Effect of Preoperative Malnutrition Based on Albumin and BMI on Hepatocellular Carcinoma Surgery and Prediction of Risk Factors of Complications.

BACKGROUND: To investigate the correlation between preoperative malnutrition and perioperative variables in patients with hepatocellular carcinoma (HCC) and to analyze the risk factors of complications after HCC resection. METHODS: All patients who underwent hepatectomy because of HCC in the First Affiliated Hospital of Chongqing Medical University from June 1, 2018, to December 1, 2021, were analyzed retrospectively. Preoperative malnutrition was defined as body mass index (BMI) < 18.5 kg/m2 or serum albumin level < 3.5 g/dL within 30 days before operation. RESULTS: A total of 415 patients with HCC hepatectomy were included, and 75 (18.1%) were classified as malnutrition group. In the malnutrition group, blood loss (662.1 ± 748.1 VS 404.6 ± 681.9, P = 0.002), transfusion rate (36.0% VS 13.5%, P < 0.001), postoperative hospital stays (13.3 ± 9.6 VS 10.1 ± 4.2, P < 0.001), 30-day postoperative mortality (4.0 VS 0.6%, P = 0.043), complications rate (68% VS 34.8%, P < 0.001), and severe complication rate (17.3% VS 2.4%, P < 0.001) were significantly higher than those in the well-nourished group. Multivariate analysis showed that age (HR 1.037, 95% CI 1.015-1.059, P = 0.001), preoperative malnutrition (HR 2.933, 95% CI 1.515-5.679, P = 0.001), simultaneous cholecystectomy (HR 2.004, 95% CI 1.168-3.440, P = 0.012), cirrhosis (HR 4.997, 95% CI 2.864-8.718, P < 0.001), and transfusion (HR 5.166, 95% CI 2.272-11.748, P < 0.001) were independent risk factors for postoperative complications. In addition, preoperative malnutrition (HR 8.209, 95% CI 2.711-24.864, P < 0.001) and operation time (HR 1.088, 95% CI 1.003-1.103, P = 0.004) were independent risk factors for severe complications. CONCLUSION: Preoperative malnutrition can adversely affect the outcome of HCC resection. For patients with advanced age, cirrhosis, and malnutrition, preoperative planning is very important, and we should be more careful during the operation to avoid transfusion caused by bleeding and not to carry out preventive cholecystectomy, which are helpful to reduce the occurrence of postoperative complications.

A semi-independent policies training method with shared representation for heterogeneous multi-agents reinforcement learning.

Humans do not learn everything from the scratch but can connect and associate the upcoming information with the exchanged experience and known knowledge. Such an idea can be extended to cooperated multi-reinforcement learning and has achieved its success on homogeneous agents by means of parameter sharing. However, it is difficult to straightforwardly apply parameter sharing when dealing with heterogeneous agents thanks to their individual forms of input/output and their diverse functions and targets. Neuroscience has provided evidence that our brain creates several levels of experience and knowledge-sharing mechanisms that not only exchange similar experiences but also allow for sharing of abstract concepts to handle unfamiliar situations that others have already encountered. Inspired by such a brain's functions, we propose a semi-independent training policy method that can well tackle the conflict between parameter sharing and specialized training for heterogeneous agents. It employs a shared common representation for both observation and action, enabling the integration of various input and output sources. Additionally, a shared latent space is utilized to maintain a balanced relationship between the upstream policy and downstream functions, benefiting each individual agent's target. From the experiments, it can approve that our proposed method outperforms the current mainstream algorithms, especially when handling heterogeneous agents. Empirically, our proposed method can also be improved as a more general and fundamental heterogeneous agents' reinforcement learning structure for curriculum learning and representation transfer. All our code is open and released on https://gitlab.com/reinforcement/ntype.

Rare combined variations of accessory left hepatic artery and accessory right hepatic artery: a case report and literature review.

Variations in the hepatic artery are commonly described in the literature, which is vital for the success procedure of all hepatobiliary surgery. Usually a variation occurs in either the accessory right hepatic artery (aRHA) or the accessory left hepatic artery (aLHA). However, we report an extremely rare case where the variation occurs in both simultaneously. We over served the aRHA arising from the gastroduodenal artery and branching into the superior pancreatic duodenum artery, while the aLHA arose from the common hepatic artery and branched into right gastric artery. This situation has never been reported in literature. We will discuss the meaning of this hepatic artery variation in a clinical setting.

[Recapping laminoplasty for the treatment of severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis].

OBJECTIVE: To investigate operation skills, therapeutic effects and indications of racapping laminoplasty for the treatment of severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis. METHODS: In the study, 41 patients with severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis were treated with recapping laminoplasty. After the treatment, the size of vertebral canal, spinal stability, altitude recovery of vertebral body and rehabilitation of nerve function were observed. RESULTS: All the patients were followed up and the duration ranged from 1 to 3 years. The anterior height of compressed vertebral bodies restored from preoperative 58% to postoperative 97%, posterior height was from preoperative 76% to postoperative 98.7%. The Cobb angle was corrected from preoperative 24.6 degrees to postoperative 1.8 degrees, and the size of vertebral canal restored from preoperative 43% to postoperative 93%. According to Frankel classification, 1 patient who were at A grade had no changes and others improved by 1 to 3 degrees. CONCLUSION: This is an ideal operation method for treating burst fractures of thoracolumbar vertebra with spinal stenosis, which is simple, safe and enlarging vertebral canal, at the same time completely decompressing the dura mater and nerve roots. This method eliminated secondary spinal stenosis, reconstructed posterior column and increased spinal stability.