall survival outcomes of non-TO GBC patients who received ACT and those who did not were statistically significant; ACT improved the prognosis of patients in the non-TO group ( P <0.05). CONCLUSION: Achieving a TO is associated with a better long-term prognosis among GBC patients after curative-intent resection, and ACT can improve the prognosis of those with non-TO.

Laparoscopic surgery of intra-abdominal lymphatic malformation in children.

Lymphatic malformation (LM) in the abdomen is uncommon in children, and the standard treatment is surgical excision. The present study aimed to evaluate the safety and efficacy of laparoscopic surgery of intra-abdominal LM in a pediatric population. The medical records of 10 children with intra-abdominal LM treated by laparoscopic resection from March 2017 to June 2021 in The Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) were retrospectively reviewed. Equal numbers of female and male patients were included and underwent surgery at the median age of 55 months (range, 40 days-94 months). Abdominal pain was the most frequent symptom presenting in eight patients (80%). All children were referral patients, and half of them presented to the emergency department with acute abdominal pain. All 10 of the patients benefited from laparoscopic treatment; three patients underwent extraperitoneal segmental intestinal resection and anastomosis via an enlarged umbilical incision, and two patients were converted to laparotomy because of a large retroperitoneal LM with involvement of the colon. No recurrence or complications occurred in the patients during the follow-up period with mean of 35 months (range, 11-60 months) after surgery. Overall, laparoscopic resection of intra-abdominal LM was an effective, minimally invasive therapy in the pediatric population. Segmental intestinal resection is usually required to achieve the complete removal of lesions to lessen the risk for recurrence.

Urban Air Pollution and Mental Stress: A Nationwide Study of University Students in China.

Background: Studies exploring the relationship between air pollution levels and mental stress have rarely been done, and no studies have been done comparing university student mental stress levels based on regional air pollution levels. Objectives: The objective of this study was to evaluate the association between air pollution and mental stress among university students. Methods: Participants were 11,942 students, who were identified through a multistage survey sampling process conducted in 50 universities. Regional air pollution levels were retrieved from a national database, and mental stress was measured using a perceived stress scale. Both unadjusted and adjusted methods were utilized in the data analyses. Results: Mental stress prevalence was 36.9% (95% Confidence Interval: 24.4-49.5%). The final model indicated that regional air pollution levels were positively associated with students' mental stress. Conclusions: This study provided new and direct evidence of the health hazards of air pollution. The findings underscore the need to develop and implement stringent environmental protection policies, while simultaneously raising public awareness of environmental protection.

Violent Injuries Among College Students in China: An Exploration of Gender Mental Stress Model.

The purpose of this study was to explore the gender-specific mental stress model of violent injuries among Chinese college students. A cross-sectional, multistage sampling process was employed to recruit a total of 5025 college students from 22 universities in China. Survey respondents reported their exposure to violent injuries and noted individual and environmental factors that could relate to violent injuries. Both unadjusted and adjusted statistical methods were used to examine the relationships between selected individual and environmental variables with violent injuries among male and female college students. The overall prevalence of violent injuries among male and female college students in this study was 4.40% (95% CI [0.10%, 7.80%]) and 5.20% (95% CI [0.05%, 10.35%]). The study found that higher mental stress (OR: 3.32), lower level universities (OR: 5.99), and family location in rural areas (OR: 4.00) were associated with a higher likelihood of violent injuries, and mothers employed as professionals (OR: 0.07) was associated with lower prevalence of violent injuries among male students. Unlike male students, mental stress and mothers' occupation were not associated with violent injuries among female students. University type was also associated with violent injuries but this association was inverted (OR: 0.06) among female students. This study found gender-specific relationships affecting violent injuries among college students in China. Prevention strategies need to be developed in consideration of gender influences and should be enacted to reduce the negative impact of violent injuries on society and personal health in China.

Sorption behavior of phenanthrene in Yangtze estuarine sediments: sequential separation.

In the present study, phenanthrene was chosen as the probe compound for determining the sorption of PAHs in sediments from Yangtze estuary and nearby coastal area, China. Sorption isotherms were fitted well by the Freundlich and dual models, respectively. Selected sediments were further sequentially separated to remove the carbonate and organic carbon (OC). Calculated OC sorption capacity values based on both H(2)O(2) oxidization and 375 °C combustion methods were similar and comparable to the K(oc) values estimated by the empirical linear sorption equations. Both sorption models and sorption data using sequentially separated samples achieve the similar conclusions: (1) the partition behavior dominated by OC in sediments with f(oc)>0.01; (2) for sediments with 0.001

[Study on nanoparticles in Yangtze Estuary].

Filtration and cross-flow ultrafiltration (CFUF) was applied for the effective separation of NPs in the Yangtze Estuary. The physiochemical properties of NP were characterized, and their relationships with environmental factors were further studied in the present study. The results show that NP size in Yangtze Estuary ranged from 69.5 to 263.5 nm with the average value of 157.3 nm and Zeta-potential values ranged from -40.1 mV to 196.0 mV. NOC concentrations ranged from 0.3 mg/L to 1.5 mg/L and the average value was 0.7 mg/L. NOC account for 5.1% to 30.5% of DOC, with an average of 16.7%. The binding capacity of metals with NP in the Yangtze River Estuary was in the order of Zn > Cu > total Cr > Co > Ni > Mn > Fe > Li > Al > B > K > Ba > Sr > Mg > Ca > Na, which reveals that terrigenous input may be the main source of NOC in the Yangtze River. The binding capacity of NP with trace metal is generally higher than the conventional metallic element. There was no significant correlation between NP size and salinity, DOC, NOC, SPM and Zeta-potential, respectively. Compared to NOC and UOC, better correlation was investigated between DOC, salinity and NP bound trace metals.