Background
This study aimed to compare sequential treatment by transcatheter arterial chemoembolization (TACE) and percutaneous radiofrequency ablation (RFA) with partial hepatectomy for ...hepatocellular carcinoma (HCC) within the Milan criteria.
Methods
In a randomized clinical trial, patients with HCC within the Milan criteria were included and randomized 1 : 1 to the partial hepatectomy group or the TACE + RFA group. The primary outcome was overall survival and the secondary outcome was recurrence‐free survival.
Results
Two hundred patients were enrolled. The 1‐, 3‐ and 5‐year overall survival rates were 97·0, 83·7 and 61·9 per cent for the partial hepatectomy group, and 96·0, 67·2 and 45·7 per cent for the TACE + RFA group (P = 0·007). The 1‐, 3‐ and 5‐year recurrence‐free survival rates were 94·0, 68·2 and 48·4 per cent, and 83·0, 44·9 and 35·5 per cent respectively (P = 0·026). On Cox proportional hazard regression analysis, HBV‐DNA (hazard ratio (HR) 1·76; P = 0·006), platelet count (HR 1·00; P = 0·017) and tumour size (HR 1·90; P < 0·001) were independent prognostic factors for recurrence‐free survival, and HBV‐DNA (HR 1·61; P = 0·036) was a risk factor for overall survival. The incidence of complications in the partial hepatectomy group was higher than in the TACE + RFA group (23·0 versus 11·0 per cent respectively; P = 0·024).
Conclusion
For patients with HCC within the Milan criteria, partial hepatectomy was associated with better overall and recurrence‐free survival than sequential treatment with TACE and RFA. Registration number: ACTRN12611000770965 (http://www.anzctr.org.au/).
Partial hepatectomy better
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Properties of many layered materials, including copper- and iron-based superconductors, topological insulators, graphite and epitaxial graphene, can be manipulated by the inclusion of different ...atomic and molecular species between the layers via a process known as intercalation. For example, intercalation in graphite can lead to superconductivity and is crucial in the working cycle of modern batteries and supercapacitors. Intercalation involves complex diffusion processes along and across the layers; however, the microscopic mechanisms and dynamics of these processes are not well understood. Here we report on a novel mechanism for intercalation and entrapment of alkali atoms under epitaxial graphene. We find that the intercalation is adjusted by the van der Waals interaction, with the dynamics governed by defects anchored to graphene wrinkles. Our findings are relevant for the future design and application of graphene-based nano-structures. Similar mechanisms can also have a role for intercalation of layered materials.
The noise-shaping successive approximation register (NS-SAR) analog-to-digital converter (ADC) is an emerging hybrid architecture that achieves high resolution and power efficiency simultaneously by ...combining the merits of the SAR ADC and the <inline-formula> <tex-math notation="LaTeX">\Delta \Sigma </tex-math></inline-formula> ADC. Most prior works adopting the cascaded integrator feed-forward (CIFF) structure demonstrate inefficiency in realizing optimized noise transfer function (NTF). This paper presents a second-order NS-SAR ADC employing the error-feedback (EF) structure to realize complex NTF zeros for noise-shaping enhancement with the minimum modification to a standard SAR. It implements a low-power scaling-friendly EF path by using a passive finite impulse response (FIR) and a comparator-reused dynamic amplifier with process-voltage-temperature (PVT) tracking background calibration. Fabricated in 40-nm CMOS, the prototype chip consumes <inline-formula> <tex-math notation="LaTeX">84~\mu \text{W} </tex-math></inline-formula> when operating at 10 MS/s. The NS-SAR achieves peak Schreier FoM of 178 dB with 79-dB signal to noise and distortion ratio (SNDR) at an oversampling ratio (OSR) of 8.
Our tightest upper limit on the sum of neutrino mass eigenvalues M
ν comes from cosmological observations that will improve substantially in the near future, enabling a detection. The combination of ...the baryon acoustic oscillation feature measured from the Dark Energy Spectroscopic Instrument and a Stage-IV Cosmic Microwave Background experiment has been forecasted to achieve σ(M
ν) < 1/3 of the lower limit on M
ν from atmospheric and solar neutrino oscillations. Here we examine in detail the physical effects of neutrino mass on cosmological observables that make these constraints possible. We also consider how these constraints would be improved to ensure at least a 5σ detection.
Over the years, there has been significant advancement in the safety and effectiveness of external cyclosurgery for glaucoma. This progress ranges from the initial "cyclodestructive surgery" to ...modern cycloplasty techniques, expanding beyond end-stage glaucoma treatment. Notably, innovative approaches like micropulse transscleral cycloplasty and ultrasonic cycloplasty are now being employed in earlier stages of glaucoma with better visual acuity, qualifying as minimally invasive procedures. Through a comprehensive review of the historical evolution of external cyclosurgery, elucidation of the mechanisms, clinical outcomes, and potential complications associated with novel cycloplasty techniques, and integration of practical clinical insights, this article aims to furnish clinicians with a profound comprehension of external cyclosurgery for glaucoma.
The amygdala is important for processing emotion, including negative emotion such as anxiety and depression induced by chronic pain. Although remarkable progress has been achieved in recent years on ...amygdala regulation of both negative (fear) and positive (reward) behavioral responses, our current understanding is still limited regarding how the amygdala processes and integrates these negative and positive emotion responses within the amygdala circuits. In this study with optogenetic stimulation of specific brain circuits, we investigated how amygdala circuits regulate negative and positive emotion behaviors, using pain as an emotional assay in male rats. We report here that activation of the excitatory pathway from the parabrachial nucleus (PBN) that relays peripheral pain signals to the central nucleus of amygdala (CeA) is sufficient to cause behaviors of negative emotion including anxiety, depression, and aversion in normal rats. In strong contrast, activation of the excitatory pathway from basolateral amygdala (BLA) that conveys processed corticolimbic signals to CeA dramatically opposes these behaviors of negative emotion, reducing anxiety and depression, and induces behavior of reward. Surprisingly, activating the PBN-CeA pathway to simulate pain signals does not change pain sensitivity itself, but activating the BLA-CeA pathway inhibits basal and sensitized pain. These findings demonstrate that the pain signal conveyed through the PBN-CeA pathway is sufficient to drive negative emotion and that the corticolimbic signal via the BLA-CeA pathway counteracts the negative emotion, suggesting a top-down brain mechanism for cognitive control of negative emotion under stressful environmental conditions such as pain.
It remains unclear how the amygdala circuits integrate both negative and positive emotional responses and the brain circuits that link peripheral pain to negative emotion are largely unknown. Using optogenetic stimulation, this study shows that the excitatory projection from the parabrachial nucleus to the central nucleus of amygdala (CeA) is sufficient to drive behaviors of negative emotion including anxiety, depression, and aversion in rats. Conversely, activation of the excitatory projection from basolateral amygdala to CeA counteracts each of these behaviors of negative emotion. Thus, this study identifies a brain pathway that mediates pain-driven negative emotion and a brain pathway that counteracts these emotion behaviors in a top-down mechanism for brain control of negative emotion.
High-resolution angle-resolved photoelectron spectroscopy is used to examine the electronic band structure of FeTe_{0.5}Se_{0.5} near the Brillouin zone center. A consistent separation of the α_{1} ...and α_{2} bands is observed with little k_{z} dependence of the α_{1} band. First-principles calculations for bulk and thin films demonstrate that the antiferromagnetic coupling between the Fe atoms and hybridization-induced spin-orbit effects lifts the degeneracy of the Fe d_{xz} and d_{yz} orbitals at the zone center leading to orbital ordering. These experimental and computational results provide a natural microscopic basis for the nematicity observed in the Fe-based superconductors.
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The past two decades have witnessed the stagnation of the clock speed of microprocessors followed by the recent faltering of Moore's law as nanofabrication technology approaches its unavoidable ...physical limit. Vigorous efforts from various research areas have been made to develop power-efficient and ultrafast computing machines in this post-Moore's law era. With its unique capacity to integrate complex electro-optic circuits on a single chip, integrated photonics has revolutionized the interconnects and has shown its striking potential in optical computing. Here, we propose an electronic-photonic computing architecture for a wavelength division multiplexing-based electronic-photonic arithmetic logic unit, which disentangles the exponential relationship between power and clock rate, leading to an enhancement in computation speed and power efficiency as compared to the state-of-the-art transistors-based circuits. We experimentally demonstrate its practicality by implementing a 4-bit arithmetic logic unit consisting of 8 high-speed microdisk modulators and operating at 20 GHz. This approach paves the way to future power-saving and high-speed electronic-photonic computing circuits.
Opioids are commonly used for pain relief, but their strong rewarding effects drive opioid misuse and abuse. How pain affects the liability of opioid abuse is unknown at present. In this study, we ...identified an epigenetic regulating cascade activated by both pain and the opioid morphine. Both persistent pain and repeated morphine upregulated the transcriptional regulator MeCP2 in mouse central nucleus of the amygdala (CeA). Chromatin immunoprecipitation analysis revealed that MeCP2 bound to and repressed the transcriptional repressor histone dimethyltransferase G9a, reducing G9a-catalyzed repressive mark H3K9me2 in CeA. Repression of G9a activity increased expression of brain-derived neurotrophic factor (BDNF). Behaviorally, persistent inflammatory pain increased the sensitivity to acquiring morphine-induced, reward-related behavior of conditioned place preference in mice. Local viral vector-mediated MeCP2 overexpression, Cre-induced G9a knockdown, and CeA application of BDNF mimicked, whereas MeCP2 knockdown inhibited, the pain effect. These results suggest that MeCP2 directly represses G9a as a shared mechanism in central amygdala for regulation of emotional responses to pain and opioid reward, and for their behavioral interaction.
Dirac-like surface states on surfaces of topological insulators have a chiral spin structure that suppresses backscattering and protects the coherence of these states in the presence of nonmagnetic ...scatterers. In contrast, magnetic scatterers should open the backscattering channel via the spin-flip processes and degrade the state's coherence. We present angle-resolved photoemission spectroscopy studies of the electronic structure and the scattering rates upon the adsorption of various magnetic and nonmagnetic impurities on the surface of Bi2Se3, a model topological insulator. We reveal a remarkable insensitivity of the topological surface state to both nonmagnetic and magnetic impurities in the low impurity concentration regime. Scattering channels open up with the emergence of hexagonal warping in the high-doping regime, irrespective of the impurity's magnetic moment.
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