Anatomic versus non-anatomic resection of hepatocellular carcinoma with microvascular invasion: A systematic review and meta-analysis.

The efficacy of anatomical resection (AR) and non-anatomical resection (NR) in the treatment of hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) remains unknown. This study compared the safety and outcomes of these surgical procedures. A systematic literature search was conducted. The main outcomes were overall survival (OS), disease-free survival (DFS). Overall hazard ratio (HR) was calculated from Kaplan-Meier plots and outcomes using random-effects models. There was no significant difference in postoperative complications between the AR and NR groups (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.72-1.17, p = 0.496). OS was higher with AR at 1 year (RR: 0.66, 95% CI: 0.45-0.98, p = 0.037), 3 years (RR: 0.64, 95% CI: 0.50-0.82, p = 0.000), and 5 years (RR: 0.76, 95% CI: 0.65-0.89, p = 0.001). AR was associated with a higher OS rate (HR: 0.62, 95% CI: 0.47-0.82, p = 0.001). AR was associated with improved DFS at 1 year (RR: 0.65, 95% CI: 0.52 to 0.82, p = 0.000), 3 years (RR: 0.75, 95% CI: 0.66 to 0.86, p = 0.000), and 5 years (95% CI: 0.75 to 0.94, p = 0.002). Compared with NR, AR had significant advantages on overall HR of DFS (HR: 0.64, 95% CI: 0.45 to 0.91, p = 0.012). In conclusion, AR was associated with higher rates of OS and DFS in HCC patients with MVI. Thus, for well-presented liver function HCC patients which are predicted to have positive MVI, AR is recommended.

NARFIB: A Novel Prognostic Score Based on the Neutrophil-to-Albumin Ratio and Fibrinogen Can Predict the Prognosis of Gastrointestinal Stromal Tumors.

OBJECTIVE: The neutrophil-to-albumin ratio (NAR) and fibrinogen are significantly related to tumor progression. The present study evaluated the prognostic impact of the NAR plus fibrinogen concentration in gastrointestinal stromal tumor (GIST) cases. METHODS: The baseline characteristics, postoperative NAR, and fibrinogen concentrations were retrospectively analyzed for 229 Chinese patients who underwent radical gastrectomy for GIST. Receiver operating characteristic (ROC) curves were applied to estimate the optimal critical points for NAR and fibrinogen. Cox regression analysis was applied to determine significant prognostic variables. RESULTS: Multivariate analyses revealed that poor recurrence-free survival was associated with elevated values for fibrinogen (hazard ratio [HR]: 5.015, 95% confidence interval [CI]: 1.993-12.619, P=0.001) and NAR (HR: 4.669, 95% CI: 1.776-12.273, P = 0.002). Combining fibrinogen and the NAR into the NARFIB score provided an area under the ROC curve of 0.833, which was greater than the areas for NAR (0.708) or fibrinogen (0.778). When the NAR and fibrinogen were replaced by the NARFIB score in the multivariate analysis, the independent prognosticators were tumor site (HR: 2.927, 95% CI: 1.417-6.045, P=0.004), mitotic index (HR: 2.661, 95% CI: 1.110-6.380, P=0.028), and the NARFIB score (HR: 14.116, 95% CI: 3.243-61.443, P<0.001). The NARFIB score retained its prognostic significance in various subgroup analyses and was significantly related to gender, surgical approach, tumor size, mitosis, tumor site, risk classification, and recurrence. CONCLUSION: These results suggest that the NARFIB score may help guide prognostication and risk stratification for GIST, which might benefit from targeted therapy.

Relationship Between Fibrinogen to Albumin Ratio and Prognosis of Gastrointestinal Stromal Tumors: A Retrospective Cohort Study.

OBJECTIVE: The fibrinogen to albumin ratio (FAR) is an important parameter that reflects the coagulation state, systemic inflammation, and nutritional status of a patient and plays an essential role in tumor progression. Here, we evaluate the prognostic significance of FAR in gastrointestinal stromal tumor (GIST) patients that underwent radical surgery. METHODS: We retrospectively analyzed the data of 227 GIST patients that underwent radical surgery in Beijing Hospital from October 2004 to July 2018. We drew a curve of receiver operating characteristics to confirm the optimal critical values for hemoglobin (Hb), prognostic nutrition index (PNI), and FAR. Cox regression analysis and the Kaplan-Meier method were used to assess the prognostic factors. RESULTS: The FAR optimal critical value for postoperative recurrence-free survival (RFS) was 0.09. Many significant factors, including approach, the location and size of the tumor, mitotic index, risk classification, Hb levels, PNI, and recurrence, affect FAR. Multivariate analysis indicated that for patients with GISTs who underwent surgery, the tumor location (hazard ratio [HR]=3.393, 95% confidence interval [CI]: 1.539-7.479, P=0.002), mitotic index (HR=4.788, 95% CI: 1.836-12.486, P=0.001), tumor rupture (HR=10.954, 95% CI: 2.170-55.296, P=0.004), and FAR (HR=3.093, 95% CI: 1.303-7.339, P=0.010) were independent factors affecting RFS. Moreover, the FAR remained of prognostic significance for GIST stratified by subgroup analysis. CONCLUSION: Preoperative FAR is a reliable marker for evaluating the prognosis of GIST, the prognostic ability of FAR is significantly better than Hb and PNI.

Micro-Incision of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration for Elderly Patients with Choledocholithiasis.

Common bile duct (CBD) stones are common in elderly patients. The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach. Its safety and efficacy have not been studied in elderly patients with secondary choledocholithiasis. This study evaluates the safety and efficacy of LTM-CBDE in elderly (≥65 years) patients with secondary choledocholithiasis and compares the results with those in younger patients. In this retrospective analysis, 128 patients underwent LTM-CBDE from March 2007 to December 2013. The patients were divided into two groups according to age: the elderly group consisted of 50 patients aged ≥65 years and the younger group consisted of 78 patients aged <65 years. The preoperative morbidity rate, American Society of Anesthesiologists (ASA) score, previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality were compared in both groups. The preoperative morbidity (41 vs. 28) and ASA score (2.5 ± 0.7 vs. 1.8 ± 0.6) were higher in the elderly group (P = 0.000, in both groups). No significant differences in previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality (P > 0.05) were found between the two groups from March 2007 to December 2013. LTM-CBDE is a safe and effective treatment procedure for elderly patients with secondary choledocholithiasis. For suitable patients, we recommend LTM-CBDE as the treatment of choice.

[Influence of Spectral Pre-Processing on PLS Quantitative Model of Detecting Cu in Navel Orange by LIBS].

Cu in navel orange was detected rapidly by laser-induced breakdown spectroscopy (LIBS) combined with partial least squares (PLS) for quantitative analysis, then the effect on the detection accuracy of the model with different spectral data ptetreatment methods was explored. Spectral data for the 52 Gannan navel orange samples were pretreated by different data smoothing, mean centralized and standard normal variable transform. Then 319~338 nm wavelength section containing characteristic spectral lines of Cu was selected to build PLS models, the main evaluation indexes of models such as regression coefficient (r), root mean square error of cross validation (RMSECV) and the root mean square error of prediction (RMSEP) were compared and analyzed. Three indicators of PLS model after 13 points smoothing and processing of the mean center were found reaching 0. 992 8, 3. 43 and 3. 4 respectively, the average relative error of prediction model is only 5. 55%, and in one word, the quality of calibration and prediction of this model are the best results. The results show that selecting the appropriate data pre-processing method, the prediction accuracy of PLS quantitative model of fruits and vegetables detected by LIBS can be improved effectively, providing a new method for fast and accurate detection of fruits and vegetables by LIBS.

[Determination of soluble solids content in navel oranges by Vis/NIR diffuse transmission spectra combined with CARS method].

Soluble solids content (SSC) is one of important internal quality index for navel oranges. In the present study, visible/near infrared (Vis/NIR) diffuse transmission spectra of navel oranges were acquired using a QualitySpec spectrometer in the wavelength range of 350-1 000 nm, and CARS (competitive adaptive reweighted sampling) was used to select important variables related with SSC of navel oranges from spectra data, then was compared with other variable selection methods such as uninformative variables elimination (UVE) and successive projections algorithm (SPA). Finally, partial least squares (PLS) regression was used to develop calibration model for SSC of navel oranges using the 38 selected variables, and the calibration model was used to predict the SSC of 75 samples in the prediction set. The results indicate that CARS method is superior to other variable selection methods such as UVE and SPA, and can select the important variables for SSC efficiently. The calibration model of SSC developed by CARS-PLS is superior to that model developed by full-spectrum PLS, the correlation coefficient (r) and root mean square error (RMSE) in the calibration and prediction sets are 0.948, 0.347% and 0.917, 0.394%, respectively. So, Vis/NIR diffuse transmission spectra combined with CARS method is feasible to assess soluble solids content of navel oranges, and CARS method can simplify the prediction model and improve model prediction precision.

[Effect of mycophenolic acid on maturation, endocytotic capacity and allostimulatory properties of human myeloid dendritic cell].

OBJECTIVE: To study the effect of mycophenolic acid (MPA) on maturation, endocytotic capacity and allostimulatory properties of human myeloid dendritic cell (MDC). METHODS: The peripheral blood mononuclear cells were isolated freshly from healthy volunteers (n = 15). The study group was treated by MPA. Co-stimulatory and adhesion molecular on MDC were analyzed by flow cytometry. After isolation of blood dendritic cell antigen-1(+) (BDCA-1(+)), the cellular uptake of FITC-dextran was measured by flow cytometry. After mixed lymphocyte reaction, the percentage of allogenic CD(4)(+) T cell in G(0) phase was analyzed by flow cytometry. RESULTS: (1) Maturation: Compared to control group, MPA down-regulated the level of CD40, CD62L, HLA-DR, CD54, CD80, CD83 and CD86 on MDC significantly in study group (t = -3.713, P > 0.010). (2) Endocytotic capacity: MPA enhanced significantly the endocytotic capacity of MDC in study group (t = 10.171, P = 0.000). (3) Allostimulatory capacity: Compared to control group, MPA reduced the ability of MDC to stimulate markedly the T cell proliferation in study group. CONCLUSION: MPA may enhance the phagocytic capacity of human peripheral MDC, inhibit the maturity of MDC and impair its allostimulatory capacity of CD(4)(+) T lymphocyte.

Effect of hyperbaric oxygen and ulinastatin on plasma endotoxin, soluble CD14, endotoxin-neutralizing capacity and cytokines in acute necrotizing pancreatitis.

BACKGROUND: We sought to study the effect of a combination therapy comprised of hyperbaric oxygen (HBO) and ulinastatin on the plasma levels of endotoxin, soluble CD14 (sCD14), endotoxin neutralizing capacity (ENC) and cytokines in acute necrotizing pancreatitis (ANP) in rats. METHODS: We randomly allocated 90 Sprague-Dawley rats into 6 groups: group 1 (ordinary control), group 2 (sham operation), group 3 (ANP), group 4 (ANP with HBO), group 5 (ANP with ulinastatin) and group 6 (ANP with HBO and ulinastatin). We induced ANP by retrograde injection of 3.5% sodium taurocholate (2.5 mL/kg) via the pancreatic duct. Five minutes after induction, animals in groups 5 and 6 were infused with ulinastatin (20 000 U/kg) via the portal vein. Thirty minutes after induction, animals in groups 4 and 6 received HBO therapy. We collected samples 3, 6 and 10 hours after induction of ANP. RESULTS: We found that the plasma level of endotoxin in group 3 was significantly higher than in group 4 (3, 6 h, both p < 0.001), group 5 (3 h, p < 0.001; 6 h, p = 0.014) and group 6 (both p < 0.001). The level of plasma sCD14 in group 3 was significantly higher than in group 4 (3, 6 h, both p < 0.001), group 5 (3, 6 h, both p = 0.001) and group 6 (3 h, p < 0.001; 6 h, p = 0.001). The plasma endotoxin and sCD14 levels in group 6 were significantly lower than in groups 4 and 5. The plasma ENC level in group 6 was significantly higher than in groups 3, 4 and 5 (p < 0.001). The ENC level in groups 4 and 5 were higher than in group 3, but there was no significant difference. The plasma level of tumour necrosis factor-alpha (TNF-alpha) and IL-6 in group 6 were significantly lower than in groups 3, 4 and 5 (p < 0.001). The TNF-alpha and IL-6 levels in groups 4 and 5 were lower than in group 3, but there was no significant difference. CONCLUSION: The use of an early combination therapy of HBO and ulinastatin was more effective than either therapy alone in the treatment of ANP.