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Spinal surgeons＇ learning curve for lumbar microendoscopic discectomy： a prospective study of our first 50 and latest 10 cases

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Chinese Medical Journal 2008年第21期121卷 2148-2151页

作者： rong li-min xie pei-gen shi de-hai dong jian-wen liu bin feng feng cai dao-zhang department of Orthopaedics Third Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong 510630 China

Background Microendoscopic discectomy （MED） is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation, but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve. We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons＇ learning curve. Methods Fifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each： A-E. The control group F was ten MED patients treated later by the same medical team （September-October 2006）. All operations were performed by the same team of spinal surgeons with no MED experience before June 2002. We compared groups by operation time, blood loss, complications and need for open surgery after MED failure. Results Operation times by group were： A, （107±14） minutes; B, （85±13） minutes; C, （55±19） minutes; D, （52±12） minutes; E, （51±13） minutes; and F, （49±15） minutes. Blood loss were： A, （131±73） ml; B, （75±20） ml; C, （48±16） ml; D, （44±17） ml; E, （45±18） ml; and F, （45±16） ml. Both operation time and blood loss in groups C, D, E and F were smaller and more stable compared with groups A and B. Japanese Orthopedic Association assessment （JOA） score of each group in improvement rate immediately and one year after operation were as follows （in percentage）： A, （79.8±8.8）/（89.8±7.7）; B, （78.6±8.5）/（88.5±7.8）; C, （80.8±11.3）/（90.8±6.7）; D, （77.7±11.4）/（88.9±9.3）; E, （84.0±8.7）/（89.6±9.0）; and F, （77.8±11.6）/ （86.9±8.4）. Groups showed no statistical difference in improvement rates. Complications developed in three patients in group A, two in group B, and none in the other groups. Conclusions Spinal surgeons performing MED become proficient after 10-20 operations, when their skill becomes fairly sophisticated. Patients＇ improvement rate is the same regardless of surgeons＇ phase of learning curve.

关键词： lumbar disc herniation microendoscopic discectomy learning curve spinal surgeons

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轴向椎体间融合术微创治疗腰骶椎失稳症

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中华显微外科杂志 2009年第1期32卷 15-18页

作者：戎利民董健文刘斌冯丰史德海谢沛根蔡道章中山大学附属第三医院骨科广州510630

目的评价轴向椎体间融合术（AxialiF）微创手术治疗L5／S1失稳症的临床有效性和安全性。方法采用尾骨尖旁2cm切口，在G臂X线透视下，经骶椎前方建立工作通道，骨性通道入口在S1-2之间，用特殊工具经轴向的工作通道切除椎间盘、植骨，最... 详细信息

目的评价轴向椎体间融合术（AxialiF）微创手术治疗L5／S1失稳症的临床有效性和安全性。方法采用尾骨尖旁2cm切口，在G臂X线透视下，经骶椎前方建立工作通道，骨性通道入口在S1-2之间，用特殊工具经轴向的工作通道切除椎间盘、植骨，最后拧入长度合适的轴向固定螺栓。治疗12例L5／S1失稳症，观察手术时间、术中出血量、围手术期并发症以及随访观察椎间融合情况，并采用视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评价手术前后患者症状改善情况。结果手术时间30～70min，术中出血50—90ml，无并发症发生，所有患者于术后第2天戴腰围活动。随访时间3～9个月，VAS和ODI分别由术前6．66±0．89和61．18±7．93降至术后3个月2．08±0．79和21．51±3．63．差异有统计学意义。术后融合情况：1例于术后6个月完全融合，10例部分融合，1例尚未见融合。结论轴向椎体间融合术手术创伤小，并发症少，术后恢复快，为L5/S1，节段提供一个安全而微创的椎体间融合方式。

关键词：腰椎失稳症轴向椎体间融合术微创手术

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SAPT:a synchrotron-based proton therapy facility in Shanghai

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Nuclear Science and Techniques 2023年第10期34卷 36-46页

作者： Man-Zhou zhang de-ming li li-Ren Shen hai-rong zhang Zhi-ling Chen Han-wen Du ming Gu Rui li de-Kang liu Yue-Hu Pu Jun-feng Yu jian-feng Chen Chu Chen Chun-Long Guo Hao Guo Ge-Yang jiang Zhi-Qiang jiang lin Jin wen-Jing li Xiu-Fang li Ye lin ming liu Yong-Hao liu Ya-Juan liu ming Lv Qing-Ru Mi lian-Hua Ouyang Wei-Guo shi Hang Shu Qi-Sheng Tang Kun Wang Zhi-Shan Wang Jun Wu Xiao-bing Wu Jia-Qiang Xu wen-Zhen Xu Chong-Xian Yin Cheng Yu Ren-Xian Yuan Qi-bing Yuan hai-Qun zhang Miao zhang wen-Zhi zhang li-Ying Zhao Wei-min Zhou Shou-Xian Fang Xi-dong Sun Zhen-Tang Zhao Shanghai Institute of Applied Physics Chinese Academy of SciencesShanghai 201800China Shanghai Advanced Research Institute Chinese Academy of SciencesShanghai 201204China APACTRON Particle Equipment Co. Ltd.Shanghai 201815China The Institute of High Energy Physics Chinese Academy of SciencesBeijing 100049China

Because of its excellent dose distribution,proton therapy is becoming increasingly popular in the medical application of cancer treatment.A synchrotron-based proton therapy facility was designed and constructed in *** synchrotron,beam delivery system,and other technical systems were commissioned and reached their expected *** a clinical trial of 47 patients was finished,the proton therapy facility obtained a registration certificate from the National Medical Products *** characteristics of the accelerator and treatment systems are described in this article.

关键词： Proton therapy Synchrotron Slow extraction Gantry Beam delivery system

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A human-specific insertion promotes cell proliferation and migration by enhancing TBC1D8B expression

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Science China(life Sciences) 2024年第4期67卷 765-777页

作者： Hui Zhao lin-lin liu jian Sun lian Jin hai-bing xie jian-Bo li Hui Xu dong-dong Wu Xiao-lin Zhuang min-Sheng Peng Ya-Jun Guo Wei-Zhu Qian Newton OOtecko Wei-Jie Sun liang-Hu Qu Jie He Zhao-li Chen rong liu Ce-shi Chen Ya-Ping zhang State Key Laboratory for Conservation and Utilization of Bio-resource School of Life SciencesSchool of Ecology and Environmental ScienceYunnan UniversityKunming 650091China School of Forensic Medicine Kunming Medical UniversityKunming 650500China Academy of Biomedical Engineering Kunming Medical UniversityKunming 650500China The Third Affiliated Hospital Kunming Medical UniversityKunming 650118China Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province Kunming Institute of ZoologyChinese Academy of SciencesKunming 650201China State Key Laboratory of genetic Resources and Evolution Yunnan Laboratory of Molecular Biology of Domestic AnimalsKunming Institute of ZoologyChinese Academy of SciencesKunming 650201China The Key Laboratory of gene Engineering of the ministry of Education State Key Laboratory for BiocontrolSun Yat-sen UniversityGuangzhou 510275China National Engineering Research Center for Antibody Medicine and Shanghai Key Laboratory of Cell Engineering and Antibody Shanghai 201203China department of Thoracic Surgery Cancer Institute and HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

Human-specific insertions play important roles in human phenotypes and *** we reported a 446-bp insertion(Insert-446)in intron 11 of the TBC1D8B gene,located on chromosome X,and traced its origin to a portion of intron 6 of the EBF1 gene on chromosome ***,Insert-446 was present in the human Neanderthal and denisovans genomes,and was fixed in humans after human-chimpanzee *** have demonstrated that Insert-446 acts as an enhancer through binding transcript factors that promotes a higher expression of human TBC1D8B gene as compared with orthologs in *** addition,over-expression TBC1D8B promoted cell proliferation and migration through“a dual finger”catalytic mechanism(Arg538 and Gln573)in the TBC domain in vitro and knockdown of TBC1D8B attenuated tumorigenesis in *** of Insert-446 prevented cell proliferation and migration in cancer and normal *** results reveal that the human-specific Insert-446 promotes cell proliferation and migration by upregulating the expression of TBC1D8B *** findings provide a significant insight into the effects of human-specific insertions on evolution.

关键词： human-specific insertion enhancer gene expression cell proliferation and migration

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The Lyman-alpha Solar Telescope(LST) for the ASO-S mission——Ⅱ. design of LST

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Research in Astronomy and Astrophysics 2019年第11期19卷 33-48页

作者： Bo Chen Hui li Ke-Fei Song Quan-feng Guo pei-Jie zhang ling-Ping He Shuang Dai Xiao-dong Wang hai-feng Wang Chun-Long liu Hong-Ji zhang Guang zhang Yunqi Wang shi-Jie liu Hong-Xin zhang Lei liu shi-Lei Mao Yang liu Jia-Hao Peng Peng Wang liang Sun Yang liu Zhen-Wei Han Yan-Long Wang Kun Wu Guang-Xing Ding Peng Zhou Xin Zheng ming-Yi Xia Qing-wen Wu Jin-jiang xie Ya Chen Shu-Mei Song Hong Wang Bo Zhu Chang-Bo Chu wen-Gang Yang li feng Yu Huang Wei-Qun Gan Ying li Jing-Wei li Lei Lu jian-Chao Xue Bei-li Ying ming-Zhe Sun Cheng Zhu Wei-min Bao Lei deng Zeng-Shan Yin Changchun Institute of Optics FineMechanics and PhysicsChinese Academy of SciencesChangchun 130033China State Key Laboratory of Applied Optics Changchun 130033China Key Laboratory of Dark Matter and Space Astronomy Purple Mountain ObservatoryChinese Academy of SciencesNanjing 210034China School of Astronomy and Space Science University of Science and Technology of ChinaHefei 230026China Xi’an Institute of Optics and Precision Mechanics Chinese Academy of SciencesXi’an 710119China Shandong University Weihai 264209China Innovation Academy for Microsatellites Chinese Academy of SciencesShanghai 201210China

As one of the three payloads for the Advanced Space-based Solar Observatory(ASO-S)mission,the Lyman-alpha(Lyα)Solar Telescope(LST)is composed of three instruments:a Solar Corona Imager(SCI),a LyαSolar Disk Imager(SDI)and a full-disk White-light Solar Telescope(WST).When working in-orbit,LST will simultaneously perform high-resolution imaging observations of all regions from the solar disk to the inner corona up to 2.5 R⊙(R⊙stands for the mean solar radius)with a spatial resolution of 4.8′′and 1.2′′for coronal and disk observations,respectively,and a temporal resolution of 30–120 s and 1–120 s for coronal and disk observations,*** maximum exposure time can be up to20 s due to precise pointing and image stabilization *** the three telescopes of LST,SCI is a dual-waveband coronagraph simultaneously and independently observing the inner corona in the HI Lyα(121.6±10 nm)line and white light(WL)(700±40 nm)wavebands by using a narrowband Lyαbeam splitter and has a field of view(FOV)from 1.1 to 2.5 R⊙.The stray-light suppression level can attainline and 360.0 nm wavebands,respectively,which adopt an off-axis two-mirror reflective structure with an FOV up to 1.2 R⊙,covering the inner coronal edge area and relating to coronal *** present the up-to-date design for the LST payload.

关键词： telescopes—instrumentation high angular resolution—Sun flares—Sun coronal mass ejections(CMEs)—Sun UV radiation

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Paired quasi-periodic pulsations of hard X-ray emission in a solar flare

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Science China(Physics,Mechanics & Astronomy) 2023年第5期66卷 195-206页

作者： hai-Sheng Zhao dong li Shao-lin Xiong Yan-Qiu zhang Yang Su Wei Chen Yi Zhao Xiao-Bo li Jia-Cong liu wen-Xi Peng Rui Qiao Xin-Qiao li Xiang-Yang wen li-ming Song shi-Jie Zheng Xin-Ying Song Xiao-Yun Zhao Yue Huang Shuang-Nan zhang Shuo Xiao Ce cai Zheng-Hua An Can Chen Gang Chen Wei Chen Yan-Qi Du min Gao Ke Gong dong-Ya Guo Zhi-Wei Guo jian-jian He bin li Chao li Chao-Yang li Gang li jian-Hui li Lu li Qing-Xin li Yan-Guo li Jing liang Xiao-Hua liang Jin-Yuan liao Xiao-Jing liu Ya-Qing liu Qi Luo Xiang Ma bin Meng Ge Ou dong-li shi Jing-Yan shi Gong-Xing Sun Xi-Lei Sun You-li Tuo Chen-Wei Wang Hui Wang Jin Wang Jin-Zhou Wang Ping Wang wen-Shuai Wang Hong Wu Sheng-Lun xie Yan-bing Xu Yu-Peng Xu Wang-Chen Xue Sheng Yang min Yao jian-Ying Ye Qi-bin Yi Chao-Yue zhang Da-li zhang Fan zhang Fei zhang Hong-Mei zhang Kai zhang Peng zhang Xiao-Lu zhang Zhen zhang Guo-Ying Zhao shi-Yi Zhao Chao Zheng Xing Zhou Yue Zhu Key Laboratory for Particle Astrophysics Institute of High Energy PhysicsChinese Academy of SciencesBeijing 100049China Purple Mountain Observatory Chinese Academy of SciencesNanjing 210023China University of Chinese Academy of Sciences Beijing 100049China department of Astronomy Beijing Normal UniversityBeijing 100875China School of Computing and Artificial Intelligence Southwest Jiaotong UniversityChengdu 611756China Physics and Space Science College China West Normal UniversityNanchong 637002China Key Laboratory of Stellar and Interstellar Physics and department of Physics Xiangtan UniversityXiangtan 411105China Institute of Astrophysics Central China Normal UniversityWuhan 430079China School of Physics Changchun University of Science and TechnologyChangchun 130022China College of Physics and Engineering Qufu Normal UniversityQufu 273165China College of Physics Sciences&Technology Hebei UniversityBaoding 071002China

We investigate high time resolution data obtained by the Gravitational wave high-energy Electromagnetic Counterpart All-sky Monitor(GECAM)during the flare event on 2022 April 21 at 01:52 *** subpeaks with durations of 4-6 s have been detected in the hard X-ray precursor phase,and the key feature is that they appear in pairs and seem like double-peak *** subpeaks are rarely observed in hard X-ray band and confirmed by the microwave obtained by Nobeyama Radio Polarimeters(NoRP)and Radio Solar Telescope Network(RSTN).While an exponential function can describe the continuum component of the time profile from the precursor to part of the impulsive *** periods of quasi-periodic pulsations(QPPs)are detected to be about 7.3 and 12.8 s for the precursor and impulsive phase,respectively,with at least 95%confidence *** paired QPPs are assumed to be double-peak QPPs and then the scenario of current loop coalescence model is found to be in good agreement with our *** precursor phase can be interpreted as the oscillating coalescence of two islands,while the impulsive phase can be interpreted as more islands to coalesce one by one to form larger islands.

关键词： solar flare QPPs loop coalescence circular-ribbon flare

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罗哌卡因局部浸润用于显微内镜腰椎间盘切除术后镇痛

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中国医院药学杂志 2008年第18期28卷 1575-1577页

作者：戎利民蔡道章董健文刘斌史德海中山大学附属第三医院骨科广东广州510630

目的:评价罗哌卡因切口周围局部浸润在显微内镜腰椎间盘髓核摘除术后镇痛中的作用。方法:83例行显微内镜腰椎间盘髓核摘除术患者随机分成2组,A组(n=43)手术开始前以0.75%盐酸罗哌卡因10mL于切口周围肌层和皮下局部浸润;B组(n=40)手术开... 详细信息

目的:评价罗哌卡因切口周围局部浸润在显微内镜腰椎间盘髓核摘除术后镇痛中的作用。方法:83例行显微内镜腰椎间盘髓核摘除术患者随机分成2组,A组(n=43)手术开始前以0.75%盐酸罗哌卡因10mL于切口周围肌层和皮下局部浸润;B组(n=40)手术开始前以0.9%生理盐水10mL于切口周围肌层和皮下局部浸润。对手术后患者的疼痛指数、阿片类镇痛药物使用量以及切口愈合情况等进行统计观察。结果:A组患者的结果明显优于B组,A组患者术后疼痛反应轻、阿片类镇痛药物使用量少、胃肠道反应发生率低、住院时间更短。所有患者未出现切口愈合不良等并发症。结论:罗哌卡因切口周围局部浸润对于缓解显微内镜腰椎间盘髓核摘除术后疼痛具有优良的效果,能明显缩短患者术后恢复的时间,值得临床推广使用。

关键词：显微内镜腰椎间盘髓核摘除术罗哌卡因超前镇痛

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显微内镜椎间盘摘除术治疗老年腰椎间盘突出症

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中国矫形外科杂志 2008年第19期16卷 1508-1509页

作者：戎利民蔡道章董健文谢佩根史德海中山大学附属第三医院骨科广州市天河路600号510630

[目的]探讨老年椎间盘突出症临床特点,评价显微内镜椎间盘摘除术治疗老年腰椎间盘突出症的疗效和安全性。[方法]对21例诊断为腰椎间盘突出症的老年患者的临床特点、影像学资料、显微内镜椎间盘摘除术治疗效果进行分析总结。[结果]所有... 详细信息

[目的]探讨老年椎间盘突出症临床特点,评价显微内镜椎间盘摘除术治疗老年腰椎间盘突出症的疗效和安全性。[方法]对21例诊断为腰椎间盘突出症的老年患者的临床特点、影像学资料、显微内镜椎间盘摘除术治疗效果进行分析总结。[结果]所有患者年龄在60岁以上,腰腿痛为主要症状,病史中均无间歇性跛行,21例患者中,L5S1椎间盘突出2例,L4、5间隙13例,L3、4间隙6例。所有患者均行显微内镜椎间盘摘除术,术后恢复优良率90%,平均16个月,随访优良率80%。[结论]老年椎间盘突出症指征掌握适当,显微内镜椎间盘髓核摘除手术可取得优良的疗效,椎间融合术不应作为常规的手术选择。

关键词：腰椎间盘突出症老年显微内镜腰椎间盘摘除术

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A practical community-based response strategy to interrupt Ebola transmission in sierra Leone, 2014–2015

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Infectious Diseases of Poverty 2016年第1期5卷 670-679页

作者： Zhong-Jie li wen-Xiao Tu Xiao-Chun Wang Guo-Qing shi Zun-dong Yin hai-Jun Su Tao Shen Da-Peng zhang jian-dong li Shan Lv Chun-li Cao Rui-Qian xie Hong-Zhou Lu rong-Meng jiang Zheng Cao Zhi-Jie An Lei-Lei li Jie Xu Yan-wen Xiong Wei Zang Wei zhang Hong-Wei zhang wen-Sen Chen Hua ling wen Xu jian cai Huan-Jin Luo Xue-Sheng Xing Can-Jun Zheng Qiang Wei Xin-Xu li Mei li hai jiang li-Quan deng ming-Quan Chen Xiang Huo feng Xu Xue-Hui Lai Xi-Chen Bai Long-Jie Ye jian-Yi Yao wen-Wu Yin Jiao-Jin Sun lin Xiao Fu-Qiang liu Xiao-Qiang liu Hong-Wei Fan Zeng-Qiang Kou Ji-Kun Zhou Hao zhang Da-Xin Ni Thomas TSamba Qun li Hong-Jie Yu Yu Wang Xiao-feng liang Division of Infectious Disease Key Laboratory of Surveillance and Early-warning on Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina Public Health Emergency Center Chinese Center for Disease Control and PreventionBeijingChina National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and PreventionBeijingChina Chinese Field Epidemiology Training Program Chinese Center for Disease Control and PreventionBeijingChina National Immunization Program Chinese Center for Disease Control and PreventionBeijingChina Bureau of Disease Prevention and Control National Health and Family Planning Commission of the People’s Republic of ChinaBeijingChina National Institute for Viral Disease Control and Prevention Chinese Center for Disease Control and PreventionBeijingChina National Institute of Parasitic Disease Chinese Center for Disease Control and PreventionShanghaiChina Chinese Center for Health Education BeijingChina department of Infectious Diseases Shanghai Public Health Clinical CenterShanghaiChina Beijing Ditan Hospital Capital Medical UniversityBeijingChina Health News BeijingChina National Institute for Communicable Disease Control and Prevention Chinese Center for Disease Control and PreventionBeijingChina department of Training Chinese Center for Health EducationBeijingChina Center for Infectious Diseases Beijing Youan HospitalCapital Medical UniversityBeijingChina Infection Management The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina Chongqing Municipal Center for Disease Control and Prevention ChongqingChina Yunnan Provincial Center for Disease Control and Prevention KunmingChina Division of Infectious Disease Control and Prevention Zhejiang Provincial Center for Disease Control and PreventionHangzhouChina Guangdong Provincial Center for Disease Control and Prevention GuangzhouChina Division of Acute Infectious Disease Control and Prevention Hubei Provincial Center for Disease Control and PreventionW

Background:The Ebola virus disease spread rapidly in West Africa in 2014,leading to the loss of thousands of *** engagement was one of the key strategies to interrupt Ebola transmission,and practical community level measures needed to be explored in the field and tailored to the specific context of ***:First,community-level education on Ebola virus disease(EVD)prevention was launched for the community’s social mobilizers in six districts in Sierra Leone beginning in November ***,from January to May of 2015,in three pilot communities,local trained community members were organized to engage in implementation of EVD prevention and transmission interruption measures,by involving them in alert case report,contact tracing,and social *** epidemiological indicators of transmission interruption in three study communities were ***:A total of 6016 community social mobilizers from 185 wards were trained by holding 279 workshops in the six districts,and EVD message reached an estimated 631680 *** three pilot communities,72 EVD alert cases were reported,with 70.8%of them detected by trained local community members,and 14 EVD cases were finally *** tracing detected 64.3%of EVD *** median duration of community infectivity for the cases was 1 *** secondary attack rate was 4.2%,and no third generation of infection was *** health worker was infected,and no unsafe burial and noncompliance to EVD control measures were *** community-based measures were modeled to reduce 77 EVD cases,and the EVD-free goal was achieved four months earlier in study communities than whole country of Sierra ***: The community-based strategy of social mobilization and community engagement was effective in casedetection and reducing the extent of Ebola transmission in a country with weak health system. The successfullypractical experience to reduce the risk of Ebola transmission in the

关键词： Ebola virus disease Community engagement Health education Outbreak control

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Efficacy and safety of sirolimus early conversion protocol in liver transplant patients with hepatocellular carcinoma:A single-arm, multicenter, prospective study

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 106-112页

作者： Ren-Yi Su Sun-bin ling Qiao-Nan Shan Xu-Yong Wei Rui Wang Chang-Ku Jia li Zhuang Tian Shen li-min Ding Zhi-Dan Xu Lai-Bang Luo li-Bo Sun Guang-ming li Tai-shi Fang Nan jiang Kun zhang Zhao-Jie Su Zhi-hai Peng Ren Lang Tao jiang Qiang He lin-Sen Ye Yang Yang Yu-Ting He wen-Zhi Guo liu-gen Lan Xu-Yong Sun dong Chen Zhi-Shui Chen Da-Wei Zhou Shao-Jun Ye Qi-Fa Ye min Tian jian-Hua shi Bo Wang jiang liu Qian Lu Wei Rao Jin-Zhen cai Tao Lv Jia-Yin Yang Pu-Sen Wang lin Zhong Jing-Sheng Ma Qi-gen li Sheng-dong Wu Chang-jiang Lu cai-de Lu dong-Hua zhang Xuan Wang Zi-Qiang li Mu-jian Teng Jun-Jie li wen-Tao jiang jian-Hua li Quan-Bao zhang Ning-Qi Zhu Zheng-Xin Wang Kang He Qiang Xia Shao-Hua Song Zhi-Ren Fu Wei Qiu Guo-Yue Lv Rui-Peng Song Ji-Zhou Wang Zheng Wang jian Zhou Gang Chen Ying-Peng Zhao li li Ze-min Hu Qi-Jie Luo Zhong-Zhou Si bin xie Xiao-Shun He Zhi-Yong Guo Shu-Sen Zheng Xiao Xu department of Hepatobiliary and Pancreatic Surgery The Center for Integrated Oncology and Precision MedicineAffiliated Hangzhou First People’s HospitalZhejiang University School of MedicineHangzhou 310006China NHC Key Laboratory of Combined Multi-organ Transplantation Hangzhou 310003China department of Hepatobiliary and Pancreatic Surgery Shulan(Hangzhou)HospitalZhejiang Shuren University School of MedicineHangzhou 310022China department of Hepatobiliary and Pancreatic Surgery The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China department of Transplantation Jiangxi Provincial People’s Hospital Affiliated to Nanchang UniversityNanchang 330006China liver Transplantation Center Beijing You’an HospitalCapital Medical UniversityBeijing 100069China department of Hepatic Surgery National Clinical Research Center for Infectious DiseaseShenzhen Third People’s HospitalThe Second Affiliated Hospital of Southern University of Science and TechnologyShenzhen 518112China department of general Surgery Xiang’an Hospital of Xiamen UniversityXiamen 361000China deartment of Hepatobiliary and Pancreaticosplenic Surgery Beijing Chaoyang HospitalCapital Medical UniversityBeijing 100020China department of Hepatic Surgery and liver Transplantation Center The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510630China department of Hepatobiliary and Pancreatic Surgery The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China department of liver Transplantation The Second Affiliated Hospital of Guangxi Medical UniversityNanning 530000China Institute of Organ Transplantation Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Institute of Hepatobiliary Diseases of Wuhan University Transplant Center of Wuhan UniversityHubei Key Laboratory of Medical Technology on TransplantationZhongnan Hospital of Wuhan UniversityWuhan 430071China department of Hepatobiliary Surgery The First Affiliated Hos

Mammalian target of rapamycin(m TOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant(LT) recipients in Western countries. However, the pertinent studies in Eastern world are paucity. Therefore, we designed a clinical trial to test whether sirolimus can improve recurrence-free survival(RFS) in hepatocellular carcinoma(HCC) patients beyond the Milan criteria after LT. This is an open-labeled, single-arm, prospective, multicenter, and real-world study aiming to evaluate the clinical outcomes of early switch to sirolimus-based regimens in HCC patients after LT. Patients with a histologically proven HCC and beyond the Milan criteria will be enrolled. The initial immunosuppressant regimens are center-specifc for the frst 4-6 weeks. The following regimens integrated sirolimus into the regimens as a combination therapy with reduced calcineurin inhibitors based on the condition of patients and centers. The study is planned for 4 years in total with a 2-year enrollment period and a 2-year follow-up. We predict that sirolimus conversion regimen will provide survival benefts for patients particular in the key indicator RFS as well as better quality of life. If the trial is conducted successfully, we will have a continued monitoring over a longer follow-up time to estimate indicator of overall survival. We hope that the outcome will provide better evidence for clinical decision-making and revising treatment guidelines based on Chinese population data.

关键词： Sirolimus Immunosuppressive agents Hepatocellular carcinoma liver transplantation Conversion

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