[Evaluation of the efficacy of urine-based lipoarabinomannan antigen test in the diagnosis of pulmonary tuberculosis].

Objective: To analyze the diagnostic efficacy of urinary lipoarabinomannan (LAM) antigen detection method in tuberculosis patients, and to provide an experimental basis for the clinical application of urinary LAM kit in China. Methods: From March to May 2023, 228 patients with lung diseases [134 male, 94 female, age 20-82 (44.8±16.7) years] were prospectively collected in Beijing Chest Hospital, Capital Medical University, including 143 pulmonary tuberculosis patients and 85 non-tuberculosis patients. Urine and sputum samples from patients were collected for traditional etiological detection and urinary LAM antigen detection. The screening results of each positive detection combination were analyzed, and the difference analysis and regression analysis were performed. Results: The detection sensitivity and specificity of the urinary LAM kit were 46.2% (95%CI: 37.9%-54.7%) and 96.5% (95%CI: 89.3%-99.1%), respectively, with an overall coincidence rate of 64.9%. The detection rate of LAM antigen detection and GeneXpert MTB/RIF (Xpert) combined (60.8%, 87/143) was significantly higher than that of Xpert alone (49.7%, 71/143), and the difference was statistically significant (P<0.05). The results of risk factor analysis showed that the risk of negative urinary LAM antigen test results increased significantly as the bacterial load decreased. Conclusions: Urine LAM antigen detection method has a high specificity and can be combined with traditional methods to effectively improve the detection rate. Urinary LAM antigen detection method still has limitations, such as the influence of bacterial load and the inability to distinguish nontuberculosis mycobacteria samples, which needs further experimental verification.

Increased Vδ1γδT cells predominantly contributed to IL-17 production in the development of adult human post-infectious irritable bowel syndrome.

BACKGROUND: γδT cells play an important role in the mucosa inflammation and immunity-associated disorders. Our previous study reported that γδ T cells producing IL-17 were involved in the pathogenesis of post-infectious irritable bowel syndrome (PI-IBS). However, their subset characteristic profile in this kind of disease remains unclear. Thus the current study's aim is to investigate the functionally predominant subset and its role in PI-IBS. METHODS: The total T cells were collected from the peripheral blood of patients with PI-IBS. The peripheral proportion of Vδ1 and Vδ2 subset was detected by FACS after stained with anti δ1-PE and anti δ2-APC. The local colonic proportion of this two subsets were measured under laser confocal fluorescence microscope. Vδ1 γδ T cells were enriched from the total peripheral T cells by minoantibody-immuno-microbeads (MACS) method and cultured, functionally evaluated by CCK-8 assay (proliferation), CD69/CD62L molecules expression assay (activation) and ELISA (IL-17 production) respectively. RESULTS: 1. Vδ1 γδ T cells significantly increased while Vδ2 γδ T cells remained unchanged in both the peripheral blood and local colonic tissue from PI-IBS patients (p < 0.05). 2. When cultured in vitro, the Vδ1 γδ T cells remarkably proliferated, activated and produced IL-17 (p < 0.05). CONCLUSIONS: Our results suggest that Vδ1 γδ T cells was the predominant γδ T cells subset in both peripheral and intestinal tissue, and was the major IL-17 producing γδ T cells in PI-IBS.

MiR-593-5p inhibited proliferation and migration of lung adenocarcinoma by targeting ICAM-1.

OBJECTIVE: The aim of this study was to investigate the role of microRNA-593-5p (miR-593-5p) in the development of lung adenocarcinoma (LA). PATIENTS AND METHODS: The expression level of miR-593-5p in LA tissues and cell lines was detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Luciferase reporter gene assay and Western blot were performed to evaluate the interaction between miR-593-5p and intercellular cell adhesion molecule-1 (ICAM-1). Furthermore, the effects of the miR-593-5p/ICAM-1 axis on A549 cells were determined by MTS, colony formation assay, and transwell assay, respectively. RESULTS: MiR-593-5p was significantly downregulated in both clinical samples and cell lines. The bioinformatics analysis predicted that miR-593-5p could complementarily bind to the 3'-UTR of ICAM-1. Luciferase reporter gene assay confirmed that ICAM-1 was the direct target of miR-593-5p. Western blot results demonstrated that miR-593-5p could effectively reduce the protein expression of ICAM-1 in cells. In vitro experiments indicated that the proliferation and migration of A549 cells were significantly inhibited by miR-593-5p transfection. However, the overexpression of ICAM-1 could effectively reverse the inhibitory effects of miR-593-5p in vitro. These results indicated that the inhibitory effects of miR-593-5p on LA were achieved by regulating ICAM-1 expression. CONCLUSIONS: MiR-593-5p/ICAM-1 axis might be a potential therapeutic target for the diagnosis and treatment of LA.

Fatigue device driven by a three degree of freedom tripodal piezoelectric actuator.

A miniature piezoelectric-driven fatigue device with three degrees of freedom is developed. The device integrates two fatigue testing functions, including uniaxial tensile fatigue and tensile-bending combined loading modes. The synchronous tensile-bending loading principle is described, which is applicable for calculating the vector displacements along two orthogonal directions and investigating the anisotropic fatigue properties. Regarding the combined loading mode, maximum load/displacement amplitudes for tensile and bending vector components that could be achieved are 16.9 N/22.8 µm and 3.3 N/5.6 µm, respectively. Based on tensile and tensile-bending combined fatigue loading modes, the displacement responses and fatigue lives at loading frequencies ranging from 1 Hz to 100 Hz are valuated experimentally to indicate the validation.

[Clinical application of folded free radial forearm flaps for reconstruction of full-tickness cheek defects after resection of buccal carcinoma].

Objective:To investigate the therapeutic effect of folded free radial forearm flaps (RFF) for reconstruction of full-tickness cheek defects after the resection of buccal carcinoma.Method:Seventeen cases of buccal carcinoma received radical neck dissection with cheekectomy and mandibulectomy, and the folded RFF to reconstruct full-tickness cheek defects simultaneously. Preoperative Allen test, ultrasonic doppler blood flow meter examination or computed tomography angiography confirmed good vascular condition of the forearm. Result: RFF were obtained from all patients, and completely survived. During the follow-up period of 6-36 months, the lateral morphology of the cheek was restored well and the mouth opening is normal. Language and swallowing function recovered well, without salivation or cheek biting. There were no obvious complications in the donor site. One case（T3N1M0）died of pulmonary metastatic carcinoma a year later. Conclusion:The success rate is high and the morphology and function recovered well of the folded RFF for reconstruction of full-tickness cheek defects, so it is a reliable method to reconstruct full-tickness cheek defects after the resection of buccal carcinoma.

Note: Motor-piezoelectricity coupling driven high temperature fatigue device.

The design and performance evaluation of a novel high temperature fatigue device simultaneously driven by servo motor and piezoelectric actuator is our focus. The device integrates monotonic and cyclic loading functions with a maximum tensile load of 1800 N, driving frequency of 50 Hz, alternating load of 95 N, and maximum service temperature of 1200 °C. Multimodal fatigue tests with arbitrary combinations of static and dynamic loads are achieved. At temperatures that range from RT to 1100 °C, the tensile and tensile-fatigue coupling mechanical behaviors of UM Co50 alloys are investigated to verify the feasibility of the device.

Identifying the molecular targets of Salvia miltiorrhiza (SM) in ox-LDL induced macrophage-derived foam cells based on the integration of metabolomics and network pharmacology.

The identification of network targets is one of the core issues used to reveal the molecular mechanism of traditional Chinese medicine (TCM) and is also the grand challenge of modernization of TCM. In this study, a protein-protein interaction (PPI) network was constructed based on the integration of network pharmacology and metabolomics, which was used as an effective approach to elucidate the relationship between disease pathway proteins and the targets of active small-molecule compounds. The intermolecular transfer process of the drug effect of active compounds in Salvia miltiorrhiza (SM) was revealed and visualized using the PPI network. Our study indicates that PTGS2 was the most important disease protein regulated by the active compounds in SM. Furthermore, the drug targets that can be linked to PTGS2 were regarded as direct targets and the direct targets of the active compounds were identified, respectively. Western blot and co-immuno precipitation (Co-IP) were used to verify the results of the network analysis and reveal the intermolecular transfer process of the effect of Tan IIA. Biological validation revealed that Tan IIA-EDN1-PTGS2-anandamide was a major intervention way of Tan IIA on early atherosclerosis (AS). This work provides a new perspective for the discovery of drug targets and the specific approaches regulated by the active compounds in SM on disease pathway proteins, which is beneficial for understanding the mechanism of action of bioactive compounds and expanding their clinical applications.

The gall wasp Leptocybe invasa (Hymenoptera: Eulophidae) stimulates different chemical and phytohormone responses in two Eucalyptus varieties that vary in susceptibility to galling.

Gall-inducing insects produce various types of galls on plants, but little is known about the gall-induction mechanism of these galling insects. The gall wasp Leptocybe invasa Fisher & LaSalle (Hymenoptera: Eulophidae) forms galls of different sizes on several Eucalyptus species. To clarify the physiological responses of Eucalyptus to L. invasa infestation, we measured the dynamics of nitrogen (N), carbon (C), total phenolics, total tannins and four types of phytohormones (zeatin [Z] + zeatin riboside [ZR], gibberellins [GA], indole-3-acetic acid [IAA] and abscisic acid [ABA]) in galled and ungalled leaf tissues of two Eucalyptus horticultural varieties (DH201-2 [Eucalyptus grandis × Eucalyptus camaldulensis] and EA [Eucalyptus exserta]) with different susceptibility to galling throughout the larval developmental stages. Nitrogen, total phenolics, tannins and four kinds of phytohormones strongly accumulated in tissues galled by L. invasa (especially during early larval feeding stages). While N, Z + ZR and GA levels were higher, tannins and ABA levels were lower in the galled tissues on the highly susceptible variety. Nitrogen, total phenolics, GA, Z + ZR and IAA levels in the galled tissues gradually decreased during gall development, but ABA and tannins conversely increased in the galled tissues of the less susceptible variety. Our results suggest that the effects of gall-inducing insects on plants depend not only on the susceptibility of the plant infested but also on the developmental stage of galled tissues. Gall formation process is thus synergistically influenced by both gall-inducing insect and plant genotypes.

[Huge glass foreign body penetrating into the infratemporal fossa through the maxillary sinus:a case report].

We report a rare case of glass foreign body penetrating into the infratemporal fossa through the maxillary sinus. The patient felt a little difficulty to open mouth. Both CT and DSA are helpful in diagnosis and treatment. It was important to keep the foreign body stability and integrity, through the modified Weber incision around the original traumatic wound and removal of anterior wall of the maxillary sinus around the foreign body.

G12V Kras mutations in cervical cancer under virtual microscope of molecular dynamics simulations.

Kras mutations and cancers are common and their role in the progression of cancer is well known and elucidated. The present work is searching for the most deleterious mutation of the four found at codon 12 and 13 of Kras in cervical cancers using prediction servers; different servers were used to look into different factors that govern the protein function. The in silico results predicted G12V to be the most devastating; this particular mutation was then subjected to molecular dynamics simulation (MDS) for further analysis. The authors' approach of MDSs helped them to place the native and mutant structure under virtual microscope and observe their dynamics over time. The results generated are enlightening the effect of G12V variation on the dynamics of Kras. The structural variation between the native and mutant Kras over 50 nanoseconds (ns) run varied at every parameter checked and the results are in excellent agreement with the available experimental data.

A region-matching method for pulse transit time estimation: potential for improving the accuracy in determining carotid femoral pulse wave velocity.

Carotid femoral pulse wave velocity (cfPWV) is the 'gold standard' for assessment of arterial stiffness. The reliability of cfPWV measurement depends on the estimation of pulse transit time (PTT). This study aimed to validate a region-matching method for determining PTT and cfPWV against the existing 'foot-to-foot' methods. A cohort of 81 subjects (33 males and 48 females) aged 25-80 (45.1±15.7 years) were studied. PTTs were estimated by the region matching and 'foot-to-foot' methods ('diastole minimum', 'maximum first derivative', 'maximum second derivative' and 'tangent intersection' methods) with manual identification as the reference method and were subsequently used to calculate cfPWV. In a subgroup of 30 individuals, the measurements were repeated after 1 h. There were excellent correlations between cfPWV obtained by the reference method and all the estimated methods (r>0.9, P<0.001 for all), except the diastole minimum method (r=0.793, P<0.001). The region-matching method yielded cfPWV with a better accuracy (mean difference=-0.161 m s(-1), limits of agreement: -0.79 to 0.46 m s(-1)) and repeatability (mean difference=-0.228 m s(-1), intraclass correlation coefficient=0.957) comparing with the 'foot-to-foot' methods. These results demonstrate that the proposed region-matching method is more accurate and suitable for PTT estimation and cfPWV measurement.

Note: investigation on the influences of gripping methods on elastic modulus by a miniature tensile device and in situ verification.

In this paper, by gripping the specimen on various positions, including the gripping section, stress concentration transition section, and gauge length section, theoretical analysis on the influences of gripping methods on tensile elastic modulus calculation was investigated with a group of equations. Then, an image-based displacement measurement system was implemented, and the experimental verification via in situ tensile testing was carried out to verify the feasibility of the theoretical analysis by a miniature tensile device integrated with a metallographic microscope. The stress-strain curves of 2026 aluminum alloy were also obtained by gripping the specimens on various positions to illustrate the influences of gripping methods. The influence of gripping methods on elongation measurement was also investigated. This paper showed a modular calculation method of elastic modulus for the tensile testing of typical plate specimens.

Ferulic acid induces heme oxygenase-1 via activation of ERK and Nrf2.

This study investigated the effect of ferulic acid (FA) on the up-regulation of heme oxygenase-1 (HO-1) in lymphocytes and the molecular mechanisms involved. Lymphocytes were treated with FA (0.001-0.1 µM) for certain times. Cell viability, the activity and level of expression of HO-1, and signal pathways were analyzed. FA significantly upregulated HO-1 expression both at the level of mRNA and protein in lymphocytes. Moreover, FA induced NF-E2-related factor (Nrf2) nuclear translocation and transcriptional activity, which is upstream of FA induced HO-1 expression. In addition, lymphocytes treated with FA exhibited activation of extracellular regulated kinase (ERK) and treatments with U0126 (an ERK kinase inhibitor) attenuated the FA induced activation of Nrf2, resulting in a decrease in HO-1 expression. Zinc protoporphyrin (ZnPP, a HO-1 inhibitor) markedly suppressed cytoprotection from radiation-induced cell damage by FA. Results suggested that the ERK signaling pathway controlled the anti-oxidation of FA by regulating the expression of the antioxidant enzyme HO-1.

Serum fructose concentration in rats after single dose oral administration of Si-Wu-Tang.

Our previous study showed that fructose is an important active constituent that is responsible for Si-Wu-Tang's (SWT) effects promoting hematopoiesis and immunity. In order to provide primary data for analysis of the mechanism of fructose's bioactivity, the concentration of serum fructose in rats after a single oral administration dose of Si-Wu-Tang was determined. The concentration of serum fructose in fasting rats was 0.34 ± 0.24 mg/dL. After oral administration of 7.2 mL per kg body weight of SWT extract (1 mL extract corresponds to 1 g SWT dried herbs), serum fructose levels reached a peak concentration of 1.03 ± 0.25 mg/dL within 60 min, and then declined to the baseline level within 180 min, a pattern which is similar to the one reported for oral administration of pure fructose. The peak concentration was only 2-3 times higher than the baseline serum fructose concentration. These results showed that the increase of blood fructose concentration after oral administration of SWT is small and transient, which is very probably due to the quick metabolism of fructose by the liver. We suggest, for future research, it is necessary to consider the probability that fructose's bioactivity on hematopoiesis and immunity is not exerted by fructose in its original form, but after it is metabolized by the liver.

Rehmanniae Radix provides most of the free fructose and glucose in Si-Wu-Tang decoction.

Our previous study showed that free fructose is an important active constituent responsible for Si-Wu-Tang's (SWT) effect promoting hematopoiesis and immunity. However, the contribution from SWT's four ingredient drugs to the free fructose content in the SWT decoction was not clear. To answer this question, in this study, the fructose, glucose and sucrose content in the SWT decoction, in the decoctions of each single ingredient drug, and in the decoctions of the four formulae lacking each single ingredient drug were determined by HPLC-ELSD. The results showed that the fructose and glucose content in the decoction of single Rehmanniae Radix were almost the same as those in the SWT decoction. In the single Rehmanniae Radix decoction concentrations were: 4.25 ± 0.53 mg/mL for fructose, and 3.43 ± 0.60 mg/mL for glucose; in the SWT decoction concentrations were: 4.10 ± 0.43 mg/mL for fructose, and 3.42 ± 0.32 mg/mL for glucose, while the content of fructose and glucose in the decoctions of single Angelica Radix, single Paeoniae Radix, single Chuanxiong Rhizoma and the formula lacking Rehmanniae Radix were either very small or undetectable. On the other hand, the fructose and glucose content in the decoctions of the formulae lacking Angelica Radix, lacking Paeoniae Radix and lacking Chuanxiong Rhizoma also were approximately the same as those in the SWT decoction. This indicated that Rehmanniae Radix provides most of the free fructose and glucose in the SWT decoction, and therefore plays an important role in SWT's effect promoting hematopoiesis and immunity. As for sucrose in the SWT decoction, Angelica Radix was shown to be a major donor.

Length variations of i-type low-molecular-weight glutenin subunit genes in diploid wheats.

Allelic variation of the low-molecular-weight glutenin subunit (LMW-GS) is associated with the significant differences of dough quality in bread and durum wheat, and has been widely evaluated at protein level in wheat and its relatives. In this study, a PCR primer set, targeting the high variable repetitive domains, was employed to assay the length variation of i-type LMW-GS genes in the A-genomes of diploid wheats, the diploid progenitors of tetraploid and hexaploid wheat. A total of 71 accessions of diploid wheats, belonging to two wild and one cultivated species, were investigated. The higher variations of repetitive length in i-type LMW-GS genes were found in diploid wheats with Nei's genetic variation index (H) of 0.834. The two wild species, T. boeoticum and T. urartu, were found to possess the similar degree of variability, with the Nei's genetic variation index of 0.806 and 0.783, respectively. Less variations were detected in T. monococcum (H = 0.680), a cultivated species domesticated from T. boeoticum. The sufficient variations found in this study could be used as valuable sources for the enrichment of the genetic variations and the alteration of flour-processing properties of the cultivated wheat. To our knowledge, it was the first time that an analysis of length variation targeting a particular group of genes of LMW-GS complex multigene families was conducted.

Characterization of alpha-gliadin genes from diploid wheats and the comparative analysis with those from polyploid wheats.

To carry out the comparative analysis of alpha-gliadin genes on A genomes of diploid and polyploid wheats, 8 full-length alpha-gliadin genes, including 3 functional genes and 5 pseudogenes, were obtained from diploid wheats, among which 2, 2 and 4 alpha-gliadin genes were isolated from T. urartu, T. monococcum and T. boeoticum, respectively. The results indicated that higher number of alpha-gliadin pseudogenes have been present in diploid wheats before the formation of polyploid wheats. Amino acid sequence comparative analysis among 26 alpha-gliadin genes, including 16 functional genes and 10 pseudogenes, from diploid and polyploid wheats was conducted. The results indicated that all alpha-gliadins contained four coeliac toxic peptide sequences (i.e., PSQQ, QQQP, QQPY and QPYP). The polyglutamine domains are highly variable, and the second polyglutamine stretch is usually disrupted by the lysine or arginine residue at the fourth position. The unique domain I is the most conserved domain. There are 4 and 2 conserved cysteine residues in the unique domains I and II, respectively. Comparative analysis indicated that the functional alpha-gliadin genes from A genome are highly conserved, whereas the identity of pseudogenes in diploid wheats are higher than those in hexaploid wheats. Phylogenetic analysis indicated that all the analyzed functional alpha-gliadin genes could be clustered into two major groups, among which one group could be further divided into 5 subgroups. The origin of alpha-gliadin pseudogene and functional genes were also discussed.

Chromosome 8p deletion is associated with metastasis of human hepatocellular carcinoma when high and low metastatic models are compared.

Recently, we found that chromosome 8p deletion might be associated with hepatocellular carcinoma (HCC) metastasis by analyzing the differences in chromosomal alterations between primary tumors and their matched metastatic lesions of HCC with comparative genomic hybridization (CGH) (Qin et al. 1999). To further confirm this interesting finding, the genomic changes of two models bearing human HCC with different metastatic potentials (LCI-D20 and LCI-D35), and the new human HCC cell line with high metastatic potential (MHCC97) were analyzed by CGH. Gains on 1q, 6q, 7p, and 8q, and losses on 13p, 14p, 19p, 21, and 22 were detected in both LCI-D20 and LCI-D35 models. However, high copy number amplification of a minimum region at 1q12-q22 and 12q, and deletions on 1p32-pter, 3p21-pter, 8p, 9p, 10q, 14q, and 15p were detected only in the LCI-D20 model. Gains on 1p21-p32, 2p13-p21, 6p12-pter, 9p, 15q, and 16q11-q21, and losses on 2p23-pter, 4q24-qter, 7q31-qter, 12q, 17p, and 18 were detected only in the LCI-D35 model. The chromosomal aberration patterns in the MHCC97 cell line were similar to its parent LCI-D20 model, except that gains on 19q and losses on 4, 5, 10q, and 13q were found only in the cell line. These results provide some indirect clues to the metastasis-related chromosomal aberrations of HCC and further support the finding that 8p deletion is associated with HCC metastasis. 1q12-22 and 12q might harbor a novel oncogene(s) that contributes to the development and progression of HCC. Amplification on 8q and deletions on 4q and 17p may be not necessary for HCC metastasis.

Complete resection of the caudate lobe of the liver with tumor: technique and experience.

BACKGROUND/AIMS: To study the technique and curative effects of complete resection of the caudate lobe of the liver with tumors. METHODOLOGY: There were 18 patients with tumors in the caudate lobe of the liver in this study. Among them, hepatocellular carcinoma was found in 12 patients, metastasis to the caudate lobe two years after resection of rectal carcinoma in one, cholangiocarcinoma in one, and huge benign tumor in four. Complete caudate lobectomy and combined with left lateral lobectomy or left hemihepatectomy or left trilobectomy were performed in this series. RESULTS: The median operating time was 227 min and median blood loss was 1590 mL, and the median blood transfusion was 1520 mL. No operative or postoperative mortality, or any postoperative complications were found in any of the patients. The 1-, 3- and 5-year survival rates of the 12 patients with hepatocellular carcinoma were 58.3%, 55.5% and 37.8%, respectively. One patient with cholangiocarcinoma died in postoperative 4 months. One patient with metastatic rectal cancer has been alive for more than 5 years after the operation, and 4 patients with benign tumors are still alive and well. CONCLUSIONS: Complete resection of the caudate lobe of the liver should be the first choice for removal of huge tumors originating from the caudate lobe, although this procedure is quite difficult and has a high risk factor.

Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma.

BACKGROUND: Recently, the implementation of screening programs using alpha-fetoprotein (AFP) and ultrasonography in high risk populations has identified increasing numbers of patients with small hepatocellular carcinoma (small HCC). The aim of this study was to summarize the authors' experience in patients who underwent hepatectomy for small HCC and the factors that influence or improve long term survival. METHODS: The study included 1000 patients who underwent hepatectomy for small HCC (< or = 5 cm) and compared them with 1366 patients who underwent hepatectomy for large HCC (> 5 cm) during the same period. A Cox proportional-hazards model was used for multivariate analysis of prognostic factors. RESULTS: Comparison between patients with small HCC (n = 1000 patients) and patients with large HCC (n = 1366 patients) revealed that those with small HCC had a higher resection rate (93.6% [1000 of 1068 patients] vs. 55.7% [1366 of 2451 patients]; P < 0.01), a higher curative resection rate (80.5% [805 of 1000 patients] vs. 60.7% [829 of 1366 patients]; P < 0.01), a lower operative mortality rate (1.5% [15 of 1000 patients] vs. 3.7% [50 of 1366 patients]; P < 0.01), better differentiation of tumor cells (Edmondson Grade 3-4; 14.9% vs. 20.1%; P < 0.01), a higher incidence of single nodule tumors (82.6% vs. 64.4%; P < 0.01), a higher proportion of well encapsulated tumors (73.3% vs. 46.3%; P < 0.01), a lower incidence of tumor emboli in the portal vein (4.9% vs. 20.8%; P < 0.01), and higher survival rates after undergoing resection (5 years: 62.7% vs. 37.1%; P < 0.01; 10 years: 46.3% vs. 29.2%; P < 0.01). No significant difference was found between survival after undergoing minor resection (n = 949 patients) or lobectomy (n = 51 patients) in patients with small HCC (P > 0.05). Reresection for subclinical recurrence or solitary pulmonary metastasis after small HCC resection was undertaken in 84 patients. CONCLUSIONS: Resection is still the modality of first choice for the treatment of patients with small HCC. Minor resection instead of lobectomy was the key to increasing resectability and decreasing operative mortality, and reresection for subclinical recurrence or solitary pulmonary metastasis was important approach to prolonging survival further.