Development and validation of a machine learning-based early prediction model for massive intraoperative bleeding in patients with primary hepatic malignancies.

BACKGROUND: Surgical resection remains the primary treatment for hepatic malignancies, and intraoperative bleeding is associated with a significantly increased risk of death. Therefore, accurate prediction of intraoperative bleeding risk in patients with hepatic malignancies is essential to preventing bleeding in advance and providing safer and more effective treatment. AIM: To develop a predictive model for intraoperative bleeding in primary hepatic malignancy patients for improving surgical planning and outcomes. METHODS: The retrospective analysis enrolled patients diagnosed with primary hepatic malignancies who underwent surgery at the Hepatobiliary Surgery Department of the Fourth Hospital of Hebei Medical University between 2010 and 2020. Logistic regression analysis was performed to identify potential risk factors for intraoperative bleeding. A prediction model was developed using Python programming language, and its accuracy was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Among 406 primary liver cancer patients, 16.0% (65/406) suffered massive intraoperative bleeding. Logistic regression analysis identified four variables as associated with intraoperative bleeding in these patients: ascites [odds ratio (OR): 22.839; P < 0.05], history of alcohol consumption (OR: 2.950; P < 0.015), TNM staging (OR: 2.441; P < 0.001), and albumin-bilirubin score (OR: 2.361; P < 0.001). These variables were used to construct the prediction model. The 406 patients were randomly assigned to a training set (70%) and a prediction set (30%). The area under the ROC curve values for the model's ability to predict intraoperative bleeding were 0.844 in the training set and 0.80 in the prediction set. CONCLUSION: The developed and validated model predicts significant intraoperative blood loss in primary hepatic malignancies using four preoperative clinical factors by considering four preoperative clinical factors: ascites, history of alcohol consumption, TNM staging, and albumin-bilirubin score. Consequently, this model holds promise for enhancing individualised surgical planning.

Basolateral CD147 induces hepatocyte polarity loss by E-cadherin ubiquitination and degradation in hepatocellular carcinoma progress.

Hepatocytes are epithelial cells with highly specialized polarity. The disorder and loss of hepatocyte polarity leads to a weakness of cell adhesion and connection, the induction of epithelial-mesenchymal transition, and eventually the occurrence of hepatocellular carcinoma (HCC). Cluster of differentiation 147 (CD147), a tumor-related glycoprotein, promotes epithelial-mesenchymal transition and the invasion of HCC. However, the function of CD147 in hepatocyte depolarization is unknown. Here we identified that CD147 was basolaterally polarized in hepatocyte membrane of liver tissues and HepG2 cells. CD147 not only promoted transforming growth factor-ß1-mediated hepatocyte polarity loss but also directly induced endocytosis and down-regulation of E-cadherin which contributed to hepatocyte depolarization. Overexpression of CD147 induced Src activation and subsequently recruited ubiquitin ligase Hakai for E-cadherin ubiquitination and lysosomal degradation, leading to decreases of partitioning defective 3 expression and ß-catenin nuclear translocation. This signal transduction was initiated by competitive binding of CD147 with integrin ß1 that interrupted the interaction between the Arg-Gly-Asp motif of fibronectin and integrin ß1. The specific antibodies targeting integrin α5 and ß1 reversed the decrease of E-cadherin and partitioning defective 3 levels induced by CD147 overexpression. In human liver tissues, CD147 polarity rates significantly declined from liver cirrhosis (71.4%) to HCC (10.4%). CD147-polarized localization negatively correlated with Child-Pugh scores in human liver cirrhosis (r = -0.6092, P < 0.0001) and positively correlated with differentiation grades in HCC (r = 0.2060, P = 0.004). HCC patients with CD147-polarized localization had significantly better overall survival than patients with CD147 nonpolarity (P = 0.021). CONCLUSION: The ectopic CD147-polarized distribution on basolateral membrane promotes hepatocyte depolarization by activation of the CD147-integrin α5ß1-E-cadherin ubiquitination-partitioning defective 3 decrease and ß-catenin translocation signaling cascade, replenishing a molecular pathway in hepatic carcinogenesis. (Hepatology 2018;68:317-332).

Full-length soluble CD147 promotes MMP-2 expression and is a potential serological marker in detection of hepatocellular carcinoma.

BACKGROUND: As a surface glycoprotein, CD147 is capable of stimulating the production of matrix metalloproteinases (MMPs) from neighboring fibroblasts. The aim of the present study is to explore the role of soluble CD147 on MMPs secretion from hepatocellular carcinoma (HCC) cells, and to investigate the diagnostic value of serum soluble CD147 in the HCC detection. METHODS: We identified the form of soluble CD147 in cell culture supernate of HCC cells and serum of patients with HCC, and explored the role of soluble CD147 on MMPs secretion. Serum CD147 levels were detected by the enzyme-linked immunosorbent assay, and the value of soluble CD147 as a marker in HCC detection was analyzed. RESULTS: Full length soluble CD147 was presented in the culture medium of HCC cells and serum of patients with HCC. The extracellular domain of soluble CD147 promoted the expression of CD147 and MMP-2 from HCC cells. Knockdown of CD147 markedly diminished the up-regulation of CD147 and MMP-2 which induced by soluble CD147. Soluble CD147 activated ERK, FAK, and PI3K/Akt pathways, leading to the up-regulation of MMP-2. The level of soluble CD147 in serum of patients with HCC was significantly elevated compared with healthy individuals (P < 0.001). Soluble CD147 levels were found to be associated with HCC tumor size (P = 0.007) and Child-Pugh grade (P = 0.007). Moreover, soluble CD147 showed a better performance in distinguishing HCC compared with alpha-fetoprotein. CONCLUSIONS: The extracellular domain of soluble CD147 enhances the secretion of MMP-2 from HCC cells, requiring the cooperation of membrane CD147 and activation of ERK, FAK, and PI3K/Akt signaling. The measurement of soluble CD147 may offer a useful approach in diagnosis of HCC.

[Synchronous treatment of heavy metal ions and nitrate by zero-valent iron].

The wastewater which contains bivalent copper and nitrate, bivalent nickel and nitrate, hexavalent chromium and nitrate were simultaneously treated by the zero-valent iron (Fe(0)) system to investigate the feasibility of using Fe(0) for the remediation of contaminated groundwater. The experimental results indicate that nitrate has no obvious effect on the removal of heavy metals, and different heavy metal has different impacts on the removal of nitrate. Bivalent copper accelerates the nitrate removal percentage and the reaction rate. 50 mg x L(-1) bivalent copper made the nitrate removal percentage in 120 min increase from 38.2% to 95.0%, meanwhile made k(obs) of the nitrate reduction increase from 0.004 3 to 0.033 9 min(-1). And the more the concentrations of bivalent copper are, the higher the nitrate removal percentage and the reaction rate are. And it is the bivalent copper that makes the apparent activation energy of the nitrate reduction by Fe(0) decrease from 40.8 k x mol(-1) to 21.1 kJ x mol(-1), which leads to the increase of the reaction rate. When Fe(0) simultaneously treats the wastewater containing bivalent nickel and nitrate, they have no obvious effects on each other. When Fe(0) simultaneously treats the wastewater containing hexavalent chromium and nitrate, the results show the nitrate concentration remains unchanged, and prove that hexavalent chromium decreases the nitrate removal speed.

Remediation of Ni(2+)-contaminated water using iron powder and steel manufacturing byproducts.

Steel manufacturing byproducts and commercial iron powders were tested in the treatment of Ni(2+)-contaminated water. Ni2+ is a priority pollutant of some soils and groundwater. The use of zero-valent iron, which can reduce Ni2+ to its neural form appears to be an alternative approach for the remediation of Ni(2+)-contaminated sites. Our experimental data show that the removal efficiencies of Ni2+ were 95.15% and 94.68% at a metal to solution ratio of 20 g/L for commercial iron powders and the steel manufacturing byproducts in 60 min at room temperature, respectively. The removal efficiency reached 98.20% when the metal to solution ratio was 40 g/L for commercial iron powders. Furthermore, we found that the removal efficiency was also largely affected by other factors such as the pHs of the treated water, the length of time for the metal to be in contact with the Ni(2+)-contaminated water, initial concentrations of metal solutions, particle sizes and the amount of iron powders. Surprisingly, the reaction temperature appeared to have little effect on the removal efficiency. Our study opens the way to further optimize the reaction conditions of in situ remediation of Ni2+ or other heavy metals on contaminated sites.

Fe salts as catalyst for the wet oxidation of o-chlorophenol.

Catalytic wet air oxidation (CWAO) of o-chlorophenol in wastewater was studied in a stainless steel autoclave using four different Fe catalysts in the temperature range of 100-200 degrees C. Experimental results showed that high rate of o-chlorophenol and COD(Cr) (Chemical Oxygen Demand, mg/L) removal by CWAO was obtained at relatively low temperature and pressure. The catalysts Fe2(SO4)3, FeSO4, Fe2O3 and FeCl3 all exhibited high catalytic activity. More than 93.7% of the initial COD(Cr) and nearly 100% of o-chlorophenol were removed at 150 degrees C after 150 min with FeSO4 as catalyst. The CWAO of o-chlorophenol was found to be pseudo-first order reaction with respect to o-chlorophenol, with activation energy of 75.56 kJ/mol in the temperature range of 100-175 degrees C.

Simultaneous removal of nitrate and heavy metals by iron metal.

Great attention should be paid now to simultaneously removing common pollutants, especially inorganic pollutants such as nitrate and heavy metals, as individual removal has been investigated extensively. Removing common pollutants simultaneously by iron metal is a very effective alternative method. Near neutral pH, heavy metals, such as copper and nickel, can be removed rapidly by iron metal, while nitrate removal very much slower than that of copper and nickel, and copper can accelerate nitrate removal when both are removed simultaneously. Even a little amount of copper can enhance nitrate removal efficiently. Different mechanisms of these contaminants removal by iron metal were also discussed.

Reductive denitrification of nitrate by scrap iron filings.

Reduction of nitrate by zero-valent iron is a highly exergonic reaction that has long been known to occur. Use of scrap iron filings (SIF) as the PRB (Permeable Reactive Barrier) material can be used to recycle certain by-products, and identify cheaper replacements for expensive conventional PRB materials, especially pure metallic iron. The feasibility of reductive denitrification of nitrate by SIF was studied by batch experiments. Operational parameters such as pH value, SIF dosage and initial concentration of nitrate were investigated. The removal efficiency of nitrate reached 80% under the conditions of pH of 2.5, nitrate initial concentration of 45 mg/L and SIF dosage of 100 g/L within 4 h. Results indicated that nitrate removal is inversely related to pH. Low pH value condition favors for the nitrate transformation. Different from the results of others who studied nitrate reduction using iron powder, we found that there was a lag time before nitrate reduction occurs, even at low pH. Finally, the possible mechanism of nitrate reduction by Fe0 is discussed.