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BACKGROUND The objective of this study was to investigate the survival outcomes of surgical margin width in intrahepatic cholangiocarcinoma (ICC), and evaluate the efficacy of postoperative adjuvant therapy (p-AT) in ICC patients underwent narrow-margin hepatectomy (NMH).METHODS Between November 2011 and August 2017, patients who underwent hepatectomy for ICC were collected from 13 major hepatopancreatobiliary centers in China. The survival outcomes for patients who underwent wide margin hepatectomy (WMH) were compared with those who underwent NMH using the 1:1 propensity score matching (PSM). For patients who underwent NMH, the relationship between p-AT and overall survival (OS) and disease-free survival (DFS) were analyzed. RESULTS Among 478 included patients, 195(40.8%) underwent WMH whereas 283(59.2%) underwent NMH. PSM yielded 79 matched patients with similar baseline characteristics. Patients underwent WMH had a significant better OS and DFS compared with those underwent NMH (before PSM: Median OS 27 vs. 17 months, P 0.05; Stage III: OS, DFS, P >0.05). For patient underwent NMH, p-AT following NMH showed a better OS and RFS when compared to those who underwent NMH alone (OS, P = 0.05; DFS, p

BACKGROUND Lymph node (LN) involvement is a critical prognostic factor in patients with gallbladder carcinoma (GBC). Controversy exists regarding optimal categorization of nodal metastasis status, including anatomical location of positive nodes (AJCC 7th N staging), number of metastatic lymph nodes (NMLN), log odds of metastatic LNs (LODDS), and lymph node ratio (LNR). METHODS Patients who underwent curative-intent resection for GBC from six Chinese tertiary hospitals between 2008 and 2013 were analyzed retrospectively. The relative discriminative abilities of the different LN staging systems were assessed by different models including the tree-augmented naive Bayesian (TAN) model, Cox proportional hazards regression model, and binary logistic regression model. RESULTS A total of 226 patients were involved in this cohort. Based on the TAN model and composite importance measures, the most important factor affecting the prognosis in the different LN staging systems was NMLN. Among the four TAN models which were built with 4 metastatic LN markers and baseline variables, the accuracy of the NMLN-based prognostic model was 88.15%, higher than 7th N staging (86.44%), LNR (87.34%), and LODDS (85.19%). The Cox model based on NMLN (C-index: 0.763, AIC: 1371.62) had a higher fitness than the others (7th N staging C-index: 0.756, AIC: 1375.51; LNR C-index: 0.759, AIC: 1378.82; LODDS C-index 0.748, AIC: 1390.99). The AUCs of different staging binary logistic regression models were NMLN (0.872), LNR (0.872), 7th N staging (0.869) and LODDS (0.856), respectively. CONCLUSIONS NMLN was the optimal LN staging system in evaluating prognosis of GBC.

Aim. The primary aim of this study is to compare the short- and long-term outcomes between ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) with rituximab prophylaxis and ABO-compatible (ABOc) ALDLT. Background. The strategy of ABOi liver transplantation (LT) was originated initially to increase the donor pool and to enable liver transplantation in emergency conditions. However, ABOi ALDLT remains a controversial approach in comparison to ABOc ALDLT. Methods. PubMed, Embase, and the Cochrane Library study search were accomplished to recognize studies comparing ABOi and ABOc ALDLT. Meta-analyses were conducted based on the evaluation of heterogeneity using a fixed-effect model and a random-effect model to assess the short- and long-term outcomes following ABOi ALDLT with rituximab prophylaxis. Results. Nine studies comprising a total of 3,922 patients (ABOi=671 and ABOc=3,251) were identified. There was no significant difference between ABOi and ABOc groups for 1-year, 3-year, and 5-year OS and graft survival, respectively. Moreover, 1-year and 3-year OS and DFS were similar between both groups for HCC patients. However, ABOi ALDLT had higher incidences of CMV infection, AMR, overall biliary complications, and biliary stricture than ABOc ALDLT and had other comparable postoperative complications. Conclusion. Our meta-analysis included studies comparing ABOi and ABOc ALDLT after the introduction of rituximab in a desensitization protocol for ABOi ALDLT. The results of ABOi ALDLT were comparable with those of ABOc ALDLT. However, biliary complications, CMV infection, and AMR remain a concern in the era of rituximab.

Control charts are fundamental SPC tools for process monitoring. When a control chart or combination of charts signals, knowing the change point, which distributional parameter changed, and/or the change size helps to identify the cause of the change, remove it from the process or adjust the process back in control correctly and immediately. In this study, we proposed using maximum likelihood (ML) estimation of the current process parameters and their ML confidence intervals after a signal to identify and estimate the changed parameters. The performance of this ML diagnostic procedure is evaluated for several different charts or chart combinations for the cases of sample sizes and , and compared to the traditional approaches to diagnostics. None of the ML and the traditional estimators performs well for all patterns of shifts, but the ML estimator has the best overall performance. The ML confidence interval diagnostics are overall better at determining which parameter has shifted than the traditional diagnostics based on which chart signals. The performance of the generalized likelihood ratio (GLR) chart in shift detection and in ML diagnostics is comparable to the best EWMA chart combination. With the application of the ML diagnostics naturally following a GLR chart compared to the traditional control charts, the studies of a GLR chart during process monitoring can be further deepened in the future. Ph. D.