This randomized, controlled trial assessed the efficacy of transarterial Lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, Aulnay-Sous-Bois, France) chemoembolization in patients with unresectable ...hepatocellular carcinoma. From March 1996 to October 1997, 80 out of 279 Asian patients with newly diagnosed unresectable hepatocellular carcinoma fulfilled the entry criteria and randomly were assigned to treatment with chemoembolization using a variable dose of an emulsion of cisplatin in Lipiodol and gelatin-sponge particles injected through the hepatic artery (chemoembolization group, 40 patients) or symptomatic treatment (control group, 40 patients). One patient assigned to the control group secondarily was excluded because of unrecognized systemic metastasis. Chemoembolization was repeated every 2 to 3 months unless there was evidence of contraindications or progressive disease. Survival was the main end point. The chemoembolization group received a total of 192 courses of chemoembolization with a median of 4.5 (range, 1-15) courses per patient. Chemoembolization resulted in a marked tumor response, and the actuarial survival was significantly better in the chemoembolization group (1 year, 57%; 2 years, 31%; 3 years, 26%) than in the control group (1 year, 32%; 2 years, 11%; 3 years, 3%;
P = .002). When adjustments for baseline variables that were prognostic on univariate analysis were made with a multivariate Cox model, the survival benefit of chemoembolization remained significant (relative risk of death, 0.49; 95% CI, 0.29-0.81;
P = .006). Although death from liver failure was more frequent in patients who received chemoembolization, the liver functions of the survivors were not significantly different. In conclusion, in Asian patients with unresectable hepatocellular carcinoma, transarterial Lipiodol chemoembolization significantly improves survival and is an effective form of treatment. (H
EPATOLOGY 2002;35:1164-1171.)
To report the management of patients with spontaneous rupture of hepatocellular carcinoma (HCC) in a single center over a 10-year period and to evaluate a two-stage therapeutic approach.
A ...retrospective study was performed on all 1,716 patients with HCC who presented from 1989 to 1998. The two-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative method, hemostasis by transarterial embolization (TAE) or surgical means, followed by second-stage hepatic resection or transarterial oily chemoembolization (TOCE). Results of definitive treatment were compared with patients with no history of rupture during the same study period.
During the study period, 154 patients (9%) had spontaneous HCC rupture. Initial intervention to control bleeding included TAE in 42 patients, surgical hemostasis in 35 patients, and conservative management only in 53 patients. The 30-day mortality rate was 38%. Independent factors on presentation affecting 30-day mortality were shock on admission, hemoglobin, serum total bilirubin, and known diagnosis of inoperable tumor. After initial stabilization and clinical evaluation, 33 patients underwent hepatic resection and 30 patients received TOCE. Median survival of the hepatectomy patients was 25.7 months; that of the TOCE patients was 9.7 months. Compared with patients with no rupture, survival after hepatectomy (25.7 months v 49.2 months, P =.003) was inferior but still substantially long, whereas survival after TOCE was comparable (9.7 months v 8.7 months, P =.904).
Early mortality of spontaneous rupture of HCC was dependent on prerupture disease state, liver function, and severity of bleeding. Although it was a catastrophic presentation, prolonged survival could be achieved in selected patients with second-stage hepatic resection or TOCE.
This study investigated the differential influences of maternal and paternal factors on Chinese children's English as a foreign language development. It took into account both behavioral (i.e. ...parental home literacy practices, HLP; and children's vocabulary knowledge) and emotional (i.e. parental and children's foreign language reading anxiety, FLRA) aspects of home literacy environment and children's language outcomes. Forty-eight Chinese first graders were tested individually on English vocabulary knowledge. Subsequently, both parents of participating children completed a questionnaire rating their HLP on English as a foreign language, their FLRA and their child's FLRA. Results from hierarchical regression analysis showed that paternal HLP predicted children's English vocabulary knowledge and paternal FLRA predicted children's FLRA, after controlling for children's age, family income and parental education level. However, when the effects of maternal factors were accounted for, these paternal factors did not uniquely contribute to children's English vocabulary knowledge or FLRA. In contrast, maternal HLP and FLRA explained unique variance in both children's English vocabulary knowledge and FLRA, even after paternal factors were accounted for. These results have provided a more comprehensive picture of how home literacy environment contributes to children's foreign language development, by indicating maternal and paternal contributions both behaviorally and emotionally.
Somatic mutations of TET2, IDH1, and IDH2 have been described in myelodysplastic syndrome. The impact of these mutations on outcome of myelodysplastic syndrome and their progression to secondary ...acute myeloid leukemia remains unclear. Mutation status of TET2, IDH1 and IDH2 was investigated in a cohort of 46 paired myelodysplastic syndrome/acute myeloid leukemia samples and 122 non-paired cases with de novo myelodysplastic syndrome, to clarify their roles in the evolution of myelodysplastic syndrome to acute myeloid leukemia. Among the 168 de novo myelodysplastic syndrome patients, the frequency of TET2, IDH1, and IDH2 mutations was 18.5%, 4.2% and 6.0%, respectively. TET2/IDH mutations had no impact on survivals, while TET2 mutations were significantly associated with rapid progression to acute myeloid leukemia. Seventeen of the 46 paired myelodysplastic syndrome/secondary acute myeloid leukemia samples harbored TET2/IDH mutations; none acquired these mutations in acute myeloid leukemia phase. Progression to acute myeloid leukemia was accompanied by evolution of a novel clone or expansion of a minor pre-existing subclone of one or more distinct mutations in 12 of the 17 cases with TET2/IDH mutations. A minor subclone in 3 cases with biallelic TET2 inactivation subsequently expanded, indicating biallelic TET2 mutations play a role in acute myeloid leukemia progression. Twelve patients acquired other genetic lesions, and/or showed increased relative mutant allelic burden of FLT3-ITD, N/K-RAS, CEBPA or RUNX1 during acute myeloid leukemia progression. Our findings provide a novel insight into the role of TET2/IDH mutation in the pathogenesis of myelodysplastic syndrome and subsequent progression to acute myeloid leukemia.
The hypothalamic melanocortin system plays a fundamental role in the regulation of energy homeostasis. Orexins (hypocretins) are also involved in a diverse range of physiological processes, including ...food intake. Previous evidence has suggested that hypothalamic orexin expression may be influenced by the central melanocortin system. Here, we studied orexin mRNA levels in pro‐opiomelanocortin‐deficient (Pomc–/–) mice, a mouse model lacking all endogenously produced melanocortin peptides. Orexin expression in the lateral hypothalamus was significantly increased in corticosterone deficient Pomc–/– mice. Furthermore, when circulating glucocorticoids were restored to levels within the physiological range, orexin expression remained elevated. However, i.c.v. administration of the melanocortin α‐melanocyte‐stimulating hormone (MSH) to Pomc–/– mice reduced orexin expression back down to wild‐type levels. This was independent of the effects of α‐MSH on food intake because elevated orexin expression persisted in Pomc–/– mice pairfed to α‐MSH‐treated animals. These data indicate that α‐MSH may play a role in the regulation of orexin expression in Pomc–/–, with an elevation in orexin levels contributing to the hyperphagia seen in these animals.
Cullen sign in childhood malignancies Au, C C; Leung, K K Y; Hon, K L ...
Hong Kong medical journal = Xianggang yi xue za zhi,
12/2021, Letnik:
27, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Introduction We report four consecutive cases of young children with Cullen sign in a paediatric intensive care unit with abdominal malignancies and complications due to treatment. First described in ...1918, Cullen sign referred to periumbilical ecchymosis due to retroperitoneal haemorrhage of ruptured ectopic pregnancy.1 It has become one of the classic abdominal signs in acute pancreatitis. Pathophysiologically, blood tracks from the retroperitoneum through the gastrohepatic ligament to the falciform ligament of the liver, then reaches the umbilicus through the round ligament of liver to form Cullen sign.3 Cullen sign has been reported in intra-abdominal malignancies, liver cirrhosis, and rectus sheath haematoma.4 5 Author contributions All authors contributed to the concept or design of the study, interpretation of the data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.
The optimum management of hepatocellular carcinoma (HCC) associated with cirrhosis has not yet been clarified. Very few data are available in the literature regarding the prognosis after resection of ...HCC associated with hepatitis B virus (HBV)-related cirrhosis. This study evaluated the long-term results and prognostic factors after resection of HCC complicating HBV-related cirrhosis.
One hundred forty-six patients with HBV-related Child's A or B cirrhosis who had undergone resection of HCC over a 10-year period were prospectively studied for long-term results. They were compared with 155 noncirrhotic patients with HBV-related HCC resected in the same period.
The overall survival results of cirrhotic patients after resection of HCC were comparable to those of noncirrhotic patients (5-year survival, 44.3% v 45.6%, respectively; P =.216), but the former group had significantly smaller tumors. Stratified according to tumor size, the survival results were similar between cirrhotic and noncirrhotic patients with tumors </= 5 cm (5-year survival, 60.7% v 61.7%, respectively; P =.327) but were worse in cirrhotic compared with noncirrhotic patients with tumors greater than 5 cm (5-year survival, 27.8% v 39.5%, respectively; P =.034). Stage by stage, there were no significant differences in survival results between cirrhotic and noncirrhotic patients. Preoperative serum AST level greater than 100 IU/L (P =.004), perioperative transfusion (P =.015), and venous invasion (P <.001) were independent adverse prognostic factors.
The prognosis after resection of HCCs less than 5 cm in patients with compensated HBV-related cirrhosis was comparable to that of noncirrhotic patients, which suggests that surgical resection may be considered a first-line treatment for these patients. Patients with underlying active hepatitis as indicated by a high preoperative transaminase level are less favorable candidates for resection. Further studies are needed to define the relative roles of resection and transplantation for HCC associated with hepatitis B cirrhosis.
The goal of this work is to develop a least-squares finite element approach for the equations governing generalized Newtonian and viscoelastic flows such as those occurring in polymer processes. The ...Carreau generalized Newtonian model and the Giesekus viscoelastic constitutive equation are considered. The least-squares method offers the advantages of always generating a symmetric positive definite system, insensitivity to equation type, and no need for compatibility conditions between finite element spaces. Results of the weighted least-squares approach are presented, along with comparisons using a Galerkin mixed method. The numerical results indicate that with carefully chosen nonlinear weighting functions, the least-squares solution achieves an optimal convergence rate in the
L
2
-norm for the approximation to each dependent variable for the generalized Newtonian problem. For the viscoelastic flow problem, the numerical solution exhibits a second order convergence rate for the velocity and superlinear convergence rate in stress and pressure. Observed convergence rates depend strongly on the choice of weighting functions. Least-squares solutions for flows through a 4-to-1 contraction channel are also considered.
This study aims to clarify the clinicopathologic features of long-term survivors and disease-free survivors after resection of hepatocellular carcinoma (HCC).
The clinicopathologic features of 5-year ...survivors and disease-free survivors were elucidated in a cohort of 230 patients prospectively observed for > 5 years (64 to 192 months) after curative resection of HCC.
The incidence of 5-year overall and disease-free survivors were 37% (85 of 230) and 20% (45 of 230), respectively. Clinicopathologic features associated with 5-year survivors included female sex (P =.024), preoperative serum albumin > or= 40 g/L (P =.033), AST < 50 u/L (P =.001), tumor < 5 cm (P =.001), solitary tumor (P =.035), encapsulated tumor (P =.021), no venous invasion (P =.001), no microsatellite nodule (P =.001), and early pathologic tumor-node-metastasis (pTNM) stage (I or II, P <.001). Features favoring 5-year disease-free survivors were preoperative serum AST < 50 u/L (P =.007), tumor < 5 cm (P =.005), encapsulated tumor (P =.007), no venous invasion (P <.001), no microsatellite nodule (P =.001), and early pTNM stage (I or II, P <.001). By multivariate analysis, pTNM stage was the only significant predictive factor for both overall and disease-free survival.
This study shows that long-term disease-free survival > 5 years after resection of HCC can be achieved in patients with favorable tumor characteristics. Early pTNM stage was the most reliable predictor of both long-term overall and disease-free survivors.
We investigated magnetoelastic coupling through the field-driven transition to the fully polarized magnetic state in quasi-two-dimensional Cu(HF2)(pyz)2BF4 by magnetoinfrared spectroscopy. This ...transition modifies out-of-plane ring distortion and bending vibrational modes of the pyrazine ligand. The extent of these distortions increases with the field, systematically tracking the low-temperature magnetization. These distortions weaken the antiferromagnetic spin exchange, a finding that provides important insight into magnetic transitions in other copper halides.
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