Background
The Child–Pugh (CP) score is used widely to assess liver function and predict postoperative outcomes in patients with hepatocellular carcinoma (HCC). Recently, the albumin–bilirubin (ALBI) ...score has been validated as a predictor of overall survival in these patients. This study aimed to compare the ability of the ALBI and CP scores to predict outcomes in patients with HCC after liver resection with curative intent.
Methods
Consecutive patients who underwent liver resection with curative intent for HCC between January 2007 and July 2013 were included in this retrospective study. The performance of the ALBI score in predicting postoperative liver failure (PHLF) and long‐term survival was compared with that of the CP score.
Results
A total of 1242 patients were enrolled. Of these, 166 (13·4 per cent) experienced PHLF. The area under the receiver operating characteristic (ROC) curve of the ALBI score for predicting PHLF was greater than that of the CP score (0·723 versus 0·607; P < 0·001). Similar to findings for CP grade, the incidence and severity of PHLF increased with increasing ALBI grade. The ALBI grade stratified patients into at least two distinct overall survival cohorts (P < 0·001), whereas the CP grade did not. The ALBI grade also classified patients with CP grade A disease into two distinct overall survival cohorts (P < 0·001), and overall survival rates in the group with poorer survival were similar to those in the majority of patients with CP grade B disease. Both CP and ALBI scores had low power in predicting disease‐free survival.
Conclusion
The ALBI grade predicted PHLF and overall survival in patients with HCC undergoing liver resection with curative intent more accurately than the CP grade.
ALBI score may be better
Abstract
A quantum thermal machine is an open quantum system coupled to hot and cold thermal baths. Thus, its dynamics can be well understood using the concepts and tools from non-Hermitian quantum ...systems. A hallmark of non-Hermiticity is the existence of exceptional points where the eigenvalues of a non-Hermitian Hamiltonian or a Liouvillian superoperator and their associated eigenvectors coalesce. Here, we report the experimental realization of a single-ion heat engine and demonstrate the effect of Liouvillian exceptional points on the dynamics and the performance of a quantum heat engine. Our experiments have revealed that operating the engine in the exact- and broken-phases, separated by a Liouvillian exceptional point, respectively during the isochoric heating and cooling strokes of an Otto cycle produces more work and output power and achieves higher efficiency than executing the Otto cycle completely in the exact phase where the system has an oscillatory dynamics and higher coherence. This result opens interesting possibilities for the control of quantum heat engines and will be of interest to other research areas that are concerned with the role of coherence and exceptional points in quantum processes and in work extraction by thermal machines.
The diffuse Galactic γ-ray emission, mainly produced via interactions between cosmic rays and the interstellar medium and/or radiation field, is a very important probe of the distribution, ...propagation, and interaction of cosmic rays in the Milky Way. In this Letter, we report the measurements of diffuse γ rays from the Galactic plane between 10 TeV and 1 PeV energies, with the square kilometer array of the Large High Altitude Air Shower Observatory (LHAASO). Diffuse emissions from the inner (15°<l<125°, |b|<5°) and outer (125°<l<235°, |b|<5°) Galactic plane are detected with 29.1σ and 12.7σ significance, respectively. The outer Galactic plane diffuse emission is detected for the first time in the very- to ultra-high-energy domain (E>10 TeV). The energy spectrum in the inner Galaxy regions can be described by a power-law function with an index of -2.99±0.04, which is different from the curved spectrum as expected from hadronic interactions between locally measured cosmic rays and the line-of-sight integrated gas content. Furthermore, the measured flux is higher by a factor of ∼3 than the prediction. A similar spectrum with an index of -2.99±0.07 is found in the outer Galaxy region, and the absolute flux for 10≲E≲60 TeV is again higher than the prediction for hadronic cosmic ray interactions. The latitude distributions of the diffuse emission are consistent with the gas distribution, while the longitude distributions show clear deviation from the gas distribution. The LHAASO measurements imply that either additional emission sources exist or cosmic ray intensities have spatial variations.
Summary
Background
Inherited epidermodysplasia verruciformis (EV) is a rare skin disorder characterized by susceptibility to specific types of human papilloma virus (HPV) and is strongly associated ...with skin carcinomas. Inactivating mutations in EVER1/EVER2 account for most cases of EV. However, more phenotypes related to but distinct from EV have been reported with an immunodeficiency state but without EVER1/EVER2 mutation, and the genetic basis for these atypical EV cases is poorly understood.
Objectives
To identify the causative gene responsible for three siblings affected by atypical EV but without EVER1/EVER2 mutation.
Methods
Whole‐exome sequencing followed by Sanger sequencing was performed to identify the gene responsible for the patients with atypical EV enrolled in our study.
Results
A homozygous splicing mutation was detected in LCK (c.188‐2A>G). This mutation resulted in an exon 3 deletion T lymphocyte‐specific protein tyrosine kinase isoform, which further led to frameshift mutation and subsequent mRNA decay.
Conclusions
We demonstrate a novel mutation in LCK in a family affected by atypical EV with T‐cell defects, HPV infection and virus‐induced malignancy, providing new clues in the understanding of host defences against HPV and better genetic counselling of patients with the EV phenotype.
What's already known about this topic?
Epidermodysplasia verruciformis (EV) is an unusual genodermatosis characterized by an increased susceptibility to β‐human papillomavirus and is associated with a high risk of skin carcinoma.
Inactivating mutations in EVER1/EVER2 account for most cases of EV.
What does this study add?
Our study suggests an association between a novel splicing mutation in LCK and EV susceptibility.
What is the translational message?
Patients with EV should be tested for T lymphocyte‐specific protein tyrosine kinase deficiency and T‐cell function, which will help guide treatment.
Linked Comment: Uitto and Vahidnezhad. Br J Dermatol 2016; 175:1138–1139.
Several lines of geological and geochemical evidence indicate that the level of atmospheric oxygen was extremely low before 2.45 billion years (Gyr) ago, and that it had reached considerable levels ...by 2.22 Gyr ago. Here we present evidence that the rise of atmospheric oxygen had occurred by 2.32 Gyr ago. We found that syngenetic pyrite is present in organic-rich shales of the 2.32-Gyr-old Rooihoogte and Timeball Hill formations, South Africa. The range of the isotopic composition of sulphur in this pyrite is large and shows no evidence of mass-independent fractionation, indicating that atmospheric oxygen was present at significant levels (that is, greater than 10(-5) times that of the present atmospheric level) during the deposition of these units. The presence of rounded pebbles of sideritic iron formation at the base of the Rooihoogte Formation and an extensive and thick ironstone layer consisting of haematitic pisolites and oölites in the upper Timeball Hill Formation indicate that atmospheric oxygen rose significantly, perhaps for the first time, during the deposition of the Rooihoogte and Timeball Hill formations. These units were deposited between what are probably the second and third of the three Palaeoproterozoic glacial events.
A grand challenge underlies the entire field of topology-enabled quantum logic and information science: how to establish topological control principles driven by quantum coherence and understand the ...time dependence of such periodic driving. Here we demonstrate a few-cycle THz-pulse-induced phase transition in a Dirac semimetalZrTe5that is periodically driven by vibrational coherence due to excitation of the lowest Raman active mode. Above a critical THz-pump field threshold, there emerges a long-lived metastable phase, approximately 100 ps, with unique Raman phonon-assisted topological switching dynamics absent for optical pumping. The switching also manifests itself by distinct features: nonthermal spectral shape, relaxation slowing near the Lifshitz transition where the critical Dirac point occurs, and diminishing signals at the same temperature that the Berry-curvature-induced anomalous Hall effect magnetoresistance vanishes. These results, together with first-principles modeling, identify a mode-selective Raman coupling that drives the system from strong to weak topological insulators with a Dirac semimetal phase established at a critical atomic displacement controlled by the phonon coherent pumping. Harnessing of vibrational coherence can be extended to steer symmetry-breaking transitions, i.e., Dirac to Weyl ones, with implications for THz topological quantum gate and error correction applications.
Abstract
We report on analysis of observations of the bright transient X-ray pulsar Swift J0243.6+6124 obtained during its 2017-2018 giant outburst with Insight-HXMT, NuSTAR, and Swift observatories. ...We focus on the discovery of a sharp state transition of the timing and spectral properties of the source at super-Eddington accretion rates, which we associate with the transition of the accretion disk to a radiation pressure dominated (RPD) state, the first ever directly observed for magnetized neutron star. This transition occurs at slightly higher luminosity compared to already reported transition of the source from sub- to super-critical accretion regime associate with onset of an accretion column. We argue that this scenario can only be realized for comparatively weakly magnetized neutron star, not dissimilar to other ultra-luminous X-ray pulsars (ULPs), which accrete at similar rates. Further evidence for this conclusion is provided by the non-detection of the transition to the propeller state in quiescence which strongly implies compact magnetosphere and thus rules out magnetar-like fields.
ABSTRACT
We report the phase-connected timing ephemeris, polarization pulse profiles, Faraday rotation measurements, and Rotating-Vector-Model (RVM) fitting results of 12 millisecond pulsars (MSPs) ...discovered with the Five-hundred-meter Aperture Spherical radio Telescope (FAST) in the Commensal Radio Astronomy FAST survey (CRAFTS). The timing campaigns were carried out with FAST and Arecibo over 3 yr. 11 of the 12 pulsars are in neutron star–white dwarf binary systems, with orbital periods between 2.4 and 100 d. 10 of them have spin periods, companion masses, and orbital eccentricities that are consistent with the theoretical expectations for MSP–Helium white dwarf (He WD) systems. The last binary pulsar (PSR J1912−0952) has a significantly smaller spin frequency and a smaller companion mass, the latter could be caused by a low orbital inclination for the system. Its orbital period of 29 d is well within the range of orbital periods where some MSP–He WD systems have shown anomalous eccentricities, however, the eccentricity of PSR J1912−0952 is typical of what one finds for the remaining MSP–He WD systems.
Abstract
We report the discovery of a new unidentified extended
γ
-ray source in the Galactic plane named LHAASO J0341+5258 with a pretrial significance of 8.2 standard deviations above 25 TeV. The ...best-fit position is R.A. = 55.°34 ± 0.°11 and decl. = 52.°97 ± 0.°07. The angular size of LHAASO J0341+5258 is 0.°29 ± 0.°06
stat
± 0.°02
sys
. The flux above 25 TeV is about 20% of the flux of the Crab Nebula. Although a power-law fit of the spectrum from 10 to 200 TeV with the photon index
α
= 2.98 ± 0.19
stat
± 0.02
sys
is not excluded, the LHAASO data together with the flux upper limit at 10 GeV set by the Fermi-LAT observation, indicate a noticeable steepening of an initially hard power-law spectrum with a cutoff at ≈50 TeV. We briefly discuss the origin of ultra-high-energy gamma rays. The lack of an energetic pulsar and a young supernova remnant inside or in the vicinity of LHAASO J0341+5258 challenge, but do not exclude, both the leptonic and hadronic scenarios of gamma-ray production.
Malnutrition is a common and critical problem that influences outcome in cancer patients. Body composition reflects a patient's metabolic profile and physiologic reserves, which might be the true ...determinant of prognosis. In the present study, which aimed to identify valuable new prognostic indicators, we investigated the association between computed tomography-quantified body composition and short-term outcomes after gastrectomy for gastric cancer.
Skeletal muscle index, mean muscle attenuation, and ratio of visceral-to-subcutaneous adipose tissue area (vsr) were calculated from preoperative computed tomography images. Low skeletal muscle index, low mean muscle attenuation, and high vsr were respectively termed "sarcopenia," "myosteatosis," and "visceral obesity." The association of body composition with postoperative complications and serum markers of nutrition and inflammation after radical gastrectomy were analyzed.
The overall complication rate was significantly higher in the sarcopenia (62.5% vs. 27.3%,
= 0.001) and myosteatosis groups (38.2% vs. 4%,
= 0.002). Patients with visceral obesity had a higher incidence of inflammatory complications (20.3% vs. 6.5%,
= 0.01). Multivariate logistic regression analysis demonstrated that sarcopenia (
= 0.013), myosteatosis (
= 0.017), and low serum retinol-binding protein (
= 0.019) were independent risk factors for overall complications. Compared with control subjects, patients with sarcopenia had lower postoperative levels of serum retinol-binding protein (
= 0.007), and patients with visceral obesity had higher levels of C-reactive protein (
= 0.026).
Sarcopenia, myosteatosis, and visceral obesity were significantly associated with increased rates of postoperative complications and affected the postoperative nutrition and inflammation status of patients with gastric cancer.
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