A homogeneous equiaxed‐structure TC21 titanium alloy is hot rolled and annealed for different time ranging from 1 h to 6 h. The grain morphology and texture evolution of α and β phases during ...annealing are mainly investigated using the electron back‐scattered diffraction characterization. In the early annealing stage, the α grain mainly maintains the elongated morphology generated in the rolling. With increasing annealing time, more and more elongated α grains become equiaxed due to enhanced static recrystallization and boundary splitting. Differently, the β grain exhibits a fully equiaxed morphology all the time due to the sufficient static recrystallization, and get a coarsening with increasing annealing time. The α phase exhibits a (0001) basal texture in the early annealing stage, and then forms a TD‐split texture with increasing annealing time. The β phase exhibits the {001} texture at every annealing time. Based on the analysis about the texture of different grain sizes, the effects of recrystallization nucleation and oriented growth on texture evolution are discussed. It suggests that TD‐split texture in α phase is originated from both the recrystallization nucleation and oriented growth. The formation of {001} texture in β phase is mainly originated from the oriented growth.
Background
This study aims to determine the safety and efficacy of laparoscopic repeat liver resection (LRLR) for recurrent hepatocellular carcinoma (rHCC).
Methods
Twenty patients underwent LRLR for ...rHCC between 2015 and 2017. The control groups consisted of 79 open RLR (ORLR) for rHCC and 185 LLR for primary HCC. We undertook propensity score-adjusted analyses (PSA) and 1:1 propensity score matching (PSM) for the comparison of LRLR versus ORLR. Comparison of LRLR versus LLR was done using multivariable regression models with adjustment for clinically relevant covariates.
Results
Twenty patients underwent LRLR with three open conversions (15%). Both PSA and 1:1-PSM demonstrated that LRLR was significantly associated with a shorter stay, superior disease-free survival (DFS) but longer operation time compared to ORLR. Comparison between LRLR versus LLR demonstrated that patients undergoing LRLR were significantly older, had smaller tumors, longer operation time and decreased frequency of Pringle’s maneuver applied. There was no difference in other key perioperative outcomes.
Conclusion
The results of this study demonstrate that in highly selected patients; LRLR for rHCC is feasible and safe. LRLR was associated with a shorter hospitalization but longer operation time compared to ORLR. Moreover, other than a longer operation time, LRLR was associated with similar perioperative outcomes compared to LLR for primary HCC.
ABSTRACT
The observation of the transient sky through a multitude of astrophysical messengers has led to several scientific breakthroughs in the last two decades, thanks to the fast evolution of the ...observational techniques and strategies employed by the astronomers. Now, it requires to be able to coordinate multiwavelength and multimessenger follow-up campaigns with instruments both in space and on ground jointly capable of scanning a large fraction of the sky with a high-imaging cadency and duty cycle. In the optical domain, the key challenge of the wide field-of-view telescopes covering tens to hundreds of square degrees is to deal with the detection, identification, and classification of hundreds to thousands of optical transient (OT) candidates every night in a reasonable amount of time. In the last decade, new automated tools based on machine learning approaches have been developed to perform those tasks with a low computing time and a high classification efficiency. In this paper, we present an efficient classification method using convolutional neural networks (CNNs) to discard many common types of bogus falsely detected in astrophysical images in the optical domain. We designed this tool to improve the performances of the OT detection pipeline of the Ground Wide field Angle Cameras (GWAC) telescopes, a network of robotic telescopes aiming at monitoring the OT sky down to R = 16 with a 15 s imaging cadency. We applied our trained CNN classifier on a sample of 1472 GWAC OT candidates detected by the real-time detection pipeline.
Background
Minimally invasive surgery (MIS) for Mirizzi syndrome (MS) remains a technically challenging procedure with a high open conversion rate. We critically evaluated the impact of the ...systematic adoption of MI-HBP surgery on the surgical outcomes of MS.
Methods
Ninety-five patients who underwent surgery for MS were retrospectively reviewed. Systematic adoption of advanced MI-HBP surgery started in 2012. The cohort was classified into a preadoption (2002–2012) (Era 1,
n
= 58) and post-adoption (2013–2017) (Era 2,
n
= 37). Furthermore, Era 2 was divided into a cohort operated by advanced minimally invasive surgeons (AMIS) (Era 2 AMIS,
n
= 19) and those by other surgeons (Era 2 others,
n
= 19).
Results
Comparison between Era 2 and Era 1 demonstrated a significant increase in the frequency of MIS attempted (89% vs 33%,
p
< 0.01), increase in the use of choledochoplasty (24% vs 2%,
p
< 0.01), increase operation time (180 min vs 150 min,
p
= 0.03) and significantly lower open conversion rate (24% vs 58%,
p
< 0.01). Comparison between Era 2 AMIS and Era 2 others demonstrated a significantly greater adoption of MIS (100% vs 78%,
p
= 0.046) with lower open conversion rate (5% vs 50%,
p
= 0.005). Comparison between all attempted MIS cases with open procedures demonstrated a significantly higher proportion of subtotal cholecystectomies performed (40% vs 23%,
p
= 0.04), choledochoplasty (17% vs 2%,
p
= 0.04) and shorter hospital stay (4 days vs 9 days,
p
< 0.01).
Conclusions
Systematic adoption of advanced MI-HBP surgery allowed surgeons to perform MIS for MS more frequently and with a significantly lower open conversion rate. Patients who underwent successful MIS had the shortest hospital stay compared to patients who underwent open surgery or required open conversion.
RNA interference screening identified XPO1 (exportin 1) among the 55 most vulnerable targets in multiple myeloma (MM). XPO1 encodes CRM1, a nuclear export protein. XPO1 expression increases with MM ...disease progression. Patients with MM have a higher expression of XPO1 compared with normal plasma cells (P<0.04) and to patients with monoclonal gammopathy of undetermined significance/smoldering MM (P<0.0001). The highest XPO1 level was found in human MM cell lines (HMCLs). A selective inhibitor of nuclear export compound KPT-276 specifically and irreversibly inhibits the nuclear export function of XPO1. The viability of 12 HMCLs treated with KTP-276 was significantly reduced. KPT-276 also actively induced apoptosis in primary MM patient samples. In gene expression analyses, two genes of probable relevance were dysregulated by KPT-276: cell division cycle 25 homolog A (CDC25A) and bromodomain-containing protein 4 (BRD4), both of which are associated with c-MYC pathway. Western blotting and reverse transcription-PCR confirm that c-MYC, CDC25A and BRD4 are all downregulated after treatment with KPT-276. KPT-276 reduced monoclonal spikes in the Vk*MYC transgenic MM mouse model, and inhibited tumor growth in a xenograft MM mouse model. A phase I clinical trial of an analog of KPT-276 is ongoing in hematological malignancies including MM.
Background
This study aims to compare the short‐ and long‐term outcomes of patients undergoing minimally invasive liver resection (MILR) versus open liver resection (OLR) for nonrecurrent ...hepatocellular carcinoma (HCC).
Methods
Review of 204 MILR and 755 OLR without previous LR performed between 2005 and 2018. 1:1 coarsened exact matching (CEM) and 1:1 propensity‐score matching (PSM) were performed.
Results
Overall, 190 MILR were well‐matched with 190 OLR by PSM and 86 MILR with 86 OLR by CEM according to patient baseline characteristics. After PSM and CEM, MILR was associated with a significantly longer operation time 230 min (interquartile range IQR, 145–330) vs. 160 min (IQR, 125–210), p < .001 215 min (IQR, 135–295) vs. 153.5 min (120–180), p < .001, shorter postoperative stay 4 days (IQR, 3–6) vs. 6 days (IQR, 5–8), p = .001) 4 days (IQR, 3–5) vs. 6 days (IQR, 5–7), p = .004 and lower postoperative morbidity 40 (21%) vs. 67 (35.5%), p = .003 16 (18.6%) vs. 27 (31.4%), p = .036 compared to OLR. MILR was also associated with a significantly longer median time to recurrence (70 vs. 40.3 months, p = .014) compared to OLR after PSM but not CEM. There was no significant difference in terms of overall survival and recurrence‐free survival.
Conclusion
MILR is associated with superior short‐term postoperative outcomes and with at least equivalent long‐term oncological outcomes compared to OLR for HCC.
Introduction
Our primary objective was to determine if receiving intraoperative blood transfusion was a significant prognostic factor for overall and recurrence‐free survival after curative resection ...of hepatic cellular carcinoma (HCC).
Methodology
Between 2001 and 2018, 1092 patients with histologically proven primary HCC who underwent curative liver resection were retrospectively reviewed. Primary study endpoints were recurrence‐free survival (RFS) and overall survival (OS). The main analysis was undertaken using propensity‐score matching (PSM) to minimize confounding and selection biases in the comparison of patients with or without transfusion.
Results
There were 220 patients who received and 666 patients who did not receive intraoperative blood transfusion. The PSM cohort consisted of 163 pairs of patients. After PSM, the only perioperative outcome that appeared to significantly affect whether patients would receive blood transfusion was median blood loss (p = 0.001). In the PSM cohort, whether patients received blood transfusion was neither associated with OS (p = 0.759) nor RFS (p = 0.830). When the volume of blood transfusion was analyzed as a continuous variable, no significant dose–response relationship between blood transfusion volume and HR for OS and RFS was noted.
Conclusion
Intraoperative blood transfusion had no significant impact on the survival outcomes in patients who receive curative resection in primary HCC.
Background
At present, the majority of outcome studies of survival of hepatocellular carcinoma (HCC) post‐liver resection (post‐LR) present actuarial survival data, which often results in ...overestimation of survival. We sought to evaluate the actual 10‐year survival post‐LR for HCC and identify variables that are associated with long‐term survival.
Methods
We performed a retrospective review of 600 consecutive patients who underwent primary LR for HCC from 2000 to 2010 at our institution. Twenty‐eight patients (4.7%) with 90‐day mortality and 125 patients who were lost to follow‐up within 10 years were excluded leaving 447 patients who met the study criteria.
Results
There were 140 actual 10‐year survivors of which 57 (40.7%) had a recurrence within 10 years. The actual 10‐year overall survival (OS) rate of the 447 patients was 31.5% and the actual 10‐year recurrence‐free survival (RFS) was 18.6%. Multivariate analyses demonstrated that only age >65 years (OR, 0.29; p < .001) (OR, 0.973; p = .041) and presence of cirrhosis (OR. 0.37; p = .005) (OR, 0.31; p = .001) were independent factors negatively associated with actual 10‐year OS and actual 10‐year RFS, respectively.
Conclusion
Approximately one‐third of patients will survive over 10 years after LR for HCC. Amongst these 10‐year survivors, 41% had developed recurrent cancer within 10‐years of follow‐up.
Background
Minimally invasive distal pancreatectomy (MIDP) is being adopted increasingly worldwide. This study aimed to compare the short-term outcomes of patients who underwent MIDP versus open ...distal pancreatectomy (ODP).
Methods
A retrospective review of all patients who underwent a DP in our institution between 2005 and 2019 was performed. Propensity score matching based on relevant baseline factors was used to match patients in the ODP and MIDP groups in a 1:1 manner. Outcomes reported include operative duration, blood loss, postoperative length of stay, morbidity, mortality, postoperative pancreatic fistula rates, reoperation and readmission.
Results
In total, 444 patients were included in this study. Of 122 MIDP patients, 112 (91.8%) could be matched. After matching, the median operating time for MIDP was significantly longer than ODP 260 min (200–346.3) vs 180 (135–232.5),
p
< 0.001, while postoperative stay for MIDP was significantly shorter median 6 days (5–8) versus 7 days (6–9),
p
= 0.015. There were no significant differences noted in any of the other outcomes measured. Over time, we observed a decrease in the operation times of MIDP performed at our institution.
Conclusion
Adoption of MIDP offers advantages over ODP in terms of a shorter postoperative hospital stay, without an increase in morbidity and/or mortality but at the expense of a longer operation time.
Background
The management of post-liver resection recurrence is often the life-limiting factor in HCC treatment. While much has been published on intrahepatic recurrence and lung metastasis, there is ...a relative lack of data on intraabdominal extrahepatic metastasis (EHM). We sought to evaluate the outcomes of patients post-resection of intraabdominal EHM and assess preoperative factors predictive of early recurrence post-metastasectomy.
Methods
We performed a retrospective review of 25 consecutive patients who underwent metastasectomy for intraabdominal EHM from 2003 to 2016 at our institution.
Results
Of the 25 cases of EHM, 16 were in the peritoneum, 3 in the adrenal glands, 3 in the large bowel, 1 in the spleen, 1 in the pancreas and 1 in the omentum. Median overall survival was 27 months (IQR 15–89 months). Twenty-one patients (84%) developed recurrence post-metastasectomy of EHM of which 12 patients experienced early recurrence within 12 months. The median time to recurrence post-metastasectomy was 11(IQR 15.5) months. Multivariate analysis demonstrated both hepatitis B (11 (91.6%) versus 4 (44.4%),
p
= 0.00) status and high tumour grade (8 (66.6%) versus 3 (25%),
p
= 0.004) to be significant independent predictors of early recurrence. Patients who experienced early recurrence had a significantly shorter median overall survival (18 months (95% CI 12.9–23.0)) compared to those who did not (89 months (95% CI 24.8–153.1),
p
= 0.004).
Conclusion
Patients with EHM who underwent metastasectomy had a median overall survival of 27 months. Hepatitis B positivity and high primary tumour grade were preoperative predictors of futile surgery. All 7 patients who had both hepatitis B and high tumour grade experienced early recurrence post-metastasectomy.
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