Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with intermediate and advanced/relapsed hepatocellular carcinoma: a TOS-ESMO initiative endorsed by CSCO, ISMPO, JSMO, KSMO, MOS and SSO

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of hepatocellular carcinoma (HCC) was published in 2018, and covered the diagnosis, management, treatment and follow-up of early, intermediate and advanced disease. At the ESMO Asia Meeting in November 2018 it was decided by both the ESMO and the Taiwan Oncology Society (TOS) to convene a special guidelines meeting immediately after the Taiwan Joint Cancer Conference (TJCC) in May 2019 in Taipei. The aim was to adapt the ESMO 2018 guidelines to take into account both the ethnic and the geographic differences in practice associated with the treatment of HCC in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with intermediate and advanced/relapsed HCC representing the oncology societies of Taiwan (TOS), China (CSCO), India (ISMPO) Japan (JSMO), Korea (KSMO), Malaysia (MOS) and Singapore (SSO). The voting was based on scientific evidence, and was independent of the current treatment practices, the drug availability and reimbursement situations in the individual participating Asian countries.

Multivariate classification of earthquake survivors with post-traumatic stress disorder based on large-scale brain networks

OBJECTIVE

The identification of post-traumatic stress disorder (PTSD) among natural disaster survivors is remarkably challenging, and there are no reliable objective signatures that can be used to assist clinical diagnosis and optimize treatment. The current study aimed to establish a neurobiological signature of PTSD from the connectivity of large-scale brain networks and clarify the brain network mechanisms of PTSD.

METHODS

We examined fifty-seven unmedicated survivors with chronic PTSD and 59 matched trauma-exposed healthy controls (TEHCs) using resting-state functional magnetic resonance imaging (rs-fMRI). We extracted the node-to-network connectivity and obtained a feature vector with a dimensionality of 864 (108 nodes × 8 networks) to represent each subject's functional connectivity (FC) profile. Multivariate pattern analysis with a relevance vector machine was then used to distinguish PTSD patients from TEHCs.

RESULTS

We achieved a promising diagnostic accuracy of 89.2% in distinguishing PTSD patients from TEHCs. The most heavily weighted connections for PTSD classification were among the default mode network (DMN), visual network (VIS), somatomotor network, limbic network, and dorsal attention network (DAN). The strength of the anticorrelation of FC between the ventral medial prefrontal cortex (vMPFC) in DMN and the VIS and DAN was associated with the severity of PTSD.

CONCLUSIONS

This study achieved relatively high accuracy in classifying PTSD patients vs. TEHCs at the individual level. This performance demonstrates that rs-fMRI-derived multivariate classification based on large-scale brain networks can provide potential signatures both to facilitate clinical diagnosis and to clarify the underlying brain network mechanisms of PTSD caused by natural disasters.

First Observation of Excited Ω_{b}^{-} States

We report four narrow peaks in the Ξ_{b}^{0}K^{-} mass spectrum obtained using pp collisions at center-of-mass energies of 7, 8, and 13 TeV, corresponding to a total integrated luminosity of 9  fb^{-1} recorded by the LHCb experiment. Referring to these states by their mass, the mass values are m[Ω_{b}(6316)^{-}]=6315.64±0.31±0.07±0.50  MeV, m[Ω_{b}(6330)^{-}]=6330.30±0.28±0.07±0.50  MeV, m[Ω_{b}(6340)^{-}]=6339.71±0.26±0.05±0.50  MeV, m[Ω_{b}(6350)^{-}]=6349.88±0.35±0.05±0.50  MeV, where the uncertainties are statistical, systematic, and the last is due to the knowledge of the Ξ_{b}^{0} mass. The natural widths of the three lower mass states are consistent with zero, and the 90% confidence-level upper limits are determined to be Γ[Ω_{b}(6316)^{-}]<2.8  MeV, Γ[Ω_{b}(6330)^{-}]<3.1  MeV and Γ[Ω_{b}(6340)^{-}]<1.5  MeV. The natural width of the Ω_{b}(6350)^{-} peak is 1.4_{-0.8}^{+1.0}±0.1  MeV, which is 2.5σ from zero and corresponds to an upper limit of 2.8 MeV. The peaks have local significances ranging from 3.6σ to 7.2σ. After accounting for the look-elsewhere effect, the significances of the Ω_{b}(6316)^{-} and Ω_{b}(6330)^{-} peaks are reduced to 2.1σ and 2.6σ, respectively, while the two higher mass peaks exceed 5σ. The observed peaks are consistent with expectations for excited Ω_{b}^{-} resonances.

Relationship of adiponectin, leptin, visfatin and IGF-1 in cow's venous blood and venous cord blood with calf birth weight

The Intrauterine fetal development process is complicated and affected by many regulating factors such as maternal nutritional status, transcription factors and adipokines. Adipokines are kinds of active substances secreted by adipose tissue, including more than 50 kinds of molecules. To explore the correlation between calf birth weights and adipokines including adiponectin, leptin, visfatin, and IGF-1 in cows venous and venous cord blood. Fifty-four healthy multiparous Chinese Holstein cows were used; in which, cows with a calf weight less than 40 kg were included in group A (n=9); those with a calf weight between 40 kg~45 kg were included in group B (n=25) and ≥45 kg were included in group C (n=20), venous blood and cord venous blood was collected. An ELISA kit was used to evaluate the concentration of adiponectin, leptin, visfatin, and IGF-1, correlations between index-index and index-calf birth weight were analysed. In both cows venous and cord venous blood, adiponectin, leptin, visfatin, and IGF-1 levels were significantly correlated with each other (p⟨0.01), and levels of these adipokines in venous blood were significantly higher than cord venous blood (p⟨0.01). Adiponectin, leptin, visfatin, and IGF-1 in venous cord blood were positively correlated with calf birth weights, and significantly correlated with calf birth weights respectively (p⟨0.01). Our study showed that adiponectin, leptin, and IGF-1 were found in venous blood and cord venous blood, and adiponectin, leptin, and IGF-1 in venous and cord venous blood potentially inter-regulated each other; adiponectin, leptin, and IGF-1 in venous blood were not significantly correlated with calf birth weights, while adiponectin, leptin, visfatin, and IGF-1 in venous cord blood were significantly correlated with calf birth weights, respectively.

Search for A^{'}→μ^{+}μ^{-} Decays

Searches are performed for both promptlike and long-lived dark photons, A^{'}, produced in proton-proton collisions at a center-of-mass energy of 13 TeV. These searches look for A^{'}→μ^{+}μ^{-} decays using a data sample corresponding to an integrated luminosity of 5.5  fb^{-1} collected with the LHCb detector. Neither search finds evidence for a signal, and 90% confidence-level exclusion limits are placed on the γ-A^{'} kinetic mixing strength. The promptlike A^{'} search explores the mass region from near the dimuon threshold up to 70 GeV and places the most stringent constraints to date on dark photons with 214<m(A^{'})≲740  MeV and 10.6<m(A^{'})≲30  GeV. The search for long-lived A^{'}→μ^{+}μ^{-} decays places world-leading constraints on low-mass dark photons with lifetimes O(1)  ps.

Observation of Several Sources of CP Violation in B^{+}→π^{+}π^{+}π^{-} Decays

Observations are reported of different sources of CP violation from an amplitude analysis of B^{+}→π^{+}π^{+}π^{-} decays, based on a data sample corresponding to an integrated luminosity of 3  fb^{-1} of pp collisions recorded with the LHCb detector. A large CP asymmetry is observed in the decay amplitude involving the tensor f_{2}(1270) resonance, and in addition significant CP violation is found in the π^{+}π^{-}S wave at low invariant mass. The presence of CP violation related to interference between the π^{+}π^{-}S wave and the P wave B^{+}→ρ(770)^{0}π^{+} amplitude is also established; this causes large local asymmetries but cancels when integrated over the phase space of the decay. The results provide both qualitative and quantitative new insights into CP -violation effects in hadronic B decays.

Multiple Galactic Sources with Emission Above 56 TeV Detected by HAWC

We present the first catalog of gamma-ray sources emitting above 56 and 100 TeV with data from the High Altitude Water Cherenkov Observatory, a wide field-of-view observatory capable of detecting gamma rays up to a few hundred TeV. Nine sources are observed above 56 TeV, all of which are likely galactic in origin. Three sources continue emitting past 100 TeV, making this the highest-energy gamma-ray source catalog to date. We report the integral flux of each of these objects. We also report spectra for three highest-energy sources and discuss the possibility that they are PeVatrons.

Search for Lepton-Flavor Violating Decays B^{+}→K^{+}μ^{±}e^{∓}

A search for the lepton-flavor violating decays B^{+}→K^{+}μ^{±}e^{∓} is performed using a sample of proton-proton collision data, collected with the LHCb experiment at center-of-mass energies of 7 and 8 TeV and corresponding to an integrated luminosity of 3  fb^{-1}. No significant signal is observed, and upper limits on the branching fractions are set as B(B^{+}→K^{+}μ^{-}e^{+})<7.0(9.5)×10^{-9} and B(B^{+}→K^{+}μ^{+}e^{-})<6.4(8.8)×10^{-9} at 90% (95)% confidence level. The results improve the current best limits on these decays by more than one order of magnitude.

Overexpression of LncRNA FER1L4 in endometrial carcinoma is associated with favorable survival outcome

OBJECTIVE

Long noncoding RNA Fer-1-like protein 4 (FER1L4) is a novel cancer-related lncRNA and functions as a tumor suppressor in several cancers. However, the clinical significance of FER1L4 has not been investigated. The purpose of this study was to investigate whether the increased expression of FER1L4 can be used as a prognostic biomarker in endometrial carcinoma (EC).

PATIENTS AND METHODS

Expression levels of FER1L4 in 191 pairs of EC and adjacent normal tissues were detected by TaqMan Real-time quantitative RT-PCR assay. The association between FER1L4 expression and clinicopathological parameters was subsequently determined. The clinical and prognostic significance of FER1L4 expression was analyzed statistically by Kaplan-Meier estimate and Cox regression model.

RESULTS

We observed that FER1L4 in EC tissues was significantly down-regulated compared with adjacent non-tumor tissues (p<0.01). Low expression of FER1L4 was significantly correlated with distant metastasis (p=0.002), lymph node metastasis (p=0.010) and FIGO stages (p=0.006). Furthermore, Kaplan-Meier survival curves showed that overall survival rate in patients with high FER1L4 expression level was markedly higher than those with low FER1L4 expression level (p=0.0071). Finally, multivariate analysis of the prognosis factors confirmed that low FER1L4 expression was a significant independent predictor of poor survival in EC (HR=2.782, 95% CI: 1.144-5.123, p=0.004).

CONCLUSIONS

We provided the significant clinical relevance of FER1L4 in EC and suggested that FER1L4 may act as an independent prognostic indicator for EC patients.

Measurement of Charged Hadron Production in Z-Tagged Jets in Proton-Proton Collisions at sqrt[s]=8 TeV

The production of charged hadrons within jets recoiling against a Z boson is measured in proton-proton collision data at sqrt[s]=8  TeV recorded by the LHCb experiment. The charged-hadron structure of the jet is studied longitudinally and transverse to the jet axis for jets with transverse momentum p_{T}>20  GeV and in the pseudorapidity range 2.5<η<4. These are the first measurements of jet hadronization at these forward rapidities and also the first where the jet is produced in association with a Z boson. In contrast to previous hadronization measurements at the Large Hadron Collider, which are dominated by gluon jets, these measurements probe predominantly light-quark jets which are found to be more longitudinally and transversely collimated with respect to the jet axis when compared to the previous gluon dominated measurements. Therefore, these results provide valuable information on differences between quarks and gluons regarding nonperturbative hadronization dynamics.

Amplitude Analysis of B^{±}→π^{±}K^{+}K^{-} Decays

The first amplitude analysis of the B^{±}→π^{±}K^{+}K^{-} decay is reported based on a data sample corresponding to an integrated luminosity of 3.0  fb^{-1} of pp collisions recorded in 2011 and 2012 with the LHCb detector. The data are found to be best described by a coherent sum of five resonant structures plus a nonresonant component and a contribution from ππ↔KK S-wave rescattering. The dominant contributions in the π^{±} K^{∓} and K^{+} K^{-} systems are the nonresonant and the B^{±}→ρ(1450)^{0}π^{±} amplitudes, respectively, with fit fractions around 30%. For the rescattering contribution, a sizable fit fraction is observed. This component has the largest CP asymmetry reported to date for a single amplitude of (-66±4±2)%, where the first uncertainty is statistical and the second systematic. No significant CP violation is observed in the other contributions.

Search for the Lepton-Flavor-Violating Decays B_{s}^{0}→τ^{±}μ^{∓} and B^{0}→τ^{±}μ^{∓}

Results are reported from a search for the rare decays B_{s}^{0}→τ^{±}μ^{∓} and B^{0}→τ^{±}μ^{∓}, where the τ lepton is reconstructed in the channel τ^{-}→π^{-}π^{+}π^{-}ν_{τ}. These processes are effectively forbidden in the standard model, but they can potentially occur at detectable rates in models of new physics that can induce lepton-flavor-violating decays. The search is based on a data sample corresponding to 3  fb^{-1} of proton-proton collisions recorded by the LHCb experiment in 2011 and 2012. The event yields observed in the signal regions for both processes are consistent with the expected standard model backgrounds. Because of the limited mass resolution arising from the undetected τ neutrino, the B_{s}^{0} and B^{0} signal regions are highly overlapping. Assuming no contribution from B^{0}→τ^{±}μ^{∓}, the upper limit B(B_{s}^{0}→τ^{±}μ^{∓})<4.2×10^{-5} is obtained at 95% confidence level. If no contribution from B_{s}^{0}→τ^{±}μ^{∓} is assumed, a limit of B(B^{0}→τ^{±}μ^{∓})<1.4×10^{-5} is obtained at 95% confidence level. These results represent the first limit on B(B_{s}^{0}→τ^{±}μ^{∓}) and the most stringent limit on B(B^{0}→τ^{±}μ^{∓}).

Observation of New Resonances in the Λ_{b}^{0}π^{+}π^{-} System

We report the observation of a new structure in the Λ_{b}^{0}π^{+}π^{-} spectrum using the full LHCb data set of pp collisions, corresponding to an integrated luminosity of 9  fb^{-1}, collected at sqrt[s]=7, 8, and 13 TeV. A study of the structure suggests its interpretation as a superposition of two almost degenerate narrow states. The masses and widths of these states are measured to be m_{Λ_{b}(6146)^{0}}=6146.17±0.33±0.22±0.16  MeV,m_{Λ_{b}(6152)^{0}}=6152.51±0.26±0.22±0.16  MeV,Γ_{Λ_{b}(6146)^{0}}=2.9±1.3±0.3  MeV,Γ_{Λ_{b}(6152)^{0}}=2.1±0.8±0.3  MeV,with a mass splitting of Δm=6.34±0.32±0.02  MeV, where the first uncertainty is statistical, the second systematic. The third uncertainty for the mass measurements derives from the knowledge of the mass of the Λ_{b}^{0} baryon. The measured masses and widths of these new excited states suggest their possible interpretation as a doublet of Λ_{b}(1D)^{0} states.

Measurement of CP-Violating and Mixing-Induced Observables in B_{s}^{0}→ϕγ Decays

A time-dependent analysis of the B_{s}^{0}→ϕγ decay rate is performed to determine the CP -violating observables S_{ϕγ} and C_{ϕγ} and the mixing-induced observable A_{ϕγ}^{Δ}. The measurement is based on a sample of pp collision data recorded with the LHCb detector, corresponding to an integrated luminosity of 3  fb^{-1} at center-of-mass energies of 7 and 8 TeV. The measured values are S_{ϕγ}=0.43±0.30±0.11, C_{ϕγ}=0.11±0.29±0.11, and A_{ϕγ}^{Δ}=-0.67_{-0.41}^{+0.37}±0.17, where the first uncertainty is statistical and the second systematic. This is the first measurement of the observables S and C in radiative B_{s}^{0} decays. The results are consistent with the standard model predictions.

Tumour stiffness associated with tumour response to conventional transarterial chemoembolisation for hepatocellular carcinoma: preliminary findings

AIM

To evaluate whether elastic (stiffness) characteristics of tumours were associated with treatment responses and survival of patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolisation (TACE).

MATERIALS AND METHODS

A retrospective cohort study of 59 HCC patients with unresectable HCC who underwent TACE was undertaken. Acoustic radiation force impulse imaging (ARFI) was used to measure tissue stiffness of the index tumours and non-tumoural liver before TACE treatment. The correlation between the parameters of tumour stiffness and treatment response to TACE was assessed using mRECIST criteria as well as according to patient survival.

RESULTS

Tumour stiffness and its stiffness difference between tumour and non-tumoural liver were significantly associated with tumour response to TACE (p=0.019 and 0.010, respectively). Patients with tumour stiffness of <2 m/s or stiffness difference between tumour and non-tumoural liver of <0.5 were more likely to have treatment response to TACE. Univariate analysis showed that the difference in stiffness between tumour and non-tumoural livers (p=0.039) was one of the significant predictors of overall survival (OS). In multivariate analysis, alpha-fetoprotein (AFP) (p=0.006) and Barcelona Clinic Liver Cancer (BCLC) stage (p=0.017) were identified as independent predictors of survival.

CONCLUSION

Tumour stiffness characteristics might be an added predictive marker of treatment response to TACE in patients with HCC.

First Observation of the Radiative Decay Λ_{b}^{0}→Λγ

The radiative decay Λ_{b}^{0}→Λγ is observed for the first time using a data sample of proton-proton collisions corresponding to an integrated luminosity of 1.7  fb^{-1} collected by the LHCb experiment at a center-of-mass energy of 13 TeV. Its branching fraction is measured exploiting the B^{0}→K^{*0}γ decay as a normalization mode and is found to be B(Λ_{b}^{0}→Λγ)=(7.1±1.5±0.6±0.7)×10^{-6}, where the quoted uncertainties are statistical, systematic, and systematic from external inputs, respectively. This is the first observation of a radiative decay of a beauty baryon.

Observation of an Excited B_{c}^{+} State

Using pp collision data corresponding to an integrated luminosity of 8.5  fb^{-1} recorded by the LHCb experiment at center-of-mass energies of sqrt[s]=7, 8, and 13 TeV, the observation of an excited B_{c}^{+} state in the B_{c}^{+}π^{+}π^{-} invariant-mass spectrum is reported. The observed peak has a mass of 6841.2±0.6(stat)±0.1(syst)±0.8(B_{c}^{+})  MeV/c^{2}, where the last uncertainty is due to the limited knowledge of the B_{c}^{+} mass. It is consistent with expectations of the B_{c}^{*}(2^{3}S_{1})^{+} state reconstructed without the low-energy photon from the B_{c}^{*}(1^{3}S_{1})^{+}→B_{c}^{+}γ decay following B_{c}^{*}(2^{3}S_{1})^{+}→B_{c}^{*}(1^{3}S_{1})^{+}π^{+}π^{-}. A second state is seen with a global (local) statistical significance of 2.2σ (3.2σ) and a mass of 6872.1±1.3(stat)±0.1(syst)±0.8(B_{c}^{+})  MeV/c^{2}, and is consistent with the B_{c}(2^{1}S_{0})^{+} state. These mass measurements are the most precise to date.

Measurement of the Mass Difference Between Neutral Charm-Meson Eigenstates

We report a measurement of the mass difference between neutral charm-meson eigenstates using a novel approach that enhances sensitivity to this parameter. We use 2.3×10^{6} D^{0}→K_{S}^{0}π^{+}π^{-} decays reconstructed in proton-proton collisions collected by the LHCb experiment in 2011 and 2012. Allowing for CP violation in mixing and in the interference between mixing and decay, we measure the CP-averaged normalized mass difference x_{CP}=[2.7±1.6(stat)±0.4(syst)]×10^{-3} and the CP-violating parameter Δx=[-0.53±0.70(stat)±0.22(syst)]×10^{-3}. The results are consistent with CP symmetry. These determinations are the most precise from a single experiment and, combined with current world-average results, yield the first evidence that the masses of the neutral charm-meson eigenstates differ.

Observation of a Narrow Pentaquark State, P_{c}(4312)^{+}, and of the Two-Peak Structure of the P_{c}(4450)^{+}

A narrow pentaquark state, P_{c}(4312)^{+}, decaying to J/ψp, is discovered with a statistical significance of 7.3σ in a data sample of Λ_{b}^{0}→J/ψpK^{-} decays, which is an order of magnitude larger than that previously analyzed by the LHCb Collaboration. The P_{c}(4450)^{+} pentaquark structure formerly reported by LHCb is confirmed and observed to consist of two narrow overlapping peaks, P_{c}(4440)^{+} and P_{c}(4457)^{+}, where the statistical significance of this two-peak interpretation is 5.4σ. The proximity of the Σ_{c}^{+}D[over ¯]^{0} and Σ_{c}^{+}D[over ¯]^{*0} thresholds to the observed narrow peaks suggests that they play an important role in the dynamics of these states.

Observation of CP Violation in Charm Decays

A search for charge-parity (CP) violation in D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} decays is reported, using pp collision data corresponding to an integrated luminosity of 5.9  fb^{-1} collected at a center-of-mass energy of 13 TeV with the LHCb detector. The flavor of the charm meson is inferred from the charge of the pion in D^{*}(2010)^{+}→D^{0}π^{+} decays or from the charge of the muon in B[over ¯]→D^{0}μ^{-}ν[over ¯]_{μ}X decays. The difference between the CP asymmetries in D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} decays is measured to be ΔA_{CP}=[-18.2±3.2(stat)±0.9(syst)]×10^{-4} for π-tagged and ΔA_{CP}=[-9±8(stat)±5(syst)]×10^{-4} for μ-tagged D^{0} mesons. Combining these with previous LHCb results leads to ΔA_{CP}=(-15.4±2.9)×10^{-4}, where the uncertainty includes both statistical and systematic contributions. The measured value differs from zero by more than 5 standard deviations. This is the first observation of CP violation in the decay of charm hadrons.

Search for CP Violation in D_{s}^{+}→K_{S}^{0}π^{+}, D^{+}→K_{S}^{0}K^{+}, and D^{+}→ϕπ^{+} Decays

A search for charge-parity (CP) violation in Cabibbo-suppressed D_{s}^{+}→K_{S}^{0}π^{+}, D^{+}→K_{S}^{0}K^{+}, and D^{+}→ϕπ^{+} decays is reported using proton-proton collision data, corresponding to an integrated luminosity of 3.8  fb^{-1}, collected at a center-of-mass energy of 13 TeV with the LHCb detector. High-yield samples of kinematically and topologically similar Cabibbo-favored D_{(s)}^{+} decays are analyzed to subtract nuisance asymmetries due to production and detection effects, including those induced by CP violation in the neutral kaon system. The results areA_{CP}(D_{s}^{+}→K_{S}^{0}π^{+})=(1.3±1.9±0.5)×10^{-3},A_{CP}(D^{+}→K_{S}^{0}K^{+})=(-0.09±0.65±0.48)×10^{-3},A_{CP}(D^{+}→ϕπ^{+})=(0.05±0.42±0.29)×10^{-3},where the first uncertainties are statistical and the second systematic. They are the most precise measurements of these quantities to date, and are consistent with CP symmetry. A combination with previous LHCb measurements, based on data collected at 7 and 8 TeV, is also reported.