Retreatment with immunotherapy in a patient with hepatocellular carcinoma who received immune checkpoint inhibitors after primary curative treatment: a case report.

Hepatocellular carcinoma (HCC) presents a malignant pathology known for its high early recurrence rate following curative treatment, significantly impacting patient prognosis. Currently, effective strategies to mitigate early HCC recurrence remain undetermined. In this report, we document a case of HCC managed with curative radiofrequency ablation (RFA), particularly in a patient facing a high risk of early recurrence due to a substantial tumor size. In an effort to forestall recurrence, immune checkpoint inhibitors (ICIs) were preemptively administered for 6 months post-RFA. Despite this, early recurrence ensued upon ICIs cessation. Traditionally, the approach to advanced HCC has been conservative, yet recent years have seen promising outcomes with ICIs in advanced HCC. However, research on ICIs retreatment is limited. In the short term, this patient experienced widespread metastases post-ICIs discontinuation, yet exhibited prompt regression upon ICIs reinitiation. Notably, this represents the initial documented instance of employing ICIs to forestall recurrence subsequent to curative RFA in HCC. Following ICIs discontinuation, diffuse recurrence with multiple metastases emerged, with successful resolution upon ICIs retreatment.

Does digital transformation matter to green innovation: based on TOE framework and configuration perspective.

Green innovation is a guarantee for achieving high-quality economic development. However, the complex cause-and-effect relationship between digital transformation and green innovation has not been systematically studied. Digital transformation not only is about technology but also requires organizational and environmental support. Therefore, this study investigates the relationship between digital transformation and green innovation based on the TOE (technology-organization-environment) framework and configuration theory. A fuzzy set qualitative comparative analysis of data from 1948 listed companies reveals that, first, there is no necessary condition that leads to high green innovation, but digital achievements play a more general role in leading to high green innovation; second, three paths to achieve high green innovation are identified. These different configurations indicate multiple paths and complex cause-and-effect relationships to achieve high green innovation. Third, green innovation is a digital technology-based innovation, but in most cases, it also requires organization and environment support. This study can provide some theoretical and practical guidance for enterprises to enhance their green innovation capabilities through digital transformation and promote the achievement of high-quality company development.

Durability of immune response after SARS-CoV-2 vaccination in patients with chronic liver disease.

Aim: The present study aimed to evaluate the durability of immune response after basic and booster immunization with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients with chronic liver disease (CLD). Methods: Patients with CLD and complete basic or booster immunization with SARS-CoV-2 vaccines were included in this study. Based on the vaccination situation, they were divided into the basic immunity group (Basic) and the booster immunity group (Booster), which were then subdivided into four groups according to the time interval from completion of basic immunization or booster immunization to serological specimen collection. The positive rates and antibody titers of novel coronavirus neutralizing antibody (nCoV NTAb) and novel coronavirus spike receptor-binding domain antibody (nCoV S-RBD) were analyzed. Results: A total of 313 patients with CLD were enrolled in this study, including 201 in Basic and 112 in Booster. The positive rates of nCoV NTAb and nCoV S-RBD within 30 days of completing basic immunization were 80.4% and 84.8%, respectively, but decreased rapidly with the extension of vaccination time, and only 29% and 48.4% of patients with CLD remained positive for nCoV NTAb and nCoV S-RBD, respectively, after 120 days of completing basic immunization. Within 30 days of booster immunization, the positive rates of nCoV NTAb and nCoV S-RBD in patients with CLD rapidly increased from 29.0% and 48.4% at the end of basic immunization to 95.2% and 90.5%, and maintained a high level (defined as the positive rate >50%) until 120 days when the positive rates of nCoV NTAb and nCoV S-RBD were still high at 79.5% and 87.2%, respectively. After basic immunization, the time for nCoV NTAb and nCoV S-RBD to turn negative was 120 and 169 days, respectively, and the negative time of nCoV NTAb and nCoV S-RBD was significantly prolonged to 266 days and 329 days, respectively. Conclusion: It is safe and effective for patients with CLD to complete basic and booster immunization with SARS-CoV-2 vaccines. After booster immunization, the immune response of patients with CLD was further improved and the durability of the SARS-CoV-2 antibody was significantly prolonged.

Explaining Firm Performance During the COVID-19 With fsQCA: The Role of Supply Network Complexity, Inventory Turns, and Geographic Dispersion.

The COVID-19 pandemic has significantly affected firm performance. As a result, many studies have examined the significance of supply network complexity. Our paper uses the fuzzy set qualitative comparative analysis (fsQCA) method to investigate the causal relationships among the supply network complexity, geographic dispersion, inventory turns, and firm performance. Using a sample of 263 Chinese listed firms, we find that no single factor is necessary to achieve high firm performance during COVID-19 and reveal four paths to produce high performance: operational level driven, supply base complexity driven, and customer base complexity driven with supplier distance, and supply network complexity absence. Furthermore, our findings suggest that supply-based complexity-driven and customer-based complexity-driven can improve firm performance, but not all supply network complexity dimensions can improve firm performance. Hence, firms need to choose the suitable path based on their specific situations.

Evaluation of gamification techniques in learning abilities for higher school students using FAHP and EDAS methods.

The rapid development of information technology has made a wide range of cutting-edge technologies accessible, supporting the flourishing of human existence. Modern technology has made it possible for new computer-based technological strategies like gamification. The pedagogical framework is based on the "gamification" game format, which is one of the most recent teaching strategies and has an engaging component for students. Gamification, flipped learning, and problem-based learning are three examples of the technical aspect of escape rooms. In the academic setting, gamification aims to boost student engagement and motivation in order to produce a better user experience. Gamification has been found to increase levels of participation, foster it, and improve activity outcomes. Gamification is recommended in educational settings to improve students' achievement, focus, and contentment in light of these benefits. In order to establish an effective learning environment where students may effectively improve their learning capacities and boost their performance, it can be difficult to select a higher performing technique among the available techniques due to the ongoing use of gamification techniques. The fuzzy analytical hierarchy process (FAHP) and evaluation based on distance from average solution (EDAS) are applied in order to determine the criterion weighting and assess the techniques in order to make a good decision. The presented paper analyzed numerous game-based learning techniques along with their applications in the educational field. Additionally, ten criteria and eight gamification methodologies are used to assess and pick the prior pertinent works. By utilizing the suggested approaches, the decision problem has been resolved. The FAHP approach is used in the suggested analysis to evaluate the criteria and determine their weights. Then, using the EDAS method, places are assigned to the chosen procedures based on their evaluation score and criterion weighting. The results of the appraisal show that the gamification technique with the highest production takes first place and is regarded as the best-performing and most successful technique. On the other hand, it is clear that the technique with the lowest production takes the bottom spot and is referred to as the least expensive and lowest performing technique. In order to increase students' motivation, which could have a substantial impact on learning, it has been discovered that gamification is a feasible strategy.

Recommendation of mHAP and ABCR scoring systems for the decision-making of the first and subsequent TACE session in HCC patients.

BACKGROUND: Due to the high heterogeneity among hepatocellular carcinoma (HCC) patients receiving transarterial chemoembolization (TACE), the prognosis of patients varies significantly. Various predictive scoring systems have been developed to identify the patients who could benefit from TACE. However, there is no consensus on which is better. This study aims to validate and compare the predictive capabilities of scoring systems for first and subsequent TACE. MATERIALS: A total of 524 HCC patients were treated with TACE, and 222 patients who met the inclusion criteria were included. Log-rank test was used to verify the predictive value of six scoring systems for the first TACE and four TACE retreatment scoring systems. Harrell's concordance (C)-index, likelihood ratio and integrated Brier score (IBS) were used to compare the predictive performance. RESULTS: For the scoring systems of TACE, the overall survival (OS) of candidates screened by Hepatoma Arterial-embolization Prognostic (HAP), modified HAP (mHAP), mHAP3, alpha-fetoprotein, Barcelona Clinic Liver Cancer, Child-Pugh and Response (ABCR), albumin-bilirubin grade (ALBI), tumor size, alpha-fetoprotein, first TACE response and pre-/post-TACE was significantly longer than that of the noncandidates (all P < 0.05), whereas the mHAP2 and assessment for retreatment with TACE did not distinguish the candidates from noncandidates (P = 0.206, 0.115, respectively). The predictive and calibration performances of mHAP and ABCR were the highest for the first TACE and TACE retreatment, respectively. CONCLUSION: mHAP identifies the patients who could benefit from the first TACE, whereas ABCR distinguishes patients who could benefit from subsequent TACE sessions.

ASARA, a prediction model based on Child-Pugh class in hepatocellular carcinoma patients undergoing transarterial chemoembolization.

BACKGROUND: Due to the high heterogeneity among hepatocellular carcinoma (HCC) patients receiving transarterial chemoembolization (TACE), the prognosis of patients varies significantly. The decision-making on the initiation and/or repetition of TACE under different liver functions is a matter of concern in clinical practice. Thus, we aimed to develop a prediction model for TACE candidates using risk stratification based on varied liver function. METHODS: A total of 222 unresectable HCC patients who underwent TACE as their only treatment were included in this study. Cox proportional hazards regression was performed to select the independent risk factors and establish a predictive model for the overall survival (OS). The model was validated in patients with different Child-Pugh class and compared to previous TACE scoring systems. RESULTS: The five independent risk factors, including alpha-fetoprotein (AFP) level, maximal tumor size, the increase of albumin-bilirubin (ALBI) grade score, tumor response, and the increase of aspartate aminotransferase (AST), were used to build a prognostic model (ASARA). In the training and validation cohorts, the OS of patients with ASARA score ≤ 2 was significantly higher than that of patients with ASARA score > 2 (P < 0.001, P = 0.006, respectively). The ASARA model and its modified version "AS(ARA)" can effectively distinguish the OS (P < 0.001, P = 0.004) between patients with Child-Pugh class A and B, and the C-index was 0.687 and 0.706, respectively. For repeated TACE, the ASARA model was superior to Assessment for Retreatment with TACE (ART) and ALBI grade, maximal tumor size, AFP, and tumor response (ASAR) among Child-Pugh class A patients. For the first TACE, the performance of AS(ARA) was better than that of modified hepatoma arterial-embolization prognostic (mHAP), mHAP3, and ASA(R) models among Child-Pugh class B patients. CONCLUSIONS: The ASARA scoring system is valuable in the decision-making of TACE repetition for HCC patients, especially Child-Pugh class A patients. The modified AS(ARA) can be used to screen the ideal candidate for TACE initiation in Child-Pugh class B patients with poor liver function.

Identifying the pathways through digital transformation to achieve supply chain resilience: an fsQCA approach.

The manufacturing industry has placed a greater emphasis on digital transformation, especially under the impact of COVID-19. However, the influence mechanism between digital transformation and supply chain resilience is still a topic of discussion. Resource orchestration theory indicates that a firm not only need to emphasize the investment of resources but also pays attention to the allocation of resources. Therefore, based on the resource orchestration theory, this study divides the digital transformation into digital transformation breadth and digital transformation depth and combines R&D spending (R&D intensity and R&D employee) and contingency factors (firm size) to construct a theoretical path of "digital transformation-supply chain resilience." This research uses fuzzy sets qualitative comparative analysis to explore how to configure the digital transformation to achieve high supply chain resilience based on data from 193 listed manufacturing firms. Using the fsQCA software, it was discovered that there were no necessary conditions for achieving high supply chain resilience; sufficient condition analysis revealed that there are six paths to achieving high supply chain resilience, four of which can be summarized as digital transformation driven and the other two as R&D spending driven. These several approaches highlight the complicated causal relationship between digital transformation and supply chain resilience, as well as give theoretical and practical recommendations for firms looking to implement digital strategies and enhance their supply chains.

Transarterial embolization for rare spontaneous subacute intratumoral hemorrhage of hepatic hemangioma: a case report and literature review.

Background: Intratumoral hemorrhage of hepatic hemangioma is very rare. Case Description: The case of a 54-year-old female with fever and anemia. Initial ultrasound was suggestive of liver abscess, but antibiotic treatment and blood transfusion did not alleviate the patient's symptoms. After abscess puncture and drainage, the patient was admitted to our hospital due to bleeding effusion. The diagnosis of hepatic hemangioma with subacute intratumoral hemorrhage was considered by enhanced magnetic resonance imaging (MRI). The patient's condition was managed with routine liver protection, anti-infection, fluid infusion and two transarterial embolization (TAE) sessions using pingyangmycin-lipiodol emulsion. After the treatment, the patient's symptoms were resolved, the body temperature was normal and the anemia was corrected. Subsequently, we continued periodic follow-up of the patient for four years. The patient was generally in good condition, and there were no symptoms related to hepatic hemangioma, such as fever and anemia. The volume of hepatic hemangioma was reduced by half, and the intratumoral hematoma was obviously absorbed. Conclusions: For patients with previous history of hemangioma, timely MRI can provide higher diagnostic accuracy after they develop symptoms such as fever and anemia. TAE is also a safe and reliable alternative to surgical resection.

Locoregional progression-free survival of bone metastases from differentiated thyroid cancer.

To evaluate the locoregional progression-free survival (LPFS) of bone metastatic lesions from differentiated thyroid cancer (DTC) after radioiodine therapy (RAIT) and to define its influencing factors, we performed a retrospective cohort analysis of 89 patients with bone metastases from DTC who received RAIT in our department over a 17-year period. The median follow-up time was calculated using the reverse Kaplan-Meier method. The log-rank test and a multivariate Cox proportional hazards regression model were performed in the analysis of prognostic indicators for LPFS. In this research, the median follow-up time for all patients was 47 (95% CI, 35.752-58.248) months, and that for patients with no progression was 42 months. The longest follow-up time was 109 months. The median LPFS time was 58 (95% CI, 32.602-83.398) months, and the 3- and 5-year LPFS probabilities were 57.8 and 45.1%, respectively. Multivariate analysis revealed bone structural changes as an independent risk factor for LPFS (P= 0.004; hazard ratio, 49.216; 95% CI, 3.558-680.704). Furthermore, the non-total-lesion uptake subgroup presented a worse LPFS than the total-lesion uptake subgroup in patients with structural bone lesions (P = 0.027). RAIT can improve the LPFS of radioiodine-avid bone metastases from DTC, especially those without bone structural changes.

Rapid detection of Decapod iridescent virus 1 (DIV1) by recombinase polymerase amplification.

A recombinase polymerase amplification (RPA) assay was established for the rapid detection of Decapod iridescent virus 1 using primers targeted to the virus's ATPase gene (ORF114R). Optimization experiments showed that the optimal amplification temperature of the RPA assay was 37 °C and that the reaction could be completed within only 15 min. The target band of 15 min. is bright enough. In order to shorten the operational reaction time, consequently, 15 min was the optimal amplification time for our new RPA assay for DIV1. Specificity tests showed that the RPA assay did not exhibit any cross-reactivity with other shrimp pathogens(TSV, MrNV, YHV-1, WSSV, EHP, AHPND, EHNV, RSIV, RGV and IHHNV). Sensitivity tests further showed that the detection limit of the new RPA assay was 200 copies/50 µL, indicating that this assay was more sensitive than a nested polymerase chain reaction (PCR) method. A total of 509 clinical samples were assayed using the RPA and the PCR assays; analysis showed that the RPA method could detect weak-positive samples more effectively than the PCR method. Collectively, these findings indicated that the RPA assay was fast, simple, specific, sensitive and has significant potentials for clinical and on-site testing.

The first two cases of posterior reversible encephalopathy syndrome (PRES) secondary to conventional transcatheter arterial chemoembolization of hepatocellular carcinoma.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a very rare complication secondary to transcatheter arterial chemoembolization (TACE). Only two patients with liver metastasis have been reported. We report for the first time two cases of hepatocellular carcinoma (HCC) patients occurred PRES secondary toTACE. CASE PRESENTATION: The two patients with HCC developed headache, epilepsy, expressive aphasia, visual impairment and loss of consciousness, 11 and 3 h after conventional TACE (c-TACE) surgery. One patient experienced raised blood pressure during and after TACE, accompanied by a significant elevated creatinine. The magnetic resonance imaging (MRI) of the two patients showed multiple abnormal signals in the brain, mainly located in the white matter region. Combined with the clinical symptoms and MRI findings, PRES was diagnosed. Their symptoms and MRI changes improved significantly in the next two weeks. CONCLUSION: The PRES in this report is chemoembolization-associated syndrome, which might be related to the use of chemotherapy agents during TACE. And if neurological symptoms occur after TACE, patients should be closely monitored to exclude PRES.

Complete genome sequence of a novel recombinant avian leukosis virus isolated from a three-yellow chicken.

In this study, an avian leukosis virus (ALV) strain (GX-2020-01) was isolated from a three-yellow chicken, and its complete genome was 7570 bp long with the typical organization "5'LTR-gag-pol-env-3'LTR." Phylogenetic analysis and sequence comparison revealed that it belongs to the ALV-J subgroup. However, the LTR region of GX-2020-01 is highly similar to that of reference strains of ALV-K/E (96.61%-97.10%), demonstrating that this novel isolate is a natural recombinant. The replication efficiency of GX-2020-01 was significantly lower than the previously isolated ALV-J strain (NX0101), indicating that the recombination event might have resulted in slower virus replication, making it harder for it to be detected through routine testing.

Hydrogen sulfide promotes hypocotyl elongation via increasing cellulose content and changing the arrangement of cellulose fibrils in alfalfa.

Hydrogen sulfide (H2S) is known to have positive physiological functions in plant growth, but limited data are available on its influence on cell walls. Here, we demonstrate a novel mechanism by which H2S regulates the biosynthesis and deposition of cell wall cellulose in alfalfa (Medicago sativa). Treatment with NaHS was found to increase the length of epidermal cells in the hypocotyl, and transcriptome analysis indicated that it caused the differential expression of numerous of cell wall-related genes. These differentially expressed genes were directly associated with the biosynthesis of cellulose and hemicellulose, and with the degradation of pectin. Analysis of cell wall composition showed that NaHS treatment increased the contents of cellulose and hemicellulose, but decreased the pectin content. Atomic force microscopy revealed that treatment with NaHS decreased the diameter of cellulose fibrils, altered the arrangement of the fibrillar bundles, and increased the spacing between the bundles. The dynamics of cellulose synthase complexes (CSCs) were closely related to cellulose synthesis, and NaHS increased the rate of mobility of the particles. Overall, our results suggest that the H2S signal enhances the plasticity of the cell wall by regulating the deposition of cellulose fibrils and by decreasing the pectin content. The resulting increases in cellulose and hemicellulose contents lead to cell wall expansion and cell elongation.

Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease.

OBJECTIVE: To determine the clinical and liver stiffness characteristics of a cohort of Chinese patients with Hepatocellular carcinoma in different stages of Barcelona clinic liver cancer. METHODS: Details of 1180 patients with Hepatocellular carcinoma referred from October 2014 to November 2017 were collected retrospectively. Demographic data, etiology, clinical, and biochemical details were retrospectively analyzed. The changes of liver stiffness in different etiologies and different stages of Barcelona clinic liver cancer were especially analyzed. RESULTS: The onset age was 60.33 ± 9.11 (range 24-84) years, 9 cases were ≤40 years, 572 cases were 41-60 years, males accounted for 83.92%, females accounted for 16.08%; 599 cases were ≥61 years, males accounted for 78.25%, females accounted for 21.75%. Compared with males, the proportion of females ≥61 is higher than that of men. Majority (n = 787; 66.69%) had HBV infection; second commonest cause was HCV infection (n = 217; 18.39%). More patients with HBV infection were 41-60 years (69.06%) and were younger than HCV patients. There was no statistical difference in etiology, age, gender, and distribution of diabetes mellitus among different Barcelona clinic liver cancer stages (P > .05). The overall Hepatocellular carcinoma (HCC) was found to be positively correlated with alkaline phosphatase, γ-glutamyltransferase, and alpha-fetoprotein and liver stiffness measurement values from stage A to stage D (P < .05). ANOVA analysis showed that the overall liver stiffness measurement among the four BCLC stages was found to be statistically significant different in HBV-infected and HCV-infected HCC patients. CONCLUSION: Majority (99.24%) were patients aged >40 years old. Male is a high incidence population. In etiological analysis, HBV dominates HCC occurrence, HBV-, HCV-, and alcohol-associated HCC have distinct clinical and biochemical characteristics, necessitating different screening policies to optimize HCC surveillance and management.

Establishment of pyrosequencing technology to detect White Spot Syndrome Virus (WSSV) in cultured aquatic animals.

This study aimed to establish pyrosequencing methods to detect white spot syndrome virus (WSSV). One pair of polymerase chain reaction (PCR) primers, and one pyrosequencing primer, were designed for WSSV. The pyrosequencing reaction system and conditions were optimized and a pyrosequencing method for detecting WSSV was successfully established. This method was able to specifically detect WSSV in eight viruses, with high sensitivity. The minimum detectable limit for nucleic acid was 23 copies/µL. The method was verified by detecting WSSV in 1881 batches of samples collected from domestic and imported shrimps. The detection results were more sensitive than conventional PCR. This research has therefore provided a new detection method for monitoring, and controlling aquatic animal virus diseases.

Development of a Liquid Chip Technique to Simultaneously Detect Spring Viremia of Carp Virus, Infectious Hematopoietic Necrosis Virus, and Viral Hemorrhagic Septicemia of Salmonids.

A liquid chip technique was developed to detect spring viremia of carp virus (SVCV), infectious hematopoietic necrosis virus (IHNV), and viral hemorrhagic septicemia virus (VHSV) of salmonids simultaneously. Sequences of the G gene of SVCV, N gene of IHNV, and G gene of VHSV were used to design SVCV-, IHNV-, and VHSV-specific primers, which were labeled with biotin and subjected to amination modification. They were then coupled with fluorescence-coded microspheres and used for hybridization with reverse-transcription PCR products of SVCV, IHNV, and VHSV. A BD FACSArray was used to detect fluorescence signal in the reaction system. This assay system had a high sensitivity to SVCV, VHSV, and IHNV, with LODs of 10, 10, and 100 pg/µL, respectively. Moreover, the assay was specific for the detection of SVCV, IHNV, and VHSV and was not susceptible to cross-detection of other viruses, including pike fry rhabdovirus, hirame rhabdovirus, infectious pancreatic necrosis virus, viral nervous necrosis virus, yellowtail ascites virus, grass carp reovirus, red sea bream iridovirus, and koi herpesvirus. The liquid chip assay technique established in this study provides a novel, convenient, and rapid approach for the detection of SVCV, IHNV, and VHSV.

The value of grip test, lysophosphatidlycholines, glycerophosphocholine, ornithine, glucuronic acid decrement in assessment of nutritional and metabolic characteristics in hepatitis B cirrhosis.

The liver is essential for the regulation of energy, protein and amino acids, as well as in other aspects of metabolism. To identify efficient indexes for evaluation of nutritional status and metabolic characteristics during different Child-Pugh stages of hepatitis B cirrhosis, 83 patients and 35 healthy individuals were enrolled in our study. We found that grip strength, triceps skinfold thickness (TSF), body fat and skeletal muscle of the patients were reduced compared to the control group (P<0.05). Ultra-high-performance liquid chromatography data combined with mass spectrometry (UPLC-MS) showed that levels of a variety of metabolites, including lysophosphatidylcholines (LysoPCs), glycerophosphocholine, ornithine and glucuronic acid were reduced in the serum of patients with hepatitis B cirrhosis (P<0.001). However, glycerophosphoserine and taurocholic acid levels were higher than in the control group (P<0.001). Moreover, grip strength was correlated with the Child-Pugh score (P<0.05). Serum albumin, total cholesterol, LDL, LysoPCs, glycerophosphocholine, ornithine, glucuronic acid, glycerophosphoserine and taurocholic acid were correlated with the Child-Pugh score (P<0.01). These findings suggested that grip strength and the above small molecular substances might be considered as sensitive and important indexes for evaluating nutritional status and metabolic characteristics of patients with hepatitis B cirrhosis, which may help assess prognosis and adjust nutritional treatment.

Association between the HFE C282Y, H63D Polymorphisms and the Risks of Non-Alcoholic Fatty Liver Disease, Liver Cirrhosis and Hepatocellular Carcinoma: An Updated Systematic Review and Meta-Analysis of 5,758 Cases and 14,741 Controls.

BACKGROUND: Conflicting results have been obtained for the association between two common polymorphisms (C282Y, H63D) of human HFE (hereditary hemochromatosis) gene and the risks of the liver diseases, including non-alcoholic fatty liver disease (NAFLD), liver cirrhosis and hepatocellular carcinoma (HCC). METHODS: An updated systematic review and meta-analysis was conducted to evaluate the potential role of HFE polymorphisms in the susceptibility to NAFLD, liver cirrhosis and HCC. After retrieving articles from online databases, eligible studies were enrolled according to the selection criteria. Stata/SE 12.0 software was utilized to perform the statistical analysis. RESULTS: In total, 43 articles with 5,758 cases and 14,741 controls were selected. Compared with the control group, a significantly increased risk of NAFLD was observed for the C282Y polymorphism in the Caucasian population under all genetic models and for the H63D polymorphism under the allele, heterozygote and dominant models (all OR>1, Passociation<0.05). However, no significant difference between liver cirrhosis cases and the control group was observed for HFE C282Y and H63D (all Passociation>0.05). In addition, we found that HFE C282Y was statistically associated with increased HCC susceptibility in the overall population, while H63D increased the odds of developing non-cirrhotic HCC in the African population (all OR>1, Passociation<0.05). Moreover, a positive association between compound heterozygosity for C282Y/H63D and the risk of NAFLD and HCC, but not liver cirrhosis, was observed. CONCLUSION: Our meta-analysis provides evidence that the HFE C282Y and H63D polymorphisms confer increased genetic susceptibility to NAFLD and HCC but not liver cirrhosis. Additional well-powered studies are required to confirm our conclusion.

ART score and hepatocellular carcinoma: An appraisal of its applicability.

BACKGROUND: Assessment for retreatment with TACE (ART) score evaluates whether hepatocellular carcinoma (HCC) patients can benefit from transcatheter arterial chemoembolization (TACE) retreatments. As previously reported, TACE has a good prognostic effect on patients with ART score of 0-1.5, while patients with ART score≥2.5 might have minor or even no prognostic benefits. Our study verified whether ART score can guide multiple TACE retreatments in Chinese patients presenting with HCC. METHOD: Nine hundred and thirty-four patients presenting with HCC and treated with TACE were recruited from January 2008 to June 2012, at which point 137 patients had been treated with TACE at least twice and could be assessed by ART score. Patients were assessed by ART score before the second, third, and fourth TACE treatment, and divided into 0-1.5 group and ≥2.5 group. Overall survival (OS) of both groups was compared, and patients were further evaluated on whether TACE retreatment was beneficial. RESULTS: Before the second, third, fourth TACE treatment, the median OS (95% CI) was respectively 25.0 (21.1-28.0) months, 29.0 (22.0-36.0) months and 24.3 (8.2-40.4) months for patients with ART score 0-1.5. 18.0 (14.5-21.5) months, 14.0 (6.4-21.6) months and 22.0 (11.8-32.3) months for patients with ART score ≥2.5. (P values were 0.036, 0.011 and 0.152 respectively). CONCLUSION: Our results are consistent with previous study that before TACE treatment, patients should be assessed by ART score, and those with ART score 0-1.5 had superior prognosis as compared those with an ART score ≥2.5.