Although recent years have seen considerable interest in stimuli‐responsive hydrogels, their strict preparation conditions and narrow applicability limit their use as diverse sensors and soft robots. ...Herein, a versatile Agar‐Zwirrions hybrid hydrogel actuator (Agar/PSBMA) integrated with simultaneous temperature self‐sensing and wide‐range electrical response is developed. To prepare the Agar/PSBMA hydrogel, a simple and controllable preforming post‐enhancing and mechanical pressing method is used by introducing zwitterions materials into a temperature‐sensitive Agar matrix. Owing to the design, the compact multiplex complementary structure generated by this method and the materials can facilitate the improvement of flexibility, stretchability, and toughness while providing mechanical dissipation and adhesion properties. Importantly, the visible detected temperature self‐sensing ability during 10–40 °C, and quick and wide‐range bending responses of both high‐voltage and low‐voltage electric fields make it unique over other actuators. Furthermore, the electrical response behavior of the hydrogel is found to be impacted by mechanical characteristics and charge polarization based on the finite element Abaqus simulations analysis. The prepared versatile hydrogels show the potential for applications as soft robotics and controlled transportation of adhered substances while simultaneously monitoring their working temperature, which expands the response range of hydrogel actuators and broadens the scope of application.
The versatile hybrid hydrogel is developed by incorporating zwitterions into a temperature‐sensitive Agar matrix via simple preforming post‐enhancing and mechanical pressing methods. This Agar/PSBMA hydrogel shows mechanical stability, temperature self‐sensing, wide‐range bending responses of high‐voltage and low‐voltage electric fields, and potential for use in soft robotics and controlled substance transport.
Background/Purpose
Since minimally invasive surgery has been incorporated in overall surgery, pure laparoscopic technology is involved in most hepatectomies, including right hepatectomy, in patients ...with hepatocellular carcinoma (HCC). However, its feasibility and safety in right hepatectomy are still controversial owing to the limited literature. This study aimed to compare the short‐ and long‐term outcomes of pure laparoscopic right hepatectomy (PLRH) with those of open right hepatectomy (ORH) in patients with HCC.
Methods
The prospectively collected medical records of 327 patients with HCC who underwent right hepatectomy between January 2010 and April 2020 at Seoul National University Hospital were retrospectively reviewed. We performed 1:1 propensity score matching between the PLRH and ORH groups. The primary end point was short‐term outcomes, including hospital stay, blood loss, and morbidity; the secondary end point was long‐term outcomes, including overall and recurrence‐free survival.
Results
Forty‐nine patients were included in each group. Patients who underwent PLRH had a shorter postoperative hospital stay than those who underwent ORH (12.2 vs 8.9 days; P < .001). The requirement for blood transfusion was significantly lower in the PLRH group than in the ORH group (10.2% vs 2.0%; P = .010). The operative time (P = .479) and proportion of major complications (P = .487) were comparable between the groups. There were no significant differences in overall survival (P = .524) and the recurrence‐free survival rate (P = .576) between the groups.
Conclusions
Postoperative outcomes, including oncological outcomes, were comparable between PLRH and ORH, showing that PLRH can be a safe and feasible option to replace ORH in patients with HCC.
Nam et al. found that the pure laparoscopic right hepatectomy group showed postoperative outcomes, including oncologic outcomes, similar to those of the conventional open right hepatectomy group, with shorter postoperative hospital stay and lower requirement for blood transfusion. Pure laparoscopic right hepatectomy is safe and feasible for selected patients with hepatocellular carcinoma.
Hepatocellular carcinoma harbors numerous genomic and epigenomic aberrations of DNA copy numbers and DNA methylation. Transcriptomic deregulation by these aberrations plays key driver roles in ...heterogeneous progression of cancers. Here, we profile DNA copy numbers, DNA methylation, and messenger RNA expression levels from 64 cases of hepatocellular carcinoma specimens. We find that the frequencies of the aberrancies of the DNA copy-number-correlated (CNVcor) expression genes and the methylation-correlated expression (METcor) genes are co-regulated significantly. Multi-omics integration of the CNVcor and METcor genes reveal three prognostic subtypes of hepatocellular carcinoma, which can be validated by an independent data. The most aggressive subtype expressing stemness genes has frequent BAP1 mutations, implying its pivotal role in the aggressive tumor progression. In conclusion, our integrative analysis of genomic and epigenomic regulation provides new insights on the multi-layered pathobiology of hepatocellular carcinoma, which might be helpful in developing precision management for hepatocellular carcinoma patients.Hepatocellular carcinoma is known to harbour numerous genomic and epigenomic aberrations, driving transcriptomic deregulation. Here, the authors integrate genomic, epigenomic, and expression data to reveal three prognostic subtypes, providing insight to the pathobiology of hepatocellular carcinoma.
Combined liver‐kidney transplantation (CLKT) is a surgical procedure that involves transplanting both liver and kidney organs. There are two types of CLKT: simultaneous liver‐kidney transplantation ...(smLKT) and sequential LKT (sqLKT). CLKT accounts for a small percentage of liver transplantations (LTs), particularly in pediatric cases. Nevertheless, the procedure has demonstrated excellent outcomes, with high survival rates and lower rejection rates. The main indications for CLKT in pediatric patients differ somewhat from that in adults, in which end‐stage kidney disease after LT is the major indication. In children, congenital diseases are common reason for performing CLKT; the examples of such diseases include autosomal recessive polycystic kidney disease with congenital hepatic fibrosis which equally affects both organs, and primary hyperoxaluria type 1, a primary liver disease leading kidney failure. The decision between smLKT or sqLKT depends on the dominant organ failure, the specific pathophysiology, and available organ sources. However, there remain significant surgical and societal challenges surrounding CLKT. Innovations in pharmacology and genetic engineering have decreased the necessity for CLKT in early‐diagnosed cases without portal hypertension or kidney replacement therapy. Nonetheless, these advancements are not universally accessible. Therefore, decision‐making algorithms should be crafted, considering region‐specific organ allocation systems and prevailing medical environments.
ABSTRACT
Minimally invasive approaches are increasingly being applied in surgeries and have recently been used in living donor hepatectomy. We have developed a safe and reproducible method for ...minimally invasive living donor liver transplantation, which consists of pure laparoscopic explant hepatectomy and pure laparoscopic implantation of the graft, which was inserted through a suprapubic incision. Pure laparoscopic explant hepatectomy without liver fragmentation was performed in a 60‐year‐old man with alcoholic liver cirrhosis and hepatocellular carcinoma. The explanted liver was retrieved through a suprapubic incision. A modified right liver graft, procured from his 24‐year‐old son using the pure laparoscopic method, was inserted through a suprapubic incision, and implantation was performed intracorporeally throughout the procedure. The time required to remove the liver was 369 min, and the total operative time was 960 min. No complications occurred during or after the surgery. The patient recovered well, and his hospital stay was of 11 days. Pure laparoscopic living donor liver transplantation from explant hepatectomy to implantation was performed successfully. It is a feasible procedure when performed by a highly experienced surgeon and transplantation team. Further studies with larger sample sizes are needed to confirm its safety and feasibility.
Pure laparoscopic living donor liver transplantation from explant hepatectomy to implantation is a feasible procedure when performed by a highly experienced surgeon and transplantation team. Cherqui comments on page 5.
Purpose To compare the diagnostic performance of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging with that of contrast material-enhanced multidetector computed tomography (CT) in the ...detection of borderline hepatocellular nodules in patients with liver cirrhosis and to determine the Liver Imaging Reporting and Data System (LI-RADS) categories of these detected nodules. Materials and Methods The institutional review board approved this retrospective study and waived the informed consent requirement. Sixty-eight patients with pathologically proven dysplastic nodules (DNs) (low-grade DNs, n = 20; high-grade DNs, n = 17), early hepatocellular carcinomas (HCCs) (n = 42), or progressed HCCs (n = 33) underwent gadoxetic acid-enhanced MR imaging and multidetector CT. An additional 57 patients without any DNs or HCCs in the explanted livers were included as control subjects. Three radiologists independently graded the presence of liver nodules on a five-point confidence scale and assigned LI-RADS categories by using imaging findings. Jackknife alternative free-response receiver operating characteristics (JAFROC) software was used to compare the diagnostic accuracy of each modality in lesion detection. Results Reader-averaged figures of merit estimated with JAFROC software to detect hepatocellular nodules were 0.774 for multidetector CT and 0.842 for MR imaging (P = .002). Readers had significantly higher detection sensitivity for early HCCs with MR imaging than with multidetector CT (78.6% vs 52.4% P = .001, 71.4% vs 50.0% P = .011, and 73.8% vs 50.0% P = .001, respectively). A high proportion of overall detected early HCCs at multidetector CT (59.4%) and MR imaging (72.3%) were categorized as LI-RADS category 4. Most early HCCs (76.2%) and high-grade DNs (82.4%) demonstrated hypointensity on hepatobiliary phase images. In total, 30 more LI-RADS category 4 early HCCs were identified with MR imaging than with multidetector CT across all readers. Conclusion Gadoxetic acid-enhanced MR imaging performed significantly better in the detection of high-risk borderline nodules, especially early HCCs, than did multidetector CT.
RSNA, 2017 Online supplemental material is available for this article.
Background
Early recurrence after liver resection of hepatocellular carcinoma (HCC) has a great effect on the survival of patients. The aims of this study were to identify risk factors for early ...recurrence and to clarify whether early recurrence is related to patient survival rate.
Methods
We identified a total of 1010 patients with HCC recurrence after hepatic resection between 2009 and 2014 in Samsung Medical Center and Seoul National University Hospital. Inclusion criteria were preoperative solitary tumor Child-Pugh class A and curative hepatectomy. Early recurrence was defined as HCC recurrence < 1 year after surgery.
Results
A total of 628 patients were included in this study: 302 with early recurrence and 326 with late recurrence. Multivariate analysis showed that HCC grade 3 or 4, tumor size > 3 cm, and microvascular invasion were closely associated with early recurrence after liver resection for solitary HCC. When HCC recurred, the early recurrence group had large tumor size, increased tumor numbers and AFP levels, and high incidence of diffuse intrahepatic recurrence compared with the late recurrence group. The overall survival curve for the early recurrence group was lower than that for the late recurrence group (
P
< 0.001). Multivariate analysis demonstrated early recurrence was closely associated with patient survival.
Conclusions
Patients with early recurrence had different characteristics compared to patients with late recurrence after hepatic resection in solitary HCC. Early detection of recurrence is necessary through active postoperative surveillance in hepatectomy patients with poor prognostic factors.
Little is known about the performance of abbreviated MRI (AMRI) for secondary surveillance of recurrent hepatocellular carcinoma (HCC) after curative treatment.
To evaluate the detection performance ...of AMRI for secondary surveillance of HCC after curative treatment.
Retrospective.
A total of 243 patients (183 men and 60 women; median age, 65 years) who underwent secondary surveillance for HCC using gadoxetic acid-enhanced MRI after more than 2 year of disease-free period following curative treatment, including surgical resection or radiofrequency ablation (RFA).
A 3.0 T/noncontrast AMRI (NC-AMRI) (T2-weighted fast spin-echo, T1-weighted gradient echo, and diffusion-weighted images), hepatobiliary phase AMRI (HBP-AMRI) (T2-weighted fast spin-echo, diffusion-weighted, and HBP images), and full-sequence MRI ASSESSMENT: Four board-certified radiologists independently reviewed NC-AMRI, HBP-AMRI, and full-sequence MRI sets of each patient for detecting recurrent HCC.
Per-lesion sensitivity, per-patient sensitivity and specificity for HCC detection at each set were compared using generalized estimating equation.
A total of 42 recurred HCCs were confirmed in the 39 patients. The per-lesion and per-patient sensitivities did not show significant differences among the three image sets for either reviewer (P ≥ 0.358): per-lesion sensitivity: 59.5%-83.3%, 59.5%-85.7%, and 59.5%-83.3%, and per-patient sensitivity: 53.9%-83.3%, 56.4%-85.7%, and 53.9%-83.3% for NC-AMRI, HBP-AMRI, and full-sequence MRI, respectively. Per-lesion pooled sensitivities of NC-AMRI, HBP-AMRI, and full-sequence MRI were 72.6%, 73.2%, and 73.2%, with difference of -0.6% (95% confidence interval: -6.7, 5.5) between NC-AMRI and full-sequence MRI and 0.0% (-6.1, 6.1) between HBP-AMRI and full-sequence MRI. Per-patient specificity was not significantly different among the three image sets for both reviewers (95.6%-97.1%, 95.6%-97.1%, and 97.6%-98.5% for NC-AMRI and HBP-AMRI, respectively; P ≥ 0.117).
NC-AMRI and HBP-AMRI showed no significant difference in detection performance to that of full-sequence gadoxetic acid-enhanced MRI during secondary surveillance for HCC after more than 2-year disease free interval following curative treatment. Based on its good detection performance, short scan time, and lack of contrast agent-associated risks, NC-AMRI is a promising option for the secondary surveillance of HCC.
3.
Stage 2.
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