Search

Background: Hepatic pedicle clamping (HPC) is frequently utilized during hepatectomy to reduce intraoperative bleeding and diminish the need for intraoperative blood transfusion (IBT). The long-term prognostic implications of HPC following hepatectomy for hepatocellular carcinoma (HCC) remain under debate. This study aims to elucidate the association between HPC and oncologic outcomes after HCC resection, stratified by whether IBT was administered. Patients and Methods: Prospectively collected data on patients with HCC who underwent curative resection from a multicenter database was studied. Patients were stratified into two cohorts on the basis of whether IBT was administered. The impact of HPC on long-term overall survival (OS) and recurrence-free survival (RFS) between the two cohorts was assessed by univariable and multivariable Cox regression analyses. Results: Of 3362 patients, 535 received IBT. In the IBT cohort, using or not using HPC showed no significant difference in OS and RFS outcomes (5-year OS and RFS rates 27.9% vs. 24.6% and 13.8% vs. 12.0%, P = 0.810 and 0.530). However, in the non-IBT cohort of 2827 patients, the HPC subgroup demonstrated significantly decreased OS (5-year 45.9% vs. 56.5%, P < 0.001) and RFS (5-year 24.7% vs. 33.3%, P < 0.001) when compared with the subgroup without HPC. Multivariable Cox regression analysis identified HPC as an independent risk factor of OS and RFS [hazard ratios (HR) 1.16 and 1.12, P = 0.024 and 0.044, respectively] among patients who did not receive IBT. Conclusions: The impact of HPC on the oncological outcomes following hepatectomy for patients with HCC differed significantly whether IBT was administered, and HPC adversely impacted on long-term survival for patients without receiving IBT during hepatectomy. [ABSTRACT FROM AUTHOR]

The near-Earth (within ∼100 pc) supernova explosions in the past several million years can cause the global deposition of radioactive elements (e.g., 60Fe) on Earth. The remnants of such supernovae are too old to be easily identified. It is therefore of great interest to search for million-year-old near-Earth neutron stars or black holes, the products of supernovae. However, neutron stars and black holes are challenging to find even in our Solar neighbourhood if they are not radio pulsars or X-ray/γ-ray emitters. Here we report the discovery of one of the nearest (127.7 ± 0.3 pc) neutron star candidates in a detached single-lined spectroscopic binary LAMOST J235456.73+335625.9 (hereafter J2354). Utilizing the time-resolved ground-based spectroscopy and space photometry, we find that J2354 hosts an unseen compact object with Minv being 1.4–1.6 M⊙. The follow-up Swift ultraviolet (UV) and X-ray observations suggest that the UV and X-ray emission is produced by the visible star rather than the compact object. Hence, J2354 probably harbours a neutron star rather than a hot ultramassive white dwarf. Two-hour exceptionally sensitive radio follow-up observations with Five-hundred-meter Aperture Spherical radio Telescope fail to reveal any pulsating radio signals at the 6σ flux upper limit of 12.5 µJy. Therefore, the neutron star candidate in J2354 can only be revealed via our time-resolved observations. Interestingly, the distance between J2354 and our Earth can be as close as ∼ 50 pc around 2.5 million years (Myrs) ago, as revealed by the Gaia kinematics. Our discovery demonstrates a promising way to unveil the hidden near-Earth neutron stars in binaries by exploring the optical time domain, thereby facilitating understanding of the metal-enrichment history in our Solar neighbourhood. [ABSTRACT FROM AUTHOR]

Background: Although hepatitis B virus (HBV) infection remains the main cause of hepatocellular carcinoma (HCC) worldwide, metabolic syndrome, with its increase in prevalence, has become an important and significant risk factor for HCC. This study was designed to investigate the association of concurrent metabolic syndrome with long-term prognosis following liver resection for patients with HBV-related HCC. Methods: From a Chinese, multicenter database, HBV-infected patients who underwent curative resection for HCC between 2010 and 2020 were identified. Long-term oncological prognosis, including overall survival (OS), recurrence-free survival (RFS), and early (≤2 years of surgery) and late (>2 years) recurrences were compared between patients with versus those without concurrent metabolic syndrome. Results: Of 1753 patients, 163 (9.3%) patients had concurrent metabolic syndrome. Compared with patients without metabolic syndrome, patients with metabolic syndrome had poorer 5-year OS (47.5% vs. 61.0%; P = 0.010) and RFS (28.3% vs. 44.2%; P = 0.003) rates and a higher 5-year overall recurrence rate (67.3% vs. 53.3%; P = 0.024). Multivariate analysis revealed that concurrent metabolic syndrome was independently associated with poorer OS (hazard ratio: 1.300; 95% confidence interval: 1.018–1.660; P = 0.036) and RFS (1.314; 1.062–1.627; P = 0.012) rates, and increased rates of late recurrence (hazard ratio: 1.470; 95% confidence interval: 1.004–2.151; P = 0.047). Conclusions: In HBV-infected patients with HCC, concurrent metabolic syndrome was associated with poorer postoperative long-term oncologic survival outcomes. These results suggested that patients with metabolic syndrome should undergo enhanced surveillance for tumor recurrence even after 2 years of surgery to early detect late HCC recurrence. Whether improving metabolic syndrome can reduce postoperative recurrence of HCC deserves further exploration. [ABSTRACT FROM AUTHOR]

Background: Assessment of quality in the perioperative period is critical to ensure good patient care. Textbook outcomes (TO) have been proposed to combine several parameters into a single defined quality metric. The association of preoperative body mass index (BMI) with incidences of achieving or not achieving TO (non-TO) among patients undergoing hepatectomy for hepatocellular carcinoma (HCC) was characterized. Methods: Patients who underwent curative-intent hepatectomy for HCC between 2015 and 2018 were identified from a multicenter database. These patients were divided into three groups based on preoperative BMI: low-BMI (≤ 18.4 kg/m2), normal-BMI (18.5–24.9 kg/m2), and high-BMI (≥ 25.0 kg/m2). The incidences of non-TO among these three groups were compared. Multivariate analyses were performed to identify whether there was any independent association between preoperative BMI and non-TO. Results: Among 1206 patients, 100 (8.3%), 660 (54.7%), and 446 (37.0%) were in the low-BMI, normal-BMI, and high-BMI groups, respectively. The incidence of non-TO was 65.6% in the whole cohort. The incidence of non-TO was significantly higher among patients in the low- and high-BMI cohorts versus the normal-BMI cohort (75.0% and 74.7% versus 58.0%, both P < 0.01). After adjustment of other confounding factors on multivariate analysis, low-BMI and high-BMI were independently associated with higher incidences of non-TO compared with normal-BMI (OR: 1.98 and 2.27, both P < 0.05). Conclusions: Two out of three patients did not achieve TO after hepatectomy for HCC. Both preoperative low-BMI and high-BMI were independently associated with lower odds to achieve optimal TO following HCC resection. [ABSTRACT FROM AUTHOR]

Background: A potentially curative hepatic resection is the optimal treatment for hepatocellular carcinoma (HCC), but most HCCs, even at an early stage, eventually recur after resection. This study investigates clinical features of initial recurrence and long-term prognosis of patients with recurrence after curative resection for early-stage HCC. Patients and Methods: From a multicenter database, patients who underwent curative hepatic resection for early-stage HCC [Barcelona Clinic Liver Cancer (BCLC) stage 0/A] were extracted. Time to initial recurrence, patterns of initial recurrence, and treatment modalities for recurrent tumors were investigated. Univariate and multivariate analysis were used to identify independent risks associated with postoperative recurrence, as well as post-recurrence survival (PRS) for patients with recurrence. Results: Among 1424 patients, 679 (47.7%) developed recurrence at a median follow-up of 54.8 months, including 408 (60.1%) early recurrence (≤ 2 years after surgery) and 271 (39.9%) late recurrence (> 2 years). Independent risks of postoperative recurrence included cirrhosis, preoperative alpha-fetoprotein level > 400 ug/L, tumor size > 5 cm, multiple tumors, satellites, microvascular invasion, and intraoperative blood transfusion. Multivariate analysis revealed that receiving irregular recurrence surveillance, initial tumor beyond Milan criteria, early recurrence, BCLC stage B/C of the recurrent tumor, and noncurative treatments were independently associated with poorer PRS. Conclusions: Nearly half of patients with early-stage HCC experienced recurrence after resection. Understanding recurrence risks may help identify patients at high risk of recurrence who may benefit from future adjuvant therapies. Meaningful survival even after recurrence can still be achieved by postoperative regular surveillance and curative treatment. [ABSTRACT FROM AUTHOR]

Searching for compact objects (black holes, neutron stars, or white dwarfs) in the Milky Way is essential for understanding the stellar evolution history, the physics of compact objects, and the structure of our Galaxy. Compact objects in binaries with a luminous stellar companion are perfect targets for optical observations. Candidate compact objects can be achieved by monitoring the radial velocities of the companion star. However, most of the spectroscopic telescopes usually obtain stellar spectra at a relatively low efficiency, which makes a sky survey for millions of stars practically impossible. The efficiency of a large-scale spectroscopic survey, the Large Sky Area Multi-Object Fiber Spectroscopy Telescope (LAMOST), presents a specific opportunity to search for compact object candidates, i.e., simply from the spectroscopic observations. Late-type K/M stars are the most abundant populations in our Galaxy. Owing to the relatively large Keplerian velocities in the close binaries with a K/M-dwarf companion, a hidden compact object could be discovered and followed-up more easily. In this study, compact object candidates with K/M-dwarf companions are investigated with the LAMOST low-resolution stellar spectra. Based on the LAMOST Data Release 5, we obtained a sample of 56 binaries, each containing a K/M-dwarf with a large radial velocity variation ΔVR > 150 km s−1. Complemented with the photometric information from the Transiting Exoplanet Survey Satellite, we derived a sample of 35 compact object candidates, among which, the orbital periods of 16 sources were revealed by the light curves. Considering two sources as examples, we confirmed that a compact object existed in the two systems by fitting the radial velocity curve. This study demonstrates the principle and the power of searching for compact objects through LAMOST. [ABSTRACT FROM AUTHOR]

Background and Aims: Surgical resection for hepatocellular carcinoma (HCC) is potentially curative, but long-term survival remains unsatisfactory. There is currently no effective neoadjuvant or adjuvant therapy for HCC. We sought to evaluate the impact of preoperative transcatheter arterial chemoembolization (TACE) on long-term prognosis after surgical resection of huge HCCs (≥ 10 cm). Methods: Using a multicenter database, consecutive patients who underwent curative-intent resection for huge HCC without macrovascular invasion between 2004 and 2014 were identified. The association between preoperative TACE with perioperative outcomes, long-term overall survival (OS), and recurrence-free survival (RFS) was assessed before and after propensity score matching (PSM). Results: Among the 377 enrolled patients, 88 patients (23.3%) received preoperative TACE. The incidence of perioperative mortality and morbidity was comparable among patients who did and did not undergo preoperative TACE (3.4% vs. 2.4%, p= 0.704, and 33.0% vs. 31.1%, p= 0.749, respectively). PSM analysis created 84 matched pairs of patients. In examining the entire cohort as well as the PSM cohort, median OS (overall cohort: 32.8 vs. 22.3 months, p= 0.035, and PSM only: 32.8 vs. 18.1 months, p= 0.023, respectively) and RFS (12.9 vs. 6.4 months, p= 0.016, and 12.9 vs. 4.1 months, p= 0.009, respectively) were better among patients who underwent preoperative TACE vs. patients who did not. After adjustment for other confounding factors on multivariable analyses, preoperative TACE remained independently associated with a favorable OS and RFS after the resection of huge HCC. Conclusion: Preoperative TACE did not increase perioperative morbidity or mortality, yet was associated with an improved OS and RFS after liver resection of huge HCC (≥ 10 cm). [ABSTRACT FROM AUTHOR]

We revisit the vertical structure of neutrino-dominated accretion flows (NDAFs) in spherical coordinates with a new boundary condition based on the mechanical equilibrium. The solutions show that NDAF is significantly thick. The Bernoulli parameter and neutrino trapping are determined by the mass accretion rate and the viscosity parameter. According to the distribution of the Bernoulli parameter, the possible outflow may appear in the outer region of the disk. The neutrino trapping can essentially affect the neutrino radiation luminosity. The vertical structure of NDAF is like a 'sandwich', and the multilayer accretion may account for the flares in gamma-ray bursts. [ABSTRACT FROM AUTHOR]

We investigate the vertical structure of neutrino-dominated accretion flows in spherical coordinates. In our calculation, the empty funnel along the rotation axis can naturally explain the neutrino annihilable ejection. The outflow is possible due to the positive Bernoulli function, and the luminosity of neutrino annihilation is enhanced by one or two orders of magnitude. [ABSTRACT FROM AUTHOR]

The standard thin disk model predicts that when the accretion rate is moderately high, the disk is radiation-pressure-dominated and thermally unstable. However, observations indicate the opposite, namely the disk is quite stable. We present an explanation in this work by taking into account the role of the magnetic field which was ignored in the previous analysis. [ABSTRACT FROM AUTHOR]