Time-trends in liver cancer incidence and mortality rates in the U.S. from 1975 to 2017: a study based on the Surveillance, Epidemiology, and End Results database.

Background: A previous study has examined the overall cancer statistics. However, more detailed statistics regarding liver cancer have not been provided. We evaluated the incidence and mortality trends of liver and intrahepatic bile duct cancer in the United States from 1975 to 2017 based on the data in the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Age, gender, race, metastasis, tumor site, and tumor grade of patients were extracted from the SEER database. Codes C22.0 and C22.1 of the International Classification of Disease for Oncology were applied to identify patients with hepatocellular carcinoma (HCC) and/or intrahepatic cholangiocarcinoma (ICC). Age-specified incidence, age-standardized incidence and mortality, 5-year relative survival, race-specific accumulative incidence and mortality, and geographic-specific accumulative mortality were calculated in different groups. Changes in trends of liver cancer incidence and mortality were assessed using Joinpoint regression. Results: The overall incidence increased significantly from 2.641/100,000 person-years in 1975 to 8.657/100,000 person-years in 2017 [average annual percent change (AAPC) =3.42, 95% confidence interval (CI): 3.28-3.62, P<0.001]. The steepest incidence rate increase was observed in the 60-69-year-old age group (AAPC =4.40, 95% CI: 4.10-4.70, P<0.001). Males exhibited a more rapid increase in cancer incidence, from 3.928/100,000 to 13.128/100,000 person-years (AAPC =3.41, 95% CI: 3.21-3.61, P<0.001), than females [from 1.642/100,000 to 4.783/100,000 person-years (AAPC =3.03, 95% CI: 2.91-3.21, P=0.001)]. The overall mortality rate increased from 2.808/100,000 person-years in 1975 to 6.648/100,000 person-years in 2017 (AAPC =2.41, 95% CI: 2.29-2.51, P<0.001). The highest mortality rate was observed in Hawaii (6.996/100,000 person-years). Conclusions: The incidence and mortality rates of HCC and ICC increased from 1975 to 2017, especially in males, non-Hispanic Blacks and older individuals. Comprehensive policy and control measures should be implemented to reduce the burden of disease, particularly through health monitoring and intervention for high-risk groups.

A Nomogram for Preoperative Estimation of Microvascular Invasion Risk in Hepatocellular Carcinoma: Single-Center Analyses With Internal Validation.

BACKGROUND: Microvascular invasion (MVI) is highly associated with poor prognosis in patients with liver cancer. Predicting MVI before surgery is helpful for surgeons to better make surgical plan. In this study, we aim at establishing a nomogram to preoperatively predict the occurrence of microvascular invasion in liver cancer. METHOD: A total of 405 patients with postoperative pathological reports who underwent curative hepatocellular carcinoma resection in the Third Affiliated Hospital of Sun Yat-sen University from 2013 to 2015 were collected in this study. Among these patients, 290 were randomly assigned to the development group while others were assigned to the validation group. The MVI predictive factors were selected by Lasso regression analysis. Nomogram was established to preoperatively predict the MVI risk in HCC based on these predictive factors. The discrimination, calibration, and effectiveness of nomogram were evaluated by internal validation. RESULTS: Lasso regression analysis revealed that discomfort of right upper abdomen, vascular invasion, lymph node metastases, unclear tumor boundary, tumor necrosis, tumor size, higher alkaline phosphatase were predictive MVI factors in HCC. The nomogram was established with the value of AUROC 0.757 (0.716-0.809) and 0.768 (0.703-0.814) in the development and the validation groups. Well-fitted calibration was in both development and validation groups. Decision curve analysis confirmed that the predictive model provided more benefit than treat all or none patients. The predictive model demonstrated sensitivity of 58.7%, specificity of 80.7% at the cut-off value of 0.312. CONCLUSION: Nomogram was established for predicting preoperative risk of MVI in HCC. Better treatment plans can be formulated according to the predicted results.

Application of near-infrared fluorescent cholangiography using indocyanine green in laparoscopic cholecystectomy.

OBJECTIVE: Near-infrared fluorescence cholangiography (NIRF-C) can help to identify the bile duct during laparoscopic cholecystectomy. This retrospective study was performed to investigate the effect of NIRF-C in laparoscopic cholecystectomy. METHODS: Consecutive patients who underwent NIRF-C-assisted laparoscopic cholecystectomy (n = 34) or conventional laparoscopic cholecystectomy (n = 36) were enrolled in this study. Identification of biliary structures, the operation time, intraoperative blood loss, and postoperative complications were analyzed. RESULTS: Laparoscopic cholecystectomy was completed in all patients without conversion to laparotomy. The median operation time and intraoperative blood loss were not significantly different between the two groups. No intraoperative injuries or postoperative complications occurred in either group. In the NIRF-C group, the visualization rate of the cystic duct, common bile duct, and common hepatic duct prior to dissection was 91%, 79%, and 53%, respectively. The success rate of cholangiography was 100% in the NIRF-C group. NIRF-C was more effective for visualizing biliary structures in patients with a BMI of <25 than >25 kg/m2. CONCLUSIONS: NIRF-C is a safe and effective technique that enables real-time identification of the biliary anatomy during laparoscopic cholecystectomy. NIRF-C helps to improve the efficiency of dissection.

Determination of the derivative from ginkgolide B.

A new compound decomposed from ginkgolide B(GB) is discovered and identified by MS and UV spectrum. It is the dehydrate of GB, which was named as ginkgolide K before. Differently, it cannot exist independently, but only in equilibrium with GB. It is found first time that 3-hydroxy is active in some solvent.

[Investigation on the convertion between ginkgolide B and its derivative].

A derivative decomposed from ginkgolide B (GB) was isolated by semi-preparative chromatography. The results of the high performance liquid chromatography (HPLC) showed that the retention time of the derivative was approximately three times of that of GB with ultraviolet detection (UV), and the derivative can not exist independently without the presence of GB. The UV spectrum showed that the lamdamax of the derivative was 212.1 nm and the epsilonmax was 2.29 x 10(4), which were approximately 100 times higher than those of GB. This means a new conjugation bond has been formed and that means that the conjugation bond's pii-pi* electron jump occured in the derivative. Liquid chromatography-mass spectrometry showed the molecular ion peaks of the derivative in the positive mode and negative mode were m/z 429.1 (M + Na)+ and m/z 405.2 (M-H)-, respectively. The relative molecular mass of the derivative is 406.2. The derivative showed the same mode of fragment ion as GB in the mass spectrum, which might be due to the loss of a H2O from GB. Thermal stability of GB was greater than that of the derivative. They were both easily to be dissolved in dilute alkali. When the pH gradually increases, the ring-opening speed of the derivative is higher than that of GB. The derivative was obviously affected by solvent and higher temperatures. When GB was dissolved in PEG, the peak of the derivative disappeared at 50 degrees C for 15 h or at 120 degrees C for 4 h. Besides the main peak of GB, there appeared a small peak with a retention time of 1.2-3.0 min after heating 4 h at 120 degrees C. The result showed that the derivative was in a high energy state, and GB had a better stabilization. They coexisted and converted to each other. Under some specific conditions, the derivative could all convert to GB.

[Study on the relation between ginkgolide B and water by FTIR].

The method of IR was used to study GB spectrum variety with different water ratio, and it was showed that GB IR spectrum only changed in the absorption strength at 3452, 1793, 1780 and 1630 cm(-1). The reason is that the water was concealed by GB cage skeleton and formed hydroxyl bond with GB hydroxyl groups, and the structure of GB remained unchanged and accorded with standardized GB. With the help of DSC and LC-MS, the subtle relations between GB and water were explained, GB is lipophilic and can not be dissolved by water, but in general, GB is easy to absorb the water of environment, and can be dehydrated under particular conditions.

Application of L-Amino acid in determination of Huperzine A by high performance liquid chromatography.

A selective HPLC method for determination of Huperzine A in Huperzia serrata Extract has been developed and validated. Huperzine A was dissolved in 0.01 mol/L HCl, chromatographed on an Agilent Zorbax SB-C18 (150 mm x 4.6 mm i.d., 5 microm) column, with a mobile phase consisting of methanol-1mM L-Lysine water solution (50:50, v/v), and detected at 310 nm. The UV peak areas were used for quantitation of Huperzine A content. The correlation coefficient (R(2)) of the calibration was 0.9999 over the range of 1-25 microg/ml and intra- and interday precision over this range were not more than 2%. The method was successfully applied to characterize and determine the Huperzine A in Huperzia serrata Extract.