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The rapid development of miniaturized, high-frequency, and highly integrated microelectronic devices has brought about critical issues in electromagnetic compatibility and thermal management. In recent years, there has been significant interest in lightweight polymer-based composites that offer both electromagnetic interference (EMI) shielding and thermal conductivity. One promising approach involves constructing three-dimensional (3D) interconnection networks using functional fillers in the polymer matrix. These networks have been proven effective in enhancing the thermal and electrical conductivity of the composites. This mini-review focuses on the preparation and properties of 3D network-reinforced polymer composites, specifically those incorporating metal, carbon, ceramic, and hybrid networks. By comparing the effects of different filler types and distribution on the composite materials, the advantages of 3D interconnected conductive networks in polymer composites are highlighted. Additionally, this review addresses the challenges faced in the field of multifunctional thermal management and electromagnetic protection materials and provides insights into future development trends and application prospects of 3D structured composites. [ABSTRACT FROM AUTHOR]

Digital light processing 3D printing can be applied to fabricate complex silicon nitride (Si 3 N 4) components. However, because of the surface hydroxyl groups and large refractive index, it is still a foremost challenge to realize a stable photosensitive Si 3 N 4 slurry with combined benefits of low viscosity and large curing depth. In this study, we propose a new formulation strategy to prepare Si 3 N 4 slurry. Starting from the optimization of monomer ratio, we have systematically optimized powder particle size, dispersant and photoinitiator on the rheological properties and curing properties of Si 3 N 4 slurry. Specifically, we have fabricated a stable photosensitive Si 3 N 4 slurry (48 vol%) with a viscosity of 2.09 Pa s (30 s−1), a critical curing energy of 126.09 mJ/cm2 and a maximum curing depth of 80 µm. Finally, based on this optimized slurry, we have successfully obtained complex Si 3 N 4 green body with no defect, which demonstrates great potential to fabricate arbitrary complex ceramic components for various applications. [ABSTRACT FROM AUTHOR]

• MXene/AgNWs aerogels with interpenetrating double-network structure were fabricated. • The porous structure contributes to higher attenuation of electromagnetic waves. • 3D network provides channel for electron and phonon transmission in epoxy composites. • The composites possess remarkable EMI SE and thermal conductivity. The novel multifunctional materials with anti-electromagnetic interference (EMI) and effective thermal management are ideal for modern electronic industry. Generally, the EMI shielding effectiveness (SE) and thermal conductivity (TC) of materials can be effectively enhanced by compounding with high electrically and thermally conductive fillers. However, it seems that the high-performance cannot be compensated without sacrificing the high fillers loading. Herein, from one-dimensional silver nanowires (AgNWs) and two-dimensional MXene, three-dimensional MXene/AgNWs aerogels were designed as electric and heat transferring skeletons for epoxy nanocomposites by directional-freezing and freeze-drying methods. The resultant MXene/AgNWs/Epoxy nanocomposites with a low MXene/AgNWs content of 8.2 wt% combine a high electrical conductivity of 1532 S/m, and an exceptional EMI SE value of 94.1 dB with 3 mm thickness at the X-band frequency, as well as an improved TC of 2.34 W/m·K. The fabricated MXene/AgNWs/Epoxy nanocomposites possess excellent comprehensive properties enable valuable applications in electronic devices for EMI shielding and thermal management. [ABSTRACT FROM AUTHOR]

• Polymer-matrix composites. • 3-Dimensional reinforcement. • Thermal properties. • Syntactic foams. • Hollow glass microspheres. Electronic packaging materials with low dielectric constant (D k) and high thermal conductivity (TC) are of vital importance in mitigating signal delay and enhancing heat dissipation efficiency in modern electronics. However, low D k and high TC are difficult to complement each other, because high TC filler usually possesses a high D k. Herein, we have newly designed a composite material simultaneously with low D k and high TC through hollow glass microspheres (HGMs), boron nitride particles, epoxy resin and reticulated porous ceramic (RPC). The composite material prepared by sintering HGMs and RPC is more effective in improving TC while keeping low D k. Specifically, the D k of the newly designed composite is lower than 3.0 with a large TC of 0.96 W/m·K. This new epoxy-matrix composite with both low D k and high TC can shed new light on designing electronic packaging materials for advanced miniaturized electronics. [ABSTRACT FROM AUTHOR]

For new-generation miniaturized and high-frequency electronics, it is of vital importance to develop advanced electronic packaging materials, which combine high electromagnetic interference (EMI) shielding effectiveness (SE) and efficient thermal management capabilities, including heat absorption, thermal conductivity (TC) and heat dissipation. However, high EMI SE and efficient thermal management usually cannot complement each other for the same packaging material, because EMI shielding devices convert electromagnetic radiation directly into heat consumption, leading to consequent severe challenge to dispose heat dissipation. Herein, we have newly developed a high-performance phase change composites, in which MXene is confined in shape-stabilized phase change material (PCM) for simultaneous achievement of high EMI SE and efficient thermal management. Regarding high EMI, MXene can effectively shield electromagnetic radiation by converting the radiation into heat consumption. As for thermal management, PCM enables efficient heat absorption via the phase change process, and MXene enhances the thermal conductivity (TC) of MXene/PCM composite to facilitate heat dissipation. As a result, our developed MXene/PCM composite can achieve a high EMI SE of 64.7 dB in X-band, with an improved TC of 0.74 W/m·K. Furthermore, the interlayer capillary effect of MXene inhibits the leakage of liquid PCM during the solid-liquid phase transition, which can maintain the PCM shape stability. Our newly-designed shape-stabilized MXene/PCM composites with high EMI SE and large TC shed new light on designing EMI shielding materials with prolonged exposure to electromagnetic radiation, which can be envisioned to exhibit vast implications for advanced new-generation miniaturized and high-frequency electronics. [Display omitted] [ABSTRACT FROM AUTHOR]

In ternary nitrides, the Ga0.9Fe3.1N sample has ultimately been prepared through solid‐gas preparation for the gallium‐richest phase GaFe3N. The substitution of gallium atoms for iron atoms weakens the saturation magnetization of ferromagnetic γʹ‐Fe4N and induces the transmission from ferromagnetism to antiferromagnetism. A new magnetic behavior, defined as the spin glassy magnetic state, has been observed in the temperature‐dependent magnetic performance measurement process for Ga0.9Fe3.1N. The magnetic competition between ferromagnetic and antiferromagnetic Fe–Fe bonds will lead to the spin frustration of the magnetic system. And even the positional disorders caused by substitution, will all be responsible for the spin glassy behavior in Ga0.9Fe3.1N. [ABSTRACT FROM AUTHOR]

Choledochal cysts (CCs) are an important risk factor for cholangiocarcinoma, though their etiology remains debated. Given the vital role of bile fluid in digestive processes within the biliary system, examining such mechanisms from the perspective of bile fluid dynamics may offer additional insights for clinical use. This study utilized magnetic resonance imaging (MRI)-based patient-specific scans for detailed reconstruction and further employed the computational fluid dynamic method to assess the physiological functions of each system, including refilling and emptying processes. The impact of bile rheological property was also examined. Key biomechanical parameters—pressure and wall shear stress (WSS)—were displayed on a two-dimensional plane via surface mapping for enhanced visualization and comparative analysis. Outcomes demonstrated a significant reduction in bile flow velocity in CCs patients due to common bile duct's anatomical features and bile's shear-thinning, non-Newtonian nature, with a notable increase in pressure drop observed. In healthy biliary systems, WSS variations were minimal; however, in CCs patients, extreme WSS differences were found, with the highest WSS in the segmental bile duct and the lowest in the dilatation area, presenting a magnitude difference of approximately 1000. CCs one showed WSS levels 100–250 times higher than healthy ones in the common bile duct. Bile rheological properties substantially affect pressure and WSS patterns, particularly WSS, where pathological bile caused a tenfold increase in WSS compared to healthy bile. The findings aimed to enhance the understanding of biliary fluid mechanics in CCs and offer insights into selected fluidic variables for future microfluidic chip experiments. [ABSTRACT FROM AUTHOR]

Nano-SiO 2 porous thermal insulating material (TIM) has drawn tremendous research interests due to its advantages of low density, high porosity and low thermal conductivity. However, its long-term stability in humid environment can be severely deteriorated by the high hydrophilicity resulting from tetrahedral coordination of oxygen and capillary effect of porous structure. It is still a great challenge to cost-effectively fabricate bulk TIM with superior hydrophobicity and consequent remarkable self-cleaning capability. Herein, via an oil-in-water microemulsion treatment, we have proposed a new strategy to construct 3D superior hydrophobic nano-SiO 2 porous TIM. The polymethylhydrosiloxane-modified TIM exhibits a large water contact angle of 166°, and corresponding excellent self-cleaning characteristic while maintaining low thermal conductivity of 0.031 W/m·K. Moreover, our high hydrophobicity of TIM exhibits excellent durability under high temperature up to 400 °C, high humidity of 100%, and chemical erosions. Detailed knowledge of the physical chemistry basis of the superior hydrophobic nano-SiO 2 porous TIM can provide great opportunity to fabricate advanced self-cleaning and heat insulating devices especially targeted for harsh environments. [ABSTRACT FROM AUTHOR]

The high integration density of microelectronic devices leads to local heat accumulation, and effective heat dissipation and signal transmission of packaging materials have become the primary issues to be solved. However, existing polymer materials have difficulty meeting the requirements due to their unsatisfactory thermal conductivity and thermal expansion properties. In this work, we proposed the use of digital light processing (DLP) printing technology to construct a triply periodic minimum surface (TPMS) skeleton, and a continuous and efficient heat conduction path was successfully constructed in epoxy resin by impregnating h-BN on the skeleton surface. When the loading of h-BN was 20 vol%, the thermal conductivity of the TPMS(SiO 2)@BN/EP(BN) composites was 1.86 W/(m·K), which was 786 % higher than that of pure epoxy resin. In addition, the thermal expansion coefficient of the composites decreased by more than 70 %. At the test frequencies of 3∼10 MHz, the composites showed stable dielectric properties, and the dielectric constant was always maintained in a low range, between 3.85 and 4.15. This work has realized the transformation of the method for constructing a heat conduction path from disordered to ordered and from random to repeatable. This provides a new strategy for the selection of microelectronic packaging materials. [ABSTRACT FROM AUTHOR]

Purpose: 18F-FDG PET/MR has been applied to the diagnosis and preoperative staging in various tumor types; however, reports using PET/MR in hilar cholangiocarcinoma (HCCA) are rare. We investigated the value of PET/MR for preoperative staging and compared it with PET/CT in HCCA. Methods: Fifty-eight patients with HCCA confirmed by pathology were retrospectively analyzed. 18F-FDG PET/CT imaging was performed first, followed with whole-body PET/MR imaging. SUVmax of tumor and normal liver tissue were measured. Paired T test was used to compare SUVmax of tumor and normal liver tissue of PET/CT and PET/MR. In addition, McNemar test was used to compare the accuracy of TNM staging and Bismuth-Corlette typing between PET/CT and PET/MR. Results: There was no significant difference in SUVmax between PET/CT and PET/MR in primary tumor lesions (6.6 ± 5.5 vs. 6.8 ± 6.2, P = 0.439). SUVmax of PET/CT and PET/MR in normal liver parenchyma was significantly different (3.0 ± 0.5 vs. 2.1 ± 0.5, P < 0.001). The accuracy of PET/MR in diagnosing T staging and N staging was significantly higher than those of PET/CT (72.4% vs. 58.6%, P = 0.022 and 84.5% vs. 67.2%, P = 0.002). There was no significant difference between PET/CT and PET/MR in M staging (94.8% vs. 98.3%, P = 0.5). The classification accuracy of PET/MR in Bismuth-Corlette was significantly higher than that of PET/CT (89.7% vs. 79.3%), P = 0.031. Conclusions: The diagnostic accuracy of 18F-FDG PET/MR was superior to that of PET/CT in preoperative T staging, N staging, and Bismuth–Corlette classification of HCCA. In M staging, the diagnostic accuracy of PET/MR was similar to that of PET/CT. [ABSTRACT FROM AUTHOR]

Background: The efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and yet indications for PBD remain controversial. The aim of this study was to compare the postoperative morbidity and mortality in patients with malignant obstructive jaundice undergoing direct surgery versus surgery with PBD. Methods: All consecutive patients with malignant obstructive jaundice who underwent radical resection between June 2017 and December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: PBD group (PG) and direct surgery group (DG). The subgroups were chosen based on the site of obstruction. Perioperative indicators and postoperative complications were compared and analyzed. Results: A total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (46.4%). Patients in the PG group had a lower overall rate of postoperative complications compared with the DG group, with perioperative total bilirubin (TB) identified as an independent risk factor in multivariate analysis (hazard ratio = 1.004; 95% confidence interval 1.001–1.007; P = 0.017). Subgroup analysis showed that PBD reduced the complication rate in patients with proximal obstruction. In the proximal-obstruction subgroup, a preoperative TB level > 162 μmol/L predicted postoperative complications. Conclusions: PBD may reduce the overall rate of postoperative complications among patients with proximal malignant obstructive jaundice. Trial registration: ClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the role of dual-time point 18F-FDG PET/CT imaging in the primary diagnosis and staging of hilar cholangiocarcinoma (HCCA). Methods: Dual-time point FDG PET/CT findings, including early phase whole-body scanning and abdominal delayed phased performed 1 and 2 h after radiotracer injection, respectively, were retrospective reviewed in 69 patients conformed HCCA by histology. PET/CT was evaluated based on visual interpretation and the semiquantitative index of SUVmax and tumor-to-normal liver tissue ratio (TNR) for both early and delayed images. Results: For all 69 HCCA patients, the mean SUVmax of the lesion and TNR in delayed phase was significantly higher than that in early phase (6.1 ± 4.7, 2.2 ± 1.7, vs 5.1 ± 3.4, 1.6 ± 1.1; P < 0.001). The sensitivity and accuracy value of detection primary lesions was 69.6% and 70% in early phase vs 76.8% and 76.8% in delay phase, respectively. There was a significant correlation between lesion SUVmax and Ki67 index in both dual-time imaging (r = 0.462, P < 0.001 in early phase vs r = 0.47, P < 0.001 in delay phase). The sensitivity, specificity and accuracy value of metastatic lymph nodes prediction was 50%, 67.3% and 71% in early phase vs 62.5%, 73.3% and 76.8% in delayed phase, respectively. The sensitivity, specificity and accuracy of FDG PET/CT in detecting distant metastasis in our study was 75%, 100% and 97.1%. There was no difference of predicting distant metastasis between early phase and delayed phase. Conclusion: Delayed phase in dual-time point 18F-FDG PET/CT scan provides additional usefulness for detection primary tumor and lymph nodes metastases in HCCA, but there was no added benefit of delayed PET/CT imaging in detection of distant metastases in this study. SUVmax in early and delayed phase could be used to assess tumor aggressiveness in pre-treatment HCCA. [ABSTRACT FROM AUTHOR]

Background: The clinical benefits and efficacies of adjuvant therapies for gallbladder cancer (GBC) have not been verified due to insufficient clinical evidence. Methods: Patients with resected nonmetastatic stage II–IV GBC were selected from the Surveillance, Epidemiology, and End Results database and distributed into nonchemotherapy and chemoradiotherapy (NCRT), chemotherapy (CT), and chemoradiotherapy (CRT) groups. Generalized propensity score and inverse probability of treatment weighting (IPTW) were used to reduce the imbalances between groups. Results: A total of 2,689 patients were enrolled, among whom 1,193 (44.4%) were classified as stage II, 1,371 (51.0%) as stage III, and 125 (4.6%) as stage IV GBC. A total of 1,703, 444, and 542 patients were placed in the NCRT, CT, and CRT groups, respectively. After the IPTW, there were no significant differences in overall survival (OS) between the 3 treatment groups (p > 0.05) in stage II GBC patients. In patients with stage III–IV GBC, the CT group exhibited a superior OS compared to the NCRT group (p < 0.001). In addition, the CRT group exhibited a superior OS compared to the CT (p < 0.001) and NCRT (p < 0.001) groups. For patients with stage III–IV tumors, a nomogram was constructed to predict the survival benefits of adjuvant therapies. Conclusion: Patients with stage II GBC may not benefit from adjuvant therapy, while patients with stage III–IV GBC were shown to benefit from chemotherapy and chemoradiotherapy. Furthermore, chemoradiotherapy exhibited a superior OS. Nevertheless, the results need to be explained in the context of retrospective studies. [ABSTRACT FROM AUTHOR]

Background: Gallbladder cancer (GC) is a malignant disease characterized with highly cellular heterogeneity and poor prognosis. Determining the intratumoral heterogeneity and microenvironment (TME) can provide novel therapeutic strategies for GC. Methods: We performed the single‐cell RNA sequencing on the primary and lymph node metastatic gallbladder tumors and the adjacent normal tissues of five patients. The transcriptomic atlas and ligand–receptor‐based intercellular communication networks of the single cells were characterized. Results: The transcriptomic landscape of 24,887 single cells was obtained and characterized as 10 cellular clusters, including epithelial, neuroendocrine tumor cells, T&NK cells, B cells, RGS5+ fibroblasts, POSTN+ fibroblasts, PDGFRA+ fibroblasts, endothelial, myeloid cells, and mast cells. Different types of GC harbored distinct epithelial tumor subpopulations, and squamous cell carcinoma could be differentiated from adenocarcinoma cells. Abundant immune cells infiltrated into adenocarcinoma and squamous cell carcinoma, rather than neuroendocrine neoplasms, which showed significant enrichment of stromal cells. CD4+/FOXP3+ T‐reg and CD4+/CXCL13+ T helper cells with higher exhausting biomarkers, as well as a dynamic lineage transition of tumor‐associated macrophages from CCL20hi/CD163lo, CCL20lo/CD163hi to APOE+, were identified in GC tissues, suggesting the immunosuppressive and tumor‐promoting status of immune cells in TME. Two distinct endothelial cells (KDR+ and ACKR1+), which were involved in angiogenesis and lymphangiogenesis, showed remarkable ligand–receptor interactions with primary GC cells and macrophages in gallbladder tumors. Conclusions: This study reveals a widespread reprogramming across multiple cell populations in GC progression, dissects the cellular heterogeneity and interactions in gallbladder TME, and provides potential therapeutic targets for GC. [ABSTRACT FROM AUTHOR]

We have optimized a CuO-doped silver paste to significantly improve the adhesion strength of silver thick film on AlN ceramic substrate, which can be widely applied in power electronic packaging applications. Via a combination of scanning electron microscope and X-ray diffraction, we have systematically studied the silver layer morphology on top of AlN ceramic substrate, and the interphases between the silver thick film and AlN substrate. Due to the CuAl 2 O 4 intermediate formed at the silver layer/AlN interface, the adhesion strength of silver thick film can be greatly improved. Particularly, the silver paste with 3 wt% nano-CuO sintered on AlN ceramic substrate exhibits high adhesion strength of 15.3 MPa with good electrical conductivity of 0.9 mΩ/□. [ABSTRACT FROM AUTHOR]

Background: This study was designed to investigate whether 3D laparoscopic common bile duct (LCBDE) could improve surgical outcomes in choledocholithiasis patients compared with 2D LCBDE. Method: Propensity score-matched analysis was performed to balance the bias in baseline characteristic between two groups. Results: 213 patients underwent 3D LCBDE and 212 patients receiving 2D LCBDE were enrolled in this study. The operation time and blood loss in 3D group were significantly less than that in 2D group. After propensity score matching, a total of 114 paired cases were selected from the two groups. The operation time and blood loss in 3D group remain significantly lower than in 2D group. In the end, the subgroup analysis based on abdominal adhesion level was performed and it was observed that for patients with adhesion level 1 and level 2, 3D surgery could obviously decrease the operation time and intraoperative blood loss. Conclusions: 3D LCBDE would significantly reduce operation time, blood loss, and conversion rate to laparotomy in choledocholithiasis patients versus 2D LCBDE. For patients with abdominal adhesions level 1 and level 2, 3D LCBDE could provide better surgical outcomes than 2D LCBDE. [ABSTRACT FROM AUTHOR]

This paper presents that polyethylene glycol (PEG) synthesizes a form-stable phase change material (FS-PCM) with high thermal conductivity and considerable heat storage density. PEG was confined to the chain structure of epoxy resin (EP) via high-temperature melt blending and curing, which solves the leakage problem of PCMs during phase transformation. In order to increase the thermal conductivity and stability of the PEG/EP while maintaining good heat storage capacity and insulation ability, a low loading of reticulated porous Al 2 O 3 ceramic (RPC) was introduced into the PEG/EP matrix. RPC increases the thermal conductivity of FS-PCM by 5.5 times and the heat storage rate by 4 times. In addition, FS-PCM filled with 13.8 vol% RPCs has a coefficient of thermal expansion (CTE) of 80 ppm/K at 85–150 °C -a decrease of 62% over the matrix. Furthermore, the BN network is formed on RPC by vacuum impregnation technology, which further improves the thermal conductivity. This novel FS-PCM has excellent comprehensive properties and does not need for case package, indicating great prospects in thermal management and thermal storage. [ABSTRACT FROM AUTHOR]

Background: A history of abdominal biliary tract surgery has been identified as a relative contraindication for laparoscopic common bile duct exploration (LCBDE), and there are very few reports about laparoscopic procedures in patients with a history of abdominal biliary tract surgery.Methods: We retrospectively reviewed the clinical outcomes of 227 consecutive patients with previous abdominal biliary tract operations at our institution between December 2013 and June 2019. A total of 110 consecutive patients underwent LCBDE, and 117 consecutive patients underwent open common bile duct exploration (OCBDE). Patient demographics and perioperative variables were compared between the two groups.Results: The LCBDE group performed significantly better than the OCBDE group with respect to estimated blood loss [30 (5-700) vs. 50 (10-1800) ml; p = 0.041], remnant common bile duct (CBD) stones (17 vs. 28%; p = 0.050), postoperative hospital stay [7 (3-78) vs. 8.5 (4.5-74) days; p = 0.041], and time to oral intake [2.5 (1-7) vs. 3 (2-24) days; p = 0.015]. There were no significant differences in the operation time [170 (60-480) vs. 180 (41-330) minutes; p = 0.067]. A total of 19 patients (17%) in the LCBDE group were converted to open surgery. According to Clavien's classification of complications, the LCBDE group had significantly fewer postoperative complications than the OCBDE group (40 vs. 57; p = 0.045). There was no mortality in either group. Multiple previous operations (≥ 2 times), a history of open surgery, and previous biliary tract surgery (including bile duct or gallbladder + bile duct other than cholecystectomy alone) were risk factors for postoperative adhesion (p = 0.000, p = 0.000, and p = 0.000, respectively).Conclusion: LCBDE is ultimately the least invasive, safest, and the most effective treatment option for patients with previous abdominal biliary tract operations and is especially suitable for those with a history of cholecystectomy, few previous operations (< 2 times), or a history of laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background: Gallstones are the cause of a majority of biliary tract discomfort. Although many community-based studies have addressed the risk factors for gallstone disease (GSD), little is known about GSD prevalence and risk factors in Chinese populations. Methods: From January 2014 to January 2015, participants (N = 2,068,523) were recruited by Meinian Onehealth Healthcare Co., Ltd. They received a physical examination, and GSD was determined by ultrasound. Results: The prevalence of GSD was 8.1%. Risks of GSD were similar between males and females in all age groups. Risk factors for gallstones include body mass index, waist circumference, waist-to-hip ratio, and physical activity, as well as biological factors such as age, sex, and elevated blood lipid levels. Serum lipid levels of GSD were statistically different from controls in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (H-DL), low-density lipoprotein cholesterol (LDL), and apolipoprotein B (APOB). Furthermore, TC > 5.00 mmol/L, TG > 1.39 mmol/L, HDL < 1.19 mmol/L, LDL > 3.04 mmol/L, and APOB > 0.97 mmol/L were risk factors for gallstones. Conclusions: Serum lipid levels are associated with GSD. TC, TG, LDL, and APOB are risk factors, while HDL is a protective factor. [ABSTRACT FROM AUTHOR]

Background: The distant metastasis (DM) mode and treatment efficacies in the advanced biliary tract cancer (BTC) were obscure, and a credible evaluation is urgently needed. Method: A total of 6348 advanced BTC patients (ICC, intrahepatic cholangiocarcinoma, n = 1762; PHCC, perihilar cholangiocarcinoma, n = 1103; GBC, gallbladder cancer, n = 2580; DCC, distal cholangiocarcinoma, n = 538; AVC, carcinoma of Vater ampulla, n = 365) were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) process was carried out for less bias. Result: The proportion of M1 patients in each subtype at first diagnosis was 26.4% (ICC), 37.2% (PHCC), 41. 0% (GBC), 24.5% (DCC), and 12.7% (AVC), and the constitution of DM sites in different subtypes varied apparently. Moreover, the survival of metastasis sites was different (P <.05 in all the subtypes) where the multi‐metastasis and distant lymph node (dLN) only always indicated the worst and best prognosis, respectively. Chemotherapy presented the most significant survival impact with the lowest hazard ratio by multivariate cox model and still provided a survival improvement after PSM (all P <.001) in all subtypes. However, the median months manifested different between patients with and without chemotherapy among the subtypes (ICC, from 5 to 9; PHCC, from 6 to 10; AVC, from 4 to 9; GBC, from 6 to 7; DCC from 6 to 8). Conclusion: We provided a landscape about the detailed DM mode of the advanced BTC in a large population, found the survival differences among DM sites, and revealed the different chemotherapy efficacies in the BTC subtypes. [ABSTRACT FROM AUTHOR]

Gallbladder carcinoma (GBC) is a highly lethal malignancy of the gastrointestinal tract. Despite extensive research, the underlying molecular mechanism of GBC remains largely unclear. Deleted in malignant brain tumors 1 (DMBT1) is low-expression during cancer progression and as a potential tumor-suppressor gene in various types of cancer. However, its role in Gallbladder cancer remains poorly understood. Here, we found that DMBT1 was significantly low-expression and deletion of copy number in GBC tissues by qRT-PCR and Western blot. Overexpression of DMBT1 impaired survival, promoted apoptosis in GBC cells in vitro, and inhibited tumor progression in vivo. Further study of underlying mechanisms demonstrated that DMBT1 combined with PTEN which could stabilize PTEN protein, resulting in inhibiting the activation of PI3K/AKT signaling pathway. Our study revealed a new sight of DMBT1 as a tumor-suppressor gene on the PI3K/AKT pathway in GBC, which may be a potential therapeutic target for improving treatment. Down-regulation of DMBT1 suppresses progression of gallbladder carcinoma through PI3K/AKT signaling pathway activation by targeting PTEN. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic common bile duct exploration (LCBDE) has been widely promoted in recent years as a safe and effective treatment for choledocholithiasis. However, there are no standard guidelines for the treatment of patients who have concomitant hepatolithiasis of the left liver and abdominal adhesions. The aim of the current research was to compare the outcomes of open versus laparoscopic common bile duct exploration with left hepatectomy (OCBDH vs. LCBDH) in patients with choledocholithiasis concomitant with left-sided hepatolithiasis, and to evaluate the safety and feasibility of laparoscopic surgery for choledocholithiasis in patients with abdominal adhesions.Methods: Between October 2012 and October 2015, a total of 321 consecutive patients with choledocholithiasis underwent surgical treatment. LCBDE was performed in 107 patients, and open common bile duct exploration (OCBDE) was performed in 111 patients. Further, 31 patients and 72 patients underwent LCBDH and OCBDH, respectively. A total of 133 patients who underwent LCBDE or OCBDE had abdominal adhesions, which were classified as mild, moderate, or severe according to an abdominal adhesion scoring system, which was validated in the LCBDE group and OCBDE group. The perioperative results were reviewed and analyzed retrospectively.Results: In the mild adhesion group, blood loss, postoperative recovery in the LCBDE group was lesser than those in the OCBDE group. In the moderate adhesion group, the postoperative recovery was significantly shorter in the LCBDE group than in the OCBDE group. In the severe adhesion group, the operation time and blood loss in the LCBDE group were higher than those in the OCBDE group. The postoperative recovery was significantly better in the LCBDH group than in the OCBDH group.Conclusion: LCBDH can obviously improve recovery and shorten the hospitalization period. Further, LCBDE is safe and feasible for patients of choledocholithiasis with mild and moderate abdominal adhesions. [ABSTRACT FROM AUTHOR]

Background: This population-based study examined surgical outcomes and hospital and post-acute care resource use after operations of cholangiocarcinoma during 2005-2012. Study design: Using New York State hospital claims, we identified subjects with intrahepatic tumor who underwent hepatectomy only ( n = 2089), subjects with perihilar tumor who underwent hepatectomy and biliary-enteric anastomosis (BEA; n = 389) or BEA only ( n = 3721), and subjects with distal cholangiocarcinoma undergoing pancreatectomy or pancreaticoduodenectomy ( n = 228). We performed trend analyses for each group and calculated overall risk-adjusted mortality, complication, and 30-day readmission rates for hospitals using multivariable logistic regressions. Results: Mortality rate was roughly 12 % over years for perihilar cases undergoing hepatectomy and BEA, significantly higher than the rates of other 3 groups ( p = 0.000). The overall complication rate was 40 % for subjects undergoing both hepatectomy and BEA, more than doubling the rate for subjects undergoing hepatectomy or BEA alone ( p = 0.000). Average LOS declined markedly for perihilar cases undergoing hepatectomy and BEA (from 21 days in 2005 to 16 days in 2012) and subjects with distal cholangiocarcinoma (from 22 days in 2005 to 16 days in 2012), but other outcomes did not change dramatically. Risk-adjusted hospital outcome rates varied substantially. Conclusions: Surgical patients with cholangiocarcinoma incur considerable mortality, postoperative complications, and resource uses, especially among those undergoing hepatectomy and BEA for perihilar tumors. [ABSTRACT FROM AUTHOR]

14-3-3 proteins are ubiquitous adapters combining with phosphorylated serine/threonine motifs to regulate multiple cellular processes. As a negative regulator, 14-3-3 proteins could sequester the phosphorylated YAP1 in cytoplasm to inhibit its activity. In this study, we identified the K50 acetylation (K50ac) of 14-3-3ε protein and investigated its roles and mechanism in cholangiocarcinoma progression. The NAD (+)-dependent protein deacetylases inhibitor, NAM treatment significantly up-regulated the K50ac of 14-3-3ε. K50R mutation resulted in the decrease of K50ac of 14-3-3ε. The K50ac of 14-3-3ε was reversibly mediated by PCAF acetyltransferase and sirt1 deacetylases. K50ac had no obvious effect on the protein stability of 14-3-3ε, but inhibited the combination of 14-3-3ε with phosphorylated YAP1, which resulted in the activation of YAP1 in cholangiocarcinoma. K50R significantly decreased cholangiocarcinoma cell proliferation in vitro and the growth of tumor xenograft in vivo compared with WT (wild type) 14-3-3ε. The level of K50ac were higher in cholangiocarcinoma tissues accompanied by the accumulation of YAP1 in nuclear than para-carcinoma tissues. Our study revealed the underlying mechanism of K50ac of 14-3-3ε and its roles in cholangiocarcinoma, providing a potential targeting for cholangiocarcinoma therapy. [ABSTRACT FROM AUTHOR]

Abstract: CD133+ tumor cells are responsible for the initiation, propagation and recurrence of tumors, which raises the question of how to effectively target CD133+ tumor cells. Arsenic trioxide (As2O3) has considerable efficacy in treating solid tumors with induction of apoptosis. Here, we found that purified CD133+ gallbladder carcinoma cells are highly resistant to conventional chemotherapy. However, As2O3 effectively induces CD133+ gallbladder carcinoma cells apoptosis. Treatment with As2O3 reduces CD133 expression at transcriptional levels. Furthermore, the ectopic expression of CD133 attenuated the apoptotic effect of As2O3 on cells through activation of AKT signaling pathways. Collectively, As2O3 effectively targets CD133 in gallbladder carcinoma, providing a new mechanism of As2O3-induced cell apoptosis and a better understanding of drug resistance in gallbladder carcinoma. [Copyright &y& Elsevier]

Abstract: Gallbladder carcinoma (GBC), an aggressive and mostly lethal malignancy, is known to be resistant to a number of drug stimuli. Here, we demonstrated that arsenic trioxide inhibited the proliferation of gallbladder carcinoma in vivo and in vitro as well as the transcription of cell cycle-related protein Cyclin D1. And, Cyclin D1 overexpression inhibited the negative role of arsenic trioxide in cell cycle progression. We further explored the mechanisms by which arsenic trioxide affected Cyclin D1 transcription and found that the Sp1 transcription factor was down-regulated by arsenic trioxide, with a corresponding decrease in Cyclin D1 promoter activity. Taken together, these results suggested that arsenic trioxide inhibited gallbladder carcinoma cell proliferation via down-regulation of Cyclin D1 transcription in a Sp1-dependent manner, which provided a new mechanism of arsenic trioxide-involved cell proliferation and may have important therapeutic implications in gallbladder carcinoma patients. [Copyright &y& Elsevier]

• B-site precursor method can effectively inhibit the appearance of second phase. • B-site precursor method can obtain high reactivity Mg 4 Nb 2 O 9 powders. • B-site precursor method can promote integrality of the crystal structure. Mg 4 Nb 2 O 9 ceramics have been prepared by B-site precursor method in this work. Experimental results demonstrate that the uniform particles-size distribution of Mg 4 Nb 2 O 9 powders can be obtained, which exhibit high reactivity to promote the grain growth of Mg 4 Nb 2 O 9 ceramics. Moreover, the Mg 4 Nb 2 O 9 ceramics via B-site precursor method can be sintered at a wide range of sintering temperature from 1275 to 1375 °C with single phase Mg 4 Nb 2 O 9 composition and high crystallinity. Compared to the conventional solid-state method, the Mg 4 Nb 2 O 9 ceramics prepared by B-site precursor method exhibit excellent Q × f value by above 168,756 GHz. [ABSTRACT FROM AUTHOR]

Gallbladder carcinoma (GBC) is a considerable challenge because of its high metastatic potential. The tumor microenvironment is characterized by nutrient starvation, which promotes tumor metastasis. Stathmin1, an important microtubuleregulating protein, is overexpressed and promotes metastasis in GBC. It remains unclear how the harsh tumor microenvironment regulates stathmin1 expression to affect GBC metastasis. We employed glucose deficiency to mimic nutrient starvation and found that glucose deficiency upregulated stathmin1 transcription. However, glucose deficiency also promoted p27 degradation. There was a significant negative correlation between stathmin1 and p27 protein levels under glucose deficiency. Further study revealed that, under glucose deficiency, human kinase interacting with stathmin (hKIS) induced phosphorylation at Ser10 of p27 and its translocation to the cytoplasm for degradation, which upregulated the transcription factor E2F1 to promote stathmin1 transcription. hKIS knockdown significantly inhibited p27 cytoplasmic translocation and its consequent degradation. Stathmin1 knockdown significantly inhibited GBC cell migration and invasion in vitro. Our study revealed the role of the hKIS/p27/E2F1 axis in upregulating stathmin1 transcription to promote GBC cell migration and invasion under glucose deficiency conditions • We model the nutrition starvation conditions with glucose deficiency; • We found increased levels of stathmin1 of GBC in nutrition starvation condition; • Glucose deficiency induced phosphorylation of p27Kip1 at Ser10 and consequently degradation; • Phosphorylation of p27 at Ser10 promoted GBC migration and invasion; • hKIS/p27/E2F1 axis regulated stathmin1 expression and GBC cell migration and invasion under glucose deficiency conditions. [ABSTRACT FROM AUTHOR]

The MUC16 C-terminal (MUC16c) level is associated with tumor serum CA-125 levels, however, the roles remain unclear in gallbladder carcinoma (GBC). In this study, we found that MUC16c promoted glucose uptake and glycolysis for GBC cell proliferation. Mass spectrometry analysis suggested that MUC16c could combine with aldolase. The ALDOC mRNA and protein are overexpressed in GBC tumors. The IHC results also showed the consistent up-regulation of. ALDOC and MUC16c level in GBC tumor tissues than in peritumor tissues. We determined that MUC16c combining with ALDOC promoted ALDOC protein stability and disrupted the ability of ALDOC sensing glucose deficiency, which activated AMPK pathway and increased GBC cell proliferation. ALDOC knockdown significantly inhibited the glucose uptake and glycolysis induced by MUC16c. Our study established important roles of MUC16c promoting GBC cell glycolysis and proliferation and revealed the underlying mechanism of CA-125-related heavy tumor metabolic burden in GBC. [ABSTRACT FROM AUTHOR]

B Introduction: b The 8 SP th sp edition of the AJCC staging system for gallbladder cancer (GBC) has been used in clinical practice, but we have found some deficiencies in the new edition. In our modified edition, N2 disease obtained a significant subdivision and reappraisal according to T stage, and the aberrant survival reversal of stage IIIA and stage IIIB was also corrected. [Extracted from the article]

B Introduction: b Despite the advantages of 3D laparoscopy was reported, the effect of 3D laparoscopy in choledocholithiasis remained unclear. B Conclusion: b 3D laparoscopy would significantly reduce operation time, blood loss and conversion rate in patients with moderate abdominal adhesions. [Extracted from the article]

Background: The prognostic benefits and safety of extended lymphadenectomy for hilar cholangiocarcinoma remain uncertain. The available evidence is still insufficient concerning its retrospective aspect. The aim of this study is to explore the clinical effect and safety of extended lymphadenectomy compared to regional lymphadenectomy in patients with hilar cholangiocarcinoma.Methods: The Relay-HC trial is a prospective, multicenter, and randomized controlled trial. Seven hundred and thirty-four eligible patients with resectable perihilar cholangiocarcinoma across 15 tertiary hospitals in China will be randomly assigned (1:1) to receive either regional lymphadenectomy or extended lymphadenectomy. The primary objective is to determine the overall survival after the two approaches. Secondary objectives of the study include the evaluation of perioperative mortality, postoperative complication, and disease-free survival. This study has been approved by the ethics committee of each participating hospital.Discussion: The Relay-HC trial is designed to investigate the prognostic benefits and safety of expanded lymphadenectomy for hilar cholangiocarcinoma. Currently, it has never been investigated in a prospective randomized controlled clinical trial.Trial Registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR1800015688 . Registered on 15 April 2018. [ABSTRACT FROM AUTHOR]

Background: Recent studies have reported TIMs play an important role in tumors progression or regression, but the effect of TIMs in biliary tract cancer remains unclear. The aim of this study is to investigate the prognostic value of tumor infiltrating mast cells (TIMs) and its influence on gemcitabine-based adjuvant chemotherapy (ACT) benefits in biliary tract cancer patients after surgery.Methods: TIMs were evaluated by immunohistochemical staining of tryptase in 250 patients with resected gallbladder carcinoma (GBC) or extrahepatic bile duct carcinoma (EBDC) from Zhongshan Hospital. The relationships between TIMs and clinicopathological factors and postoperative prognosis were analyzed respectively.Results: High TIMs infiltration was significantly correlated with prolonged overall survival (OS). Furthermore, multivariate analysis indicated TNM stage and TIMs as independent prognostic factors for OS. Patients with high TIMs infiltration appeared to significantly benefit from Gemcitabine-based ACT in the discovery and validation cohorts. Spearman analysis identified that TIMs infiltration were positively correlated with anti-tumor CD8+ T cells.Conclusion: TIMs infiltration is an independent favorable prognostic factor in GBC and EBDC patients, which could better stratify patients with different prognosis and predict benefit from gemcitabine-based ACT. [ABSTRACT FROM AUTHOR]