Background
Approximately one-quarter of patients with Barcelona Clinic Liver Cancer (BCLC) stage 0/A hepatocellular carcinoma (HCC) suffer from tumor relapse within the first year after surgical ...resection. Little data is available for inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI), in predicting the clinical outcome of patients with very early/early stage HCC who underwent curative surgery.
Methods
A retrospective cohort study of 324 patients with BCLC stage 0/A primary HCC undergoing surgical resection was conducted to investigate the prognostic impacts of NLR, PLR, and PNI.
Results
The low-PNI group (<45) had an adverse overall survival (1-year survival rate of 92 vs. 97 %; 5-year survival rate of 57 vs. 82 %;
p
< 0.001) and disease-free survival (1-year survival rate of 69 vs. 85 %; 5-year survival rate of 39 vs. 63 %;
p
< 0.001). It was an independent predictor for disease-specific death, and early and late tumor relapses, with hazard ratios of 2.78 (
p
< 0.001), 1.82 (
p
= 0.011), and 2.55 (
p
= 0.013), respectively. Neither NLR nor PLR had any prognostic significance.
Conclusions
The PNI is a significant prognostic factor for OS and DFS of patients with very early/early stage HCC receiving curative surgery.
In this paper, we focus on the problems of load scheduling and power trading in systems with high penetration of renewable energy resources (RERs). We adopt approximate dynamic programming to ...schedule the operation of different types of appliances including must-run and controllable appliances. We assume that users can sell their excess power generation to other users or to the utility company. Since it is more profitable for users to trade energy with other users locally, users with excess generation compete with each other to sell their respective extra power to their neighbors. A game theoretic approach is adopted to model the interaction between users with excess generation. In our system model, each user aims to obtain a larger share of the market and to maximize its revenue by appropriately selecting its offered price and generation. In addition to yielding a higher revenue, consuming the excess generation locally reduces the reverse power flow, which impacts the stability of the system. Simulation results show that our proposed algorithm reduces the energy expenses of the users. The proposed algorithm also facilitates the utilization of RERs by encouraging users to consume excess generation locally rather than injecting it back into the power grid.
We examined the global incidence and mortality rates of liver cancer, and evaluated the association between incidence/mortality and socioeconomic development (Human Development Index HDI and Gross ...Domestic Product GDP) using linear regression analysis. The average annual percent change (AAPC) of the trends was evaluated from join-point regression analysis. The global incidence of liver cancer varied widely by nine-fold, and was negatively correlated with HDI (men: r = -0.232, p = 0.003; women: r = -0.369, p < 0.001) and GDP per capita (men: r = -0.164, p = 0.036; women: r = -0.212, p = 0.007). Its mortality showed a similarly negative correlation with both indices. The greatest incidence rise in men was observed in Poland (AAPC = 17.5, 95% C.I. = 5.6, 30.9) and Brazil (AAPC = 13.2, 95% C.I. = 5.9, 21.0), whereas Germany (AAPC = 6.6, 95% C.I = 2.0, 11.5) and Norway (AAPC = 6.5, 95% C.I. = 3.2, 10.0) had the greatest increase in women. The mortality rates paralleled the incidence rates in most countries. For mortality, Malta (AAPC = 11.5, 95% C.I. = 3.9, 19.8), Australia (AAPC = 6.8, 95% C.I. = 2.2, 11.5) and Norway (APCC = 5.6, 95% C.I. = 2.8, 8.5) reported the biggest increase among men; whilst Australia (AAPC = 13.4, 95% C.I. = 7.8, 19.4) and Singapore (AAPC = 7.7, 95% C.I. = 4.1, 11.5) showed the most prominent rise among women. These epidemiological data identified countries with potentially increasing trends of liver cancer for preventive actions.
Nonalcoholic fatty liver disease Brunt, Elizabeth M; Wong, Vincent W-S; Nobili, Valerio ...
Nature reviews. Disease primers,
12/2015, Volume:
1
Journal Article
Peer reviewed
Nonalcoholic fatty liver disease (NAFLD) is a disorder characterized by excess accumulation of fat in hepatocytes (nonalcoholic fatty liver (NAFL)); in up to 40% of individuals, there are additional ...findings of portal and lobular inflammation and hepatocyte injury (which characterize nonalcoholic steatohepatitis (NASH)). A subset of patients will develop progressive fibrosis, which can progress to cirrhosis. Hepatocellular carcinoma and cardiovascular complications are life-threatening co-morbidities of both NAFL and NASH. NAFLD is closely associated with insulin resistance; obesity and metabolic syndrome are common underlying factors. As a consequence, the prevalence of NAFLD is estimated to be 10-40% in adults worldwide, and it is the most common liver disease in children and adolescents in developed countries. Mechanistic insights into fat accumulation, subsequent hepatocyte injury, the role of the immune system and fibrosis as well as the role of the gut microbiota are unfolding. Furthermore, genetic and epigenetic factors might explain the considerable interindividual variation in disease phenotype, severity and progression. To date, no effective medical interventions exist that completely reverse the disease other than lifestyle changes, dietary alterations and, possibly, bariatric surgery. However, several strategies that target pathophysiological processes such as an oversupply of fatty acids to the liver, cell injury and inflammation are currently under investigation. Diagnosis of NAFLD can be established by imaging, but detection of the lesions of NASH still depend on the gold-standard but invasive liver biopsy. Several non-invasive strategies are being evaluated to replace or complement biopsies, especially for follow-up monitoring.
It is uncertain whether aspirin therapy should be continued after endoscopic hemostatic therapy in patients who develop peptic ulcer bleeding while receiving low-dose aspirin.
To test that continuing ...aspirin therapy with proton-pump inhibitors after endoscopic control of ulcer bleeding was not inferior to stopping aspirin therapy, in terms of recurrent ulcer bleeding in adults with cardiovascular or cerebrovascular diseases.
A parallel randomized, placebo-controlled noninferiority trial, in which both patients and clinicians were blinded to treatment assignment, was conducted from 2003 to 2006 by using computer-generated numbers in concealed envelopes. (ClinicalTrials.gov registration number: NCT00153725)
A tertiary endoscopy center.
Low-dose aspirin recipients with peptic ulcer bleeding.
78 patients received aspirin, 80 mg/d, and 78 received placebo for 8 weeks immediately after endoscopic therapy. All patients received a 72-hour infusion of pantoprazole followed by oral pantoprazole. All patients completed follow-up.
The primary end point was recurrent ulcer bleeding within 30 days confirmed by endoscopy. Secondary end points were all-cause and specific-cause mortality in 8 weeks.
156 patients were included in an intention-to-treat analysis. Three patients withdrew from the trial before finishing follow-up. Recurrent ulcer bleeding within 30 days was 10.3% in the aspirin group and 5.4% in the placebo group (difference, 4.9 percentage points 95% CI, -3.6 to 13.4 percentage points). Patients who received aspirin had lower all-cause mortality rates than patients who received placebo (1.3% vs. 12.9%; difference, 11.6 percentage points CI, 3.7 to 19.5 percentage points). Patients in the aspirin group had lower mortality rates attributable to cardiovascular, cerebrovascular, or gastrointestinal complications than patients in the placebo group (1.3% vs. 10.3%; difference, 9 percentage points CI, 1.7 to 16.3 percentage points).
The sample size is relatively small, and only low-dose aspirin, 80 mg, was used. Two patients with recurrent bleeding in the placebo group did not have further endoscopy.
Among low-dose aspirin recipients who had peptic ulcer bleeding, continuous aspirin therapy may increase the risk for recurrent bleeding but potentially reduces mortality rates. Larger trials are needed to confirm these findings.
Recent advancement of distributed renewable generation has motivated microgrids to trade energy directly with one another, as well as with the utility, in order to minimize their operational costs. ...Energy trading among microgrids, however, confronts challenges such as reaching a fair trading price, maximizing participants' profit, and satisfying power network constraints. In this paper, we formulate the direct energy trading among multiple microgrids as a generalized Nash bargaining (GNB) problem that involves the distribution network's operational constraints (e.g., power balance equations and voltage limits). We prove that solving the GNB problem maximizes the social welfare and also fairly distributes the revenue among the microgrids based on their market power. To address the nonconvexity of the GNB problem, we propose a two-phase approach. The first phase involves solving the optimal power flow problem in a distributed fashion using the alternative direction method of multipliers to determine the amount of energy trading. The second phase determines the market clearing price and mutual payments of the microgrids. Simulation results on an IEEE 33-bus system with four microgrids show that the proposed framework substantially reduces total network cost by 37.2%. Our results suggest direct trading need be enforced by regulators to maximize the social welfare.
Cell-free DNA (cfDNA) in human plasma is a class of biomarkers with many current and potential future diagnostic applications. Recent studies have shown that cfDNA molecules are not randomly ...fragmented and possess information related to their tissues of origin. Pathologies causing death of cells from particular tissues result in perturbations in the relative distribution of DNA from the affected tissues. Such tissue-of-origin analysis is particularly useful in the development of liquid biopsies for cancer. It is therefore of value to accurately determine the relative contributions of the tissues to the plasma DNA pool in a simultaneous manner. In this work, we report that in open chromatin regions, cfDNA molecules show characteristic fragmentation patterns reflected by sequencing coverage imbalance and differentially phased fragment end signals. The latter refers to differences in the read densities of sequences corresponding to the orientation of the upstream and downstream ends of cfDNA molecules in relation to the reference genome. Such cfDNA fragmentation patterns preferentially occur in tissue-specific open chromatin regions where the corresponding tissues contributed DNA into the plasma. Quantitative analyses of such signals allow measurement of the relative contributions of various tissues toward the plasma DNA pool. These findings were validated by plasma DNA sequencing data obtained from pregnant women, organ transplantation recipients, and cancer patients. Orientation-aware plasma DNA fragmentation analysis therefore has potential diagnostic applications in noninvasive prenatal testing, organ transplantation monitoring, and cancer liquid biopsy.
Integration of distributed generation based on renewable energy sources into the power system has gained popularity in recent years. Many small-scale electricity suppliers (SESs) have recently ...entered the electricity market, which has been traditionally dominated by a few large-scale electricity suppliers. The emergence of SESs enables direct trading (DT) of electricity between SESs and end-users (EUs), without going through retailers, and promotes the possibility of improving the benefits to both parties. In this paper, the cooperation between SESs and EUs in DT is analyzed based on coalitional game theory. In particular, an electricity pricing scheme that achieves a fair division of revenue between SESs and EUs is analytically derived by using the asymptotic Shapley value. The asymptotic Shapley value is shown to be in the core of the coalitional game such that no group of SESs and EUs has an incentive to abandon the coalition, which implies the stable operation of DT for the proposed pricing scheme. Unlike the existing pricing schemes that typically require multiple stages of calculations and real time information about each participant, the electricity price for the proposed scheme can be determined instantaneously based on the number of participants in DT and statistical information about electricity supply and demand. Therefore, the proposed pricing scheme is suitable for practical implementation. Using computer simulations, the price of electricity for the proposed DT scheme is examined in various environments, and the numerical results validate the asymptotic analysis. Moreover, the revenues of the SESs and EUs are evaluated for various types of SESs and different numbers of participants in DT. The optimal ratio of different types of SESs is also investigated.
Load aggregators can use demand response programs to motivate residential users toward reducing electricity demand during peak time periods. This article proposes a demand response algorithm for ...residential users, while accounting for uncertainties in the load demand and electricity price, users' privacy concerns, and power flow constraints imposed by the distribution network. To address the uncertainty issues, we develop a deep reinforcement learning (DRL) algorithm using an actor-critic method. We apply federated learning to enable users to determine the neural network parameters in a decentralized fashion without sharing private information (e.g., load demand, users' potential discomfort due to load scheduling). To tackle the nonconvex power flow constraints, we apply convex relaxation and transform the problem of updating the neural network parameters into a sequence of semidefinite programs (SDPs). Simulations on an IEEE 33-bus test feeder with 32 households show that the proposed demand response algorithm can reduce the peak load by 33% and the expected cost of each user by 13%. Also, we demonstrate the scalability of the proposed algorithm in 330-bus and 1650-bus feeders with real-time pricing scheme.
Summary
Background
Non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH) account for an increasing proportion of liver disease in the Asia‐Pacific region. Many areas in ...the region are experiencing epidemics of metabolic syndrome among rapidly ageing populations.
Aims
To estimate using modelling the growth in NAFLD populations, including cases with significant fibrosis that are most likely to experience advanced liver disease and related mortality.
Methods
A disease progression model was used to summarise and project fibrosis progression among the NAFLD populations of Hong Kong, Singapore, South Korea and Taiwan. For each area, changes in the adult prevalence of obesity was used to extrapolate long‐term trends in NAFLD incidence.
Results
In the areas studied, prevalent NAFLD cases were projected to increase 6%‐20% during 2019‐2030, while prevalent NASH cases increase 20%‐35%. Incident cases of hepatocellular carcinoma are projected to increase by 65%‐85%, while incident decompensated cirrhosis cases increase 65%‐100% by 2030. Likewise, NAFLD‐related mortality is projected to increase between 65% and 100% from 2019 to 2030. NAFLD disease burden is expected to increase alongside rising trends in metabolic syndrome and obesity among populations in the region. This leads to more cases of advanced liver disease and associated mortality.
Conclusions
Preventing the growth of diabetic and obese populations will be a key factor in reducing ongoing increases in NAFLD‐related disease burden in the Asia‐Pacific region.
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