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Background: Aspartate aminotransferase/platelet ratio index (APRI) and albumin-bilirubin grade (ALBI) are validated prognostic indices implicated as predictors of postoperative liver dysfunction after hepatic resection. The aim of this study was to evaluate the relevance of the combined APRI/ALBI score for postoperative clinically meaningful outcomes. Methods: Patients undergoing hepatectomy were included from the American College of Surgeons National Surgical Quality Improvement Program database. The association between APRI/ALBI score and postoperative grade C liver dysfunction, liver dysfunction-associated and overall 30-day mortality was assessed. Results: A total of 12 055 patients undergoing hepatic resection from 2014 to 2017 with preoperative blood values and detailed 30-day postoperative outcomes were included (exploration cohort: January 2014 to December 2016; validation cohort: 2017). In the exploration cohort (8538 patients), the combination of both scores (APRI/ALBI) was significantly associated with postoperative grade C liver dysfunction, 30-day mortality, and liver dysfunction-associated 30-day mortality, and was superior to either score alone. The association with postoperative 30-day mortality was confirmed in multivariable analysis. A predictive model was generated using the exploration cohort. The predicted incidence of events closely followed the observed incidence in the validation cohort (3517 patients). Subgroup analyses of tumour types were used to generate disease-specific risk models to assess risk in different clinical scenarios. These findings informed development of a smartphone application (https://tellaprialbi.37binary.com). Conclusion: The predictive potential of the combined APRI/ALBI score for clinically relevant outcomes such as mortality was demonstrated. An evidence-based smartphone application will allow clinical translation and facilitation of risk assessment before hepatic resection using routine laboratory parameters. [ABSTRACT FROM AUTHOR]

Integrated water management systems using drainage plus subirrigation (DSI) have reduced nitrate-loading of drainage water flow and may increase soybean [Glycine max (L.) Merr.] yield. Shallow drain tile depths and narrow spacings are recommended for claypan soils. Field research (2003-2006) evaluated the effects of drainage (DO) and DSI on planting date and the effects of DO and DSI at 6.1 and 12.2 m spacings on soybean yield compared to nondrained (ND) and nondrained delayed planting (NDDP) controls on claypan soils. Soybean were planted up to 17 d earlier with DO or DSI systems. Plant populations were reduced 29 to 52% in the nondrained control due to poor drainage in 3 of the 4 yr. Grain yield, water applied through the DSI system, and water level depth were similar at a 6.1 or 12.2 m drain tile spacing. Average yield increase with DSI at 6.1 and 12.2 m spacings was 12 to 29% (410-910 kg ha-1) while DO at the same spacings increased yield 9 to 22% (300-710 kg ha-1) compared to ND or NDDP controls. In a dry year (2005), drainage plus subirrigation increased yield up to 1200kg ha-1 compared to DO. Plant population variability at harvest was lower with the DO or DSI systems compared to ND or NDDP controls. Yield variability over the 4 yr was lower with DSI compared with DO or ND controls, which was affected by the spring-summer precipitation regimes and is important to farmers for a more predictable soybean marketing strategy. [ABSTRACT FROM AUTHOR]

To determine whether expanded polytetrafluoroethylene (ePTFE) patches impregnated with silver and chlorhexidine produce any adverse effects, we compared patients in whom impregnated and standard ePTFE patches were implanted at hernia repair. Patients undergoing open or laparoscopic prosthetic inguinal or ventral hernia repair were randomly assigned to receive either an impregnated (n=18) or standard (n=19) ePTFE patch. Assessments were performed preoperatively and on days 7–10, 40–44, and 80–84 postoperatively. Mean values from standard blood tests and urinalyses were within normal ranges in both study groups. The standard-patch group had a higher mean alkaline phosphatase concentration (p=0.02), probably because of two outlying values. In the impregnated-patch group, there was one prolonged ileus and two postoperative seromas. The addition of silver and chlorhexidine to ePTFE patches does not appear to produce any adverse systemic or clinical effects after hernia repair. [ABSTRACT FROM AUTHOR]

Background: A standard technique for laparoscopic ventral hernioplasty (peritoneal onlay using an expanded polytetrafluoroethylene [ePTFE] patch for hernias >/=4 cm2) is being used in a prospective, multicenter, long-term study.Methods: Demographic, operative, and postoperative data were collected and analyzed. Follow-up clinical evaluations were conducted 7-10 days, 4 weeks, 6 months, 1 year, and then annually after surgery in all patients.Results: In the first 2 years of the study, 144 patients were enrolled; nine were lost to follow-up. The mean operating time was 120 min. The mean follow-up was 222 days (range 5-731). Postoperative complications were five infections, three cases of prolonged ileus, one bowel obstruction, 23 seromas (15 resolved without intervention), and six hernia recurrences. Hospital discharge occurred a mean of 2.3 days after surgery and return to normal activity a mean of 15 days postoperatively.Conclusions: Laparoscopic prosthetic ventral hernioplasty avoids the large wound required in open repairs, with attendant complications and recurrences, and appears safe, especially if an ePTFE mesh is used. Compared with conventional open ventral hernioplasty, the laparoscopic technique may also allow shorter hospitalization and a quicker return to normal activities after surgery. [ABSTRACT FROM AUTHOR]

Purpose: There is a lack of clinical data comparing the use of different embolic agents in portal vein embolization (PVE) prior to right hepatectomy to induce hypertrophy of the future liver remnant (FLR). Here we compare the procedural and surgical outcomes following PVE and right hepatectomy in patients embolized with n-butyl-cyanoacrylate (NCBA) or polyvinyl alcohol (PVA) particles. Materials and Methods: Between January 2008 and June 2013, all patients having PVE with either NCBA or PVA prior to right hepatectomy were reviewed. Patient characteristics and PVE related technical data were collected for each group. Volumetric measurements were obtained from pre-PVE and 1-month post-PVE imaging (either CT or MRI). Based on the degree of left lobe hypertrophy, patients went on to right hepatectomy. The number of patients who went on to surgery in each group and their laboratory and clinical outcomes were collected including post-surgical complications, blood transfusion requirements, hepatic steatosis grade, hepatic fibrosis grade, tumor pathology, and hepatic markers (baseline, peak and day 5 bilirubin, AST, and INR). Results: 117 patients underwent PVE prior to right hepatectomy using NCBA (n = 62) or PVA (n = 55) as the embolic material. There was significantly less contrast volume used (p < 0.0001) and less fluoroscopy time (p < 0.0001) during the PVE procedure with NCBA versus PVA. The percentage increase in the FLR volume was 54.7 ± 31.6% for the NCBA group and 47.5 ± 27.4% for the PVA group which was not statistically significant. There were a greater number of patients who required repeat PVE and who were unable to have surgery as a result of inadequate hypertrophy in the PVA group although this was not statistically significant. Surgical outcomes including post-operative complications, number of blood transfusions, and blood work were similar in both groups. Conclusion: PVE performed with either NCBA or PVA particles provides adequate hypertrophy of the future liver remnant with similar volumetric and surgical outcomes. However, PVE with NCBA is a more efficient procedure with trends suggesting greater hypertrophy and less repeat procedures. [Copyright &y& Elsevier]

Herein we explore the role of tyrosine phosphatases in regulating YAP tyrosine phosphorylation and sensitivity to current cytotoxic chemotherapy. B Results: b Profiling of tyrosine phosphatase levels by RT-PCR and immunoblot demonstrated higher levels in KMCH cells compared to HuCCT-1; notably the YAP-interacting phosphatase PTPN11 (SHP2) was elevated. [Extracted from the article]

Background: Posthepatectomy liver failure (PHLF), complications of portal hypertension, and disease recurrence determine the outcome for hepatocellular carcinoma (HCC) patients undergoing liver resection. This study aimed to evaluate the von Willebrand factor antigen (vWF-Ag) as a non-invasive test for clinically significant portal hypertension (CSPH) and a predictive biomarker for time to recurrence (TTR) and overall survival (OS)., Methods: The study recruited 72 HCC patients with detailed preoperative workup from a prospective trial (NCT02118545) and followed for complications, TTR, and OS. Additionally, 163 compensated patients with resectable HCC were recruited to evaluate vWF-Ag cutoffs for ruling out or ruling in CSPH. Finally, vWF-Ag cutoffs were prospectively evaluated in an external validation cohort of 34 HCC patients undergoing liver resection., Results: In receiver operating characteristic (ROC) analyses, vWF-Ag (area under the curve [AUC], 0.828) was similarly predictive of PHLF as indocyanine green clearance (disappearance rate: AUC, 0.880; retention rate: AUC, 0.894), whereas computation of future liver remnant was inferior (AUC, 0.756). Cox-regression showed an association of vWF-Ag with TTR (per 10%: hazard ratio [HR], 1.056; 95% confidence interval [CI] 1.017-1.097) and OS (per 10%: HR, 1.067; 95% CI 1.022-1.113). In the analyses, VWF-Ag yielded an AUC of 0.824 for diagnosing CSPH, with a vWF-Ag of 182% or lower ruling out and higher than 291% ruling in CSPH. Therefore, a highest-risk group (> 291%, 9.7% of patients) with a 57.1% incidence of PHLF was identified, whereas no patient with a vWF-Ag of 182% or lower (52.7%) experienced PHLF. The predictive value of vWF-Ag for PHLF and OS was externally validated., Conclusion: For patients with resectable HCC, VWF-Ag allows for simplified preoperative risk stratification. Patients with vWF-Ag levels higher than 291% might be considered for alternative treatments, whereas vWF-Ag levels of 182% or lower identify patients best suited for surgery., (© 2024. Society of Surgical Oncology.)