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BACKGROUND The early diagnosis of biliary atresia (BA) is associated with a better outcome after portoenterostomy. However, very early liver biopsy findings may appear atypical for BA and delay diagnosis. Repeat biopsy histology may change rapidly to show more typical features. METHODS Between 1997 and 2018, 6 babies with jaundice had more than one biopsy to establish diagnosis. Clinical and histologic data were collected. chi-Square was used for analysis (p less then 0.05 significant). RESULTS Five patients had two biopsies, and one had three. Median age at first, second, and third biopsy was 40 (13-57), 68.5 (35-78), and 133 days, respectively. Biopsy readings showed no portal edema initially (0/6), but in all 6 on repeat biopsy (p = 0.001). Bile duct proliferation was seen in 6/6 final biopsies, but in only 1/6 initially (p = 0.003). All patients underwent a portoenterostomy (median age 75 days (43-113)). Median delay between initial biopsy and Kasai was 29 days (14-67). Transplant free survival (n = 5 patients) ranged from 184 to 716 days (median 309 days). One patient died before being transplanted. CONCLUSION Early biopsies may not display characteristic findings of BA, but these can appear quickly on subsequent evaluation. The interval needed to repeat a biopsy may have an adverse effect on bile drainage. LEVEL OF EVIDENCE IV. Solitary fibrous tumors are rare mesenchymal tumors derived from soft tissues and vascular walls. NAB2-STAT6 fusion gene serves as a marker gene for this disease and consists of the truncated repressor domain of NGFI-A-Binding protein 2 (NAB2) and the intact activation domain of STAT6. In this study, we found that EGR-1 and the proliferation-related EGR-1 target gene IGF2 were upregulated in NIH-3T3 cells transfected with NAB2-STAT6. Additionally, p-Rb (Ser795) and cyclin D1 levels were upregulated, and cell proliferation was also enhanced. We identified that treatment with the IGF2 inhibitor reduced cell proliferation in NIH-3T3 cells transfected with NAB2-STAT6. The oncogenic progression was enhanced in NIH-3T3 cells transfected with NAB2-STAT6 compared with those transfected with the empty vector. Taken together, our study suggests that the NAB2-STAT6 fusion gene is associated with cell proliferation through EGR-1 transcriptional expression and IGF2 can be a drug target for the treatment of solitary fibrous tumors. Here we show that Gas7 inhibits phosphorylated tau fibrillogenesis by binding to phosphorylated tau at its non-WW domain, presumably F-BAR domain. We revealed that Gas7 binds to the third repeat domain of tau, the core element of tau oligomerization and the C-terminal domain of tau and alters the conformation not to form fibrils. These results suggest that Gas7 may serve to protect against Alzheimer's disease and other tauopathies by preventing tau fibrillogenesis. Gene-modifying T cells expressing chimeric antigen receptor (CAR) with an extracellular domain consisting of single chain variable fragment (scFv) and an intracellular domain with a T cell activation motif, are promising cancer immuno-medicines that can exert long term potent antitumor activity. However, CAR-T cells have a high risk of causing fatal side effects. Thus, more effective and safer CAR-T cells are urgently needed. Although antigen specificity and reactivity of CAR-T cells are defined by CAR expression level and affinity, information on optimizing the scFv structure that defines CAR avidity is lacking. Here, we investigated the impacts of scFv substitution and structural modification in CAR on receptor expression and antigen recognition properties. Four CARs with distinct scFvs targeting the same antigen were unexpectedly separated into a CAR expressed on T cells and bound to the antigen, CARs that did not show antigen-binding because of cell surface aggregation, and a rarely expressed CAR. CTP-656 Among the scFv structural modifications of CARs, changes in the Fv order and linker did not noticeably affect CAR expression or antigen-binding. In contrast, complementarity-determining region (CDR)-grafting to the stable framework region in Fv dramatically improved the surface expression level of non-producible CAR. These results revealed that CAR expression efficiency and stability on T cells are influenced by the Fv structure. Therefore, stabilization of the Fv structure by CDR-grafting may be an effective means for expressing scFvs, which have excellent antigen specificity and appropriate affinity but low structural stability, as a CAR on T cells. BACKGROUND Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyse the factors associated with PTMC and mETE and the long-term prognosis of PTMC. MATERIAL AND METHODS We conducted a retrospective study with a population consisting of patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) versus group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS We observed PTMC with mETE in 11.2% (n=18) of the patients. In the multivariate analysis, mETE was associated with an age ≥45 years (OR, 4.383; 95% CI 1.051-18.283, p=.043), a tumour size ≥8mm (OR, 5.913; 95% CI 1.795-19.481; p=.003), bilaterality (OR, 4.430; 95% CI 1.294-15.173; p=.018) and metastatic lymph nodes (OR, 12.588; 95% CI 2.919-54.280; p=.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p=.112), but none of the patients died due to the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p=.034). CONCLUSIONS The mETE of MCPT is a factor of worse prognosis, associated with the presence of metastatic lymph nodes and lower disease-free survival. BACKGROUND Excessive intraoperative hemorrhage is a critical factor of poor prognoses after hepatectomy. Low central venous pressure during parenchymal transection is recognized to effectively reduce intraoperative hemorrhage in open procedures. However, the role of controlled low central venous pressure in laparoscopic hepatectomy is still controversial. METHODS In the present randomized clinical trial, we set up a standard boundary of low central venous pressure according to our Pilot Study, then enrolled patients scheduled for elective laparoscopic hepatectomy and allocated them randomly to a group undergoing central venous pressure reduction by anesthesiologic interventions or a control group. The primary efficacy endpoint was total intraoperative blood loss and perioperative adverse events. Analyses were performed following the intention-to-treat principle, and patients and surgeons were blinded (ClinicalTrials.gov, Number NCT03422913). RESULTS Between January 2017 and October 2018, 146 out of 469 patients were randomized and eligible for inclusion in the final analyses.
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