The high rate of early recurrence in hepatocellular carcinoma(HCC)post curative surgical intervention poses a substantial clinical hurdle,impacting patient outcomes and complicating postoperative management.The advent...The high rate of early recurrence in hepatocellular carcinoma(HCC)post curative surgical intervention poses a substantial clinical hurdle,impacting patient outcomes and complicating postoperative management.The advent of machine learning provides a unique opportunity to harness vast datasets,identifying subtle patterns and factors that elude conventional prognostic methods.Machine learning models,equipped with the ability to analyse intricate relationships within datasets,have shown promise in predicting outcomes in various medical disciplines.In the context of HCC,the application of machine learning to predict early recurrence holds potential for personalized postoperative care strategies.This editorial comments on the study carried out exploring the merits and efficacy of random survival forests(RSF)in identifying significant risk factors for recurrence,stratifying patients at low and high risk of HCC recurrence and comparing this to traditional COX proportional hazard models(CPH).In doing so,the study demonstrated that the RSF models are superior to traditional CPH models in predicting recurrence of HCC and represent a giant leap towards precision medicine.展开更多
AIM：To evaluate the diagnostic role of serum RASSF1A promoter hypermethylation in gastric and colorectal adenocarcinoma. METHODS：Methylation-specific polymerase chain reaction （MSPCR） was used to examine the promo...AIM：To evaluate the diagnostic role of serum RASSF1A promoter hypermethylation in gastric and colorectal adenocarcinoma. METHODS：Methylation-specific polymerase chain reaction （MSPCR） was used to examine the promoter methylation status of the serum RASSF1A gene in 47 gastric adenocarcinoma patients, 45 colorectal adenocarcinoma patients, 60 patients with benign gastrointestinal disease （30 with benign gastric disease and 30 with benign colorectal disease）, and 30 healthy donor controls. Apaired study of RASSF1A promoter methylation status in primary tumor, adjacent normal tissue, and postopertive serum were conducted in 25 gastric and colorectal adenocarcinoma patients who later were underwent surgical therapy. RESULTS：The frequencies of detection of serum RASSF1A promoter hypermethylation in gastric （34.0%） and colorectal （28.9%） adenocarcinoma patients were significantly higher than those in patients with benign gastric （3.3%） or colorectal （6.7%） disease or in healthy donors （0%） （P 〈 0.01）. The methylation status of RASSF1A promoter in serum samples was consistent with that in paired primary tumors, and the MSPCR results for RASSF1A promoter methylation status in paired preoperative samples were consistent with those in postoperative serum samples. The serum RASSF1A promoter hypermethylation did not correlate with patient sex, age, tumor differentiation grade, surgical therapy, or serum carcinoembryonic antigen level. Although the serum RASSF1A promoter hypermethylation frequency tended to be higher in patients with distant metastases, there was no correlation between methylation status and metastasis. CONCLUSION：Aberrant CpG island methylation within the promoter region of RASSF1A is a promising biomarker for gastric and colorectal cancer.展开更多
Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation(LDLT).However,in the cases that show pancreatic fistula,the limited volume of the graft and the resultant inad...Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation(LDLT).However,in the cases that show pancreatic fistula,the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula.As a result,the pancreatic fistula may result in the death of the patient.We present 2 cases in whichendoscopic treatment was effective against pancreatic fistulas that developed after LDLT.In case 1,a 61-yearold woman underwent LDLT for primary biliary cirrhosis.Because of a portal venous thrombus caused by a splenorenal shunt,the patient underwent portal vein reconstruction,and a splenorenal shunt was ligated on postoperative day(POD)7.The main pancreatic duct was injured during the manipulation to achieve hemostasis,thereby necessitating open drainage.However,discharge of pancreatic fluid continued even after POD 300.Endoscopic naso-pancreatic drainage(ENPD)was performed,and this procedure resulted in a remarkable decrease in drain output.The refractory pancreatic fistula healed on day 40 after ENPD.In case 2,a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus.When the portal vein was exposed during thrombectomy,the pancreatic head was injured,which led to the formation of a pancreatic fistula.Conservative therapy was ineffective;therefore,ENPD was performed.The pancreatic fistula healed on day 38 after ENPD.The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT.展开更多
Background and Aims:The poor outcomes of hepatocellular carcinoma(HCC)patients may be due to not only malignant tumors but also limited liver function.Therefore,as stated in major guidelines,only patients with relativ...Background and Aims:The poor outcomes of hepatocellular carcinoma(HCC)patients may be due to not only malignant tumors but also limited liver function.Therefore,as stated in major guidelines,only patients with relatively normal liver function(Child-Pugh A)would be referred for curative hepatectomy.Even so,the postsurgery survival rate of patients is still extremely poor.Direct curative resection may benefit most patients.This study aimed to improve the prognosis predicting accuracy of the Child-Pugh scoring system.Methods:This study included two cohorts:cohort A being composed of 613 HCC patients,with a 23-month median postsurgery follow-up time;and cohort B being composed of 554 tumor-free chronic liver disease patients.Kaplan-Meier test and Cox model were used for survival analysis.Independent-samples t test or one-way ANOVA was used to test the differences between different groups.Results:Serum prealbumin levels were found inversely correlated with worsening of flbrotic scores(r=-0.482,p<0.001).Lower levels of presurgery prealbumin was an independent factor of poor postsurgery prognosis in Child-Pugh A patients,with a hazard ratio of 0.731(p=0.001).By integrating prealbumin together with total bilirubin level,serum albumin concentration and prothrombin time,a modified liver disease prognosis scoring system was developed to define traditional Child-Pugh A HCC patients as Modified Child-Pugh MCP-1,MCP-2 and MCP-3,with median postsurgery overall survival times of 44.00,28.00 and 11.00 months respectively.Conclusions:Preoperative serum prealbumin is a valuable prognosis predicting biomarker for Child-Pugh A HCC patients who may be under consideration for curative resection.With serum prealbumin included as one of the parameters,the MCP scoring system might improve the postsurgery survival predicting accuracy for HCC patients.展开更多
Background:Data from single-center experience or small sample-sized studies have shown that chromoendoscopy(CE)might be superior to white-light endoscopy(WLE)for dysplasia surveillance in ulcerative colitis(UC)patient...Background:Data from single-center experience or small sample-sized studies have shown that chromoendoscopy(CE)might be superior to white-light endoscopy(WLE)for dysplasia surveillance in ulcerative colitis(UC)patients.We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies(WLT),WLE with random biopsies(WLR),and dye-based CE with targeted biopsies(CET)in UC patients.Methods:Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms(WLT,WLR,and CET).Only high-definition endoscopy was used in all three groups.The patients were followed up by annual endoscopy with biopsies through December 2017.Results:With a median follow-up time of 55 months,a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set:WLT(n=43),WLR(n=40),and CET(n=39).A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients.WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT(8.1%and 9.7%vs 1.9%;P=0.014 and 0.004,respectively).WLR obtained more biopsied samples than WLT and CET(16.465.1 vs 4.361.4 and 4.361.4;both P<0.001).During the second half of the follow-up(37-69 months),CET could identify more colonoscopies that diagnosed dysplasia than WLT(13.3%vs 1.6%,P=0.015)and showed a trend for increasing the detection rate compared with WLR(13.3%vs 4.9%,P=0.107).Conclusions:For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC,CET appeared to be more effective thanWLT and less tedious than WLR.CET was found to be particularly useful when a long-term(>3 years)follow-up was conducted for dysplasia surveillance.The trial was registered on www.chictr.org.cn(ChiCTR1900023689).展开更多
文摘The high rate of early recurrence in hepatocellular carcinoma(HCC)post curative surgical intervention poses a substantial clinical hurdle,impacting patient outcomes and complicating postoperative management.The advent of machine learning provides a unique opportunity to harness vast datasets,identifying subtle patterns and factors that elude conventional prognostic methods.Machine learning models,equipped with the ability to analyse intricate relationships within datasets,have shown promise in predicting outcomes in various medical disciplines.In the context of HCC,the application of machine learning to predict early recurrence holds potential for personalized postoperative care strategies.This editorial comments on the study carried out exploring the merits and efficacy of random survival forests(RSF)in identifying significant risk factors for recurrence,stratifying patients at low and high risk of HCC recurrence and comparing this to traditional COX proportional hazard models(CPH).In doing so,the study demonstrated that the RSF models are superior to traditional CPH models in predicting recurrence of HCC and represent a giant leap towards precision medicine.
文摘AIM：To evaluate the diagnostic role of serum RASSF1A promoter hypermethylation in gastric and colorectal adenocarcinoma. METHODS：Methylation-specific polymerase chain reaction （MSPCR） was used to examine the promoter methylation status of the serum RASSF1A gene in 47 gastric adenocarcinoma patients, 45 colorectal adenocarcinoma patients, 60 patients with benign gastrointestinal disease （30 with benign gastric disease and 30 with benign colorectal disease）, and 30 healthy donor controls. Apaired study of RASSF1A promoter methylation status in primary tumor, adjacent normal tissue, and postopertive serum were conducted in 25 gastric and colorectal adenocarcinoma patients who later were underwent surgical therapy. RESULTS：The frequencies of detection of serum RASSF1A promoter hypermethylation in gastric （34.0%） and colorectal （28.9%） adenocarcinoma patients were significantly higher than those in patients with benign gastric （3.3%） or colorectal （6.7%） disease or in healthy donors （0%） （P 〈 0.01）. The methylation status of RASSF1A promoter in serum samples was consistent with that in paired primary tumors, and the MSPCR results for RASSF1A promoter methylation status in paired preoperative samples were consistent with those in postoperative serum samples. The serum RASSF1A promoter hypermethylation did not correlate with patient sex, age, tumor differentiation grade, surgical therapy, or serum carcinoembryonic antigen level. Although the serum RASSF1A promoter hypermethylation frequency tended to be higher in patients with distant metastases, there was no correlation between methylation status and metastasis. CONCLUSION：Aberrant CpG island methylation within the promoter region of RASSF1A is a promising biomarker for gastric and colorectal cancer.
文摘Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation(LDLT).However,in the cases that show pancreatic fistula,the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula.As a result,the pancreatic fistula may result in the death of the patient.We present 2 cases in whichendoscopic treatment was effective against pancreatic fistulas that developed after LDLT.In case 1,a 61-yearold woman underwent LDLT for primary biliary cirrhosis.Because of a portal venous thrombus caused by a splenorenal shunt,the patient underwent portal vein reconstruction,and a splenorenal shunt was ligated on postoperative day(POD)7.The main pancreatic duct was injured during the manipulation to achieve hemostasis,thereby necessitating open drainage.However,discharge of pancreatic fluid continued even after POD 300.Endoscopic naso-pancreatic drainage(ENPD)was performed,and this procedure resulted in a remarkable decrease in drain output.The refractory pancreatic fistula healed on day 40 after ENPD.In case 2,a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus.When the portal vein was exposed during thrombectomy,the pancreatic head was injured,which led to the formation of a pancreatic fistula.Conservative therapy was ineffective;therefore,ENPD was performed.The pancreatic fistula healed on day 38 after ENPD.The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT.
基金supported by the SZSM201612071the National S&T Major Project for Infectious Diseases(2017YFC0908100,2017ZX10302201,2017ZX10201201)the project from Beijing Municipal Science and Technology Commission(No.Z161100000116047)
文摘Background and Aims:The poor outcomes of hepatocellular carcinoma(HCC)patients may be due to not only malignant tumors but also limited liver function.Therefore,as stated in major guidelines,only patients with relatively normal liver function(Child-Pugh A)would be referred for curative hepatectomy.Even so,the postsurgery survival rate of patients is still extremely poor.Direct curative resection may benefit most patients.This study aimed to improve the prognosis predicting accuracy of the Child-Pugh scoring system.Methods:This study included two cohorts:cohort A being composed of 613 HCC patients,with a 23-month median postsurgery follow-up time;and cohort B being composed of 554 tumor-free chronic liver disease patients.Kaplan-Meier test and Cox model were used for survival analysis.Independent-samples t test or one-way ANOVA was used to test the differences between different groups.Results:Serum prealbumin levels were found inversely correlated with worsening of flbrotic scores(r=-0.482,p<0.001).Lower levels of presurgery prealbumin was an independent factor of poor postsurgery prognosis in Child-Pugh A patients,with a hazard ratio of 0.731(p=0.001).By integrating prealbumin together with total bilirubin level,serum albumin concentration and prothrombin time,a modified liver disease prognosis scoring system was developed to define traditional Child-Pugh A HCC patients as Modified Child-Pugh MCP-1,MCP-2 and MCP-3,with median postsurgery overall survival times of 44.00,28.00 and 11.00 months respectively.Conclusions:Preoperative serum prealbumin is a valuable prognosis predicting biomarker for Child-Pugh A HCC patients who may be under consideration for curative resection.With serum prealbumin included as one of the parameters,the MCP scoring system might improve the postsurgery survival predicting accuracy for HCC patients.
基金supported by the Chinese National Scientific Research Special-Purpose Project in Public Health Profession Funds[No.201002020]National Natural Science Foundation of China[81421003 and 81627807]+1 种基金National Key Research and Development Plan[2017YFC0908300]Independent Funds of the Key Laboratory[CBSKL2015Z01].
文摘Background:Data from single-center experience or small sample-sized studies have shown that chromoendoscopy(CE)might be superior to white-light endoscopy(WLE)for dysplasia surveillance in ulcerative colitis(UC)patients.We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies(WLT),WLE with random biopsies(WLR),and dye-based CE with targeted biopsies(CET)in UC patients.Methods:Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms(WLT,WLR,and CET).Only high-definition endoscopy was used in all three groups.The patients were followed up by annual endoscopy with biopsies through December 2017.Results:With a median follow-up time of 55 months,a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set:WLT(n=43),WLR(n=40),and CET(n=39).A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients.WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT(8.1%and 9.7%vs 1.9%;P=0.014 and 0.004,respectively).WLR obtained more biopsied samples than WLT and CET(16.465.1 vs 4.361.4 and 4.361.4;both P<0.001).During the second half of the follow-up(37-69 months),CET could identify more colonoscopies that diagnosed dysplasia than WLT(13.3%vs 1.6%,P=0.015)and showed a trend for increasing the detection rate compared with WLR(13.3%vs 4.9%,P=0.107).Conclusions:For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC,CET appeared to be more effective thanWLT and less tedious than WLR.CET was found to be particularly useful when a long-term(>3 years)follow-up was conducted for dysplasia surveillance.The trial was registered on www.chictr.org.cn(ChiCTR1900023689).
