Effect of the pringle maneuver on tumor recurrence of hepatocellular carcinoma after curative resection (EPTRH): a randomized, prospective, controlled multicenter trial

Abstract Background Hepatic resection is currently still the best choice of therapeutic strategies for liver cancer, but the long-term survival rate after surgery is unsatisfactory. Most patients develop intra- and/or extrahepatic recurrence. The reasons for this high recurrence rate are not entirely clear. Recent studies have indicated that ischemia-reperfusion injury to the liver may be a significant factor promoting tumor recurrence and metastasis in animal models. If this is also true in humans, the effects of the Pringle maneuver, which has been widely used in hepatectomy for the past century, should be examined. To date, there are no reported data or randomized controlled studies examining the relationship between use of the Pringle maneuver and local tumor recurrence. We hypothesize that the long-term prognosis of patients with liver cancer could be worsened by use of the Pringle maneuver due to an increase in the rate of tumor recurrence in the liver remnant. We designed a multicenter, prospective, randomized surgical trial to test this hypothesis. Methods At least 498 eligible patients from five participating centers will be enrolled and randomized into either the Pringle group or the non-Pringle group in a ratio of 1:1 using a permuted-blocks randomization protocol. After the completion of surgical intervention, patients will be included in a 3-year follow-up program. Discussion This multicenter surgical trial will examine whether the Pringle maneuver has a negative effect on the long-term outcome of hepatocellular carcinoma patients. The trial will also provide information about prognostic differences, safety, advantages and disadvantages between Pringle and non-Pringle surgical procedures. Ultimately, the results will increase the available information about the effects of ischemia-reperfusion injury on tumor recurrence, which will be of immense benefit to general surgery. Trial registration http://www.clinicaltrials.gov NCT00725335</p

Nitrogen-Deficient Graphitic Carbon Nitride with Enhanced Performance for Lithium Ion Battery Anodes

Graphitic carbon nitride (g-C₃N₄) behaving as a layered feature with graphite was indexed as a high-content nitrogen-doping carbon material, attracting increasing attention for application in energy storage devices. However, poor conductivity and resulting serious irreversible capacity loss were pronounced for g-C₃N₄ material due to its high nitrogen content. In this work, magnesiothermic denitriding technology is demonstrated to reduce the nitrogen content of g-C₃N₄ (especially graphitic nitrogen) for enhanced lithium storage properties as lithium ion battery anodes. The obtained nitrogen-deficient g-C₃N₄ (ND-g-C₃N₄) exhibits a thinner and more porous structure composed of an abundance of relatively low nitrogen doping wrinkled graphene nanosheets. A highly reversible lithium storage capacity of 2753 mAh/g was obtained after the 300th cycle with an enhanced cycling stability and rate capability. The presented nitrogen-deficient g-C₃N₄ with outstanding electrochemical performances may unambiguously promote the application of g-C₃N₄ materials in energy-storage devices