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Postoperative morbidity following hepatectomy for hepatocellular carcinoma (HCC) is common and its impact on long-term oncological outcome remains unclear. This study aimed to investigate if postoperative morbidity impacts long-term survival and recurrence following hepatectomy for HCC. The data from a multicenter Chinese database of curative-intent hepatectomy for HCC were analyzed, and independent risks of postoperative 30-day morbidity were identified. After excluding patients with postoperative early deaths (≤90 days), early (≤2 years) and late (>2 years) recurrence rates, overall survival (OS), and time-to-recurrence (TTR) were compared between patients with and without postoperative morbidity. Among 2,161 patients eligible for the study, 758 (35.1%) had postoperative 30-day morbidity. Multivariable logistic regression analysis showed that diabetes mellitus, obesity, Child-Pugh grade B, cirrhosis, and intraoperative blood transfusion were independent risks of postoperative morbidity. The rates of early and late recurrence among patients with postoperative morbidity were higher than those without (50.7% vs. 38.8%, P < 0.001; and 41.7% vs. 34.1%, P = 0.017). Postoperative morbidity was associated with decreased OS (median: 48.1 vs. 91.6 months, P < 0.001) and TTR (median: 19.8 vs. 46.1 months; P < 0.001). After adjustment of confounding factors, multivariable Cox-regression analyses revealed that postoperative morbidity was associated with a 27.8% and 18.7% greater likelihood of mortality (hazard ratio 1.278; 95% confidence interval: 1.126–1.451; P < 0.001) and recurrence (1.187; 1.058–1.331; P = 0.004). This large multicenter study provides strong evidence that postoperative morbidity adversely impacts long-term oncologic prognosis after hepatectomy for HCC. The prevention and management of postoperative morbidity may be oncologically important. [ABSTRACT FROM AUTHOR]

Repeat hepatectomy is a feasible treatment modality for intrahepatic recurrence after hepatectomy of hepatocellular carcinoma, yet the survival benefit remains ill-defined. The objective of the current study was to define long-term, oncologic outcomes after repeat hepatectomy among patients with early and late recurrence. Patients undergoing curative-intent repeat hepatectomy for recurrent hepatocellular carcinoma were identified using a multi-intuitional database. Early and late recurrence was defined by setting 1 year after initial hepatectomy as the cutoff value. Patient clinical characteristics, overall survival, and disease-free survival were compared among patients with early and late recurrence before and after propensity score matching. Among all the patients, 81 had early recurrence and 129 had late recurrence from which 74 matched pairs were included in the propensity score matching analytic cohort. Before propensity score matching, 5-year overall survival and disease-free survival after resection of an early recurrence were 41.7% and 17.9%, respectively, which were worse compared with patients who had resection of a late recurrence (57.0% and 39.4%, both P <.01). After propensity score matching, 5-year overall survival and disease-free survival among patients with early recurrence were worse compared with patients with late recurrence (41.0% and 19.2% vs 64.3% and 43.2%, both P <.01). After adjustment for other confounding factors on multivariable Cox-regression analysis, early recurrence remained independently associated with decreased overall survival and disease-free survival (hazard ratio 2.22, 95% confidence interval 1.35–3.34, P =.001; hazard ratio 1.86, 95% confidence 1.26–2.74, P =.002). Repeat hepatectomy for early recurrence was associated with worse overall survival and disease-free survival compared with late recurrence. These data may help inform patients and selection of patients being considered for repeat hepatectomy of recurrent hepatocellular carcinoma. [ABSTRACT FROM AUTHOR]

Background: The incidence of hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) is increasing worldwide. Higher perioperative risks may be anticipated due to underlying steatohepatitis, while long-term outcomes after liver resection are unknown. We sought to investigate outcomes after liver resection for NAFLD-HCC versus hepatitis B virus (HBV)-HCC using propensity score matching (PSM).Methods: Consecutive patients who underwent liver resection for HCC between 2003 and 2014 were identified from a multicenter database. Patients with NAFLD-HCC were matched one-to-one to patients with HBV-HCC.Results: Among 1483 patients identified, 96 (6.5%) had NAFLD-HCC and 1387 (93.5%) had HBV-HCC. Patients with NAFLD-HCC were older (median age 57 vs. 50 years), more often overweight (50.0% vs. 37.5%), less often to have cirrhosis (30.2% vs. 72.5%) and liver dysfunction (Child-Pugh B: 4.2% vs. 10.7%), had larger tumor size (median 7.2 vs. 6.2 cm) yet had better tumor differentiation (27.1% vs. 17.6%) compared with patients with HBV-HCC (all P < 0.05). Perioperative mortality and morbidity were comparable between the two groups (1.0% vs. 1.4% and 20.8% vs. 23.2%, both P > 0.05). No differences were noted in median OS and RFS among patient with NAFLD-HCC versus HBV-HCC before or after PSM.Conclusion: While patients with NAFLD-HCC had different clinical characteristics than patients with HBV-HCC, liver resection resulted in similar perioperative outcomes and comparable OS and RFS among patients with NAFLD-HCC and HBV-HCC. [ABSTRACT FROM AUTHOR]

The Barcelona Clinic Liver Cancer (BCLC) categorizes a patient with performance status (PS)-1 as advanced stage of hepatocellular carcinoma (HCC) and surgical resection is not recommended. In real-world clinical practice, PS-1 is often not a contraindication to surgery for HCC. The aim of current study was to define the impact of PS on the surgical outcomes of patients undergoing liver resection for HCC. 1,531 consecutive patients who underwent a curative-intent resection of HCC between 2005 and 2015 were identified using a multi-institutional database. After categorizing patients into PS-0 (n = 836) versus PS-1 (n = 695), perioperative mortality and morbidity, overall survival (OS) and recurrence-free survival (RFS) were compared. Overall perioperative mortality and major morbidity among patients with PS-0 (n = 836) and PS-1 (n = 695) were similar (1.4% vs. 1.6%, P = 0.525 and 9.7% vs. 10.2%, P = 0.732, respectively). In contrast, median OS and RFS was worse among patients who had PS-1 versus PS-0 (34.0 vs. 107.6 months, and 20.5 vs. 60.6 months, both P < 0.001, respectively). On multivariable Cox-regression analyses, PS-1 was independently associated with worse OS (HR: 1.301, 95% CI: 1.111–1.523, P < 0.001) and RFS (HR: 1.184, 95% CI: 1.034–1.358, P = 0.007). Patients with PS-1 versus PS-0 had comparable perioperative outcomes. However, patients with PS-1 had worse long-term outcomes as PS-1 was independently associated with worse OS and RFS. Routine exclusion of HCC patients with PS-1 from surgical resection as recommended by the BCLC guidelines is not warranted. [ABSTRACT FROM AUTHOR]

Abstract Background The role of liver resection for multinodular (≥3 nodules) hepatocellular carcinoma (HCC) remains unclear, especially among patients with severe underlying liver disease. We sought to evaluate surgical outcomes among patients with cirrhosis and multinodular HCC undergoing liver resection. Methods Using a multicenter database, outcomes among cirrhotic patients who underwent curative-intent resection of HCC were examined stratified according to the presence or absence of multinodular disease. Perioperative mortality and morbidity, as well as overall survival (OS) and recurrence-free survival (RFS) were compared between the two groups. Results Among 1066 cirrhotic patients, 906 (85.0%) had single- or double-nodular HCC (the non-multinodular group), while 160 (15.0%) had multinodular HCC (the multinodular group). There were no differences in postoperative 30-day mortality and morbidity among non-multinodular versus multinodular patients (1.8% vs. 1.9%, P = 0.923, and 36.0% vs. 39.4%, P = 0.411, respectively). In contrast, 5-year OS and RFS of multinodular patients were worse compared with non-multinodular patients (34.6% vs. 58.2%, and 24.7% vs. 44.5%, both P < 0.001). On multivariable analyses, tumor numbers ≥5, total tumor diameter ≥8 cm and microvascular invasion were independent risk factors for decreased OS and RFS after resection of multinodular HCC in cirrhotic patients. Conclusions Liver resection can be safely performed for multinodular HCC in the setting of cirrhosis with an overall 5-year survival of 34.6%. Tumor number ≥5, total tumor diameter ≥8 cm and microvascular invasion were independently associated with decreased OS and RFS after resection in cirrhotic patients with multinodular HCC. [ABSTRACT FROM AUTHOR]

Abstract Background There is a striking sex difference in the incidence of hepatocellular carcinoma, with a strong predominance for men; however, the impact of sex on the incidence of recurrence after curative resection of hepatocellular carcinoma remains controversial. This study aimed to assess sex differences in the risks of recurrence and mortality for patients treated with curative resection of hepatocellular carcinoma. Methods We retrospectively reviewed data from 1,435 hepatocellular carcinoma patients treated with curative resection (1,228 men and 207 women) between 2004 and 2014 at 5 institutions in China. Patients' baseline characteristics, operative variables, and rates of early recurrence (≤2 years after resection), late recurrence (>2 years after resection), and cancer-specific mortality were evaluated and compared. To clarify the true oncologic impact of sex, multivariable competing-risks regression analyses were performed to identify predictors associated with early and late recurrence, as well as cancer-specific mortality. Results The early recurrence rates between men and women were similar (43.3% vs 42.0%, P =.728), but the late recurrence and rates of cancer-specific mortality in men were greater compared with women (17.2% vs 11.2%, P =.044; and 42.8% vs 34.3%, P =.022, respectively). Multivariable competing-risks regression analyses revealed no sex difference in early recurrence; however, men had greater late recurrence rate (hazard ratio, 1.752; 95% confidence interval, 1.145–2.682; P =.010) and rate of cancer-specific mortality (hazard ratio, 1.307; 95% confidence interval, 1.015–1.683; P =.038). Conclusion There was no difference in early recurrence rate (≤2 years after resection between men and women, but men had significantly greater late recurrence (>2 years) and rates of cancer-specific mortality after hepatocellular carcinoma resection than women. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B virus (HBV) infection is the leading cause of hepatocellular carcinoma (HCC) worldwide. The aim of the study was to identify the incidence and predictive factors of actual 10-year survival following liver resection of HBV-related HCC.Methods: A Chinese multicenter database of patients undergoing curative hepatectomy of HBV-related HCC was reviewed. Patients who survived ≥ 10 years and patients who died < 10 years after surgery were compared and analyzed. Univariable and multivariable regression analyses were performed to identify predictive factors associated with 10-year survival.Results: Among all enrolled 1016 patients, the actuarial 10-year survival rate was 24.1%, while the actual 10-year survival rate was 16.6%. There were 169 patients who survived at least 10 years after surgery and 688 who died within 10 years from surgery. These patients constituted the study population of this study. Multivariable regression analysis revealed that cirrhosis, preoperative HBV viral load > 104 copies/mL, maximum tumor size > 5 cm, multiple tumors, macroscopic and microscopic vascular invasion, postoperative HBV reactivation, and early recurrence (< 2 years after surgery) were independent risk factors associated with actual 10-year survival, while postoperative antiviral therapy, regular recurrence surveillance, and curative treatments for initial recurrence were independent protective factors.Conclusions: The actual 10-year survival after curative resection of HBV-related HCC was calculated to be 16.6%. Postoperative antiviral therapy and regular recurrence surveillance were independent protective factors associated with actual 10-year survival after liver resection of HBV-related HCC. [ABSTRACT FROM AUTHOR]

• In-Situ Polymerization of conducting polymer PEDOT in Perovskite Thin Films. • Simultaneously passivating the defects and improving carrier extraction efficiency. • Enhancing the thermal and moisture resistance of the perovskite film. • The PSCs with 22.58% PCE with enhanced stability. Solution-processed polycrystalline perovskite films have detrimental defects in the bulk and surfaces/grain boundaries, especially the uncoordinated lead ions (Pb2+) with low formation energy, limiting both the performance and stability of the photovoltaic devices. In this work, a conductive polymer poly(3,4-ethylenedioxythiophene) (PEDOT) is incorporated into a bulk perovskite film by a facile in-situ polymerization method, where 5-bromo-2,3-dihydro-thieno[3,4-b][1,4]dioxine (BEDOT) as monomer is directly added to a perovskite precursor solution and then in-situ polymerized within the perovskite film during the film formation. The PEDOT is chemically anchored at the surface and grain boundaries of the perovskite film via interaction of sulfur and oxygen atoms in PEDOT with uncoordinated lead ions in the perovskite, passivating the surface and bulk defects and also improving the charge extraction efficiency in the solar cell. Moreover, robust and hydrophobic properties of PEDOT can enhance the thermal and moisture resistance of the perovskite film. As a result, a champion power conversion efficiency (PCE) of 22.58% is achieved, along with significantly enhanced environmental, thermal, and light-soaking stability. [ABSTRACT FROM AUTHOR]

This paper presents global solutions of advection-dominated accretion flows (ADAFs) around black holes. The global solution passes through two critical points, the sonic point Rs and viscous point Rv and is thus naturally divided by these points into three radial zones: the subsonic, subviscous outer zone (R > Rv), the subsonic, superviscous middle zone (Rs < R < Rv), and the supersonic, superviscous inner zone (R < Rs). We have obtained a complete picture by means of the Rs — j parameter space which sums up the situation of ADAF solution at a glance. We find three classes of global solutions: the ADAF-thin disk solution, the ADAF-thick disk solution and the α — X type adiabatic shock-included solution. We also present the unique correspondences among Rs, Rv and Rout of the ADAF-thin disk solutions, where Rout is the outer boundary of ADAF. The adiabatic shock in the accretion flow connects the supersonic and superviscous zone of an X-type solution to the subsonic and superviscous zone of an α-type soultion. Because the shock occurs between two superviscous zones, it can exist for flows with either a low or a high viscosity. [Copyright &y& Elsevier]

The Eastern Staging System, which was specially developed for patients undergoing surgical resection for hepatocellular carcinoma (HCC), has been proposed for more than ten years. To prospectively validate the predictive accuracy of the Eastern staging on long-term survival after HCC resection. Patients who underwent hepatectomy for HCC from 2011 to 2020 at 10 Chinese hospitals were identified from a prospectively collected database. The survival predictive accuracy was evaluated and compared between the Eastern Staging with six other staging systems, including the JIS, BCLC, Okuda, CLIP, 8th AJCC TNM, and HKLC staging. Among 2365 patients, the 1-, 3-, and 5-year overall survival rates were 84.2%, 64.5%, and 52.6%, respectively. Among these seven staging systems, the Eastern staging was associated with the best monotonicity of gradients (linear trend χ2: 408.5) and homogeneity (likelihood ratio χ2: 447.3), and the highest discriminatory ability (the areas under curves for 1-, 3-, and 5-year mortality: 0.776, 0.787, and 0.768, respectively). In addition, the Eastern staging was the most informative staging system in predicting survival (Akaike information criterion: 2982.33). Using a large multicenter prospectively collected database, the Eastern Staging was found to show the best predictive accuracy on long-term overall survival in patients with resectable HCC than the other 6 commonly-used staging systems. [Display omitted] [ABSTRACT FROM AUTHOR]

This paper studies the mechanism of transition from a Shakura-Sunyaev disk to an advection-dominated accretion flow in more details, taking into consideration two-temperature plasma accretion flows with bremsstrahlung and synchrotron radiation and Comptonization. The results further show that such a transition is realizable for a quite wide range of physical conditions. [Copyright &y& Elsevier]

• A total of 5 eligible studies with 474 cases and 805 controls were included. • There were statistically significant for rs361525 in allelic model (A vs. G). • There were statistically significant for rs1800750 in dominant model (AA + GA vs. GG). • Caucasian with A site mutation of rs361525 was more susceptible to influenza A (H1N1). The aim of the study was to comprehensively evaluate the associations between tumor necrosis factor (TNF) gene polymorphism and influenza A (H1N1) susceptibility. The relevant studies were identified through a search of PubMed, Embase, and Cochrane library database until February 29, 2020, without language restrictions. Two independent reviewers extracted the data, and any discrepancies were resolved by consensus. The quality of the eligible article was evaluated by Newcastle-Ottawa Quality Assessment Scale (NOS). Egger's test was applied to evaluate publication bias. All these analyses were performed using Stata15.1 software. A total of 5 studies with 474 cases and 805 controls were included. The results of meta-analysis showed that there were statistically significant for rs361525 in allelic model (A vs. G) [OR = 2.46 (1.10, 5.52)] and for rs1800750 in dominant model (AA + GA vs. GG) [OR = 2.42 (1.24, 4.71)] in cases vs. controls. Furthermore, subgroup analysis for race showed that for rs361525 in allelic model (A vs. G), there were significant differences for Caucasian [OR = 3.64 (1.18, 11.23)] and no significant difference for Mexican [OR = 2.25 (0.82, 6.13)] in cases vs. controls. There was publication bias for rs361525 in dominant model (AA + GA vs. GG, p = 0.042) and rs1800629 in recessive model (AA vs. GG + GA, p < 0.001). Caucasian with A site mutation of -238TNF G/A (rs361525) was more susceptible to influenza A (H1N1).The -376 dominant model AA + GA of TNF genes was associated with the susceptibility to influenza A (H1N1). However, more studies with large sample size are needed to confirm the results. [ABSTRACT FROM AUTHOR]

Aging of the population and prolonged life expectancy have significantly increased the number of elderly patients undergoing hepatectomy for hepatocellular carcinoma (HCC). However, potential benefits, especially long-term oncologic outcomes of hepatectomy for elderly patients with HCC remain unclear. Patients treated with curative-intent hepatectomy for HCC in 8 Chinese hospitals were enrolled. Patients were divided into the elderly (≥70 years old) and younger (<70 years old) groups. Overall survival (OS), cancer-specific survival (CSS), and time-to-recurrence (TTR) were compared. Risk factors of CSS and TTR were evaluated by univariable and multivariable competing-risk regression analyses. Of 2134 patients, 259 (12.1%) and 1875 (87.9%) were elderly and younger aged, respectively. Postoperative 30-day and 90-day mortality was comparable among elderly and younger patients. Compared with younger patients, the elderly had a worse 5-year OS (49.4% vs. 55.3%, P = 0.032), yet a better 5-year CCS (74.5% vs. 61.0%, P = 0.005) and a lower 5-year TTR (33.7% vs. 44.9%, P < 0.001), respectively. Multivariable analyses identified that elder age was independently associated with more favorable CSS (HR 0.74, 95%CI 0.58–0.90, P = 0.011) and TTR (0.69, 0.53–0.88, P < 0.001) but was not associated with OS (P = 0.136). Age by itself is not a contraindication to surgery, and selected elderly patients with HCC can benefit from hepatectomy. Compared with younger patients, elderly patients have noninferior oncologic outcomes following hepatectomy for HCC. [ABSTRACT FROM AUTHOR]

A clear definition of "early recurrence" after hepatocellular carcinoma (HCC) resection is still lacking. This study aimed to determine the optimal cutoff between early and late HCC recurrence, and develop nomograms for pre- and postoperative prediction of early recurrence. Patients undergoing HCC resection were identified from a multi-institutional Chinese database. Minimum P -value approach was adopted to calculate optimal cut-off to define early recurrence. Pre- and postoperative risk factors for early recurrence were identified and further used for nomogram construction. The results were externally validated by a Western cohort. Among 1501 patients identified, 539 (35.9%) were recurrence-free. The optimal length to distinguish between early (n = 340, 35.3%) and late recurrence (n = 622, 64.7%) was 8 months. Multivariable logistic regression analyses identified 5 preoperative and 8 postoperative factors for early recurrence, which were further incorporated into preoperative and postoperative nomograms (C-index: 0.785 and 0.834). The calibration plots for the probability of early recurrence fitted well. The nomogram performance was maintained using the validation dataset (C-index: 0.777 for preoperative prediction and 0.842 for postoperative prediction). An interval of 8 months was the optimal threshold for defining early HCC recurrence. The two web-based nomograms have been published to allow accurate pre- and postoperative prediction of early recurrence. These may offer useful guidance for individual treatment or follow up for patients with resectable HCC. [ABSTRACT FROM AUTHOR]

The resection margin (RM) status and microscopic vascular invasion (MVI) are known prognostic factors for hepatocellular carcinoma (HCC). An enhanced understanding of their impact on long-term prognosis is required to improve oncological outcomes. Using multi-institutional data, the different impact of the RM status (narrow, <1 cm, or wide, ≥1 cm) and MVI (positive or negative) on overall survival (OS) and recurrence-free survival (RFS) after curative liver resection of solitary HCC without macrovascular invasion was analyzed. In 801 patients, 306 (38%) had a narrow RM and 352 (44%) had positive MVI. The median OS and RFS were 109.8 and 74.8 months in patients with wide RM & negative MVI, 93.5 and 53.1 months with wide RM & positive MVI, 79.2 and 41.6 months with narrow RM & negative MVI, and 69.2 and 37.5 months with narrow RM & positive MVI (both P < 0.01). On multivariable analyses, narrow RM & positive MVI had the highest hazard ratio with reduced OS and RFS (HR 2.96, 95% CI 2.11–4.17, and HR 3.15, 95% CI, 2.09–4.67, respectively). Concomitant having narrow RM and positive MVI increases the risks of postoperative death and recurrence by about 2-fold in patients with solitary HCC. [ABSTRACT FROM AUTHOR]

Abstract Background Serum prealbumin is a sensitive and stable marker for nutritional status and liver function. Whether preoperative prealbumin level is associated with long-term prognosis in patients undergoing liver resection for hepatocellular carcinoma (HCC) is unclear. Methods Patients who underwent liver resection for HCC between 2001 and 2014 at six institutions were enrolled. These patients were divided into the low and normal prealbumin groups using a cut-off value of 170 mg/L for preoperative prealbumin level. The overall survival (OS) and recurrence-free survival (RFS) were compared between them. Results In 1483 patients, 437 (29%) had a low prealbumin level. The 3- and 5-year OS and RFS rates of patients in the low-prealbumin group were 57 and 31%, and 40 and 20%, respectively, which were significantly poorer than those in the normal-prealbumin group (76 and 43%, and 56 and 28%, respectively, both p < 0.001). Multivariable Cox-regression analyses revealed that preoperative prealbumin level was an independent predictor of OS (HR, 1.45, 95% CI: 1.24–1.70, p <0.001) and RFS (HR, 1.28, 95% CI: 1.10–1.48, p <0.001). Conclusions Preoperative prealbumin level could be used in predicting long-term prognosis for patients undergoing liver resection for HCC. [ABSTRACT FROM AUTHOR]

Abstract: Hybrid films of polyaniline (PANI) and manganese oxide (MnO x ) were obtained through potentiodynamic deposition from solutions of aniline and MnSO4 at pH 5.6. The hybrid films demonstrated characteristic redox behaviors of PANI in acidic aqueous solution. Characterization of the hybrid films by XRD indicated the amorphous nature of MnO x in the films in which manganese existed in oxidation states of +2, +3 and +4, based on XPS measurement. Hybrid film of PANI and MnO x , PM120 obtained from the solution of 0.1M aniline and 120mM Mn2+ displayed a well opened nanofibrous structure which showed an 44% increase in specific capacitance from that of PANI (408Fg−1) to 588Fg−1, measured at 1.0mAcm−2 in 1M NaNO3 (pH 1). The hybrid film kept more than 90% of its capacitance after 1000 charging-discharging cycles, with a coulombic efficiency of 98%. The specific capacitance of a symmetric capacitor using PM120 as the electrodes is 112Fg−1. [Copyright &y& Elsevier]

B Introduction: b The long-term prognosis after liver resection for multinodular (>= 3 nodules) hepatocellular carcinoma (HCC) is generally considered to be unfavorable. B Method: b From a multicenter database, consecutive patients who underwent curative-intent liver resection for HCC with 2 tumor nodules and without macrovascular invasion were retrospectively reviewed. B Conclusion: b Liver resection was safe and feasible in patients having HCC with 2 tumor nodules, with acceptable perioperative and long-term outcomes. [Extracted from the article]

B Introduction: b Surgical resection for hepatocellular carcinoma (HCC) is potentially curative, but long-term survival remains unsatisfactory. B Result: b Of the 377 patients in this study, 88 (23.3%) received preoperative TACE followed by surgical resection. B Conclusion: b Preoperative TACE did not increase peri-operative morbidity or mortality, yet was associated with an improve OS and RFS after liver resection of huge HCC (>= 10 cm). [Extracted from the article]