Preoperative frailty as a key predictor of short- and long-term outcomes among octogenarians undergoing hepatectomy for hepatocellular carcinoma: a multicenter comprehensive analysis.

BACKGROUND: When considering hepatectomy for elderly HCC patients, it's essential to assess surgical safety and survival benefits. This study investigated the impact of preoperative frailty, assessed with the Clinical Frailty Scale (CFS), on outcomes for octogenarians undergoing HCC hepatectomy. METHODS: A retrospective cohort study of octogenarians who had hepatectomy for HCC between 2010 and 2022 at 16 hepatobiliary centers was conducted. Patients were categorized as frail or non-frail based on preoperative CFS, with frailty defined as CFS ≥5. The primary endpoints were overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS), with perioperative outcomes as secondary endpoints. RESULTS: Among 240 octogenarians, 105 were characterized as being frail. Frail patients had a higher incidence of postoperative 30-day morbidity and postoperative 30-day and 90-day mortality versus non-frail patients. Meanwhile, 5-year OS, RFS and CSS among frail patients were lower compared with non-frail patients. Univariable and multivariable analysis revealed that preoperative frailty was an independent risk factor of postoperative 30-day morbidity (OR: 2.060), OS (HR: 2.384), RFS (HR: 2.190) and CSS (HR: 2.203). CONCLUSION: Preoperative frailty, as assessed by the CFS, was strongly associated with both short-term outcomes and long-term survival among octogenarians undergoing hepatectomy for HCC. Incorporating frailty assessment into the preoperative evaluation may help optimize patient selection and perioperative care.

Case report: Surgical treatment and literature review of a recurrent case of glucagonoma.

A 40-year-old male patient was admitted due to abdominal distension and discomfort in the upper abdomen persisting for three days. Enhanced CT of the upper abdomen revealed an irregularly dense soft tissue area in the body and tail of the pancreas, approximately 7.6 × 3.1 cm in size, with blurred boundaries, and indistinct separation from the splenic artery and vein. Multiple liver lesions of varying sizes and slightly lower densities were also observed. Liver tumor biopsy considering a neuroendocrine tumor G2, combined with the medical history, led to a diagnosis of pancreatic neuroendocrine tumor G2 with liver metastasis. Physical examination showed mild tenderness in the upper abdomen but no other significant positive signs. During treatment, the patient developed multiple red papular rashes around the mouth, on both lower limbs, and the perineum, accompanied by itching. The glucagon level was 1138.3 pg/L. The patient underwent resection of the pancreatic body and tail, splenectomy, partial liver tumor resection, and cholecystectomy. Within five days post-surgery, the skin lesions began to crust and flake off. On the 14th day post-surgery, the serum glucagon level was rechecked at 136.4 pg/L. As of April 2024, progression of liver lesions was noted, with no significant skin symptoms during the period.

Stratifying risk of failure to achieve textbook outcomes among patients undergoing hepatectomy for hepatocellular carcinoma: A multicenter score validation study.

BACKGROUND AND AIMS: The concept of textbook outcomes (TOs) has gained increased attention as a critical metric to assess the quality and success of outcomes following complex surgery. A simple yet effective scoring system was developed and validated to predict risk of not achieving textbook outcomes (non-TOs) following hepatectomy for hepatocellular carcinoma (HCC). METHODS: Using a multicenter prospectively collected database, risk factors associated with non-TO among patients who underwent hepatectomy for HCC were identified. A predictive scoring system based on factors identified from multivariate regression analysis was used to risk stratify patients relative to non-TO. The score was developed using 70 % of the overall cohort and validated in the remaining 30 %. RESULTS: Among 3681 patients, 1458 (39.6 %) failied to experience a TO. Based on the derivation cohort, obesity, American Society of Anaesthesiologists score(ASA score), Child-Pugh grade, tumor size, and extent of hepatectomy were identified as independent predictors of non-TO. The scoring system ranged from 0 to 10 points. Patients were categorized into low (0-3 points), intermediate (4-6 points), and high risk (7-10 points) of non-TO. In the validation cohort, the predicted risk of developing non-TOs was 39.0 %, which closely matched the observed risk of 39.9 %. There were no differences among the predicted and observed risks within the different risk categories. CONCLUSIONS: A novel scoring system was able to predict risk of non-TO accurately following hepatectomy for HCC. The score may enable early identification of individuals at risk of adverse outcomes and inform surgical decision-making, and quality improvement initiatives.

Reversible interconversion of pharmaceutical salt polymorphs facilitated by mechanical methods.

Salification of the drug trimethoprim with enantiopure D- or L-lactic acid afforded salts with up to five times improved solubility. Both salts are polymorphic and we demonstrate fully reversible interconversion (cycling) between the drug polymorphs using mechanochemistry and slurry methods. We show drug polymorph interconversion requires both solvent contact and mechanical force, revealing strategies for cycling between solid material forms.

Triple-Columned and Multiple-Layered 3D Polymers: Design, Synthesis, Aggregation-Induced Emission (AIE), and Computational Study.

Conjugated polymers and oligomers have great potentials in various fields, especially in materials and biological sciences because of their intriguing electronic and optoelectronic properties. In recent years, the through-space conjugation system has emerged as a new assembled pattern of multidimensional polymers. Here, a novel series of structurally condensed multicolumn/multilayer 3D polymers and oligomers have been designed and synthesized through one-pot Suzuki polycondensation (SPC). The intramolecularly stacked arrangement of polymers can be supported by either X-ray structural analysis or computational analysis. In all cases, polymers were obtained with modest to good yields, as determined by GPC and 1H-NMR. MALDI-TOF analysis has proven the speculation of the step-growth process of this polymerization. The computational study of ab initio and DFT calculations based on trimer and pentamer models gives details of the structures and the electronic transition. Experimental results of optical and AIE research confirmed by calculation indicates that the present work would facilitate the research and applications in materials.

Removal of the Micropollutants Propranolol Hydrochloride and 2-Naphthol From Water by Pyridine-Functionalized Polymers.

The number and concentration of micropollutants in aqueous environments are increasing. Two such micropollutants include the pharmaceutical, propranolol hydrochloride, and dye intermediate, 2-naphthol. Here, we describe the synthesis of both linear and crosslinked pyridine-functionalized copolymers that bind and remove propranolol hydrochloride and 2-naphthol from water solutions. Propranolol hydrochloride and 2-naphthol both contain hydrogen-bond-donor groups, and the pyridine moiety on the polymer acts as a hydrogen-bond acceptor to facilitate removal. Copolymers with different amounts of pyridine comonomer are synthesized, and as the amount of the pyridine comonomer is increased, the ability of the polymer to bind and remove the contaminant also increases. The concentrations of propranolol hydrochloride and 2-naphthol decreased by approximately 20-40% and 60-88%, respectively, depending on the polymer type that is used in the binding experiment. A control polymer was synthesized by using styrene in place of the pyridine monomer. In analogous binding experiments, the styrene polymer decreases the concentration of propranolol hydrochloride by 2% and 2-naphthol by 26%. Thus, the binding effectiveness is significantly reduced when the hydrogen-bond-acceptor group is not present on the polymer. We also show that the best performing crosslinked pyridine-functionalized polymer is reusable. Overall, these polymer adsorbents demonstrate the potential for removal of micropollutants from water.

Unique supramolecular complex of diclofenac: structural robustness, crystal-to-crystal solvent exchange, and mechanochemical synthesis.

We describe an unexpected, cyclic supramolecular complex that results from self-assembly of the nonsteroidal anti-inflammatory drug, diclofenac and 4,4'-azopyridine. The cycles self-assemble into 1D columns occupied by solvent, which can be removed at elevated temperatures (>100 °C) while retaining crystallinity. The complex exhibits solvent exchange ability that occurs through crystal-to-crystal transformations. Finally, the complex can be synthesized using mechanochemistry. Materials exhibiting the structural framework and robustness described here could be applied to removal of hazardous materials or undesirable solvents.