Adiabatic weak coherent MHz linewidth O-band single-photon carrier for low erroneous phase decoding.

For weak coherent single-photon secure data communication among short-reach metropolitan intra-/inter-city networks at the O-band (1250-1350 nm), the commercially available semiconductor laser sources are emerging but still suffering from high single-mode-fiber (SMF) loss, broad linewidth, and unstable wavelength. To overcome such disadvantages for enabling the efficient phase-coding link with sufficient secure key rate, a specifically designed adiabatic package with active temperature-/current-feedback control is proposed for the paired O-band MHz-linewidth master-to-slave injection-locked DFBLDs and a polarization-maintaining 1-bit-delay interferometer is stabilized with using a passively adiabatic cell to achieve accurate differential phase decoding. Even though, the phonon-induced phase fluctuation still occurs at rising and falling edges of the decoded long-pattern secure data bits delivered from the slave DFBLD, which is mainly attributed to the intra-cavity heating under excessive free-carrier generation via the master DFBLD injection. To stabilize the differential-phase-shift (DPS) keying protocol, the phase-code distortion caused by over-injection-induced Auger heating is effectively suppressed by reducing the overly biased injection with precise master-injection-level control. The rising-/falling-edge damping distortion of the phase-shift-encoded secure bit-stream envelope is suppressed by appropriately decreasing the DC bias current and adjusting the AC encoding amplitude of the master DFBLD. Such operation reduces the incorrect π phase shift in the injection-locked slave DFBLD biased at optimized below-threshold DC offset, thus allowing single-photon DPS-keying data transmission over 15-km SMF with slightly increasing the single-photon bit-error ratio from <3% (0-km) to 6.2% (15-km).

Optimal treatment strategy and prognostic analysis of salvage liver transplantation for patients with early hepatocellular carcinoma recurrence after hepatectomy.

AIM: We aimed to investigate the prognostic factors for salvage liver transplant in patients with early hepatocellular carcinoma recurrence after hepatectomy. METHODS: This retrospective analysis included 53 patients who underwent salvage living-donor liver transplantation between January 2007 and January 2018. There were 24 and 29 patients in the early (recurrence ≤24 months after primary liver resection) and the late recurrence groups, respectively. RESULTS: In the multivariate Cox regression model, pre-liver transplant downstaging therapy, early recurrence (ER) after primary liver resection , and recurrence-to-liver-transplant ≥12 months were independent risks to predict recurrent hepatocellular carcinoma recurrence after salvage living-donor liver transplantation. Compared with the late recurrence group, the ER group showed lower disease-free survival rates (p < 0.001); however, the overall survival rates did not differ between the two groups (p = 0.355). The 1-, 3-, and 5-year disease-free survival rates were 83.3%, 70.6%, and 66.2%, and 96.0%, 91.6%, and 91.6% in the early and late recurrence groups, respectively. When stratified by recurrence-to-liver transplant time and pre-liver transplant downstaging therapy in the ER group, disease-free survival and overall survival rates were significantly different. CONCLUSION: ER after primary liver resection with advanced tumor status and a longer period of recurrence-to-liver-transplant (≥12 months) have a negative impact on salvage liver transplant. Our findings provide novel recommendations for treatment strategies and eligibility for salvage liver transplant candidates.

Liver Resection Criteria for Patients with Hepatocellular Carcinoma and Multiple Tumors Based on Total Tumor Volume.

BACKGROUND: In many Asian hepatocellular carcinoma (HCC) guidelines, resection is an option for multiple HCCs. It is difficult to compare small but multiple tumors vs. fewer large tumors in terms of the traditional tumor burden definition. We aimed to evaluate the role of liver resection for multiple HCCs and determine factors associated with survival benefits. METHODS: We reviewed 160 patients with multiple HCCs who underwent liver resection between July 2003 and December 2018. The risk factors for tumor recurrence were assessed using Cox proportional hazards modeling, and survival was analyzed using the Kaplan-Meier method. RESULTS: In all 160 patients, 133 (83.1%) exceeded the Milan criteria. Total tumor volume (TTV) > 275 cm3 and serum alpha-fetoprotein (AFP) level > 20 ng/mL were associated with disease-free survival. Patients beyond the Milan criteria were grouped into three risk categories: no risk (TTV ≤ 275 cm3 and AFP ≤ 20 ng/mL, n = 39), one risk (either TTV > 275 cm3 or AFP > 20 ng/mL, n = 76), and two risks (TTV > 275 cm3 and AFP > 20 ng/mL, n = 18). No-risk group had comparable disease-free survival (p = 0.269) and overall survival (p = 0.215) to patients who met the Milan criteria. CONCLUSION: Patients with TTV ≤ 275 cm3 and AFP ≤ 20 ng/mL can have good outcomes even exceed the Milan criteria.

Coupling angle tolerance of the 850-nm single-mode VCSEL output collimated by lensed OM4-MMF or GI-SMF for a NRZ-OOK link.

By collimating the single-mode (SM) vertical-cavity surface-emitting laser (VCSEL) at 850 nm with either the OM4 multi-mode fiber (OM4-MMF) or the graded-index single-mode fiber (GI-SMF) with lensed end-face, the directly encoded non-return-to-zero on-off keying (NRZ-OOK) data transmission performance is characterized when tilting the coupling angle with respect to the surface normal of the SM-VCSEL. In comparison with the lensed OM4-MMF and lensed SMF coupling, the lensed OM4-MMF collimator shows a large coupling angle tolerance with the coupling efficiency only degraded by 5% when enlarging the tilted angle from 0° to 10°. In contrast, the lensed GI-SMF collimator attenuates the coupled SM-VCSEL output by more than 50% when tilting the coupling angle up to 10°. For the lensed OM4-MMF coupling, the receivable NRZ-OOK data rate in BtB and after 100-m OM4-MMF cases can achieve 50 Gbit/s with its corresponding BER degraded from 6.5 × 10-10 to 8.8 × 10-10 when enlarging its tilting angle ranged from 0° to 10°. By changing the collimator to the lensed SMF, the decoded BER significantly degrades from 5.8 × 10-5 to 1.2 × 10-1 when coupling and transmitting the NRZ-OOK data at 50 Gbit/s. Owing to the low coupling efficiency via the lensed SMF collimator, the error-free NRZ-OOK data rate under the lensed SMF coupling somewhat decreases to 35 Gbit/s in the BtB link and to 32 Gbit/s after the 100-m GI-SMF link with allowable coupling angle tilted from 0° to 4°. This work confirms the applicability of the lensed MMF or SMF collimator for coupling the SM-VCSEL output with a relatively large tolerance on the tilting angle with respect to the surface normal of the SM-VCSEL.

Quick preparation of ABO-incompatible living donor liver transplantation for acute liver failure.

Acute liver failure is life-threatening and has to be treated by liver transplantation urgently. When deceased donors or ABO-compatible living donors are not available, ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) becomes the only choice. How to prepare ABO-I LDLT urgently is an unsolved issue. A quick preparation regimen was designed, which was consisted of bortezomib (3.5 mg) injection to deplete plasma cells and plasma exchange to achieve isoagglutinin titer ≤ 1: 64 just prior to liver transplantation and followed by rituximab (375 mg/m2 ) on post-operative day 1 to deplete B-cells. Eight patients received this quick preparation regimen to undergo ABO-I LDLT for acute liver failure from 2012 to 2019. They aged between 50 and 60 years. The median MELD score was 39 with a range from 35 to 48. It took 4.75 ± 1.58 days to prepare such an urgent ABO-I LDLT. All the patients had successful liver transplantations, but one patient died of antibody-mediated rejection at post-operative month 6. The 3-month, 6-month, and 1-year graft/patient survival were 100%, 87.5%, and 75%, respectively. In conclusion, this quick preparation regimen can reduce isoagglutinin titers quickly and make timely ABO-I LDLT feasible for acute liver failure.

Improving outcomes of liver resection for hepatocellular carcinoma associated with portal vein tumor thrombosis over the evolving eras of treatment.

BACKGROUND: The outcomes and management of hepatocellular carcinoma (HCC) have undergone several evolutionary changes. This study aimed to analyze the outcomes of patients who had undergone liver resection for HCC with portal vein tumor thrombosis (PVTT) in terms of the evolving era of treatment. MATERIALS AND METHODS: A retrospective analysis of 157 patients who had undergone liver resection for HCC associated with PVTT was performed. The outcomes and prognostic factors related to different eras were further examined. RESULTS: Overall, 129 (82.1%) patients encountered HCC recurrence after liver resection, and the median time of recurrence was 4.1 months. Maximum tumor size ≥ 5 cm and PVTT in the main portal trunk were identified as the major prognostic factors influencing HCC recurrence after liver resection. Although the recurrence-free survival had no statistical difference between the two eras, the overall survival of patients in the second era was significantly better than that of the patients in the first era (p = 0.004). The 1-, 2-, and 3-year overall survival rates of patients in the second era were 60.0%, 45.7%, and 35.8%, respectively, with a median survival time of 19.6 months. CONCLUSION: The outcomes of HCC associated with PVTT remain unsatisfactory because of a high incidence of tumor recurrence even after curative resection. Although the management and outcomes of patients with HCC and PVTT have greatly improved over the years, surgical resection remains an option to achieve a potential cure of HCC in well-selected patients.

Models to predict disease-free survival for hepatocellular carcinoma patients with surgical resections.

BACKGROUND AND OBJECTIVES: Precise prognostic prediction for an individual hepatocellular carcinoma (HCC) patient before and after liver resection is important. We aimed to establish simple prognostic models to predict disease-free survival (DFS) for these patients. METHODS: Six hundred and ninety-eight HCC patients with liver resections were reviewed. Preoperative (model 1) and postoperative (model 2) nomogram-based scoring systems were constructed by multivariate analyses, and DFS was estimated. RESULTS: Among 698 patients, 490 (70.2%) patients had tumor recurrence at a median follow-up of 84.4 months. Risk factors of tumor recurrence in model 1 included viral hepatitis, platelet count, albumin, indocyanine green retention rate, multiplicity of tumor, and radiologic total tumor volume (TTV). Prognostic variables identified in model 2 were viral hepatitis, platelet count, multiplicity of tumor, cirrhosis, microvascular invasion, and pathologic TTV. By nomogram in model 1, the patients were classified into three groups with 5-year DFS of 61.0%, 35.7%, and 21.1%, respectively (P < .0001). In model 2, the patients were divided into five groups with 5-year DFS of 58.0%, 43.7%, 24.0%, 15.4%, and 0.0%, respectively (P < .0001). CONCLUSION: Based on nomogram models, DFS for the patients who had liver resection for HCC can be predicted before liver resection and re-assessed after liver resection.

Low-dose anti-hepatitis B immunoglobulin regimen as prophylaxis for hepatitis B recurrence after liver transplantation.

BACKGROUND: Combination of anti-hepatitis B immunoglobulin (HBIg) and antiviral nucleotide/nucleoside is the most common regimen for prophylaxis against hepatitis B virus (HBV) recurrence. However, what the optimal regimen is for HBIg administration remains subject to debate. METHODS: Two hundred and thirty-two HBV patients who had liver transplantation were included in this study. According to the decline rate of HBIg, the patients were divided into quick (group Q, n = 95) and slow decline groups (group S, n = 137). Quick HBIg decline was defined as anti-HBs titer <200 IU/mL at postoperative month (POM) 1, when 24 000 IU of HBIg was given perioperatively. HBV recurrence was defined as reappearance of hepatitis B surface antigen (HBsAg). RESULTS: After a mean (range) follow-up of 42.2 (24.1-76.8) months, the HBV recurrence rate was 12.1% for all 232 patients. The median (interquartile) HBIg titer was 96.2 (41.0-158.0) IU in group Q patients, compared to 418.0 (298.8-692.8) IU in group S patients at POM 1 (P < .001). For the patients in group Q, 18 patients (18.9%) had HBV recurrence; this was higher than the 10 (7.3%) patients in group S (P = .013). Multivariate analysis showed that quick HBIg decline and hepatocellular carcinoma recurrence were the risk factors for HBV recurrence. CONCLUSION: Perioperative low-dose HBIg and antiviral nucleotide/nucleoside can effectively prevent HBV recurrence in patients with slow HBIg decline. For patients with quick HBIg decline, the idealized HBIg and antiviral agent regimen should be adjusted to establish an effective regimen as prophylaxis against HBV recurrence.

Prognostic impact and risk factors of low body mass index in patients undergoing liver transplantation.

We aimed to investigate the effect of body mass index (BMI) on the overall survival rates and to identify the risk factors associated with adverse outcomes. A total of 381 adult-to-adult living donor liver transplantations performed were retrospectively analyzed. These patients were classified according to the BMI categories established by the World Health Organization: The underweight group (BMI<18.5 kg/m2 ) and the non-underweight group (BMI≥18.5 kg/m2 ). The underweight group had significantly worse outcomes, compared with that of the non-underweight group (5-year overall survival: 45.6% vs 74.6%, P<.001). Underweight patients with CD4/CD8 ratio <1.4 had a significant worse prognosis, compared with those with CD4/CD8 ratio ≥1.4. (The 1-, 3-, and 5-year overall patient survival rates in both groups were 71.0% vs 20%, 58.9% vs 0%, and 53.6% vs 0%, respectively, P=.002.) In the multivariate analysis, only CD4/CD8 ratio <1.4 was an independent poor prognostic factor (hazard ratio=7.063, 95% confidence interval=1.329-37.547, P=.022). CONCLUSIONS: Pre-operative CD4/CD8 ratio <1.4 is an independent poor prognostic indicator for underweight patients undergoing liver transplantation. Early intervention in replenishing the nutrient deficit and cautious use of immunosuppressive regimens are essential to prepare this high-risk population for a more successful liver transplantation.

Clinical strategy for the reconstruction of middle hepatic vein tributaries in right liver living donor liver transplantation.

BACKGROUND: Venous drainage of the right paramedian sector (segments V and VIII), which is mainly via the middle hepatic vein (MHV), remains the major concern when using a right liver graft in living donor liver transplantation (LDLT). We herein describe our approach to decision making in the reconstruction of MHV tributaries in LDLT using a right liver graft without the MHV trunk. METHODS: A total of 77 consecutive right liver LDLTs were performed between January 2011 and December 2012. The MHV trunk was not taken with the graft, and all MHV tributaries were ligated during donor hepatectomy. The right liver graft was subsequently assessed on the back table for congestion in the right paramedian sector as an indicator for the need to reconstruct MHV tributaries. RESULTS: Based on the algorithm, reconstruction of MHV tributaries was performed in 18 patients (23.4 %). Although a mild degree of congestion in the right paramedian sector was noted in a few liver grafts without venous reconstruction, this congestion was well tolerated by recipients and was not visible afterward. The recipients' outcomes were similar in groups with and without venous reconstruction, and the 1-year survival rates were 83.3 and 86.2 %, respectively. CONCLUSION: A right liver graft without the MHV trunk can be successfully performed in LDLT with a satisfactory outcome. However, these experiences show that this approach might be safely applied as a strategy for determining the necessity of reconstruction of MHV tributaries in a right liver graft without the MHV trunk in LDLT.

Prognostic significance of the number of tumors and aggressive surgical approach in colorectal cancer hepatic metastasis.

BACKGROUND: Although liver resection (LR) for colorectal cancer (CRC) hepatic metastasis is the best strategy to improve patient outcomes, there are considerable concerns regarding the recurrence of CRC after LR. In this study, we investigated the prognostic indicators associated with CRC recurrence after LR for hepatic metastasis. METHODS: This is a retrospective review of patients who underwent curative LR for CRC hepatic metastasis between January 2008 and December 2012. The clinicopathological features and outcome parameters affecting prognosis were analyzed. RESULTS: A total of 332 LRs with curative intent were performed in 278 patients, of whom 168 (60.4%) experienced CRC recurrence after the first LR, and 206 of the 332 LRs (62.0%) developed CRC recurrence. A preoperative serum carcinoembryonic antigen level greater than 100 ng/mL and four or more metastatic tumor nodules were independent prognostic factors for CRC recurrence after LR. The disease-free survival rate after LR was significantly associated with the number of metastatic nodules. The patients who underwent surgical resection for recurrent CRC had favorable outcomes, with a five-year overall survival rate of 65.2%. CONCLUSION: The number of metastatic tumors significantly affects the outcomes of patients who undergo LR for CRC hepatic metastasis, indicating that a novel therapeutic strategy for patients at high risk may be required. However, favorable long-term outcomes are achievable through aggressive treatment with surgical resection of the recurrent CRC.

Liver regeneration of living donor after liver donation for transplantation: Disparity in the left and right remnant liver.

Donor safety is crucial for living donor liver transplantation (LDLT), and sufficient liver regeneration significantly affects outcomes of living donors. This study aimed to investigate clinical factors associated with liver regeneration in living donors. The study retrospectively reviewed 380 living donors who underwent liver donation at Chang Gung Memorial Hospital in Linkou. The clinical characteristics and medical parameters of donors were analyzed and compared according to liver donation graft type. There were 355 donors (93.4%) with right hemi-liver donations and 25 donors (6.6%) with left hemi-liver donations. Left hemi-liver donors had a higher body mass index (BMI) and a larger ratio of remnant liver volume (RLV) to total liver volume (TLV). However, the 2 groups showed no significant difference in the liver regeneration ratio. The type of remnant liver (P < .001), RLV/body weight (P = .027), RLV/TLV (P < .001), serum albumin on postoperative day 7 and total bilirubin levels on postoperative day 30 were the most significant factors affecting liver regeneration in living donors. In conclusion, adequate liver regeneration is essential for donor outcome after liver donation. The remnant liver could eventually regenerate to an adequate volume similar to the initial TLV before liver donation. However, the remnant left hemi-liver had a faster growth rate than the remnant right hemi-liver in donors.

Mutlicolor electroluminescent Si quantum dots embedded in SiOx thin film MOSLED with 2.4% external quantum efficiency.

The enhanced recombination and external quantum efficiency (EQE) of the multi-color metal-oxide-semiconductor light-emitting diodes (MOSLEDs) made on the SiOx film with buried Si quantum dots (Si-QDs) grown by plasma-enhanced chemical vapor deposition are demonstrated. By shrinking Si-QD size from 4.2 to 1.8 nm with increasing RF plasma power from 20 to 50 W, these MOSLEDs enhance the maximal electroluminescent (EL) power from 0.1 to 0.7 µW. This is mainly attributed to the enhanced recombination rate by enlarging the overlap between electron and hole wave-functions. As evidence, the photoluminescent lifetime is significantly shortened from 5 µs to 0.31µs due to the enhanced direct recombination in smaller Si-QDs. The corresponding power-current slope and EQE are observed to increase from 0.09 to 5.7 mW/A and from 1.9 × 10(-5) to 2.4%, respectively. The EL enhancement originates from shorter wavelength and stronger carrier confinement within Si-QDs with smaller size, as confirmed by the increased barrier height at the ITO/SiOx:Si-QD interface from 1.05 to 3.62 eV. The smaller and denser Si-QDs result in a current endurance to operate the MOSLED at breakdown edge with highest power conversion efficiency, thus providing a maximal blue-light EL power at 0.7 µW with the highest EQE of 2.4%.

Synthesis of Nano-Structured Ge as Transmissive or Reflective Saturable Absorber for Mode-Locked Fiber Laser.

Amorphous-Ge (α-Ge) or free-standing nanoparticles (NPs) synthesized via hydrogen-free plasma-enhanced chemical vapor deposition (PECVD) were applied as transmissive or reflective saturable absorbers, respectively, for starting up passively mode-locked erbium-doped fiber lasers (EDFLs). Under a threshold pumping power of 41 mW for mode-locking the EDFL, the transmissive α-Ge film could serve as a saturable absorber with a modulation depth of 52-58%, self-starting EDFL pulsation with a pulsewidth of approximately 700 fs. Under a high power of 155 mW, the pulsewidth of the EDFL mode-locked by the 15 s-grown α-Ge was suppressed to 290 fs, with a corresponding spectral linewidth of 8.95 nm due to the soliton compression induced by intra-cavity self-phase modulation. The Ge-NP-on-Au (Ge-NP/Au) films could also serve as a reflective-type saturable absorber to passively mode-lock the EDFL with a broadened pulsewidth of 3.7-3.9 ps under a high-gain operation with 250 mW pumping power. The reflection-type Ge-NP/Au film was an imperfect mode-locker, owing to their strong surface-scattered deflection in the near-infrared wavelength region. From the abovementioned results, both ultra-thin α-Ge film and free-standing Ge NP exhibit potential as transmissive and reflective saturable absorbers, respectively, for ultrafast fiber lasers.

Elevation of Lipid Metabolites in Deceased Liver Donors Reflects Graft Suffering.

Liver transplantation can be performed with deceased or living donor allografts. Deceased liver grafts are donated from brain- or circulation-death patients, and they have usually suffered from a certain degree of damage. Post-transplant graft function and patient survival are closely related to liver allograft recovery. How to define the damage of liver grafts is unclear. A total of 47 liver donors, 23 deceased and 24 living, were enrolled in this study. All deceased donors had suffered from severe brain damage, and six of them had experienced cardio-pulmonary-cerebral resuscitation (CPR). The exploration of liver graft metabolomics was conducted by liquid chromatography coupled with mass spectrometry. Compared with living donor grafts, the deceased liver grafts expressed higher levels of various diacylglycerol, lysophosphatidylcholine, lysophosphatidylethanolamine, oleoylcarnitine and linoleylcarnitine; and lower levels of cardiolipin and phosphatidylcholine. The liver grafts from the donors with CPR had higher levels of cardiolipin, phosphatidic acid, phosphatidylcholine, phatidylethanolamine and amiodarone than the donors without CPR. When focusing on amino acids, the deceased livers had higher levels of histidine, taurine and tryptophan than the living donor livers. In conclusion, the deceased donors had suffered from cardio-circulation instability, and their lipid metabolites were increased. The elevation of lipid metabolites can be employed as an indicator of liver graft suffering.

Converting from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in Patients with Hepatitis B Following Liver Transplantation.

BACKGROUND Taiwan has a high prevalence of hepatitis B virus (HBV) infection. HBV-related end-stage liver disease is the leading cause of liver transplantation (LT). Tenofovir alafenamide (TAF) is a recently approved agent for the treatment of chronic HBV infection that improves renal profiles compared with tenofovir disoproxil fumarate (TDF) in phase III trials. This study aimed to assess the outcomes of TAF treatment in LT recipients. MATERIAL AND METHODS This retrospective study analyzed 17 LT recipients who underwent treatment with TDF and TAF. Changes in baseline renal function were compared. RESULTS Seventeen LT recipients received TDF for ≥48 weeks and were switched to TAF. During TDF treatment, estimated glomerular filtration rate (eGFR) (using the Modification of Diet in Renal Disease [MDRD] formula) decreased significantly at weeks 24 and 48. At week 48, only 2 patients (11.8%) displayed improved renal function, whereas the other patients showed decreased eGFR ranging from 5.48% to 62.84%. After switching to TAF, the median eGFR increased by 3.01% at week 24 and decreased by 0.31% at week 48. Seven patients (47%) showed improved renal function at week 48 after TAF treatment. CONCLUSIONS Switching from TDF to TAF was associated with fewer short-term renal impairment while maintaining the antiviral efficacy in LT recipients.

Significance of Physical Status and Liver Function Reserve for Outcome of Patients with Advanced Hepatocellular Carcinoma Receiving Lenvatinib Treatment.

Background: Tyrosine kinase inhibitors (TKIs) remain the primary therapeutic option for patients with advanced-stage hepatocellular carcinoma (HCC). However, the selection of a suitable TKI is an issue in real-world clinical practice. Thus, this study aimed to identify patients most likely to benefit from lenvatinib treatment. Methods: A retrospective review of 143 patients with unresectable advanced-stage HCC treated with lenvatinib between January 2020 and December 2021 was performed. Outcomes related to lenvatinib treatment were measured, and the clinical parameters affecting prognosis were analyzed. Results: Overall, the median time of progression-free survival (PFS) and overall survival (OS) were 7.1 months and 17.7 months, respectively. Prognostic analyses found that Child-Pugh score > 5 (hazard ratio [HR] = 2.43, 95% confidence interval [CI] = 1.55-3.80, p = 0.001) was a significant factor affecting the PFS of HCC after lenvatinib treatment. Child-Pugh score > 5 (HR = 2.12, 95% CI = 1.20-3.74, p = 0.009), body weight ≥ 60 kg (HR = 0.54, 95% CI = 0.32-0.90, p = 0.020), and additional trans-arterial chemoembolization (TACE) treatment (HR = 0.38, 95% CI = 0.21-0.70, p = 0.003) were significant prognostic factors for OS. However, early α-fetoprotein reduction was not significantly correlated with patient outcomes. Additionally, patients with pre-treatment neutrophil-lymphocyte ratio > 4.07 showed a significant worse PFS and OS than other patients. Conclusion: The outcome of patients with advanced-stage HCC remains poor. However, the host condition, including good physical status and better functional liver preservation, largely affected the outcome of patients receiving lenvatinib treatment. Moreover, additional locoregional therapy for intrahepatic HCC, other than TKI treatment, can be considered in certain patients to achieve a favorable outcome.

Adjustment of Immunosuppressants to Facilitate Anti-COVID-19 Antibody Production after mRNA Vaccination in Liver Transplant Recipients.

Liver transplant recipients are immunocompromised and have low immunogenicity to produce antibodies in anti-COVID-19 vaccination. Whether immunosuppressant adjustment could facilitate anti-COVID-19 antibody production in anti-COVID-19 mRNA vaccination is undetermined. Our patients were informed to temporarily suspend mycophenolate mofetil (MMF) or everolimus (EVR) for 2 weeks during both the 1st and 2nd doses of Moderna mRNA-1273 vaccine. A total of 183 recipients receiving two doses of Moderna mRNA-1273 vaccine were enrolled and grouped into tacrolimus monotherapy (MT, n = 41), and dual therapy with non-adjustment (NA, n = 23), single suspension (SS, n = 19) and double suspension (DS, n = 100) of MMF/EVR in two-dose mRNA vaccination. A total of 155 (84.7%) patients had a humoral response to vaccines in this study. The humoral response rates were 60.9%, 89.5%, 91.0% and 80.5% in NA, SS, DS, and MT group patients, respectively (p = 0.003). Multivariate analysis showed that favorable factors for humoral response were temporary suspension of MMF/EVR and monotherapy, and unfavorable factors were deceased donor liver transplantation, WBC count < 4000/uL, lymphocyte < 20% and tacrolimus trough level ≥ 6.8 ng/mL. In conclusion, temporary two-week suspension of anti-proliferation immunosuppressants could create a window to facilitate antibody production during anti-COVID-19 mRNA vaccination. This concept may be applied to other vaccinations in liver transplant recipients.

Low-Temperature PECVD Growth of Germanium for Mode-Locking of Er-Doped Fiber Laser.

A low-temperature plasma-enhanced chemical vapor deposition grown germanium (Ge) thin-film is employed as a nonlinear saturable absorber (SA). This Ge SA can passively mode-lock the erbium-doped fiber laser (EDFL) for soliton generation at a central wavelength of 1600 nm. The lift-off and transfer of the Ge film synthesized upon the SiO2/Si substrate are performed by buffered oxide etching and direct imprinting. The Ge film with a thickness of 200 nm exhibits its Raman peak at 297 cm-1, which both the nanocrystalline and polycrystalline Ge phases contribute to. In addition, the Ge thin-film is somewhat oxidized but still provides two primary crystal phases at the (111) and (311) orientations with corresponding diffraction ring radii of 0.317 and 0.173 nm, respectively. The nanocrystalline structure at (111) orientation with a corresponding d-spacing of 0.319 nm is also observed. The linear and nonlinear transmittances of the Ge thin-film are measured to show its self-amplitude modulation coefficient of 0.016. This is better than nano-scale charcoal and carbon-black SA particles for initiating the mode-locking at the first stage. After the Ge-based saturable absorber into the L-band EDFL system without using any polarized components, the narrowest pulsewidth and broadest linewidth of the soliton pulse are determined as 654.4 fs and 4.2 nm, respectively, with a corresponding time-bandwidth product of 0.32 under high pumping conditions.