[Surgical treatment and prognosis analysis of hilar cholangiocarcinoma].

Objective: To investigate the surgical treatment effect and prognostic factors of hilar cholangiocarcinoma. Methods: This is an ambispective cohort study. From August 2005 to December 2022,data of 510 patients who diagnosed with hilar cholangiocarcinoma and underwent surgical resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively collected. In the cohort,there were 324 males and 186 females,with an age of (M (IQR)) 63(13)years (range:25 to 85 years). The liver function at admission was Child-Pugh A (343 cases,67.3%) and Child-Pugh B (167 cases,32.7%). Three hundred and seventy-two(72.9%) patients had jaundice symptoms and the median total bilirubin was 126.3(197.6) µmol/L(range: 5.4 to 722.8 µmol/L) at admission. Two hundred and fourty-seven cases (48.4%) were treated with percutaneous transhepatic cholangial drainage or endoscopic nasobiliary drainage before operation. The median bilirubin level in the drainage group decreased from 186.4 µmol/L to 85.5 µmol/L before operation. Multivariate Logistic regression was used to identify the influencing factors for R0 resection,and Cox regression was used to construct multivariate prediction models for overall survival(OS) and disease-free survival(DFS). Results: Among 510 patients who underwent surgical resection,Bismuth-Corlett type Ⅲ-Ⅳ patients accounted for 71.8%,among which 86.1% (315/366) underwent hemi-hepatectomy,while 81.9% (118/144) underwent extrahepatic biliary duct resection alone in Bismuch-Corlett type Ⅰ-Ⅱ patients. The median OS time was 22.8 months, and the OS rates at 1-,3-,5-and 10-year were 72.2%,35.6%,24.8% and 11.0%,respectively. The median DFS time was 15.2 months,and the DFS rates was 66.0%,32.4%,20.9% and 11.0%,respectively. The R0 resection rate was 64.5% (329/510), and the OS rates of patients with R0 resection at 1-,3-,5-and 10-year were 82.5%, 48.6%, 34.4%, 15.2%,respectively. The morbidity of Clavien-Dindo grade Ⅲ-Ⅴ complications was 26.1%(133/510) and the 30-day mortality was 4.3% (22/510). Multivariate Logistic regression indicated that Bismuth-Corlett type Ⅰ-Ⅲ (P=0.009), hemi-hepatectomy and extended resection (P=0.001),T1 and T2 patients without vascular invasion (T2 vs. T1:OR=1.43 (0.61-3.35),P=0.413;T3 vs. T1:OR=2.57 (1.03-6.41), P=0.010;T4 vs. T1, OR=3.77 (1.37-10.38), P<0.01) were more likely to obtain R0 resection. Preoperative bilirubin,Child-Pugh grade,tumor size,surgical margin,T stage,N stage,nerve infiltration and Edmondson grade were independent prognostic factors for OS and DFS of hilar cholangiocarcinoma patients without distant metastasis. Conclusions: Radical surgical resection is necessary to prolong the long-term survival of hilar cholangiocarcinoma patients. Hemi-hepatectomy and extended resection,regional lymph node dissection and combined vascular resection if necessary,can improve R0 resection rate.

Chemical and mechanical stability of an ion-exchanged lithium disilicate glass in artificial saliva.

Multi-component lithium disilicate (LD) glasses were ion-exchanged in a pure or mixed nitrate salt bath. The surface morphologies, mechanical properties, chemical stability and ion leaching of ion-exchanged LD glasses before and after storage in artificial saliva for 21 days were investigated. It can be found that chemical stability of ion-exchanged LD glass was temperature-dependent. The residual compressive stress induced by ion-exchange increased the chemical potential of alkali ions in glass, and the ion-exchanged LD glass, especially 235 °C/64 h group, chemical stability in artificial saliva for 21 days were deteriorated. Back-exchange treatment could relax the stress on the outermost layer of the ion-exchanged LD glass without deteriorating its strengthening effect, and back-exchanged LD glass presented good chemical and mechanical stability in artificial saliva. The results might help to enhance the service stability of ion-exchanged LD glass-ceramics in the oral condition.

Lung cancer screening study from a smoking population in Kunming.

OBJECTIVE: Yunnan, China, is a central tobacco-producing region with a large smoking population and an increasing incidence of lung cancer in recent years. This study aimed to understand the incidence of lung cancer and the characteristics of lung nodules on low-dose computed tomography (LDCT) scans of the chest in a long-term smoking population in Kunming. PATIENTS AND METHODS: Long-term smokers in Kunming who were not at risk of evident lung disease symptoms were recruited through recommendation and publicity by the Kunming University of Science and Technology. RESULTS: Among 375 cases eligible for inclusion,14 cases of lung cancer were detected with a detection rate of 3.73% (95% CI: 2.55%-4.27%), including one case of squamous carcinoma, one case of small cell lung cancer, seven cases of adenocarcinoma of the lung and five cases of early-stage lung cancer (35.71%). In the group of < 6 mm solid nodules and < 5 mm non-solid nodules, no lung cancer was detected in 201 cases; lung cancer was detected in 14 cases in 61 cases, and there was a statistical difference between the two groups (p < 0.05). CONCLUSIONS: The lung cancer detection rate in long-term smokers was high, with the type predominantly adenocarcinoma and a high incidence of lung nodules, and increased when solid nodules≥6 mm or non-solid nodules ≥ 5 mm were present. It is recommended that screening for lung cancer by LDCT of the chest be introduced in the male smoking population who meet the risk factors and that screening for lung cancer in women should be redefined as a high-risk factor.

Impact of sleep status on lung adenocarcinoma risk: a prospective cohort study.

OBJECTIVE: The association between sleep status and lung adenocarcinoma risk was analyzed using long-term follow-up data from 60,443 patients over the period 2016-2022 to provide a reference for exploring the association between sleep status and lung adenocarcinoma development. PATIENTS AND METHODS: Based on long-term follow-up data, a total of 60,443 people were included. Sleep data collected for the study included insomnia symptoms, lunch break habits, and sleep duration. A sleep score (0-3) was constructed based on difficulty falling asleep, premature awakening and sleep duration. Proportional risk regression models were used to analyze the association between each sleep factor, sleep score and lung cancer risk. RESULTS: The study population was followed up for 9.9 ± 4.8 years and a total of 307 cases of lung adenocarcinoma were first recorded during the follow-up period. After controlling for potential confounders, the risk ratios (HR) for lung adenocarcinoma in those with difficulties going asleep or waking up too early were 1.12 (95% CI: 1.02-1.14) and 1.07 (95% CI: 1.01-1.11), respectively, compared to those without symptoms of insomnia. The HR for lung adenocarcinoma in those with less than 7 h of sleep [HR = 1.17 (95% CI: 1.05-1.21)] was compared to those with ≥ 7 h of sleep per day. Compared to those with a sleep score of 3 (highest quality sleep), those with a sleep score of 2, 1 and 0 corresponded to HR of 1.06 (95% CI: 1.01-1.12), 1.11 (95% CI: 1.09-1.18) and 1.15 (95% CI: 1.01-1.32) respectively. CONCLUSIONS: Patients who suffer from insomnia or have a short sleep schedule are at increased risk of developing lung cell cancer. Sleep has an important impact on health and improving sleep conditions can reduce the incidence of lung cancer.

Propagation rules of shock waves in confined space under different initial pressure environments.

In this paper, an initial pressure adjustable explosion vessel was developed, and the effect of negative pressure, positive pressure (0.2-1.8 atm) different initial ambient pressure on the explosive shock wave generated by the explosion of explosives was studied. The relationships between the specific impulse, shock wave velocity, the amount of explosive gas products and the ambient pressure were analyzed for different initial pressure environments. It was found that: the overpressure of the blast shock wave decreases with the initial ambient pressure of the explosion, and there exists a negative pressure environment with a dramatic pressure decrease near 0.6 atm, defined as the super-sensitive negative pressure Pcr. The propagation velocity of an explosive wave increases with a decrease in the ambient pressure, and the propagation velocity at a pressure of 1.8 atm is four times less than the velocity at a pressure of 0.2 atm. The production of explosive gas products did not change. The greater the initial pressure of the environment where the explosive is located, the smaller the ratio of the gas generated by the explosion to the initial force gas in the explosion vessel is, and the greater the impact on the propagation of shock waves is. The maximum attenuation of the first specific impulse i1 is 72.97% and the maximum attenuation of the second specific impulse i2 is 72.39%. The experiments provide reference data for high-altitude military confrontation, high-altitude weapons and ammunition development, and deep-earth protection engineering.

[Efficacy and safety of neoadjuvant immunotherapy for hepatocellular carcinoma].

Objective: To study the surgical safety and efficacy of preoperative neoadjuvant therapy with immune checkpoint inhibitors combined with anti-angiogenic drugs in patients with China liver cancer staging(CNLC)-Ⅱb and Ⅲa resectable hepatocellular carcinoma. Methods: The data of 129 patients with Ⅱb and Ⅲa hepatocellular carcinoma who underwent surgery at the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were analyzed. All patients were divided into two groups: the neoadjuvant therapy group(n=14,13 males and 1 female,aged (55.4±12.6)years(range:34 to 75 years)) received immune combined targeted therapy before surgery,immune checkpoint inhibitor camrelizumab was administered intravenously at a dose of 200 mg each time,every 2 weeks for 3 cycles,anti-angiogenesis drug apatinib was taken orally and continuously with a dose of 250 mg for 3 weeks and the conventional surgery group(n=115,103 males and 12 females,aged (55.8±12.0)years(range:21 to 83 years)) did not receive antitumor systemic therapy before surgery. There were 3 patients with CNLC-Ⅱb,11 with CNLC-Ⅲa in the neoadjuvant group;28 patients with CNLC-Ⅱb,87 with CNLC-Ⅲa in the conventional group. Student's t test or rank-sum test was used to compare the differences between two groups for quantitative data, Fisher's exact probability method was used to compare the differences of proportions between two groups, and Log-rank test was used to compare survival differences between two groups. Results: The 1-year recurrence rate in the neoadjuvant group was 42.9%,and the 1-year recurrence rate in the conventional group was 64.0%,with a statistically significant difference between the two groups(χ²=3.850,P=0.050);The 1-year survival rate in the neoadjuvant group was 100% and that in the conventional group was 74.2%,with a statistically significant difference between the two groups(χ²=5.170,P=0.023). According to the stratified analysis of the number of tumors,for single tumor,the 1-year recurrence rate in the neoadjuvant group was 25.0%,and that in the conventional surgery group was 71.0%,and the difference between the two groups was statistically significant(χ²=5.280, P=0.022). For multiple tumors, the 1-year recurrence rate in the neoadjuvant group was 66.7%,and the 1-year recurrence rate in the conventional surgery group was 58.9%,with no significant difference between the two groups(χ²=0.110,P=0.736). The operative time,intraoperative blood loss,and postoperative hospital stay in the neoadjuvant group were similar to those in the conventional group,and their differences were not statistically significant. Conclusions: Immune checkpoint inhibitors combined with anti-angiogenic targeted drugs as a neoadjuvant therapy for resectable hepatocellular carcinoma can reduce the 1-year recurrence rate and improve the 1-year survival rate,especially for those with solitary tumor. Limited by the sample size of the neoadjuvant group,the safety of immune combined targeted therapy before surgery cannot be observed more comprehensively,and further studies will be explored.

[The stability and repeatability of radiomics features based on lung diffusion-weighted imaging].

Objective: To evaluate the feasibility, robustness and reproducibility of radiomics features derived from lung diffusion-weighted imaging (DWI). Methods: Thirty patients with pulmonary nodules/masses who underwent magnetic resonance imaging examination in the Department of Radiology, the First Affiliated Hospital of Guangzhou Medical University, from January 4 2019 to May 5 2019, including 16 males and 14 females, aged from 27 to 69 (57±11) years, were prospectively collected. Planar echo imaging (EPI) -DWI and fast spin-echo (TSE) -DWI scans were performed under free-breathing conditions. Each scan was repeated at an interval of 5 minutes, and the corresponding apparent diffusion coefficient (ADC) maps were reconstructed. Each DWI and ADC sequence (a total of eight groups of images) were manually segmented by two radiologists, and a total of 396 radiomics features in 6 categories were extracted from each group of images. Consistency correlation coefficient (CCC) and dynamic range (DR) were used to evaluate the robustness of features between two scans, and stable features were defined as both CCC values and DR values ≥0.85. Intra-observer and interobserver reproducibility were evaluated by intra-group correlation coefficient (ICC), and ICC values≥0.75 was considered to be good reproducibility. Results: Regardless of EPI or TSE technique, the number of robust features extracted fromDWI (TSE: n=197, EPI: n=169) were higher than that of the corresponding ADC (TSE: n=126, EPI: n=148). The proportion of robust features of TSE-DWI、EPI-DWI、TSE-ADC、EPI-ADC was 49.7% (197/396), 42.7% (169/396), 31.8% (126/396) and 37.4% (148/396), respectively. Of the 396 features, 54 (13.6%) of them demonstrated great robustness (CCC and DR≥0.85) and interobserver and interobserver reproducibility (ICC≥0.75) across all sequences. Conclusions: Radiomics features derived from lung DWI showed robustness and reproducibility. Different sequences and different feature clusters have different proportions of stable features, and some features have good robustness and reproducibility between different scans, different observers, and even different sequences.

Improving early running-in wear characteristics for dental lithium disilicate glass-ceramics by ion-exchange.

OBJECTIVES: This study examined the effects of Li+→Na+ ion-exchange on the early wear performance of dental lithium disilicate (LD) glass-ceramics. METHODS: Specimens with different shapes were prepared using IPS e.max Press as the LD glass-ceramics. Ion-exchange was conducted by placing polished specimens in molten salt containing 25% NaNO3 and 75% KNO3 at 385 °C for 16 or 64 h. The ion-exchanged specimens were analyzed using X-ray diffraction (XRD) and energy-dispersive X-ray spectroscopy (EDS) to investigate the structure and the elemental distribution. Thereafter, the specimens were tested for flexural strength, Vickers hardness, and fracture resistance. A portion of the specimens were tested with a pin-on-disk tribometer with 10 N for 40 × 104 wear cycles in artificial saliva. Wear analysis of the specimens was performed using a 3D profilometer and analyzed with one-way analyses of variance and Tukey's post hoc pairwise comparisons. Worn surfaces were examined with scanning electron microscopy. RESULTS: The LD glass-ceramics exhibited strong time-dependent wear behavior, with typical running-in and steady wear stages. Ion-exchange treatments at 385 °C for 16 h and 64 h both enhanced the mechanical properties and decreased the wear rates of early running-in wear stage. The early wear performance of specimens treated with ion-exchange for long time (64 h) was improved significantly. CONCLUSION: A thicker ion-exchange layer may be obtained by processing ion-exchange for a long time. This protocol improves the early wear performance of the glass-ceramics effectively. CLINICAL SIGNIFICANCE: Dental restorations may fail prematurely due to excessive wear. It is important to improve the early wear performance of the glass-ceramics. Ion-exchange has the potential to strengthen dental LD glass-ceramics. Understanding the effect of ion-exchange on the early wear performance of glass-ceramics provides insight improving the early wear performance of these restorations.

Effect of Li+/Na+ exchange on mechanical behavior and biological activity of lithium disilicate glass-ceramic.

Lithium disilicate (LD) glass-ceramics with a stoichiometric composition were ion-exchanged in pure NaNO3 or mixed NaNO3 + KNO3 molten salt baths below the glass transition temperature (Tg). The microstructures, surface morphologies, mechanical properties and bioactivities of the ion-exchanged glass-ceramics were studied in detail. It was found that the strength and toughness of LD glass-ceramic could be enhanced from 175 MPa to 0.96 MPa m1/2 before ion-exchange to 546 MPa and 4.31 MPa m1/2 respectively under a lowered ion-exchange temperature because the less stress relaxation. In addition, a gradient of Na+ rich layer in the surface of glass-ceramic was induced by Li+/Na+ exchange, which could be beneficial to the formation of HA (Hydroxyapatite) with nano-size porous after soaking in SBF (Simulated Body Fluid) solution and exhibited better bioactivity compared with the original LD glass-ceramic. The results might provide a reference for the strengthening and biological activation of LD glass-ceramics in bone restoration applications.

[Efficacy of radial shock wave guided by soft tissue surgery theory in the treatment of lateral epicondylitis].

Objective: To explore the efficacy of radial shock wave therapy (RSWT) for lateral epicondylitis (LE). Methods: A total of 54 cases suffering from LE from Department of Pain Medicine of Fujian Provincial Hospital between December 2017 to October 2019 were randomly assigned to experimental group (n=27) and control group (n=27). Subjects in the experimental group were applied with RSWT in the lateral elbow area plus scapular back area, while patients in control group were applied with RSWT only in the lateral elbow area. Patients in both groups underwent RSWT one session per week for four weeks. Numeric rating scale (NRS), pain-free grip (PFG) test and patient-rated tennis elbow evaluation (PRTEE) in both groups were evaluated and compared at the pre-treatment, one week, one month and three months after treatment. Results: The NRS scores at pre-treatment, one week, one month and three months after treatment in experimental group were 6.5±1.6, 4.0±1.1, 3.9±1.5, 1.7±1.1, respectively, while those in control group were 6.2±1.4, 3.8±1.3, 4.2±1.2, 2.6±1.2, respectively. Compared with those at pre-treatment, the NRS scores in both groups were significantly decreased at one week, one month and three months after treatment (all P<0.05). The PRTEE and PFG results showed significant improvement after treatment (all P<0.05). The NRS scores and PRTEE at three months after treatment in the experimental group were 18±11, 1.7±1.1, respectively, which were significantly lower than those in the control group (25±11, 2.6±1.2, respectively) (both P<0.05). Conclusions: RSWT exerts a beneficial effect on LE. Guided by the soft tissue surgery theory, RSWT in the lateral elbow area plus scapular back area produces better pain reduction and functional improvement compared with RSWT only in the lateral elbow area.

[Observation on the clinical effect of self-designed modified rhomboid skin flap in facial wound repair].

Objective: To investigate the clinical effect of self-designed modified rhomboid flap in repairing rhomboid, round, and teardrop-shaped wounds on the face. Methods: A retrospective observational study was conducted. From August 2018 to April 2020, 30 patients with facial lesions admitted into Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the People's Hospital of Jianchuan County in Yunnan province met the inclusion criteria, including 16 males and 14 females, aged 23 to 88 years. The wound area ranged from 1.0 cm×1.0 cm to 7.0 cm×5.0 cm, with 10 cases of rhomboid wounds, 12 cases of round wounds, and 8 cases of teardrop-shaped wounds. The self-designed modified rhomboid flaps were applied to repair the wounds and after that, the patients were followed up for 1 to 18 months to record the survival of flaps, wound tension, scar formation and complications after surgery. Results: No necrosis or blackening was observed at the tip of the flaps after surgery. All the flaps survived and the wounds healed well with little tension, minimal scars, and no complications. Conclusions: The self-designed modified rhomboid flap is especially suitable for facial wounds with multiple important organs, multiple anatomical subunits, and areas with large changes in soft tissue tension, which can reduce not only the rotation of the flap, but also unnecessary excision of normal skin and soft tissue.

[Application value of machine learning algorithms for predicting recurrence after resection of early-stage hepatocellular carcinoma].

Objective: To compare the performance of multiple machine learning algorithms in predicting recurrence after resection of early-stage hepatocellular carcinoma(HCC). Methods: Clinical data of 882 early-stage HCC patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from May 2009 to December 2019 and treated with curative surgical resection were retrospectively collected. There were 701 males and 181 females,with an age of (57.3±10.5)years(range:21 to 86 years). All patients were randomly assigned in a 2∶1 ratio, the training dataset consisted of 588 patients and the test dataset consisted of 294 patients. The construction of machine learning-based prediction models included random survival forest(RSF),gradient boosting machine,elastic net regression and Cox regression model. The prediction accuracy of the model was measured by the concordance index(C-index). The prediction error of the model was measured by the integrated Brier score. Model fit was assessed by the calibration plot. The performance of machine learning models with that of rival model and HCC staging systems was compared. All models were validated in the independent test dataset. Results: Median recurrence-free survival was 61.7 months in the training dataset while median recurrence-free survival was 61.9 months in the validation dataset, there was no significant difference between two datasets in terms of recurrence-free survival(χ²=0.029,P=0.865). The RSF model consisted of 5 commonly used clinicopathological characteristics, including albumin-bilirubin grade,serum alpha fetoprotein,tumor number,type of hepatectomy and microvascular invasion. In both training and test datasets,the RSF model provided the best prediction accuracy,with respective C-index of 0.758(95%CI:0.725 to 0.791) and 0.749(95%CI:0.700 to 0.797),and the lowest prediction error,with respective integrated Brier score of 0.171 and 0.151. The prediction accuracy of RSF model for recurrence after resection of early-stage HCC was superior to that of other machine learning models,rival model(ERASL model) as well as HCC staging systems(BCLC,CNLC and TNM staging),with statistically significant difference(P<0.01). Calibration curves demonstrated good agreement between RSF model-predicted probabilities and observed outcomes.All patients could be stratified into low-risk,intermediate-risk or high-risk group based on RSF model;statistically significant differences among three risk groups were observed in both training and test datasets(P<0.01). The risk stratification of RSF model was superior to that of TNM staging. Conclusion: The proposed RSF model assembled with 5 commonly used clinicopathological characteristics in this study can predict the recurrence risk with favorable accuracy that may facilitate clinical decision-support for patients with early-stage HCC.

[Surgical treatment of primary liver cancer:a report of 10 966 cases].

Objective: To summarize the experience of surgical treatment of primary liver cancer. Methods: The clinical data of 10 966 surgically managed cases with primary liver cancer, from January 1986 to December 2019 at Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, were retrospectively analyzed. The life table method was used to calculate the survival rate and postoperative recurrence rate. Log-rank test was used to compare the survival process of different groups, and the Cox regression model was used for multivariate analysis. In addition, 2 884 cases of hepatocellular carcinoma(HCC) with more detailed follow-up data from 2009 to 2019 were selected for survival analysis. Among 2 549 patients treated with hepatectomy, there were 2 107 males and 442 females, with an age of (56.6±11.1) years (range: 20 to 86 years). Among 335 patients treated with liver transplantation, there were 292 males and 43 females, with an age of (51.0±9.7) years (range: 21 to 73 years). The outcomes of hepatectomy versus liver transplantation, anatomic versus non-anatomic hepatectomy were compared, respectively. Results: Of the 10 966 patients with primary liver cancer, 10 331 patients underwent hepatectomy and 635 patients underwent liver transplantation. Patients with liver resection were categorized into three groups: 1986－1995(712 cases), 1996－2008(3 988 cases), 2009‒2019(5 631 cases). The 5-year overall survival rate was 32.9% in the first group(1986－1995). The 5-year overall survival rate of resected primary liver cancer was 51.7% in the third group(2009-2019), among which the 5-year overal survival rates of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed liver cancer were 57.4%, 26.6% and 50.6%, respectively. Further analysis was performed on 2 549 HCC patients with primary hepatectomy. The 1-, 3-, 5-, and 10-year overall survival rates were 88.1%, 71.9%, 60.0%, and 41.0%, respectively, and the perioperative mortality rate was 1.0%. Two hundred and forty-seven HCC patients underwent primary liver transplantation, with 1-, 3-, 5-, and 10-year overall survival rates of 84.0%, 64.8%, 61.9%, and 57.6%, respectively. Eighty-eight HCC patients underwent salvage liver transplantation, with the 1-, 3-, 5-, and 10-year overall survival rates of 86.8%, 65.2%, 52.5%, and 52.5%, respectively. There was no significant difference in survival rates between the two groups with liver transplantation (P>0.05). Comparing the overall survival rates and recurrence rates of primary hepatectomy (2 549 cases) with primary liver transplantation (247 cases), the 1-, 3-, 5-, and 10-year overall survival rates in patients within Milan criteria treated with hepatectomy and transplantation were 96.3%, 87.1%, 76.9%, 54.7%, and 95.4%, 79.4%, 77.4%, 71.7%, respectively (P=0.754). The 1-, 3-, 5-year recurrence rates were 16.3%, 35.9%, 47.6% and 8.1%, 11.7%, 13.9%, respectively(P<0.01). The 1-, 3-, 5-, 10-year overall survival rates in patients with no large vessels invasion beyond the Milan criteria treated with liver resection and transplantation were 87.2%, 65.9%, 53.0%, 33.0% and 87.6%, 71.8%, 71.8%, 69.3%, respectively(P=0.003); the 1-, 3-, 5-year recurrence rate were 39.2%, 57.8%, 69.7% and 29.7%, 36.7%, 36.7%, respectively (P<0.01). The 1-, 3-, 5-, and 10-year overall survival rates in patients with large vessels invasion treated with liver resection and transplantation were 62.1%, 36.1%, 22.2%, 15.0% and 62.9%, 31.8%,19.9%, 0, respectively (P=0.387); the 1-, 3-, 5-year recurrence rates were 61.5%, 74.7%, 80.8% and 59.7%, 82.9%, 87.2%, respectively(P=0.909). Independent prognostic factors for both overall survival and recurrence-free survival rates of HCC patients treated with liver resection included gender, neoadjuvant therapy, symptoms, AST, intraoperative or postoperative blood transfusion, tumor number, tumor size, cirrhosis, macrovascular invasion, microvascular invasion, and pathological differentiation. Propensity score matching analysis of 443 pairs further showed that there was no significant difference in overall survival rate between anatomical liver resection and non-anatomical liver resection(P=0.895), but the recurrence rate of non-anatomical liver resection was higher than that of anatomical liver resection(P=0.035). Conclusions: In the past decade, the overall survival rate of HCC undergoing surgical treatment is significantly higher than before. For HCC patients with good liver function reservation, surgical resection can be performed first, and salvage liver transplantation can be performed after recurrence. The effect of salvage liver transplantation is comparable to that of primary liver transplantation. As for the choice of liver resection approaches, non-anatomical resection can reserve more liver tissue and can be selected as long as the negative margin is guaranteed.

Improved reliability of mechanical behavior for a thermal tempered lithium disilicate glass-ceramic by regulating the cooling rate.

Traditional thermal tempering was applied to lithium disilicate (LD) glass-ceramic specimens with bar-like and disc-like shapes. The tempering process was conducted by heating the specimens to a temperature below the dynamic softening point, and then rapid cooling in silicone oil with different temperatures ranging from room-temperature to 300 °C to regulate the cooling rate. Effect of the oil-temperature on mechanical behavior of the tempered glass-ceramic was investigated. For the tempering at the lower oil-temperature (e.g., at room-temperature), it was found that the LD glass-ceramic specimens with both the bar-like and disc-like shapes could be remarkably strengthen and toughen, however, obvious anisotropy in fracture toughness was displayed by the specimens with the bar-like shape. With increasing the oil-temperature up to 250 °C, the mechanical anisotropy of the bar-like specimens could be significantly alleviated without much loss of the strengthening effect. The results can provide references for improving reliability of mechanical behavior for the tempered LD glass-ceramic by regulating the cooling condition according to specimen geometry.

[Clinical efficacy and prognostic factors analysis following curative hepatectomy for hepatocellular carcinoma patients with different China Liver Cancer Staging].

Objective: To examine clinical efficacy and prognostic factors of hepatocellular carcinoma(HCC) patients with different China Liver Cancer Staging (CNLC) after hepatectomy. Methods: From January 2010 to December,2019,549 patients underwent surgical resection and pathologically proven HCC were retrospectively reviewed in the First Affiliated Hospital of Nanjing Medical University. There were 462 males(84.2%) and 87 females(15.8%);the median age was 57 years (range: 21-84 years). Preoperative parameters,intraoperative and postoperative conditions,and postoperative pathological examination were observed.Survival analysis was performed by Kaplan-Meier method and the Log-rank test. Factors associated with disease-free survival(DFS) and overall survival(OS) of HCC patients were identified using univariate and multivariate Cox proportional hazards regression models. Results: Among the 549 patients underedwent liver resection,200 patients(36.4%) belonged to CNLC Ⅰa,whiles 148 patients(27.0%) belonged to CNLC Ⅰb. Furthermore,there were 49 patients(8.9%) with CNLC Ⅱa,32 patients(5.8%) with CNLC Ⅱb, 101 patients(18.4%) with CNLC Ⅲa and 19 patients(3.5%) with CNLC Ⅲb.The 1-,3-,5-,10-year OS for the entire cohort was 83.8%,69.0%,54.2%,37.7%,respectively,while 1-,3-, 5-year DFS was 61.0%,44.2%,36.0%, respectively. The 1-,3-, 5-year OS and DFS for CNLC Ⅰa were 97.3%,90.6%,80.5% and 83.9%,65.0%,54.0%,respectively;The 1-, 3-, 5-years OS and DFS for CNLC Ⅰb were 87.9%,71.0%,47.7%,and 58.4%,42.3%,33.4%,respectively.The 5-year OS for CNLC Ⅱa (37.2%) and Ⅱb(44.3%) were similar to CNLC Ⅰb. The 1-, 3-, 5-year OS and DFS for CNLC Ⅲb were 35.3%,13.2%,0 and 23.5%,0 and 0,respectively. Univariate analysis showed that preoperative symptoms,AFP level,total protein level,AST level,total bilirubin level,intraoperative blood loss,intraoperative or postoperative blood transfusion,postoperative complications,tumor number and size,microvascular invasion,macrovascular invasion and tumor differentiation were prognostic factors for long-term survival(≥5 years)(all P<0.05). The multivariate analysis suggested that AST level,intraoperative blood loss,tumor number and size,macrovascular invasion and tumor differentiation were the independent prognostic factors of long-term OS (all P<0.05). Conclusions: HCC patients with different stages of CNLC have different recurrence patterns and prognosis.After strict preoperative evaluation,patients with CNLC Ⅱa-Ⅲb can also benefit from radical resection. AST level,intraoperative blood loss,tumor number,tumor size,macrovascular invasion and tumor differentiation were independent factors that affect long-term survival. This will provide an important basis for the choice of treatment and the evaluation of surgical prognosis for patients with HCC.

Effects of sources and levels of liquor distiller's grains with solubles on the growth performance, carcass characteristics, and serum parameters of Cherry Valley ducks.

Liquor distiller's grains with solubles (LDGS) is high in yield and rich in crude fiber and crude protein, which suggests that LDGS might be developed and used as unconventional feedstuff for ducks. The aim of this study was to investigate the effects of sources and levels of LDGS on growth performance, carcass characteristics, serum parameters, and intestinal morphology of Cherry Valley ducks from 15 to 42 D of age. A total of 3,300 15-day-old male ducks were randomly assigned into a 1 plus 2 × 5 factorial design including 2 different sources of LDGS (unfermented LDGS [ULDGS] and fermented LDGS [FLDGS]) at 5 levels (4, 8, 12, 16, and 20%) for 4 wk. Each treatment group included 6 pens with 50 ducks per pen. Levels of dietary LDGS and the interaction between sources and levels of LDGS had no effect on final body weight, average daily feed intake (ADFI), average daily gain, or feed-to-gain ratio (F:G) of ducks from day 15 to 42 (P > 0.05). Compared with dietary ULDGS, dietary FLDGS increased final body weight (P < 0.05) and ADFI (P < 0.05) and decreased the F:G (P = 0.03). The levels of LDGS and interaction effect between levels and sources of LDGS had no effect on carcass characteristics (P > 0.05). Regardless of the inclusion level, ducks fed with diets containing FLDGS had a higher percentage of thigh muscle (P < 0.01) than birds fed with diets containing ULDGS. Sources of dietary LDGS, levels of dietary LDGS, and their interaction had no effect on serum biochemistry parameters (P > 0.05) and intestinal morphology, including villus height, crypt depth, and villus height-to-crypt depth ratio (P > 0.05). In conclusion, the inclusion of LDGS in the diet at levels up to 20% had no negative effect on the growth performance, carcass characteristics, serum parameters, and intestinal morphology of ducks. Compared with ULDGS, FLDGS increased final body weight, ADFI, and thigh muscle yield and decreased the F:G of ducks. Therefore, LDGS, especially with fermentation, could be developed as an unconventional feedstuff resource for ducks from 15 to 42 D of age.

[Application and challenge of radiomics technique in the era of precision medicine for hepatobiliary disease].

Radiomics, as an emerging technique of omics, shows the pathophysiological information of images via extracting innumerable quantitative features from digital medical images. In recent years, it has been an exponential increase in the number of radiomics studies. The applications of radiomics in hepatobiliary diseases at present include: assessment of liver fibrosis, discrimination of malignant from benign tumors, prediction of biological behavior, assessment of therapeutic response, and prognosis. Integrating radiomics analysis with machine learning algorithms has emerged as a non-invasive method for predicting liver fibrosis stages, microvascular invasion and post-resection recurrence in liver cancers, lymph node metastasis in biliary tract cancers as well as treatment response in colorectal liver metastasis, with high performance. Although the challenges remain in the clinical transformation of this technique, radiomics will have a broad application prospect in promoting the precision diagnosis and treatment of hepatobiliary diseases, backed by multi-center study with large sample size or multi-omics study.

Improved reliability of wear performance for a fluorapatite veneering porcelain by ion-exchange strengthening and toughening.

OBJECTIVES: Purpose of the present study was to explore the improvement of wear performance for a nano fluorapatite veneering porcelain by ion-exchange. METHODS: Bar and disk specimens were prepared by IPS e.max Ceram as the nano fluorapatite veneering porcelain. Ion-exchange was performed in a melted KNO3 bath at two temperatures for different time-periods. After the ion-exchange, the bars were tested for flexural strength, surface Vickers hardness and HIF toughness, the disks were tested for wear performance paired with zirconia antagonist using a pin-on-disk tribometer with 10 N for 70✕104 wear cycles in artificial saliva. Wear analysis of the porcelain and zirconia was performed with a 3D profilometer. The microstructure and worn surface morphology were examined with scanning electron microscopy. One-way analysis of variance and Tukey's post-hoc pairwise comparison were used to analyse the wear data. RESULTS: The nano fluorapatite veneering porcelain before ion-exchange presented strong time-dependent wear behavior. Furthermore, wear rate of the original porcelain exhibited a very large standard deviation in the running-in wear stage, which was correlated with highly inhomogeneous distribution of the characteristic fluorapatite crystals in the microstructure. After ion-exchange at 350 °C and 380 °C, especially after the processing at 350 °C for 128 h, the wear rates of both running-in and steady wear stages could be significantly decreased. More importantly, the standard deviation of wear rate in the running-in wear stage could be remarkably reduced after the treatment. The improved reliability of wear performance was attributed to the strengthening and toughening effects of the ion-exchange processing. CONCLUSION: For the fluorapatite veneering porcelain, the ion-exchange protocol to obtain an ion-exchange layer with less stress relaxation and a considerable depth could strengthen and toughen the porcelain; as a result, the reliability of wear performance could be remarkably improved.