Lvnan Yan

A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria.

Objective: To compare the long-term outcomes of surgical resection and radiofrequency ablation for the treatment of small hepatocellular carcinoma (HCC). Summary Background Data: Radiofrequency ablation (RFA) is a promising, emerging therapy for small HCC. Whether it is as effective as surgical resection (RES) for long-term outcomes is still indefinite. Methods: Two hundred thirty HCC patients who met the Milan criteria and were suitable to be treated by either RES or RFA entered into a randomized controlled trial. The patients were regularly followed up after treatment for 5years (except for those who died). The primary end point was overall survival; the secondary end points were recurrence-free survival, overall recurrence, and early-stage recurrence. Results: The 1-, 2-, 3-, 4- and 5-year overall survival rates for the RFA group and the RES group were 86.96%, 76.52%, 69.57%, 66.09%, 54.78% and 98.26%, 96.52%, 92.17%, 82.60%, 75.65%, respectively. The corresponding recurrence-free survival rates for the 2 groups were 81.74%, 59.13%, 46.08%, 33.91%, 28.69% and 85.22%, 73.92%, 60.87%, 54.78%, 51.30%, respectively. Overall survival and recurrence-free survival were significantly lower in the RFA group than in the RES group (P = 0.001 and P = 0.017). The 1-, 2-, 3-, 4-, and 5-year overall recurrence rates were 16.52%, 38.26%, 49.57%, 59.13%, and 63.48% for the RFA group and 12.17%, 22.60%, 33.91%, 39.13%, and 41.74% for the RES group. The overall recurrence was higher in the RFA group than in the RES group (P = 0.024). Conclusions: Surgical resection may provide better survival and lower recurrence rates than RFA for patients with HCC to the Milan criteria.

XRCC1 genetic polymorphism Arg399Gln and hepatocellular carcinoma risk: a meta-analysis.

Background: Studies investigating the association between X‐ray repair cross‐complementing group 1 (XRCC1) genetic polymorphism Arg399Gln and hepatocellular carcinoma (HCC) risk report conflicting results. The aim of this study was to quantitatively summarize the evidence for such a relationship.

A Novel Power Divider Based on Dual-Composite Right/Left Handed Transmission Line

A novel 3 dB power divider based on dual-composite right/left handed transmission line (D-CRLH TL) is proposed for the first time. The D-CRLH TLs are applied as artificial transmission lines. The wideband compact D-CRLH power divider is with low insertion loss and excellent amplitude and phase balance. The experimental results show that |S 11| is below −15 dB; the isolation is higher than 15 dB; and the insertion loss is less than 1 dB from 0.85 GHz to 4.3 GHz. The two output ports achieve the same amplitude and phase. The amplitude balance is below 0.3 dB, and the phase balance is less than 3°. The simulation results agree well with the measurements. The power divider has good application prospects in microwave systems.

Relationship Between TH1/TH2 Cytokines and Immune Tolerance in Liver Transplantation in Rats

OBJECTIVE To explore the relationship between Th1/Th2 cytokine expressions and immune tolerance in rat liver transplantation. METHODS Recipients were divided into three groups (each group = 12 rats). The allograft group underwent orthotopic liver transplantation from male Wistar-to-Sprague-Dawley (SD) rats. The isograft group of SD-to-SD liver transplantation was complemented with a control group of normal male SD rats that had sham operations. We evaluated the 2-week survival rates histological changes, as well as serum and mRNA expression levels of Th1/Th2 cytokines: interferon-gamma (IFN-gamma) and interleukin-10 (IL-10). RESULTS The 1-week survival in the isograft and allograft groups were 100% and 41.67%, respectively. The 2-week survival rates were 75% and 8.33% (P < .05). Light microscopic inspection revealed severe acute rejection in the allograft but not the isograft group in the first week postoperation. This observation was verified by the cellular morphology under transmission electron microscopy. Serum IFN-gamma (Th1 cytokine) levels (pg/mL) determined by enzyme-linked immunosorbent assay in the allograft, isograft, and control groups were 386.67 +/- 14.36, 159.83 +/- 16.53, and 87.83 +/- 8.67, respectively; for IL-10 (Th2 cytokine), they were 126.33 +/- 13.10, 288.33 +/- 17.10, and 70.50 +/- 7.23, respectively (P < .05, allograft vs isograft). The semiquantitative reverse-transcriptase polymerase chain reaction assay showed that expression of IFN-gamma and IL-10 mRNA was similar to that of serum levels. IFN-gamma mRNA was more highly expressed in the allograft group and IL-10 mRNA, in the isograft group (P < .05). CONCLUSIONS The dynamic equilibrium of Th1/Th2 cytokines is critically involved in immune tolerance. The deviation of Th1 to Th2 may be one mechanism of immune tolerance.

Salvage Liver Transplantation for Recurrent Hepatocellular Carcinoma within UCSF Criteria after Liver Resection

Background Salvage liver transplantation (SLT) is restricted to patients who develop hepatocellular carcinoma (HCC) recurrence within Milan criteria (MC). Little is known about outcomes for SLT in patients with recurrent HCC within University of California San Francisco (UCSF) criteria after liver resection (LR). Methods Between January 2001 and December 2011, 380 patients with HCC meeting UCSF criteria, 200 of which were resected (LR group) from a perspective of SLT in case of recurrence, and 180 directly underwent LT (PLT). We compared patient characteristics, perioperative and long-term outcomes between SLT and PLT groups. We also assessed the outcome of LR and PLT groups. Results Among the 200 patients in LR group, 86 (43%) developed HCC recurrence and 15/86 (17%) of these patients presented HCC recurrence outside UCSF criteria. Only 39 of the 86 patients underwent SLT, a transplantation rate of 45% of patients with HCC recurrence. Compared with PLT group, LR group showed lower overall survival rate (P = 0.005) and higher recurrence rate (P = 0.006). Although intraoperative blood loss and required blood transfusion were more frequent in SLT group, the perioperative mortality and posttransplant complications were similar in SLT and PLT groups. The overall survival and recurrence rates did not significantly differ between the two groups. When stratifying by graft type in the SLT group, overall survival and recurrence rates did not significantly differ between deceased donor LT (DDLT) and living donor LT (LDLT) groups. In the subgroup analysis by MC, similar results were observed between patients with recurrent HCC meeting MC and patients with recurrent HCC beyond MC but within UCSF criteria. Conclusion Our single institution experience demonstrated that prior hepatectomy and SLT for recurrent HCC within UCSF criteria was feasible and SLT could achieve the same outcome as PLT.

Systematic Review and Meta-Analysis of the Relationship between EPHX1 Polymorphisms and Colorectal Cancer Risk

Background Microsomal epoxide hydrolase (EPHX1) plays an important role in both the activation and detoxification of PAHs, which are carcinogens found in cooked meat and tobacco smoking. Polymorphisms at exons 3 and 4 of the EPHX1 gene have been reported to be associated with variations in EPHX1 activity. The aim of this study is to quantitatively summarize the relationship between EPHX1 polymorphisms and colorectal cancer (CRC) risk. Methods Two investigators independently searched the Medline, Embase, CNKI, and Chinese Biomedicine Databases for studies published before June 2012. Summary odds ratios (ORs) and 95% confidence intervals (CIs) for EPHX1 Tyr113His (rs1051740) and His139Arg (rs2234922) polymorphisms and CRC were calculated in a fixed-effects model and a random-effects model when appropriate. Results This meta-analysis yielded 14 case-control studies, which included 13 studies for Tyr113His (6395 cases and 7893 controls) and 13 studies for His139Arg polymorphisms (5375 cases and 6962 controls). Overall, the pooled results indicated that EPHX1 Tyr113His polymorphism was not associated with CRC risk; while the His139Arg polymorphism was significantly associated with decreased CRC risk (Arg/His vs. His/His, OR = 0.90, 95%CI = 0.83–0.98; dominant model, OR = 0.92, 95%CI = 0.85–0.99). The statistically significant association between EPHX1 His139Arg polymorphism and CRC was observed among Caucasians and population-based case-control studies. This association showed little heterogeneity and remained consistently strong when analyses were limited to studies in which genotype frequencies were in Hardy–Weinberg equilibrium, or limited to studies with matched controls. When cumulative meta-analyses of the two associations were conducted by studies’ publication time, the results were persistent and robust. Conclusion This meta-analysis suggests that EPHX1 Tyr113His polymorphism may be not associated with CRC development; while the EPHX1 His139Arg polymorphism may have a potential protective effect on CRC.

Estimation of Standard Liver Volume for Liver Transplantation in the Chinese Population

INTRODUCTION The accurate assessment of standard liver volume (SLV) is necessary for the safety of both the donor and the recipient in living donor liver transplantation. However, the accuracy of SLV formulas relates to cohorts or races. This study examined the accuracy of a simple linear formula versus previous formulas of SLV for Chinese adults. METHODS Among 112 patients with normal liver, we created a new formula for SLV with stepwise regression analysis using the following variables: age, gender, body weight, body height, body mass index, and body surface area. The agreement between the actual liver volume (LV) and calculated LV using various formulas was prospectively evaluated among 63 living donors by paired-sample students t-test and Lins concordance correlation coefficient. RESULTS A new formula was developed SLV (mL) = 949.7 x BSA (m(2)) - 48.3 x age - 247.4 where age was counted as 1 for those <40, 2 if 41-60, and 3 if >60 years old. The calculated LV using our formula showed no significant difference from the actual LV using the paired-samples students t-test (P = .653). Lins concordance correlation coefficient showed substantial agreement between estimated LV using our formula and actual LV. Furthermore, this study also observed an almost perfect agreement between our formula and the Yoshizumi et al formula. CONCLUSION Our formula, which accurately estimated LV among Chinese adults, may be applicable to adults of other ethnicitis.

Quality of life and psychologic distress of recipients after adult living-donor liver transplantation (LDLT)-A study from mainland China.

This cross-sectional study investigated potential factors impacting quality of life in 125 recipients after living-donor liver transplantation (LDLT). Health-related quality of life (HRQoL) was measured by using the Chinese version of Medical Outcomes Study Short Form-36 (SF-36), and psychologic symptoms by using the Symptom Checklist-90-Revised (SCL-90-R). Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaire. A total of 102 recipients (81.6%) completed the questionnaires. All SF-36 domain scores (except the mental health score) were lower in the study than in the general population of Sichuan. The mental quality of life was significantly lower in female than in male subjects (P = .000). Regarding the role-physical (P = .016), social functioning (P = .000), and role-emotional (P = .004) domains, recipients >1 year after transplantation scored higher than those <1 year. Bodily pain scores were lower in recipients with prior acute liver failure than those with hepatic carcinoma or hepatic cirrhosis (P = .032). Social functioning was poorer in recipients with than in those without complications (P = .039). Mental component summary scale (MCS) scores and some of physical component summary scale (PCS) significantly correlated with symptom dimension scores of the SCL-90-R (P < .05). In conclusion, gender, time since transplant, etiology of disease, complications, occupation, and some psychologic symptoms were possible factors influencing postoperative HRQoL of LDLT recipients.

Risk Factors for Early Recurrence of HBV-related Hepatocellular Carcinoma Meeting Milan Criteria after Curative Resection

BACKGROUND The prognosis of patients with hepatocellular carcinoma (HCC) after curative resection varies greatly. Few studies had investigated the risk factors for early recurrence (recurrence-free time ≤ 1 year) of hepatitis B virus (HBV)-related HCCs meeting Milan criteria. METHODS A retrospective analysis was performed on the 224 patients with HCC meeting Milan criteria who underwent curative liver resection in our center between February 2007 and March 2012. The overall survival (OS) rate, recurrence-free survival (RFS) rate and risk factors for early recurrence were analyzed. RESULTS After a median follow-up of 33.3 months, HCC reoccurred in 105 of 224 patients and 32 died during the period. The 1-, 3- and 5-year OS rates were 97.3%, 81.6% and 75.6% respectively, and the 1-, 3- and 5-year RFS rates were 73.2%, 53.7% and 41.6%. Cox regression showed alpha-fetoprotein (AFP) > 800 ng/ml (HR 2.538, 95% CI 1.464-4.401, P=0.001), multiple tumors (HR 2.286, 95% CI 1.123-4.246, P=0.009) and microvascular invasion (HR 2.518, 95% CI 1.475-4.298, P=0.001) to be associated with early recurrence (recurrence-free time ≤ 1-year) of HCC meeting Milan criteria. CONCLUSIONS AFP > 800 ng/ml, multiple tumors and microvascular invasion are independent risk factors affecting early postoperative recurrence of HCC. In addition resection appears capable of replacing liver transplantation in some situations with safety and a better outcome.

Quantitative estimation of the degree of hepatic macrovesicular steatosis in a disease‐free population: A single‐center experience in mainland China

The aim of this study was to derive a simple equation to enable the extent of hepatic macrovesicular steatosis (HMS) to be predicted quantitatively from data obtained noninvasively and hence avoid unnecessary liver biopsies. One hundred sixty‐seven potential living liver donors and 45 subjects suspected of having nonalcoholic fatty liver disease (NAFLD) underwent percutaneous liver biopsy to evaluate HMS quantitatively. Their hepatic unenhanced computed tomography (CT) attenuation, body mass index (BMI), and indices of serum lipids were reviewed. Logistic regression analysis was undertaken to screen for independent predictors of HMS. Linear regression analysis was then used to plot the relationship between the severity of histologically confirmed HMS and identified independent predictors of HMS. For potential donors with HMS of severity ≥ 5% by histological assessment, the following equation was derived: The calculated HMS for potential donors with histologically confirmed HMS of severity < 5% seemed to be unreliable (R2 = = 0.230, P < 0.3). In addition, in subjects suspected of having NAFLD, there was a close agreement between values for histologically confirmed HMS and calculated values for HMS derived from the equation (intraclass correlation coefficient = 0.88). Hepatic CT imaging in conjunction with other noninvasive clinical data may enable the extent of HMS to be accurately predicted with the equation derived from potential donors with appreciable degrees of histologically confirmed HMS. Liver Transpl 15:1605–1612, 2009.