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Background: Salvage liver transplantation (SLT) is the ideal treatment for patients with recurrent hepatocellular carcinoma (HCC) and liver cirrhosis. The optimal timing for offering SLT was controversial. This study aimed at investigating the impact of time to recurrence and other prognostic factors on survival outcome after SLT.Methods: Between May 2000 and April 2019, patients who had undergone hepatectomy or ablation for HCC and later received SLT in Queen Mary Hospital were included. Clinico-pathological data during primary treatment and SLT were retrospectively reviewed. Kaplan-Meier analysis and log-rank test were used to determine overall and disease-free survival after SLT. Prognostic factors affecting overall and disease-free survival were determined by multivariate analysis using Cox regression analysis. P-value of less than 0.05 was considered statistically significant.Results: Fifty-three patients were identified within the specified period including 22 patients in early recurrence group (ER group, time to recurrence within 1 year) and 31 patients in late recurrence group (LR group, time to recurrence more than 1 year). The 1-, 5-, and 10-year overall survival after primary treatment was 100%, 76.6%, and 61.1% in the ER group and 100%, 90%, and 76.4% in the LR group (p = 0.59). There were no statistical differences in overall survival (p = 0.84) and disease-free survival (p = 0.85) after SLT between ER and LR group. Pre-transplant alpha-fetoprotein >  = 400 ng/mL (p = 0.007) and macrovascular invasion in explant (p = 0.002) were independent risk factors for shorter overall survival after primary treatment.Conclusion: Time to recurrence after primary treatment of HCC did not affect survival outcome after SLT. With careful patient selection, SLT could be offered to patient with early or late tumor recurrence. [ABSTRACT FROM AUTHOR]

Abstract Sushi is a popular food product in Hong Kong and around the world. It has been found susceptible to fraudulent substitution or mislabeling in various countries in North America, Europe, and Asia. In Hong Kong, the hygiene aspect of sushi products is tightly regulated, with regular evaluation of bacterial content. However, less concern is put on the authenticity and labeling of sushi products. The present study represents a first DNA-based survey for the identification of fish and fish roes used in sushi products commonly available in Hong Kong. The accuracy of the English and/or Chinese names on the product labels was also evaluated based on the common names of the identified species shown in FishBase (for English labels) and The Fish Database of Taiwan (for Chinese labels). Accuracy of local common names (in Chinese) were assessed individually. Ninety-three pieces of sushi, with 85 fish samples and 43 roe samples, were collected from restaurants and other retailers for 16S rRNA gene sequencing. All samples were successfully sequenced. Species identification was performed by BLAST and phylogenetic clustering. The molecular results were then used to verify the information declared at purchase. Out of the 128 samples, 96 samples were labeled in English and 107 samples in Chinese. The overall rate of mislabeling in English was 26.0% (25/96) and that in Chinese was 17.8% (19/107), reflecting a moderate level of mislabeling. The English labels phonetically translated from Japanese had a high rate of mislabeling (40%). The most commonly mislabeled sushi type was herring roe of herring sushi, most of which was identified as Mallotus villosus (capelin). Highlights • 93 pieces of sushi were collected in Hong Kong for 16S rRNA sequencing analysis. • 16S rRNA sequence identified most fish in sushi products at genus or species level. • Overall rate of mislabeling in English was 26.0% and that in Chinese was 17.8%. • English labels translated from Japanese had a high rate of mislabeling (40%). [ABSTRACT FROM AUTHOR]

Highlights • Using a lab-on-a-disc (LOAD) approach, sample-to-answer detection of genetically modified (GM) papaya was designed. • A detectable signal was achieved in 20 min, which is faster than the traditional benchtop setup. • The fluorescent signal from the LOAD platform could be observed by eye and quantified by smartphone app. • Detection limit for GM screening was 10 pg/µL DNA and 0.02 µL papaya juice. • On-site testing of transgenic food in our portable LOAD platform was achieved. Abstract With genetically modified (GM) food circulating on the market, a rapid transgenic food screening method is needed to protect consumer rights. The on-site screening efficiency of GM food testing is low. We report rapid sample-to-answer detection of GM papayas with loop-mediated isothermal amplification (LAMP) and a compact, portable, integrated microfluidic platform using microfluidic lab-on-a-disc (LOAD). GM samples were differentiated from non-GM papaya, based on the detection of a specific GM (P-35S (Cauliflower mosaic virus 35S promoter)) and non-GM DNA marker (papain) in 15 min. The detection limits for DNA and juice from papaya were 10 pg/µL and 0.02 µL, respectively. Our LOAD platform is a simple and robust solution for GM screening, which is anticipated to be a foundation for on-site testing of transgenic food. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the merits of the anterior approach, if any, in colorectal liver metastasis (CRLM) resection.Methods: Data of patients who underwent partial hepatectomy for CRLM were reviewed. Patients treated by the anterior approach were compared with patients treated by the conventional approach.Results: Ninety-eight patients had right hepatectomy, extended right hepatectomy, or right trisectionectomy. Among them, 71 patients underwent the conventional approach (CA group) and 27 underwent the anterior approach (AA group). The two groups were comparable in demographic, pathological, and perioperative characteristics except that the AA group had higher levels of aspartate transaminase (median, 41 vs. 31 U/L; p = 0.006) and alanine transaminase (median, 27 vs. 22 U/L; p = 0.009), larger tumors (median, 7 vs. 4 cm; p = 0.000), and more extensive resections (p < 0.001). The median overall survival was 40 months (range, 0.69-168.6 months) in the CA group and 33.7 months (range, 0.95-99.8 months) in the AA group (p = 0.22), and the median disease-free survival was 9.7 months (range, 0.62-168.6 months) in the CA group and 6.2 months (range, 0.72-99.8 months) in the AA group (p = 0.464). Univariate and multivariate analyses identified 4 independent prognostic factors for overall survival: lymph node status of primary tumor (HR 1.352, 95% CI 0.639-2.862, p = 0.034), intraoperative blood loss (HR 1.253, 95% CI 1.039-1.510, p = 0.018), multiple liver tumor nodules (HR 1.775, 95% CI 1.029-3.061, p = 0.039), and microvascular invasion (HR 2.058, 95% CI 1.053-4.024, p = 0.035).Conclusions: The two approaches resulted in comparable survival outcomes even though the AA group had larger tumors and more extensive resections. The anterior approach allows better mobilization and easier removal of large tumors once the liver is opened up. [ABSTRACT FROM AUTHOR]

Background The impact of reoperation for complications after major liver resection for hepatocellular carcinoma was evaluated. Methods In this retrospective study covering 25 years, patients with reoperation for complications after major liver resection for hepatocellular carcinoma were compared with patients without reoperation in terms of demographics, tumor characteristics, operative details, postoperative results, oncologic outcomes, and survival. Reasons for reoperation were also investigated. Results Forty-nine out of 1,092 patients underwent reoperation within a median of 0.2 days (range, 0–6.9 days) after hepatectomy. Patients with and without reoperation had similar baseline characteristics and liver function. Nonetheless, patients with reoperation had a higher indocyanine green retention rate at 15 minutes (12.55% vs 10.5%, P = .015), more operative blood loss (1.4 L vs 1 L, P = .012), a higher blood transfusion rate (44.9% vs 29.2%, P = .029), longer hospital stay (21 days vs 11 days, P < .001), a higher hospital mortality (38.8% vs 3.0%, P < .001), and a higher 90-day mortality (38.8% vs 4.7%, P < .001). Hemorrhage was the most common cause for reoperation (26/49, 53.1%), mainly resulting from coagulopathic bleeding from raw areas (12/26, 46.2%) and bleeding from diaphragmatic veins (6/26, 23.1%). However, reoperation did not affect 5-year overall survival (50.2% vs 48.3%, P = .468). Conclusion Postoperative hemorrhage was associated with a high mortality, signifying the importance of meticulous hemostasis and careful perioperative management. Oncologic outcomes, however, were not affected by reoperation. [ABSTRACT FROM AUTHOR]

Objectives This retrospective review was conducted to compare the efficacy of radiofrequency ablation ( RFA) with that of transarterial chemoembolization ( TACE) in treating large (5-8 cm) unresectable solitary hepatocellular carcinomas ( HCCs). Methods Patients with large unresectable solitary HCCs primarily treated by RFA or TACE were reviewed. The primary endpoint was overall survival. Secondary endpoints were tumour response, time to disease progression, and treatment-related morbidity and mortality. Results There were 15 patients in the RFA group. Of these, 12 achieved complete ablation, one had ablation site recurrence, and five developed complications. Median disease-free survival in this group was 13.0 months (range: 2.8-38.0 months). The TACE group included 26 patients, of whom four obtained a partial response, none achieved a complete response, and five developed complications. The median time to disease progression in this group was 8.0 months (range: 1.0-68.0 months). There were no hospital deaths in this series. Median survival was 39.8 months in the RFA group and 19.8 months in the TACE group ( P = 0.257). Rates of 1-, 2- and 5-year survival were 93.3%, 86.2% and 20.9%, respectively, in the RFA group and 73.1%, 40.6% and 18.3%, respectively, in the TACE group. Conclusions Both RFA and TACE are feasible treatments for large unresectable solitary HCCs. Both modes show comparable rates of complications and longterm survival, but RFA achieves better initial tumour control and results in better short-term survival. [ABSTRACT FROM AUTHOR]

Objectives There is controversy over whether hepatocellular carcinoma ( HCC) should be primarily treated with living donor liver transplantation ( LDLT) if liver resection ( LR) can be effective. This retrospective study was conducted to compare survival outcomes in patients treated with either modality for solitary HCC measuring ≤8 cm in diameter. Methods Outcomes in patients with solitary HCC primarily treated by LDLT were analysed. Patients with solitary HCC of similar sizes with or without microvascular invasion primarily treated with LR were selected at a ratio of 6 : 1 for comparison. Results In-hospital mortality amounted to 0% and 1.3% in the LDLT ( n = 50) and LR ( n = 300) groups, respectively ( P = 0.918). Complication rates were 34% and 20% in the LDLT and LR groups, respectively ( P = 0.027). Rates of 1-, 3-, 5- and 10-year overall survival were 98%, 94%, 89% and 83%, respectively, in the LDLT group and 95%, 85%, 76% and 56%, respectively, in the LR group ( P = 0.013). Rates of 1-, 3-, 5- and 10-year disease-free survival were 96%, 90%, 87% and 81%, respectively, in the LDLT group and 81%, 64%, 57% and 40%, respectively, in the LR group ( P < 0.0001). Conclusions Living donor liver transplantation surpassed LR in survival outcomes, achieving a 10-year overall survival rate 1.5 times as high and a 10-year disease-free survival rate twice as high as those facilitated by LR. However, it entailed more complications, in addition to the inevitable risks to the donor. [ABSTRACT FROM AUTHOR]

Background & Aims: We investigated the efficacy of entecavir, a cyclopentyl guanosine nucleoside analogue, as monoprophylaxis in patients with chronic hepatitis B who received a liver transplant. Methods: We studied data from 80 consecutive patients who received a liver transplant (47 from living donors and 33 from deceased donors) for hepatitis B–related disease and entecavir monotherapy as prophylaxis. None of the patients received hepatitis B immunoglobulin. Indications for transplant included decompensation from cirrhosis (27.5%), acute-on-chronic hepatitis B (47.5%), and hepatocellular carcinoma (25%). The median follow-up time was 26 months (range, 5–40 months). Before transplant, 33 patients were not on antiviral therapy and 47 were on oral therapy (18 had received less than 3 months of treatment). Results: At the time of transplant, the median log HBV DNA level was 3.5 copies/mL (range, 1.54–8.81); 21 patients (26%) had undetectable levels of HBV DNA. The cumulative rate of hepatitis B surface antigen (HBsAg) loss was 86% and 91% after 1 and 2 years, respectively. Ten patients had reappearance of HBsAg. Eighteen patients (22.5%) were HBsAg positive at the time of their last examination; 17 of these had undetectable levels of HBV DNA, and the remaining patient had a low level of HBV DNA (217 copies/mL). There was no evidence of mutations at sites that confer resistance to entecavir among patients who were HBsAg positive. Conclusions: Although only 26% of patients had complete viral suppression at the time of transplant, 91% lost HBsAg, with 98.8% achieving undetectable levels of HBV DNA. A hepatitis B immunoglobulin–free regimen of entecavir monotherapy is effective after liver transplantation for chronic hepatitis B. [ABSTRACT FROM AUTHOR]

Abstract: The aim of our study was to assess the effectiveness of thoracic manipulation (TM) on patients with chronic neck pain. 120 patients aged between 18 and 55 were randomly allocated into two groups: an experimental group which received TM and a control group without the manipulative procedure. Both groups received infrared radiation therapy (IRR) and a standard set of educational material. TM and IRR were given twice weekly for 8 sessions. Outcome measures included craniovertebral angle (CV angle), neck pain (Numeric Pain Rating Scale; NPRS), neck disability (Northwick Park Neck Disability Questionnaire; NPQ), health-related quality of life status (SF36 Questionnaire) and neck mobility. These outcome measures were assessed immediately after 8 sessions of treatment, 3-months and at a 6-month follow-up. Patients that received TM showed significantly greater improvement in pain intensity (p = 0.043), CV angle (p = 0.049), NPQ (p = 0.018), neck flexion (p = 0.005), and the Physical Component Score (PCS) of the SF36 Questionnaire (p = 0.002) than the control group immediately post-intervention. All these improvements were maintained at the 6-month follow-ups. This study shows that TM was effective in reducing neck pain, improving dysfunction and neck posture and neck range of motion (ROM) for patients with chronic mechanical neck pain up to a half-year post-treatment. [ABSTRACT FROM AUTHOR]

This was a cross-sectional correlation study to explore the relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Moreover, the reliability of the photographic measurement of the sagittal posture of thoracic and cervical spine was investigated. Forty-five subjects without neck pain and forty-seven subjects with neck pain were recruited. Using a photographic method, the sagittal thoracic and cervical postures were measured by the upper thoracic and the craniovertebral (CV) angles respectively. The Numeric Pain Rating Scale (NPRS) and Chinese version Northwick Park Neck Pain Questionnaire (NPQ) were used to assess neck pain severity and disability. The upper thoracic angle was positively correlated (rs = 0.63, p < 0.01) while the CV angle was negatively correlated (rs = −0.56, p < 0.01) with the presence of neck pain. The upper thoracic angle was negatively correlated with the CV angles (rs = −0.62, p < 0.01) in subjects with neck pain. Similar to the CV angle, the upper thoracic angle was moderately correlated with the neck pain severity (rs = 0.43, p = 0.01) and disability (rs = 0.44, p = 0.02). The upper thoracic angle (OR = 1.37, p < 0.01) was a good predictor for presence of neck pain even better than that of the CV angle (OR = 0.86, p = 0.04). [Copyright &y& Elsevier]

Abstract: The study was a cross-sectional reliability study with the objective of assessing the reliability and validity of the Electronic Head Posture Instrument (EHPI) in measuring the craniovertebral (CV) angle for subjects with or without neck pain. Twenty-six subjects (mean age=36.88, SD±9.95) with chronic neck pain and 27 subjects (mean age=31.85, SD±7.63) without neck pain were recruited. The CV angle was measured by the EHPI which consists of an electronic angle finder, a transparent plastic base and a camera stand. Two therapists were recruited to assess the intra- and inter-rater reliability of the EHPI in two separate sessions of measurement. The difference in CV angle between the two groups was determined. The CV angle of the patient group (mean 43.94, SD±3.61) was significantly smaller (p <0.001) than that of the normal group (mean 50.58, SD±2.09). Intra-rater (intra-class correlation coefficient (ICC) ranged from 0.86 to 0.94) and inter-rater (ICC ranged from 0.85 to 0.91) reliability of the EHPI in measuring CV angle for both groups of subjects were high. In conclusion the EHPI was found to be reliable and valid in measuring the CV angle for subjects with or without neck pain. [Copyright &y& Elsevier]

Cordyceps is one of the most expensive and widely used functional foods. But the authenticity is still a concern due to the lack of appropriate markers. By targeting polysaccharides, this study aimed to develop a specific, and bioactive marker for Cordyceps. Firstly, the results of screening tests of 250 samples by examining both genetic markers and polysaccharide profile showed that a unique polysaccharide fraction (named CCP) was particular to the caterpillar parts. Its potential as a marker was further demonstrated by its ability to induce NO and cytokine production in RAW 264.7 cells. CCP was characterized to be an α-1,4-glucan with a branch at C-6 by the conventional structure analyzing and de novo oligosaccharides sequencing. The content of CCP was closely correlated to the traditional classification criteria. Generally, CCP was a marker that simultaneously enables qualitative and quantitative analysis of Cordyceps. • A unique polysaccharide fraction (named CCP) was specific to Cordyceps caterpillar. • CCP, an α-1,4-glucan, was determined by conventional and de novo oligosaccharides sequencing analysis. • CCP could induce NO and cytokine production in RAW 264.7 cells. • CCP was a quality marker due to the correlation of content and classification criteria. [ABSTRACT FROM AUTHOR]

Historically relaparotomy has been the first choice of treatment for PPH but endovascular intervention has been gaining popularity in the past decades. Regarding the management of delayed PPH, 9 patients underwent immediate relaparotomy (Relaparotomy group) and 3 of them required multiple relaparotomy. 5 patients underwent immediate endovascular intervention (Endovascular group) and 2 achieved haemostasis by embolization. [Extracted from the article]

Objective: To derive and validate a scoring system for major complication after hepatectomy. Background: Complications after hepatectomy significantly compromise survival outcomes, method to predict such risk is lacking. A reliable scoring system is therefore awaited. Methods: Consecutive adult patients receiving hepatectomy for primary or secondary liver malignancy from 1995 to 2014 were recruited. After randomization, patients were allocated to derivation and validation group respectively. A scoring system predicting occurrence of major complication was developed. Results: There were 2613 patients eligible for the study. The overall complication rate for the series was 10%. Impaired performance status (p = 0.014), presence of pre-existing medical illness (p = 0.008), elevated ALP (p = 0.005), urea (p < 0.001), and hypoalbuminemia (p = 0.008), and major hepatectomy (p < 0.001) were found to be independently associated major complications. A score was assigned to each of these factors according to their respective odd ratio. A total score of 0-17 was calculated for all patients. This score was shown to discriminate well with complication rate in both derivation and validation group (c-statistic: 0.71, p < 0.001 and 0.74, p < 0.001 respectively). The complication rate for low (score 0-5), moderate (score 6-10) and high (score 10 or above) risk group were respectively 5%, 16% and 28%. This risk stratification model was tested and confirmed in the validation group using Chi-square goodness-of-fit test (p = 0.864). Conclusion: A validated risk stratification model provides an accurate and easy-to-use reference tool for patients and clinicians during the informed consent process. [ABSTRACT FROM AUTHOR]

Background Hepatocellular carcinoma ( HCC) with bile duct tumour thrombus ( BDTT) is rare. The aim of the present study was to determine the prognosis of HCC with BDTT after a hepatectomy. Methods A retrospective analysis was performed on all HCC patients with BDTT having a hepatectomy from 1989 to 2012. The outcomes in these patients were compared with those in the control patients matched on a 1:6 ratio. Results Thirty-seven HCC patients with BDTT having a hepatectomy (the BDTT group) were compared with 222 control patients. Patients in the BDTT group had poorer liver function (43.2% had Child-Pugh B disease). More patients in this group had a major hepatectomy (91.9% versus 27.5%, P = 0.001), portal vein resection (10.8% versus 1.4%, P = 0.006), en-bloc resection with adjacent structures (16.2% versus 5.4%, P = 0.041), hepaticojejunostomy (75.7% versus 1.6%, P < 0.001) and complications (51.4% versus 31.1%, P = 0.016). The two groups had similar hospital mortality (2.7% versus 5.0%, P = 0.856), 5-year overall survival (38.5% versus 34.6%, P = 0.59) and 5-year disease-free survival (21.1% versus 20.8%, P = 0.81). Multivariate analysis showed that lymphovascular permeation, tumour size and post-operative complication were significant predictors for worse survival whereas BDTT was not. Discussion A major hepatectomy, extrahepatic biliary resection and hepaticojejunostomy should be the standard for HCC with BDTT, and long-term survival is possible after radical surgery. [ABSTRACT FROM AUTHOR]

Background High-intensity focused ultrasound ( HIFU) ablation is a non-invasive treatment for hepatocellular carcinoma ( HCC). At present, data on the treatment's long-term outcome are limited. This study analysed the survival outcome of HIFU ablation for HCCs smaller than 3 cm. Patients and methods Forty-seven patients with HCCs smaller than 3 cm received HIFU treatment between October 2006 and September 2010. Fifty-nine patients who received percutaneous radiofrequency ablation ( RFA) were selected for comparison. The two groups of patients were compared in terms of pre-operative variables and survival. Results More patients in the HIFU group patients had Child- Pugh B cirrhosis (34% versus 8.5%; P = 0.001). The 1- and 3-year overall survival rates of patients whose tumours were completely ablated in the HIFU group compared with the RFA group were 97.4% versus 94.6% and 81.2% versus 79.8%, respectively ( P = 0.530). The corresponding 1- and 3-year disease-free survival rates were 63.6% versus 62.4% and 25.9% versus 34.1% ( P = 0.683). Conclusions HIFU ablation is a safe and effective method for small HCCs. It can achieve survival outcomes comparable to those of percutaneous RFA and thus serves as a good alternative ablation treatment for patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Fourteen patients did not have metastasis (53.8%), two patients (7.7%) showed indeterminate, 3 patients (11.5%) showed metastatic lymph node and 7 patients (26.9%) showed reactive adenopathy. The accuracy of using PET/CT to determine absence or presence of lymph node metastasis were 10/14=71.4% and 1/3=33.3% respectively; while the accuracy of making the correct diagnosis was only 11/26=42.3%. B Conclusion: b PET/CT has a low sensitivity and high specificity for detecting regional lymph node metastasis for resectable hilar cholangiocarcinoma. [Extracted from the article]

Patients who received either LT or resection with pathological diagnosis of HCC and portal vein invasion were recruited. Majority (61.5%) of the patients in the LT group has Vp2 (tumour invasion at the 2 SP nd sp order portal vein branch) while all patients in the resection group had Vp2 disease. After propensity score matching, 10 patients in the LT group were compared with 30 patients in the resection group. [Extracted from the article]

B Introduction: b The latest 8 SP th sp American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system has launched with some modifications in T staging. There was no survival difference between patients withT1a and T1b tumors (p=0.85), nor between those T3 and T4 tumors (p=0.565). [Extracted from the article]