First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up

AIM

To compare the long-term local control of hepatocellular carcinoma (HCC) and risk of peritoneal seeding via percutaneous radiofrequency ablation (RFA) using artificial ascites with those of RFA without artificial ascites.

MATERIALS AND METHODS

The Institutional Review Board approved this retrospective study. From April 2005 to February 2008, 160 patients (121 men, 39 women; age range 36-79 years) with a single subcapsular HCC (mean size 2.19 cm) were treated with ultrasonography-guided percutaneous RFA as a first-line therapy. Forty-four patients were treated with RFA using artificial ascites, whereas the other 116 patients were treated without artificial ascites. The cumulative local tumour progression (LTP) and peritoneal seeding were compared in both groups using follow-up computed tomography (CT). Cumulative LTP rates were analysed using the Kaplan-Meier method and the log-rank test. Risk of peritoneal seeding was investigated by means of multivariate analysis.

RESULTS

The overall median follow-up period was 52.5 months (range 13-76 months). The 1, 2, 4, and 6 year cumulative LTP rates were 17.1, 27.6, 35.2, and 35.2%, respectively, in the group with artificial ascites, and 8, 15.2, 26.6, and 34.4% in the group without artificial ascites, without significant difference (p = 0.332). The rates of peritoneal seeding were 6.8% (3/44) in the group with artificial ascites and 2.6% (3/116) in the group without artificial ascites, a non-significant difference (p = 0.347). The biopsy prior to RFA was the independent risk factor of peritoneal seeding regardless of the use of artificial ascites.

CONCLUSION

Long-term local tumour control and risk of peritoneal seeding were comparable for RFA with or without artificial ascites when used as a first-line therapy for subcapsular HCC.

A high-power 626 nm diode laser system for Beryllium ion trapping

We describe a high-power, frequency-tunable, external cavity diode laser system near 626 nm useful for laser cooling of trapped (9)Be(+) ions. A commercial single-mode laser diode with rated power output of 170 mW at 635 nm is cooled to ≈-31°C, and a single longitudinal mode is selected via the Littrow configuration. In our setup, involving two stages of thermoelectric cooling, we are able to obtain ≈130 mW near 626 nm, sufficient for efficient frequency doubling to the required Doppler cooling wavelengths near 313 nm in ionized Beryllium. In order to improve nonlinear frequency conversion efficiency, we achieve larger useful power via injection locking of a slave laser. In this way the entirety of the slave output power is available for frequency doubling, while analysis may be performed on the master output. We believe that this simple laser system addresses a key need in the ion trapping community and dramatically reduces the cost and complexity associated with Beryllium ion trapping experiments.

First result from the Alpha Magnetic Spectrometer on the International Space Station: precision measurement of the positron fraction in primary cosmic rays of 0.5-350 GeV

A precision measurement by the Alpha Magnetic Spectrometer on the International Space Station of the positron fraction in primary cosmic rays in the energy range from 0.5 to 350 GeV based on 6.8 × 10(6) positron and electron events is presented. The very accurate data show that the positron fraction is steadily increasing from 10 to ∼ 250  GeV, but, from 20 to 250 GeV, the slope decreases by an order of magnitude. The positron fraction spectrum shows no fine structure, and the positron to electron ratio shows no observable anisotropy. Together, these features show the existence of new physical phenomena.

Investigation of a planar optical waveguide in 2D PPLN using helium implantation technique

In this work, we report the investigation of a planar waveguide in a 2D periodically-poled lithium niobate (PPLN). The waveguide is fabricated by helium (He(+)) implantation at 2 MeV and a fluence of 1.5 x 10(16) ions/cm(2). Second harmonic generation (SHG) at 532 nm using a Q-switched laser and a CW laser diode at 1064 nm, was measured as a function of angular distribution and temperature. The experimental results show higher gain in SHG conversion efficiency in the waveguide than in the bulk 2D PPLN. In particular, SHGs from 2D reciprocal lattice vectors (RLV) are observed and studied.

Experimental optimization of the optical and electrical properties of a half-wavelength-thick organic hetero-structure in a Micro-cavity

In the context of progress towards the organic laser diode, we experimentally investigate the optical and electrical optimization of an OLED in a vertical λ/2 microcavity. The microcavity consists of a quarter-wavelength TiO₂/SiO₂ multilayer mirror, a half-wavelength-thick OLED and a semitransparent aluminum cathode. The Alq3/DCM2 guest-host system is used as the emitting layer. This study focuses on the design and the fabrication of a half-wavelength thick organic hetero-structure exhibiting a high current density despite both the thickness increase and the cathode thickness reduction. The emission wavelength, the line-width narrowing and the current-density are studied as a function of two key parameters: the hetero-structure optical thickness and the aluminum cathode thickness. The experimental results show that a 125 nm thick cavity OLED ended by a 20 nm thick aluminum cathode exhibits a resonance at 606 nm with a full width at half maximum of 11 nm, and with current-densities exceeding 0.5 A/cm². We show that even without a top high-quality-mirror the incomplete microcavity λ/2 OLED hetero-structure exhibits a clear modification of the spontaneous emission at normal incidence.

20 THz-bandwidth continuous-wave fiber optical parametric amplifier operating at 1 µm using a dispersion-stabilized photonic crystal fiber

We report the experimental demonstration of a continuous-wave all-fiber optical parametric amplifier in the 1 µm band with a record bandwidth of more than 20 THz and a peak gain of almost 40 dB. This is achieved by using a photonic crystal fiber with a high figure of merit and strongly reduced longitudinal dispersion fluctuations. Due to their unique bandwidth and gain characteristics, fiber parametric amplifiers at 1 µm provide an interesting alternative to solid-state or ytterbium-doped fiber amplifiers for ultrafast optical pulse and signal processing.

The use of therapeutic peptides to target and to kill cancer cells

Peptide therapeutics is a promising field for emerging anti-cancer agents. Benefits include the ease and rapid synthesis of peptides and capacity for modifications. An existing and vast knowledge base of protein structure and function can be exploited for novel peptide design. Current research focuses on developing peptides that can (1) serve as tumor targeting moieties and (2) permeabilize membranes with cytotoxic consequences. A survey of recent findings reveals significant trends. Amphiphilic peptides with clusters of hydrophobic and cationic residues are features of anti-microbial peptides that confer the ability to eradicate microbes and show considerable anti-cancer toxicity. Peptides that assemble and form pores can disrupt cell or organelle membranes and cause apoptotic or necrotic death. Cell permeable and tumor-homing peptides can carry biologically active cargo to tumors or tumor vasculature. The challenge lies in developing the clinical application of therapeutic peptides. Improving delivery to tumors, minimizing non-specific toxic effects and discerning pharmacokinetic properties are high among the needs to produce a powerful therapeutic peptide for cancer treatment.

Antibacterial activity of bark of Alnus pendula against methicillin-resistant Staphylococcus aureus

BACKGROUND AND OBJECTIVES

Methicillin-resistant Staphylococcus aureus (MRSA) infections are a rapidly growing health problem around the globe. Recently, there has been considerable interest in the use of plant materials as an alternative method to control pathogenic microorganisms. In this study we evaluated the antibacterial activity of bark of Alnus pendula against MRSA.

MATERIALS AND METHODS

The MIC determination was done using the microdilution broth method and bacterial growth was determined by measuring optical density using spectrophotometer.

RESULTS

Alnus pendula bark EtOH extract and fractions (F-1, -2, -3 and -4) were investigated against MRSA. The most active fractions (F-3 and F-4) led to the isolation of oregonin (ORE) and hirsutanone (HIR). These compounds were active against MRSA strains with minimum inhibitory concentrations (MICs) ranging from 31.25 to 250 microg/ml MIC and 2 MIC of HIR completely inhibited the growth of MRSA.

CONCLUSIONS

The bark EtOH extract of Alnus Pendula has potent antibacterial activity against MRSA.

Radiofrequency ablation combined with transcatheter arterial embolisation in rabbit liver: investigation of the ablation zone according to the time interval between the two therapies

OBJECTIVES

This study was designed to evaluate the extent of the radiofrequency ablation zone in relation to the time interval between transcatheter arterial embolisation (TAE) and radiofrequency ablation (RFA) and, ultimately, to determine the optimal strategy of combining these two therapies for hepatocellular carcinoma.

METHODS

15 rabbits were evenly divided into three groups: Group A was treated with RFA alone; Group B was treated with TAE immediately followed by RFA; and Group C was treated with TAE followed by RFA 5 days later. All animals underwent perfusion CT (PCT) scans immediately after RFA. Serum liver transaminases were measured to evaluate acute liver damage. Animals were euthanised for pathological analysis of ablated tissues 10 days after RFA. Non-parametric analyses were conducted to compare PCT indices, the RFA zone and liver transaminase levels among the three experimental groups.

RESULTS

Group B showed a significantly larger ablation zone than the other two groups. Arterial liver perfusion and hepatic perfusion index represented well the perfusion decrease after TAE on PCT. Although Group B showed the most elevated liver transaminase levels at 1 day post RFA, the enzymes decreased to levels that were not different from the other groups at 10 days post-RFA.

CONCLUSIONS

When combined TAE and RFA therapy is considered, TAE should be followed by RFA as quickly as possible, as it can be performed safely without serious hepatic deterioration, despite the short interval between the two procedures.

Black-light continuum generation in a silica-core photonic crystal fiber

We report the observation of a broadband continuum spanning from 350 to 470 nm in the black-light region of the electromagnetic spectrum as a result of picosecond pumping a solid-core silica photonic crystal fiber at 355 nm. This was achieved despite strong absorption and a large normal dispersion of silica glass in the UV. Further investigations reveal that the continuum generation results from the interplay of intermodally phase-matched four-wave mixing and cascaded Raman scattering. We also discuss the main limitations in terms of bandwidth and power due to temporal walk-off, fiber absorption, and the photo darkening effect, and we suggest simple solutions.

Small (≤ 2 cm) hepatocellular carcinoma in patients with chronic liver disease: comparison of gadoxetic acid-enhanced 3.0 T MRI and multiphasic 64-multirow detector CT

OBJECTIVES

To compare the diagnostic performance of gadoxetic acid-enhanced MRI using 3.0 T with that of multiphasic 64-multirow detector CT (MDCT) for the detection of small (≤2 cm) hepatocellular carcinoma (HCC) in patients with chronic liver disease.

METHODS

A total of 54 patients (44 men, 10 women; age range, 33-81 years) with 59 HCCs (≤2 cm in diameter) who underwent both multiphasic (arterial, portal venous, equilibrium) 64-MDCT and gadoxetic acid-enhanced 3.0 T MRI were enrolled in this study. Two observers independently and randomly reviewed the MR and CT images on a lesion-by-lesion basis. The diagnostic performance of these techniques for the detection of HCC was assessed by alternative free-response receiver operating characteristic (ROC) analysis, in addition to evaluating the sensitivity and positive predictive value.

RESULTS

For each observer, the areas under the ROC curve were 0.874 and 0.863 for MRI, respectively, as opposed to 0.660 and 0.687 for CT, respectively. The differences between the two techniques were statistically significant for each observer (p<0.001). The sensitivities (89.8% and 86.4%) of MRI for both observers were significantly higher than those (57.6% and 61.0% for each observer, respectively) of MDCT. No significant difference was seen between the positive predictive values for the two techniques (p>0.05).

CONCLUSION

Gadoxetic acid-enhanced 3.0 T MRI shows a better diagnostic performance than that of 64-MDCT for the detection of small (≤2 cm) HCCs in patients with chronic liver disease.

Biplane fluoroscopy-guided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience

OBJECTIVE

The purpose of this study was to assess the technical feasibility and local efficacy of biplane fluoroscopy-guided percutaneous radiofrequency (RF) ablation combined with transcatheter arterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC).

METHOD

Our retrospective study was approved by the institutional review board and informed consent was waived. 18 patients with 19 HCCs (mean 2.5 cm diameter; range 2-4.2 cm) were treated with percutaneous RF ablation combined with TACE. After segmental TACE, 18 (95%) of 19 HCCs were visible on fluoroscopy. Shortly (median 2 days; range 1-4 days) after TACE, percutaneous RF ablation was performed under real-time biplane fluoroscopic guidance. We evaluated major complications, rate of technical success at immediate post-RF ablation CT images and local tumour progression at follow-up CT images.

RESULTS

Major complication was not observed in any patients. Technical success was achieved for all 18 visible HCCs. During the follow-up period (median 20 months; range 5-30 months), no local tumour progression was found.

CONCLUSION

Biplane fluoroscopy-guided RF ablation combined with TACE is technically feasible and effective for treatment of HCC.

Frequency-selective excitation of guided acoustic modes in a photonic crystal fiber

We present experimental and numerical results demonstrating the simultaneous frequency-selective excitation of several guided acoustic Brillouin modes in a photonic crystal fiber with a multi-scale structure design. These guided acoustic modes are identified by using a full vector finite-element model to result from elastic radial vibrations confined by the wavelength-scale air-silica microstructure. We further show the strong impact of structural irregularities of the fiber on the frequency and modal shape of these acoustic resonances.

Dietary prescriptions for the overweight patient: the potential benefits of low-carbohydrate diets in insulin resistance

Obesity in the USA continues to be a medical problem of epidemic proportions, affecting one-third of American adults. This increase in body weight and body mass index (BMI) is a risk factor for insulin resistance; individuals with insulin resistance are at increased risk for the development of type 2 diabetes and cardiovascular disease. The identification of effective dietary treatments (e.g. low-carbohydrate diet, low-fat diet) for patient populations with insulin resistance remains controversial. While a variety of dietary approaches will result in weight and cardiac risk factor reduction, individuals who have been identified as insulin-resistant may derive additional short-term weight loss results from a low-carbohydrate diet compared to a low-fat diet.

Correlation between the immature characteristics of umbilical cord blood-derived mesenchymal stem cells and engraftment of hematopoietic stem cells in NOD/SCID mice

Umbilical cord blood (UCB)-derived mesenchymal stem cells (MSC) facilitate the engraftment of human (h) hematopoietic stem cells when transplanted simultaneously in animal and human studies. However, the type of MSCs that preferentially enhance the engraftment of HSCs is unknown. Recent studies have shown that MSCs derived from a single source are heterogeneous in terms of cell size, morphology, proliferation rate, and differentiation potential. This study was designed to investigate the properties of UCB-MSCs, which influence the engraftment of hHSCs in a NOD/SCID mouse model. We categorized MSCs as being the most effective (UCB-352 MSCs) or the least effective (UCB-156 MSCs) at promoting the homing and engraftment of HSCs, and compared the characteristics of these 2 MSC populations. We observed that the 2 populations showed differences in characteristics typical of immature MSCs, and related to proliferation potential. We showed that UCB-352 MSCs, which proliferate quickly, preferentially enhanced the engraftment of HSCs in NOD/SCID mice. In addition, we observed differences in the pattern of both PODXL and Oct4 expression, and in the levels of cytokines such as SDF-1 and SCF using flow cytometry and membrane arrays. The more effective UCB-352 MSCs expressed higher levels of PODXL and Oct4, which were associated with immaturity, than did the UCB-156 MSCs. Furthermore, UCB-352 cells secreted greater levels of SDF-1 and SCF, both of which are required for hematopoiesis. We propose that the proliferation potential of UCB-MSCs, coupled with their immature characteristics, may serve as a novel standard to promote the homing and engraftment of HSCs.

Photonic crystal fiber mapping using Brillouin echoes distributed sensing

In this paper we investigate the effect of microstructure irregularities and applied strain on backward Brillouin scattering by comparing two photonic crystal fibers drawn with different parameters in order to minimize diameter and microstructure fluctuations. We fully characterize their Brillouin properties including the gain spectrum and the critical power. Using Brillouin echoes distributed sensing with a high spatial resolution of 30 cm we are able to map the Brillouin frequency shift along the fiber and get an accurate estimation of the microstructure longitudinal fluctuations. Our results reveal a clear-cut difference of longitudinal homogeneity between the two fibers.

Nonlinear dynamics of semiconductor lasers with feedback and modulation

The nonlinear dynamics of two semiconductor laser systems: (i) with optical feedback, and (ii) with optical feedback and direct current modulation are evaluated from multi-GHz-bandwidth output power time-series. Animations of compilations of the RF spectrum (from the FFT of the time-series) as a function of optical feedback level, injection current and modulation signal strength is demonstrated as a new tool to give insight into the dynamics. The results are contrasted with prior art and new observations include fine structure in the RF spectrum at low levels of optical feedback and non-stationary switching between periodic and chaotic dynamics for some sets of laser system parameters. Correlation dimension analysis successfully identifies periodic dynamics but most of the dynamical states are too complex to be extracted using standard algorithms.

Cutaneous endometriosis: a combination of medical and surgical treatment

Cutaneous and subcutaneous endometriosis occurs most commonly as a secondary process in scars after abdominal or pelvic surgical procedures including hysterectomy, cesarean sections and episiotomy. Simple excision is the recommended management and local recurrence after adequate excision is uncommon. A 32-year-old woman presented with a 5-cm firm tumor on the right perineum. There was cyclical bleeding and fluctuation in size. She was initially treated with subcutaneous goserelin acetate. The lesion decreased in size and was then successfully excised 4 months later.

Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation

The purpose of this study was to assess the feasibility and efficacy of percutaneous radiofrequency ablation combined with transarterial chemoembolisation (TACE) for the treatment of hepatocellular carcinoma that are invisible on both ultrasound and unenhanced CT. 73 patients with a total of 101 nodular hepatocellular carcinomas were referred for possible radiofrequency (RF) ablation. Of these, 14 lesions (14%) in 14 patients were invisible on both ultrasound and unenhanced CT. The invisible nodules averaged 1.2 cm in diameter (range, 0.8-2.0 cm; median, 1.1 cm). After segmental TACE, percutaneous RF ablation was performed if the index tumour was visible on fluoroscopy, ultrasound or CT. All cases of combined treatment were evaluated for size of ablative zone, complications, rate of technical effectiveness at 1-month follow-up CT and local tumour progression. After TACE, percutaneous RF ablation was technically feasible in 10 (71%) of the 14 nodules. RF ablation was performed with the guidance of fluoroscopy (n = 6, 42%), ultrasound (n = 2, 14%) or CT (n = 2, 14%). The mean diameter of the ablative zone by percutaneous RF ablation combined with TACE was 4.8+/-0.7 cm and 3.4+/-0.6 cm in the long and short axis, respectively. No major complications were documented. The primary technical effectiveness rate for nodules treated by combined treatment was 100% (10/10) at 1-month follow-up CT. No local tumour progression was found during the follow-up period (median 15 months; range 4-20 months). Percutaneous RF ablation combined with TACE is a feasible and effective technique for treating small hepatocellular carcinomas that are not visible on ultrasound or unenhanced CT.

Cutaneous adverse effects in patients treated with the multitargeted kinase inhibitors sorafenib and sunitinib

BACKGROUND

The multitargeted kinase inhibitors sorafenib and sunitinib have improved treatment of solid tumours including renal cell carcinoma and hepatocellular carcinoma by offering better clinical responses. However, sorafenib and sunitinib are commonly associated with cutaneous toxicity.

OBJECTIVES

We conducted this study to make a clinical assessment of the cutaneous toxicities induced by the oral multitargeted kinase inhibitors sorafenib and sunitinib.

METHODS

Retrospectively, we reviewed medical records of patients receiving multitargeted kinase inhibitors, including 109 patients on sorafenib for the treatment of renal cell carcinoma or hepatocellular carcinoma and 119 patients receiving sunitinib for treatment of renal cell carcinoma or a gastrointestinal stromal tumour. Clinical data on cutaneous toxicities were collated. We describe the incidences and intensities of toxicities, and analyse the data statistically.

RESULTS

The most common cutaneous toxicity was hand-and-foot skin reaction (HFSR). Other cutaneous toxicities included alopecia, stomatitis, skin discoloration (hair or face), subungual splinter haemorrhage, facial swelling, facial erythema and xerosis. HFSR and severe stomatitis required therapy modifications to relieve symptoms, but other cutaneous toxicities did not affect treatment course. HFSR was observed in 48% of patients treated with sorafenib and 36% of those treated with sunitinib. Median time to onset was 18.4 days in patients receiving sorafenib and 32.4 days in those receiving sunitinib. HFSR and stomatitis were early symptoms compared with other cutaneous toxicities. Patients with severe HFSR were likely to develop the symptoms at early phases of therapy. A significant correlation between the severity of HFSR and development of alopecia and stomatitis was found.

CONCLUSIONS

Multitargeted kinase inhibitors are associated with a significant risk of various cutaneous adverse events. HFSR is the commonest and most serious cutaneous toxicity in patients treated with these drugs.

Experimental determination of proton-induced cross-sections on natural zirconium

We measured cross-sections for the formation of (86g,87m,87g)Y, (88,89g)Zr, and (90,92m)Nb radionuclides for proton-induced reactions on natural zirconium by using a conventional stacked-foil activation technique in the energy range between 1 and 40MeV at the MC-50 cyclotron of the Korea Institute of Radiological and Medical Science. We compared the measured data with the available literature data and the theoretical calculation by the model codes TALYS and ALICE-IPPE. We also deduced the integral yields for thick targets from the measured cross-sections of the produced radionuclides. The optimum production possibility of the medically important (89g)Zr and (86)Y radionuclides were discussed elaborately.