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Tang X, Li H, Deng G, Zheng X, Wang X, Huang Y, Gao Y, Meng Z, Qian Z, Liu F, Lu X, Shi Y, Li B, Gu W, Xiang X, Xiong Y, Hou Y, Chen J, Gao N, Luo S, Ji L, Li J, Zheng R, Ren H, Chen J. New Algorithm Rules Out Acute-on-chronic Liver Failure Development within 28 Days from Acute Decompensation of Cirrhosis. J Clin Transl Hepatol 2022; 000:000-000. [PMID: 36969896 DOI: 10.14218/jcth.2022.00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/27/2022] [Accepted: 07/16/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Approximately 10% of patients with acute decompensated (AD) cirrhosis develop acute-on-chronic liver failure (ACLF) within 28 days. Such cases have high mortality and are difficult to predict. Therefore, we aimed to establish and validate an algorithm to identify these patients on hospitalization. METHODS Hospitalized patients with AD who developed ACLF within 28 days were considered pre-ACLF. Organ dysfunction was defined according to the chronic liver failure-sequential organ failure assessment (CLIF-SOFA) criteria, and proven bacterial infection was taken to indicate immune system dysfunction. A retrospective multicenter cohort and prospective one were used to derive and to validate the potential algorithm, respectively. A miss rate of <5% was acceptable for the calculating algorithm to rule out pre-ACLF. RESULTS In the derivation cohort (n=673), 46 patients developed ACLF within 28 days. Serum total bilirubin, creatinine, international normalized ratio, and present proven bacterial infection at admission were associated with the development of ACLF. AD patients with ≥2 organ dysfunctions had a higher risk for pre-ACLF patients [odds ratio=16.581 95% confidence interval: (4.271-64.363), p<0.001]. In the derivation cohort, 67.5% of patients (454/673) had ≤1 organ dysfunction and two patients (0.4%) were pre-ACLF, with a miss rate of 4.3% (missed/total, 2/46). In the validation cohort, 65.9% of patients (914/1388) had ≤1 organ dysfunction, and four (0.3%) of them were pre-ACLF, with a miss rate of 3.4% (missed/total, 4/117). CONCLUSIONS AD patients with ≤1 organ dysfunction had a significantly lower risk of developing ACLF within 28 days of admission and could be safely ruled out with a pre-ACLF miss rate of <5%.
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Affiliation(s)
- Xiaoting Tang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hai Li
- Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China
| | - Guohong Deng
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xin Zheng
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yan Huang
- Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanhang Gao
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongji Meng
- Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Zhiping Qian
- Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Feng Liu
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaobo Lu
- Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Yu Shi
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, Zhejiang, China
- National Clinical Research Center of Infectious Disease, Hangzhou, Zhejiang, China
| | - Beiling Li
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenyi Gu
- Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China
| | - Xiaomei Xiang
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yan Xiong
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yixin Hou
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jun Chen
- Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Na Gao
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Sen Luo
- Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Liujuan Ji
- Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jing Li
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Rongjiong Zheng
- Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Haotang Ren
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, Zhejiang, China
- National Clinical Research Center of Infectious Disease, Hangzhou, Zhejiang, China
| | - Jinjun Chen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Hepatology Unit, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Correspondence to: Jinjun Chen, Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China. ORCID: https://orcid.org/0000-0003-4275-9149. Tex/Fax: +86-20-62787423, E-mail:
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Yeo YH, He X, Lv F, Zhao Y, Liu Y, Yang JD, Zu J, Ji F, Nguyen MH. Trends of Cirrhosis-related Mortality in the USA during the COVID-19 Pandemic. J Clin Transl Hepatol 2022; 000:000-000. [PMID: 36969898 DOI: 10.14218/jcth.2022.00313] [Citation(s) in RCA: 0] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022] Open
Abstract
Immunocompromised status and interrupted routine care may render patients with cirrhosis vulnerable to the coronavirus disease 2019 (COVID-19) pandemic. A nationwide dataset that includes more than 99% of the decedents in the U.S. between April 2012 and September 2021 was used. Projected age-standardized mortality during the pandemic were estimated according to prepandemic mortality rates, stratified by season. Excess deaths were determined by estimating the difference between observed and projected mortality rates. A temporal trend analysis of observed mortality rates was also performed in 0.83 million decedents with cirrhosis between April 2012 and September 2021 was included. Following an increasing trend of cirrhosis-related mortality before the pandemic, with a semiannual percentage change (SAPC) of 0.54% [95% confidence interval (CI): (0.0-1.0%), p=0.036], a precipitous increase with seasonal variation occurred during the pandemic (SAPC 5.35, 95% CI: 1.9-8.9, p=0.005). Significantly increased mortality rates were observed in those with alcohol-associated liver disease (ALD), with a SAPC of 8.44 (95% CI: 4.3-12.8, p=0.001) during the pandemic. All-cause mortality of nonalcoholic fatty liver disease rose steadily across the entire study period with a SAPC of 6.79 (95% CI: 6.3-7.3, p<0.001). The decreasing trend of HCV-related mortality was reversed during the pandemic, while there was no significant change in HBV-related deaths. While there was significant increase in COVID-19-related deaths, more than 55% of the excess deaths were the indirect impact of the pandemic. We observed an alarming increase in cirrhosis-related deaths during the pandemic especially for ALD, with evidence in both direct and indirect impact. Our findings have implications on formulating policies for patients with cirrhosis.
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Affiliation(s)
- Yee Hui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xinyuan He
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Fan Lv
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yunyu Zhao
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yi Liu
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jian Zu
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Fanpu Ji
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Correspondence to: Mindie H. Nguyen, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA 94304, USA. ORCID: https://orcid.org/0000-0002-6275-4989. Tel: +1-650-498-5691, Fax: +1-650-498-5692, E-mail: ; Fanpu Ji, Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 Xi Wu Road, Xi’an, Shaanxi 710004, China. ORCID: https://orcid.org/0000-0002-1463-8035. Tel/Fax: +86-29-87678223, E-mail: or
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California, USA
- Correspondence to: Mindie H. Nguyen, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA 94304, USA. ORCID: https://orcid.org/0000-0002-6275-4989. Tel: +1-650-498-5691, Fax: +1-650-498-5692, E-mail: ; Fanpu Ji, Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 Xi Wu Road, Xi’an, Shaanxi 710004, China. ORCID: https://orcid.org/0000-0002-1463-8035. Tel/Fax: +86-29-87678223, E-mail: or
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Lin J, Su M, Zheng J, Gu L, Wu H, Wu X, Lin H, Wu Z, Li D. Fas/FasL and Complement Activation are Associated with Chronic Active Epstein-Barr Virus Hepatitis. J Clin Transl Hepatol 2022; 000:000-000. [PMID: 36969885 DOI: 10.14218/jcth.2022.00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Chronic active Epstein-Barr virus hepatitis (CAEBVH) is a rare and highly lethal disease characterized by hepatitis and hepatomegaly. This study aimed to investigate the clinicopathological features and pathogenic mechanisms of CAEBVH. METHODS Ten patients with confirmed Epstein-Barr virus hepatitis infection were enrolled. The clinicopathological characteristics of these patients were summarized and analyzed. Flow cytometry was utilized to detect peripheral blood immune cell phenotypes and whole exome sequencing was used to explore pathogenic genetic mechanisms. Lastly, immunohistochemical staining was employed to verify pathogenic mechanisms. RESULTS Clinical features observed in all Epstein-Barr virus hepatitis patients included fever (7/10), splenomegaly (10/10), hepatomegaly (9/10), abnormal liver function (8/10), and CD8+ T cell lymphopenia (6/7). Hematoxylin and eosin staining revealed lymphocytic infiltration in the liver. Positive Epstein-Barr virus-encoded small RNA in-situ hybridization (EBER-ISH) of lymphocytes of liver tissues was noted. Whole exome sequencing indicated that cytotoxic T lymphocytes and the complement system were involved. The expression of CD8, Fas, FasL, and Caspase-8 expression as well as apoptotic markers was enhanced in the Epstein-Barr virus hepatitis group relative to the controls (p<0.05). Lastly, Complement 1q and complement 3d expression, were higher in CAEBVH patients relative to controls (p<0.05). CONCLUSIONS CAEBVH patients developed fever, hepatosplenomegaly, and lymphadenopathy. Histopathological changes were a diffuse lymphocytic sinusoidal infiltrate with EBER-ISH positivity. Fas/FasL and complement activation were involved in CAEBVH patients.
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Affiliation(s)
- Jing Lin
- Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
| | - Miao-Fang Su
- Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
| | - Jiao-Long Zheng
- Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
| | - Lei Gu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai-Cong Wu
- Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
| | - Xia Wu
- Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
| | - Hai-Yan Lin
- Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
| | - Zhi-Xian Wu
- Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
| | - Dong-Liang Li
- Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
- Correspondence to: Dong-Liang Li, Department of Hepatobiliary Medicine, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of the Joint Logistic Support Force, PLA, Fuzhou, Fujian 350025, China. ORCID: https://orcid.org/0000-0001-5536-8468. Tel/Fax: +86-591-2285-9128, E-mail:
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Sang YB, Kim G, Hwang S, Kang H, Chon HJ. Dramatic Response to Cabozantinib in a Patient with Refractory Hepatocellular Carcinoma with c- MET Amplification. J Clin Transl Hepatol 2022; 000:000-000. [PMID: 36969903 DOI: 10.14218/jcth.2022.00212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 12/04/2022] Open
Abstract
We report a case of a patient with c-MET amplified hepatocellular carcinoma (HCC) who had a dramatic response to cabozantinib despite being refractory to four previous lines of systemic therapy. The patient had previously received regorafenib plus nivolumab as first-line treatment, lenvatinib as second-line, sorafenib as third-line, and ipilimumab plus nivolumab as fourth-line treatment in sequence. However, all regimens showed early progression within 2 months. The patient's HCC was well-controlled, with a partial response (PR) of over 9 months after beginning cabozantinib treatment. Although there were mild adverse events such as diarrhea and elevated liver enzymes, they were tolerable. Next-generation sequencing (NGS) of the patient's previous surgical specimen indicated amplification of c-MET genes. Although it is well known that cabozantinib has excellent effectiveness for inhibiting c-MET at the preclinical level, to the best of our knowledge this is the first case of dramatic response to cabozantinib in a patient with advanced HCC with c-MET amplification.
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Affiliation(s)
- Yun Beom Sang
- Department of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Korea
| | - Gwangil Kim
- Department of Pathology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Korea
| | - Sohyun Hwang
- Department of Pathology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Korea
- CHA Future Medicine Research Institute, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do, Korea
| | - Haeyoun Kang
- Department of Pathology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Korea
| | - Hong Jae Chon
- Department of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Korea
- CHA Future Medicine Research Institute, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do, Korea
- Correspondence to: Hong Jae Chon, Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. ORCID: https://orcid.org/0000-0002-6979-5812. Tel/Fax: +82-31-780-7590, E-mail:
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Zuo D, Liu H, Liu D, Fang Q, Li P, Tu L, Xiong Y, Zeng Y, Liu P. Value of Non-tumoral Liver Volume in the Prognosis of Large Hepatocellular Carcinoma Patients After R0 Resection. J Clin Transl Hepatol 2022; 000:000-000. [PMID: 36969888 DOI: 10.14218/jcth.2022.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/02/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Hepatectomy is an effective treatment for selected patients with large hepatocellular carcinoma (HCC). This study aimed to develop a nomogram incorporating non-tumoral liver volume (non-TLV) and liver function markers to predict the patients' overall survival (OS) and disease-free survival (DFS). METHODS Data of 198 consecutive large HCC patients who underwent hepatectomy at the Zhongshan Hospital Xiamen University were collected. Another 68 patients from the Mengchao Hepatobiliary Surgery Hospital served as an external validation cohort. The nomograms were developed based on the independent prognostic factors screened by multivariate Cox regression analyses. Concordance index (C-index), calibration curves, and time-dependent receiver operating characteristic (ROC) curves were used to measure the discrimination and predictive accuracy of the models. RESULTS High HBV DNA level, low non-TLV/ICG, vascular invasion, and a poorly differentiated tumor were confirmed as independent risk factors for both OS and DFS. The model established in this study predicted 5-year post-operative survival and DFS in good agreement with the actual observation confirmed by the calibration curves. The C-indexes of the nomograms in predicting OS and DFS were 0.812 and 0.823 in the training cohort, 0.821 and 0.846 in the internal validation cohort, and 0.724 and 0.755 in the external validation cohort. The areas under the ROC curves (AUCs) of nomograms for predicted OS and DFS at 1, 3, and 5 year were 0.85, 0.86, 0.83 and 0.76, 0.76, 0.63, respectively. CONCLUSIONS Nomograms with non-TLV/ICG predicted the prognosis of single large HCC patients accurately and effectively.
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Affiliation(s)
- Dongliang Zuo
- Department of Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yuntong Li
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Hongzhi Liu
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Surgery Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Dongxu Liu
- Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Qinliang Fang
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Pengtao Li
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Liang Tu
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Yu Xiong
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Yongyi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Surgery Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Correspondence to: Pingguo Liu, Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, 201 Hubin South Rd., Xiamen, Fujian 361001, China. Tel/Fax: +86-592-2993141, E-mail: ; Yongyi Zeng, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, Fujian 350025, China. Tel/Fax: +86-591-8370-5927, E-mail:
| | - Pingguo Liu
- Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
- Correspondence to: Pingguo Liu, Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, 201 Hubin South Rd., Xiamen, Fujian 361001, China. Tel/Fax: +86-592-2993141, E-mail: ; Yongyi Zeng, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, Fujian 350025, China. Tel/Fax: +86-591-8370-5927, E-mail:
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