A novel strategy for enhancing the stability of aptamer conformations in heavy metal ion detection.

BACKGROUND: Detection methods based on aptamer probes have great potential and progress in the field of rapid detection of heavy metal ions. However, the unstable conformation of aptamers often results in poor sensitivity due to the dissociation of aptamer-target complex in real environments. RESULTS: In this study, we developed a locking aptamer probe and combined it with AgInZnS quantum dots for the first time to detect cadmium ions. When cadmium ions are combined with the probe, the cadmium ions are fixed in the core-locking position, forming a stable cavity structure. The limit of detection (LOD) was achieved at a concentration of 6.9 nmol L-1, with a broad detection range from 10 nmol L-1 to 1000 µmol L-1, and good recovery rates (92.93%-102.8 %) were achieved in aquatic product testing. The locking aptamer probe with stable conformation effectively enhances the stability of the aptamer-target complex and remains good stability in four buffer environments as well as a 600 mmol L-1 salt solution; it also exhibits good stability at pH 6.5-7.5 and temperatures ranging from 25 °C to 35 °C. SIGNIFICANCE: Overall, our study presented a general, simple, and cost-effective strategy for stabilizing aptamer conformations, and used for highly sensitive detection of cadmium ions.

Amperometry for real-time and on-site monitoring of phenol and H2O2 during the treatments.

In conventional wastewater treatment processes, a predetermined quantity of chemicals is introduced at the onset, without ongoing monitoring of the treatment progress. Thus, it is difficult to perform timely intervention in the treatment process. Herein, we develop an amperometry-guided wastewater treatment strategy based on a green oxidation process with H2O2 and an iron-tetraamidomacrocyclic ligand (Fe-TAML) catalyst. During the process, users can monitor both phenol and H2O2 concentrations in real time and then intervene by adding more H2O2 to accelerate the reaction. As a proof of concept, a wastewater sample containing 9.3 ppm of phenol is treated by using the amperometry-guided strategy with 1 dosage of Fe-TAML (0.45 ppm) and 3 dosages of H2O2 (1.86 ppm). After the treatment, phenol concentration in the wastewater decreases to 0 ppm after 21 min. In contrast, with only 1 dosage of Fe-TAML (0.45 ppm) and 1 dosage of H2O2 (1.86 ppm), the reaction slows down after 5 min and stops prematurely. After that, the reaction kinetics of ppb-level phenol are investigated, in which the phenol rate and the rate constant are estimated. Compared to conventional detections, the designed amperometry shows faster response, lower limit of detection (LOD, phenol: 11 ppb, H2O2: 80 ppb) and consumable cost, easier operation, and no pollution generated. This example demonstrates the importance of early intervention during wastewater treatment with the help of real-time information.

Electrospun Core-Sheath Fibers with a Uniformly Aligned Polymer Network Liquid Crystal (PNLC).

Electrospun polymer-liquid crystal (PLC) fibers have potential applications such as wearable sensors and adaptive textiles because of their rapid response and high flexibility. However, existing PLC fibers only have a narrow responsive range and poor resistance to heat and chemicals. Herein, a new type of PLC fiber is prepared by using a coaxial electrospinning process. The core solution is 4'-pentyl-4-biphenylcarbonitrile (5CB), and the sheath solution is a mixture containing 13 wt % PVP and 10 wt % reactive mesogen (RM). After UV exposure of the fibers, 5CB in the core and RM diffusing from the core are cross-linked into an LC polymer. The fibers have a highly uniform morphology with an average diameter of 3.2 ± 0.5 µm, and mesogens inside the fibers align unidirectionally with the long axis of the fibers. The fibers show a broad phase-transition temperature range between 13.5 and 155.5 °C and have a response time of less than 10 s. The temperature range can also be controlled by adjusting components in the electrospun fibers and UV exposure time. The core-sheath fibers prepared in such a manner exhibit excellent heat and chemical resistance with reversible optical responses. Moreover, when the fibers are exposed to volatile organic compounds (VOCs) such as toluene, the fibers show a rapid optical response to toluene vapor within 25 s. This study demonstrates that the fibers are potentially useful for preparing flexible temperature and chemical sensors.

Systemic and Local Effects Among Patients With Betel Quid-Related Oral Cancer.

The major predisposing factors of developing oral cancer include smoking, alcohol drinking, and betel quid chewing. Betel quid chewing could cause the abrasion and damage of oral mucosa by crude fibers, chemical insults by additive slaked lime, and arecoline from areca nut. These would lead to the local consequence of oral submucosal fibrosis, which is regarded clinically as a precancer lesion and a major cause of trismus. In addition, the components and additives in betel quid contain chemical toxins and carcinogens, which would further affect the oral mucosa and gradually develop a malignancy. Following literature review, aside from having a greater total tumor burden and more local diseases in the oral cavity and digestive tract, patients with betel quid-related oral cancer also have more systemic diseases from metabolic syndrome, hypertension, cardiovascular disease, type II diabetes mellitus, and obesity than those without this habit. In conclusion, those patients who have the history of smoking, alcohol drinking, and betel quid chewing would present much more unique clinical characteristics than those who only have a history of smoking and alcohol drinking. More attention should therefore be paid to pretreatment evaluation, treatment strategy, and posttreatment follow-up among betel quid chewers.

Aptamer-Based Gold Nanoparticles-PDMS Composite Stamps as a Platform for Micro-Contact Printing.

In the present study, a functional template made up of in situ synthesised gold nanoparticles (AuNPs) is prepared on polydimethylsiloxane (PDMS) for patterning of target protein onto the desired solid substrates. Unlike previous studies in which bioreceptor probes are randomly attached to the PDMS stamp through electrostatic interactions, herein, we propose an AuNPs-PDMS stamp, which provides a surface for the attachment of thiol-modified biorecognition probes to link to the stamp surface through a dative bond with a single anchoring point based on thiol chemistry. By using this platform, we have developed the ability for microcontact printing (µCP) to selectively capture and transfer target protein onto solid surfaces for detection purposes. After µCP, we also investigated whether liquid crystals (LCs) could be used as a label-free approach for identifying transfer protein. Our reported approach provides promise for biosensing of various analytes.

The Prognostic Value of Preoperative Albumin-to-Alkaline Phosphatase Ratio on Survival Outcome for Patients With Locally Advanced Oral Squamous Cell Carcinoma.

Background: This retrospective cohort study was to assess the prognostic value of preoperative albumin-to-alkaline phosphatase ratio (AAPR) on survival outcome for patients with locally advanced oral squamous cell carcinoma (LAOSCC). Methods: A total of 250 patients with LAOSCC receiving upfront radical surgery at a single institute from January 2008 to December 2017 were enrolled. The primary endpoint was the survival predictability of preoperative AAPR on the 5-year overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Cox proportional hazards model was used for survival analysis. The X-tile software was used to estimate the optimal cut-off value of preoperative AAPR on survival prediction. A predictive nomogram incorporating the clinicopathological factors on OS was further generated. Results: The 5-year OS, CSS, and DFS rates were 68.6%, 79.7%, and 61.7%, respectively. The optimal cut-off of preoperative AAPR to predict the 5-year OS was observed to be 0.51. For those with preoperative AAPR≧0.51, the 5-year OS, CSS, and DFS were statistically significantly superior to those with preoperative AAPR<0.51 (OS: 76.1% vs 48.5%, P < .001; CSS: 84.3% vs 66.4%, P = .005; DFS: 68.9% vs 42.6%, P < .001). In Cox model, we observed that preoperative AAPR<0.51 was a significantly negative prognosticator of OS (HR: 2.22, 95% CI: 1.466-3.361, P < .001), CSS (HR: 2.037, 95% CI: 1.16-3.578, P = .013), and DFS (HR: 1.756, 95% CI: 1.075-2.868, P = .025). After adding the variable of preoperative AAPR, the c-index of the predictive nomogram incorporating assorted clinicopathological factors increases from 0.663 to 0.692 for OS. Conclusion: Our results suggest that preoperative AAPR serves as an independent survival predictor for patients with LAOSCC. The nomogram incorporating preoperative AAPR and various clinicopathological features may be a convenient tool to estimate the mortality risk for patients with LAOSCC.

Prediction of Occult Contralateral Nodal Metastasis in Surgical Treated p16 Negative Oropharyngeal Squamous Cell Carcinoma.

Background: It is well known that p16 negative oropharyngeal squamous cell carcinoma (OPSCC) has a high probability of spreading to the ipsilateral neck. However, no consensus exists as to whether to perform elective treatment for clinical nodal negative in contralateral neck. Methods: A total of 85 patients with p16 negative OPSCC who underwent primary tumor excision and bilateral neck dissections between 2005 and 2018 were analyzed retrospectively. Clinicopathologic variables were used to identify factors predicting occult contralateral nodal metastasis (OCNM). A nomogram was developed to assess the risk of OCNM and the model was validated internally by using bootstrap resampling. Results: The overall prevalence of pathologically positive contralateral nodes was 30.6% (26/85) in our cohort, and the rate of OCNM was 18.3% (11/60). The presence of ipsilateral clinical extranodal extension (cENE) was significantly associated with contralateral neck metastasis (odds ratio, 5.662; 95% CI, 2.079-15.415) with increased risk of OCNM (odds ratio, 4.271; 95% CI, 1.045-17.458). Moreover, the concordance index of the proposed nomogram model without ipsilateral cENE was 0.623 and could increase to 0.717 with the inclusion of ipsilateral cENE in the calculation. Conclusion: The risk of OCNM in p16 negative OPSCC with ipsilateral cENE is notable. Ipsilateral cENE-based nomogram might assist in individual decision-making regarding contralateral nodal negative neck management and help avoid the over- and under-treatment of p16 negative OPSCC.

A highly sensitive fluorescent sensor for ammonia detection based on aggregation-induced emission luminogen-doped liquid crystals.

As a toxic substance, ammonia can cause serious irritation to the human respiratory system and lungs. Although many detection techniques have been reported, most of them have drawbacks, such as expensive devices and complex and time-consuming fabrication processes. Thus, it is important to develop a simple method for ammonia detection. In this paper, we demonstrate a highly sensitive fluorescent sensor for ammonia detection based on aggregation-induced emission luminogen-doped liquid crystals without the use of polarizers. The homeotropic orientation of the liquid crystals on a modified substrate can be disturbed by ammonia, resulting in the fluorescence intensity change of an aggregation-induced emission luminogen. This aggregation-induced emission luminogen-doped liquid crystal-based fluorescent sensor for ammonia detection exhibited a low detection limit of 5.4 ppm, which is 3 times lower than previously reported liquid crystal-based optical sensors. The detection range is also broad from 0 ppm to 1600 ppm. Meanwhile, this sensor can be applied to detect aqueous ammonia with a low limit of detection of 1.8 ppm. The proposed fluorescent sensor for ammonia detection based on an aggregation-induced emission luminogen-doped liquid crystal is highly sensitive, highly selective, simple, and low cost with wide potential applications in chemical and biological fields. This strategy of designing a liquid crystal fluorescent sensor provides an inspiring stage for other toxic chemical substrates by changing specific decorated molecules.

Patients of stage I oral cancer with pathologically low-risk feature managed by primary tumor resection alone: Impact of depth of invasion and a nomogram analysis.

Objectives: To evaluate the importance of depth of invasion (DOI) in patients with pathologically low-risk feature stage I oral squamous cell carcinoma (OSCC) managed by primary tumor resection alone. Methods: Patients with stage I OSCC, at pathologically low risk, underwent primary tumor resection without neck dissection were enrolled retrospectively between 2007 and 2015. Low risk was defined as the absence of positive or close margins, lymphovascular invasion, perineural invasion, worst pattern of invasion-5, and poor differentiation in histologic grade. The primary endpoints included overall survival (OS), cancer specific survival (CSS), local recurrence free survival (LRFS), and regional recurrence free survival (RRFS). A nomogram based on the DOI was established for predicting RRFS. Results: A total of 198 patients were enrolled in this study. DOI was the only prognosticator to achieve statistical significance in all primary endpoints according to univariate analysis. Patients with DOI <3 mm tumor showed better five-year OS, CSS, LRFS, and RRFS than those with DOI ≥3 mm tumor. The concordance index of the nomogram model without DOI was 0.684, which could increase to 0.733 when DOI was included in the calculation. Conclusion: Patients with pathologically low-risk stage I OSCC correlate with a higher chance in occult neck metastasis if increasing DOI (≥3 mm) is noticed. Indeed, the chance of occult neck metastasis is significantly higher in this group (14% vs. 2%) than in those with DOI <3 mm. Elective neck dissection is advised if DOI is ≥3 mm to achieve better clinical outcomes. Level of Evidence: 4.

State-of-the-Art Development in Liquid Crystal Biochemical Sensors.

As an emerging stimuli-responsive material, liquid crystal (LC) has attracted great attentions beyond display applications, especially in the area of biochemical sensors. Its high sensitivity and fast response to various biological or chemical analytes make it possible to fabricate a simple, real-time, label-free, and cost-effective LC-based detection platform. Advancements have been achieved in the development of LC-based sensors, both in fundamental research and practical applications. This paper briefly reviews the state-of-the-art research on LC sensors in the biochemical field, from basic properties of LC material to the detection mechanisms of LC sensors that are categorized into LC-solid, LC-aqueous, and LC droplet platforms. In addition, various analytes detected by LCs are presented as a proof of the application value, including metal ions, nucleic acids, proteins, glucose, and some toxic chemical substances. Furthermore, a machine-learning-assisted LC sensing platform is realized to provide a foundation for device intelligence and automatization. It is believed that a portable, convenient, and user-friendly LC-based biochemical sensing device will be achieved in the future.

Clinical outcomes of Eustachian tube dysfunction in chronic rhinosinusitis following endoscopic sinus surgery.

BACKGROUND: The effects of endoscopic sinus surgery (ESS) on the symptom burden of Eustachian tube dysfunction (ETD) in chronic rhinosinusitis (CRS) patients were investigated. METHODS: Ninety-two patients with CRS following ESS were prospectively enrolled and followed up every 3 months for 1 year. The 7-item ETD Questionnaire (ETDQ-7) and 22-item Sino-Nasal Outcome Test (SNOT-22) were administered before ESS and at each visit following ESS. RESULTS: Before surgery, 25% of patients reported ETDQ-7 scores ≥ 14.5, indicating the presence of ETD. The mean preoperative ETDQ-7 and SNOT-22 scores were 13.3 and 40.0, respectively. The mean ETDQ-7 and SNOT-22 scores were significantly decreased to 8.2 and 17.0 at 1 year following ESS, respectively. Most patients reported alleviation of their symptoms within the first 3 months, and the prevalence of ETD had decreased to 3.3% at 1 year. Patients who received revision surgery had higher ETDQ-7 scores during the follow-up period. Additionally, 5.4% of patients reported worsening of their symptoms. CONCLUSION: ETD symptoms can be effectively alleviated in most patients within 3 months following ESS. However, 5.4% of patients reported worsening of their symptoms at the 1-year follow-up. Additional objective studies should be conducted to evaluate Eustachian tube function thoroughly in CRS patients.

Nasality outcome in unilateral chronic rhinosinusitis following functional endoscopic sinus surgery.

BACKGROUND/PURPOSE: In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS). METHODS: A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. Questionnaires on sinonasal symptoms and nasality were recorded. The change in the nasalance score of vowels [a], [i] [u], nasal consonant [m], 2 nasal syllable repetitions, and 2 Chinese sentences were measured. The patients were evaluated preoperatively, 6 months, and 12 months after the operation. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease. RESULTS: Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund-Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p = 0.01) following FESS. In the further subgroup analysis, the change in nasalance was significant in the wide opening surgery group, but not in the limited surgery group. CONCLUSION: Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the objective nasalance score was corresponded to a significant improvement of subjective self-reported nasality assessment postoperatively.

OSA Treatment on Cardio- and Cerebrovascular Comorbidities: A Long-term Nationwide Cohort Study.

OBJECTIVE: To compare the cardio- and cerebrovascular outcomes and survival rates of surgical and nonsurgical interventions for patients with obstructive sleep apnea (OSA) based on a national population-based database. STUDY DESIGN: Retrospective cohort study. SETTING: Taiwan National Health Insurance Research Database. METHODS: We analyzed all cases of OSA among adults (age >20 years and confirmed with ICD-9-CM) from January 2001 to December 2013. We compared the patients with OSA who received upper airway surgery with age-, sex-, and comorbidity index-matched controls with continuous positive airway pressure (CPAP) treatment. The risk of myocardial infarction (MI) or stroke after treatment of OSA-related surgery versus CPAP was investigated. RESULTS: During follow-up, 112 and 92 incident cases of MI occurred in the OSA surgery and CPAP treatment groups, respectively (rates of 327 and 298 per 100,000 person-years). Furthermore, 50 and 39 cases were newly diagnosed with stroke in the OSA surgery and CPAP treatment groups (rates of 144 and 125 per 100,000 person-years). Cox proportional hazard regressions showed that the OSA treatment groups (OSA surgery vs CPAP) were not significantly related to MI (hazard ratio, 1.03 [95% CI, 0.781-1.359]; P = .833) and stroke (hazard ratio, 1.12 [95% CI, 0.736-1.706]; P = .596) at follow-up, after adjustment for sex, age at index date, days from diagnosis to treatment, and comorbidities. CONCLUSION: Our study demonstrated that there was no difference of cardio- and cerebrovascular results between CPAP and surgery for patients with OSA in a 13-year follow-up. LEVEL OF EVIDENCE: 3.

Aptamer Laden Liquid Crystals Biosensing Platform for the Detection of HIV-1 Glycoprotein-120.

We report a label-free and simple approach for the detection of glycoprotein-120 (gp-120) using an aptamer-based liquid crystals (LCs) biosensing platform. The LCs are supported on the surface of a modified glass slide with a suitable amount of B40t77 aptamer, allowing the LCs to be homeotropically aligned. A pronounced topological change was observed on the surface due to a specific interaction between B40t77 and gp-120, which led to the disruption of the homeotropic alignment of LCs. This results in a dark-to-bright transition observed under a polarized optical microscope. With the developed biosensing platform, it was possible to not only identify gp-120, but obtained results were analyzed quantitatively through image analysis. The detection limit of the proposed biosensing platform was investigated to be 0.2 µg/mL of gp-120. Regarding selectivity of the developed platform, no response could be detected when gp-120 was replaced by other proteins, such as bovine serum albumin (BSA), hepatitis A virus capsid protein 1 (Hep A VP1) and immunoglobulin G protein (IgG). Due to attributes such as label-free, high specificity and no need for instrumental read-out, the presented biosensing platform provides the potential to develop a working device for the quick detection of HIV-1 gp-120.

Liquid Crystal Based Binding Assay for Detecting HIV-1 Surface Glycoprotein.

Surface protein gp-120 of HIV-1 virus plays an important role in the infection of HIV-1, but detection of gp-120 during the early stage of infection is very difficult. Herein, we report a binding bioassay based on an RNA aptamer B40t77, which binds specifically to gp-120. The bioassay is built upon a hydrophobic glass slide with surface immobilized gp-120. When the glass surface is incubated in a solution containing B40t77, the aptamer is able to bind to gp-120 specifically and remove it from the surface after a short incubation time of 30 min. The result of the binding event can be amplified by using liquid crystal (LC) into optical signals in the final step. By using this bioassay, we are able to detect as low as 1 µg/ml of gp-120 with high specificity within 30 min. No response is obtained when gp-120 is replaced by other protein such as bovine serum albumin (BSA). This is the first qualitative bioassay which provides a simple way for the detection of gp-120 with the naked eye. The assay is robust, low-cost and does not require additional labeling. Thus, the bioassay is potentially useful for the early detection of HIV-1 in resources-limited regions.

Multifunctional sensors based on liquid crystals scaffolded in nematic polymer networks.

Stimuli-responsive liquid crystal (LC) materials have attracted great attention due to their unique characteristics and anisotropic properties. They are not only important for fundamental studies, but also have many potential applications in the electro-optical and biochemical fields. Herein, the interference color obtained from a nematic polymer network-stabilized liquid crystal (PNLC) system is demonstrated to reflect the environmental conditions, including temperature and the presence of volatile organic vapors. The polymerization of LC monomers forms a stable network to template the LCs, while still maintaining the dynamic nature and thermal tunability of LCs. Via adjusting the concentration of LC monomer, a wide temperature sensing range can be achieved between 36 °C and 100 °C with visible color. The same sensor can be used to detect concentration profiles of toluene vapor in a microchannel with a limit of detection of 2300 ppm. This stimuli-responsive PNLC system is expected to be potentially useful for many other naked-eye sensing applications.

Using Co-Culture to Functionalize Clostridium Fermentation.

Clostridium fermentations have been developed for producing butanol and other value-added chemicals, but their development is constrained by some limitations, such as relatively high substrate cost and the need to maintain an anaerobic condition. Recently, co-culture is emerging as a popular way to address these limitations by introducing a partner strain with Clostridium. Generally speaking, the co-culture strategy enables the use of a cheaper substrate, maintains the growth of Clostridium without any anaerobic treatment, improves product yields, and/or widens the product spectrum. Herein, we review recent developments of co-culture strategies involving Clostridium species according to their partner stains' functions with representative examples. We also discuss research challenges that need to be addressed for the future development of Clostridium co-cultures.

Aerobic acetone-butanol-isopropanol (ABI) fermentation through a co-culture of Clostridium beijerinckii G117 and recombinant Bacillus subtilis 1A1.

An engineered B. subtilis 1A1 strain (BsADH2) expressing a secondary alcohol dehydrogenase (CpSADH) was co-cultured with C. beijerinckii G117 under an aerobic condition. During the fermentation on glucose, B. subtilis BsADH2 depleted oxygen in culture media completely and created an anaerobic environment for C. beijerinckii G117, an obligate anaerobe, to grow. Meanwhile, lactate produced by B. subtilis BsADH2 was re-assimilated by C. beijerinckii G117. In return, acetone produced by C. beijerinckii G117 was reduced into isopropanol by B. subtilis BsADH2 via expressing the CpSADH, which helped maintain the redox balance of the engineered B. subtilis. In the symbiotic system consisting of two strains, 1.7 â€‹g/L of acetone, 4.8 â€‹g/L of butanol, and 0.9 â€‹g/L of isopropanol (with an isopropanol/acetone ratio of 0.53) was produced from 60 â€‹g/L of glucose. This symbiotic system also worked when oxygen was supplied to the culture, although less isopropanol was produced (0.9 â€‹g/L of acetone, 4.9 â€‹g/L of butanol, and 0.2 â€‹g/L of isopropanol). The isopropanol titer was increased substantially to 2.5 â€‹g/L when we increased the inoculum size of B. subtilis BsADH2 and optimized other process parameters. With the Bacillus-Clostridium co-culture, switching from the original acetone-butanol (AB) fermentation to an aerobic acetone-butanol-isopropanol (ABI) fermentation can be easily achieved without genetic engineering of Clostridium. This strategy of employing a recombinant Bacillus to co-culture with Clostridium should be potentially useful to modify traditional acetone-butanol-ethanol fermentation for the production of other value-added chemicals.

The Development of Dry Eye Disease After Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study.

We aim to evaluate the risk of dry eye disease (DED) occurrence in patients with surgery-indicated chronic rhinosinusitis (CRS) via the national health insurance research database in Taiwan. After exclusion, patients with a diagnostic code of CRS and had received functional endoscopic sinus surgery (FESS) were regarded as having surgery-indicated CRS and enrolled in the study group, then each patient in the study group was age- and gender-matched to four non-CRS patients that served as the control group. The outcome was considered as the development of DED and Cox proportional hazard regression was used for the statistical analysis, which involved multiple potential risk factors of DED. A total of 6076 patients with surgery-indicated CRS that received FESS and another 24,304 non-CRS individuals were enrolled after exclusion. There were 317 and 770 DED events in the study group and the control group during the 16-year follow-up interval, and the study group demonstrated a significantly higher adjusted hazard ratio (1490, 95% confidence intervals (CI): 1.303-1.702) of DED development compared to the control group in the multivariable analysis. In addition, the cumulative probability analysis illustrated a positive correlation of DED occurrence and the disease period of surgery-indicated CRS (p < 0.0001). In the subgroup analysis, both genders revealed a higher but not significant incidence of developing DED in the study group. In conclusion, the existence of surgery-indicated CRS will increase the risk of developing DED, which correlated to the disease interval.

Cytoreduction surgery and hyperthermic intraperitoneal chemotherapy for treating advanced peritoneal metastases of hepatocellular carcinoma.

BACKGROUND: An effective treatment strategy for peritoneal metastasis (PM) of hepatocellular carcinoma (HCC-PM) has yet to be established. Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown favorable outcomes in certain malignancies, their role in peritoneal metastatic HCC is unclear. Herein, we present a series of patients with HCC-PM treated with CRS/HIPEC and evaluate their outcomes. METHODS: Records of patients with HCC-PM who had undergone CRS/HIPEC at the Hyperthermia Center of Yuan's General Hospital, Kaohsiung, Taiwan, between September 2015 and December 2016 were reviewed retrospectively. Patients were followed up until September 2019. We assessed the clinical courses and outcomes of these patients to clarify the benefits of CRS/HIPEC. RESULTS: Six patients were included in our study. HCC-PM occurred synchronously in one patient and occurred metachronously in five patients after therapeutic minimally invasive procedures, including radiofrequency ablation, laparoscopic hepatectomy, robotic hepatectomy or spontaneously. The median peritoneal cancer index was 18.5. All patients experienced complete peritoneal cytoreduction without perioperative mortality. One patient had two CTCAE grade 3 complications. The median follow-up was 16 months. The median overall survival was 15.7 months. Four patients died of lung metastasis or liver failure owing to intrahepatic recurrence. The survival rates observed at 1, 2, and 4 years were 66.7%, 33.3%, and 33.3%, respectively. CONCLUSIONS: CRS followed by HIPEC is feasible in patients with HCC-PM and might provide selected patients a chance for local disease control and longer survival. CRS/HIPEC might be considered as a treatment option in highly selected patients, as part of multimodal therapy approaches.