[Hepatic resection with removal of tumor thrombi for hepatocellular carcinoma with tumor thrombi in portal vein and curative analysis]

OBJECTIVE

To study the therapeutic effects of surgical treatment for hepatocellular carcinoma (HCC) with tumor thrombi in the main trunk or the first branch of the portal vein (PVTT) and factors affecting prognosis.

METHODS

111 HCC patients with PVTT underwent hepatic resection with removal of tumor thrombi in the first left or the right branch of the portal vein or removal of tumor thrombi by direct opening of the main trunk of the portal vein. Hepatic artery infusion and/or portal vein infusion were performed after hepatic resection with removal of tumor thrombi for HCC with PVTT in 22 of the patients. Among 111 patients, 32 received postoperative transhepatic arterial chemoembolization and/or portal vein chemotherapy. Conservative treatment and surgical exploration or hepatic artery ligation (HAL) and infusion (HAI) and/or portal vein infusion (PVI) were performed in other 14 and 20 HCC patients with PVTT, respectively.

RESULTS

The 1-, 2-, 3-, 4- and 5- year survival rates were 61.7%, 36.2%, 32.3%, 24.4% and 22.4% in the resected group, respectively, whereas 14 HCC patients with PVTT treated conservatively died in three months and the 1-, 2- year survival rates were 6.0% and 0 in the 20 patients with surgical exploration or HAL and HAI and/or PVI respectively.

CONCLUSIONS

Hepatic resection with removal of tumor thrombi for HCC with PVTT should be encouraged for the prolongation of life span and quality of life.

[Inhibitor of plasminogen activator 1 (PAI-1) in hepatocellular carcinoma]

OBJECTIVE

To study the expression of the type-1 inhibitor of plasminogen activator (PAI-1) on protein and mRNA in hepatocellular carcinoma (HCC), and the relation between PAI-1 and biological behaviour of HCC.

METHOD

The tumor specimens of HCC (n = 48) and benign liver tumor (contorl n = 12) were tested by immunohistochemistry for the expression of PAI-1 protein. The tumor specimens of HCC (n = 20) and normal liver tissue (contorl n = 5) were evaluated by Northern blot analysis for the expression of PAI-1 mRNA.

RESULT

PAI-1 protein and PAI-1 mRNA were higher in tumor cell than in the marginal tissue of tumor and in control (P < 0.01 and P < 0.05). In deaths 2 years after surgery, PAI-1 was increased as compared to the survival group (P < 0.05). When negative PAI-1 conupared with positive urokinase-type plasminogen activator (uPA) and positive uPA receptor (uPAR). The nambeigs invasion case increased, the difference was more significant than that in the group with negative PAI-1, uPA and uPAR (P = 0.039).

CONCLUSION

The expression of PAI-1 protein and PAI-1 mRNA is increased in HCC. PAI-1 contributes to the invasion, metastasis and prognosis of HCC.

[Retrospective analysis of severe infection complicated with acute respiratory distress syndrome in children confirmed by autopic reports]

A retrospective review was made on 9 children (7-day to 14-month old) suffering from serious pneumonia complicated with acute respiratory distress syndrome and septicemia. The main clinical manifestation was continuous and serious hypoxemia, which was hard to treat, but PaCO2 was not increased obviously. The failure of multiple organs is not only a common complication, but also is a common cause of death. Consecutive observation of chest X-ray photograph is helpful to the diagnosis as the disease gets worse. Autopsy is still an important way to improve the knowledge of diseases in clinical diagnosis.

[Predictive chemotherapy of breast cancer directed by MTT assay in vitro]

OBJECTIVE

The predictive value of in vitro MTT assay for chemotherapy to breast cancer patients was studied.

METHODS

Of the 156 advanced breast cancer patients, 83 had had MTT assay before chemotherapy. According to the result of the MTT assay, 73 patients in MTT sensitive group received chemotherapy. The other 10 patients in MTT resistant group and 73 patients in the control group were given chemotherapy according to clinician' experience.

RESULTS

The response rate in MTT sensitive group was 76.7% (56/73). There was statistically significant difference as compared with 0(0/10) in the resistant group and 43.8% (32/73) in the control group. Between MTT sensitive group and control group, similar results were obtained at different therapeutic phases, in the subgroups of most lesions and chemotherapeutic schemes. Both the relapse rate and mortality rate were reduced remarkably in the MTT sensitive group. But there was no difference in the median remission and survival of relapsed patients in the two groups. Between in vitro and in vivo, the overall coincident rate was 79.5% [(56 + 10)/83].

CONCLUSION

The in vitro MTT assay can predict chemotherapy for breast cancer giving satisfactory results.

[The expression of platelet-derived endothelial cell growth factor in liver cancer]

OBJECTIVE

To investigate the expression of platelet-derived endothelial cell growth factor (PD-ECGF) in liver cancer and explore its related intervention with Capecitabine for the growth and metastasis of liver cancer.

METHODS

The protein level of PD-ECGF was determined using immunohistochemical method in 61 HCC samples and the mRNA level was detected using Northern blot analysis. Capecitabine was administered orally in 24 nude mice bearing LCI-D20 tumor. All treatments lasted 3 weeks. The tumor size was calculated by the following formula: V = a x b2 x 0.5. Lung metastasis was evaluated by HE staining in lung samples.

RESULTS

The PD-ECGF expression rate in 61 HCC and paratumoral liver tissues was 70.5% and 47.5%, respectively. The rate was higher in HCC tissues with advanced TNM stage than in those with early TNM stage (81.1% vs 54.2%, P < 0.05). The mRNA level of PD-ECGF was related well to its protein expression. The tumor size on day 3 after last treatment measured in the control, and low dose (1.05 mmol.kg-1.day-1), moderate dose (2.10 mmol.kg-1.day-1) and high dose (3.15 mmol.kg-1.day-1) of Capecitabine treatment groups was 447 mm3 +/- 159 mm3, 414 mm3 +/- 97 mm3, 240 mm3 +/- 119 mm3 and 209 mm3 +/- 150 mm3, respectively. High doses of Capecitabine increased the inhibitory effect on the growth and lung metastasis of HCC implant.

CONCLUSION

PD-ECGF is highly expressed in HCC and correlates with the TNM staging. Capecitabine may inhibit the growth and metastasis of HCC.

[Prognostic factors of primary liver cancer]

To investigate the prognostic factors of primary liver cancer (PLC) and improve the long-term results, 1,248 cases of PLC were analysed. Univariate analysis demonstrated that discovery approach, staging of PLC, original gamma-GPT, resection, radical resection, original AFP, tumor size, tumor number, and tumor capsule have very significant effects on prognosis of PLC (all P < 0.001); cirrhosis, HBsAg, local resection, and tumor embolus in portal vein were also significant difference (all P < 0.05); age, sex, original AFP, hepatitis, and differentiation of PLC cells were no significant difference (all P > 0.05). Multivariate analysis demonstrated that original gamma-GPT, radical resection, tumor size, and tumor number were the most significant prognostic factors (all P < 0.001). Some aspects improving long-term survival were discussed.

Self-energy correction to momentum-density distribution of positron-electron pairs

Positron two-dimensional angular correlation of annihilation radiation (2D ACAR), i.e., the 2D projection of the electron momentum densities sampled by positron, in Si is employed to verify the prediction of the density functional theory within the local-density approximation (LDA). Carefully conducted test shows that the LDA introduces small but definite discrepancies to the 2D-ACAR anisotropies. Self-energy calculation using the GW method indicates that density-fluctuation contributes anisotropic momentum-density correction and thus improves the agreement between theory and experiment. These results provide valuable annotations to the arguments concerning the accuracy and validity of the LDA and GW schemes.

Deep-Eutectic-Solvent-in-Water Pickering Emulsions Stabilized by Starch Nanoparticles

Deep eutectic solvents (DESs) have received extensive attention in green chemistry because of their ease of preparation, cost-effectiveness, and low toxicity. Pickering emulsions offer advantages such as long-term stability, low toxicity, and environmental friendliness. The oil phase in some Pickering emulsions is composed of solvents, and DESs can serve as a more effective alternative to these solvents. The combination of DESs and Pickering emulsions can improve the applications of green chemistry by reducing the use of harmful chemicals and enhancing sustainability. In this study, a Pickering emulsion consisting of a DES (menthol:octanoic acid = 1:1) in water was prepared and stabilized using starch nanoparticles (SNPs). The emulsion was thoroughly characterized using various techniques, including optical microscopy, transmission microscopy, laser particle size analysis, and rheological measurements. The results demonstrated that the DES-in-water Pickering emulsion stabilized by the SNPs had excellent stability and retained its structural integrity for more than 200 days at room temperature (20 °C). This prolonged stability has significant implications for many applications, particularly in the field of storage and transportation. This Pickering emulsion based on DESs and SNPs is sustainable and stable, and it has great potential to improve green chemistry practices in various fields.

Large-grain scintillator screens for proton radiography

Protons from the Los Alamos Neutron Science Center have been used for pulsed radiography in dynamic experiments for the past 25 years. Pulses of protons are imaged on a scintillator, and the light from these images is captured by fast gated cameras. The need for fast, bright scintillators has led to some compromises in image quality due to tiling the scintillators and backgrounds with totally internally reflected light. We show how large-grain scintillator screens, made using a thin plastic binder, solve these problems.

P11.07 LAPTM5 functions as a tumor suppressor via CD40 - NFêB pathway inhibition and represents a potential biomarker for temozolomide sensitivity in CD40 proficient glioblastoma

BACKGROUND

Glioma therapy is challenged by the invasive nature of glioma resulting in tumor recurrence and treatment resistance. Lysosomal protein transmembrane 5 (LAPTM5) was identified to inhibit invasion by screening for invasion-associated genes in glioma. The aim of this study was to decipher the function of LAPTM5 in glioblastoma and its interaction with the CD40 receptor which was shown to be highly expressed in up to 40% of glioblastoma.

METHODS

LAPTM5 expression was correlated with clinical outcome of glioma patients. Knockdown of LAPTM5 was performed in different glioma cell lines to analyze the impact on clonogenicity, invasiveness, sensitivity to temozolomide chemotherapy and tumorigenicity in-vitro and in-vivo in a subcutaneous xenograft mouse model. Expression array was used to elucidate the underlying pathways. CD40 knockdown and overexpression was induced to prove the crosstalk of LAPTM5 and CD40.

RESULTS

LAPTM5 expression correlated with better overall survival in high grade glioma patients and acted as a tumor suppressor in CD40 positive glioblastoma cells. LAPTM5 inhibited CD40-mediated NFκB activation resulting in anti-invasive, anti-clonogenic and temozolomide sensitizing effects in-vitro and in-vivo. Vice-versa, knockdown of LAPTM5 enhanced tumorigenicity by activation of the NFκB pathway which was overcome by NFκB inhibition. Importantly, CD40 expression was required for LAPTM5-mediated tumor suppressive activity.

CONCLUSION

LAPTM5 conveyed tumor suppressive and temozolomide sensitizing effects in CD40-positive glioblastoma by inhibition of CD40-mediated NFκB activation and thereby might provide a reasonable biomarker for sensitivity to temozolomide in CD40-positive glioblastoma.

[The clinical and pathology study of HBV precore mutant infection in chronic HBV patients]

OBJECTIVE

To elucidate the clinical feature, pathological change and IFN therapy of HBV pre-c mutant(1,896 G-->A point mutation).

METHODS

Mutation specific PCR was employed for detecting precore mutation from 108 serum and/or liver samples of patients with chronic hepatitis B infection. Liver damage was evaluated with Knodell's histology activity index(HAI) in 46 patients.

RESULTS

HBV precore mutant existed popularly in different e systems status, but the detective rate of HBV precore mutant or mutant prevailing over wild type in HBeAb+ group(14.29%, 46.23%) was significantly higher than that in HBeAg+(0%, 6.45%)group. Mutant infection was associated with the severity of liver diseases, the detective rate in severe chronic hepatitis group was significantly higher(13.64%, 40.91%) than that in chronic asympotamatic carriers groupe(0%, 15.62%). 5 precore mutant positive patients with IFN treatment showed either response or nonresponse to IFN therapy. There was no significant difference of liver pathological change between mutant type and wild type infection in patients with mild chronic hepatitis.

CONCLUSION

HBV precore mutant infection existed commonly in patients with chronic hepatitis B, despite of the e system status, though it was more prevalent in patients with HBeAb positive. Further study is needed in the pathogenicity and the treatment of HBV precore mutation.

[Changes of PAI-1 and biological behaviour of human hepatocellular carcinoma in metastatic model of nude mice]

OBJECTIVE

To study the relationship between plasminogen activator inhibitor type-1 (PAI-1) and biological behaviour of hepatocellular carcinoma (HCC).

METHOD

40 nude mice with LCI-D20 metastatic modes of human HCC (MMHCC) were established. The change of PAI-1 was determined by PAI-1 kit and immunohistochemistry with monoclonal antibody against PAI-1 in MMHCC progression.

RESULT

Following MMHCC progression from early to advanced stage, PAI-1 increased from 6.2 +/- 1.8 Au/ml to 15.4 +/- 0.7 Au/ml in plasma (P < 0.05), from 0.4 +/- 0.1 Au/mg to 0.8 +/- 0.3 Au/mg in extract (P < 0.05). The correlation between PAI-1 and tumor size and AFP level was strong (r = 0.9648 and r = 0.9544, P < 0.05 and P < 0.05).

CONCLUSION

PAI-1 was increased gradually following tumor progression in MMHCC. PAI-1 correlated with tumor size and AFP level. PAI-1 related well with the invasiveness and prognosis of HCC.

[Auxiliary partial orthotopic liver transplantation in rats]

A rat model of auxiliary partial orthotopic liver transplantation (APOLT) was developed in this study. Under hemihepatic inflow and outflow occlusions, the recipient underwent 75% partial hepatectomy before the liver graft comprising 30% of the donor liver was implanted on the orthotopic site. Forty rat APOLT were successfully performed. The 5-day survival rate of the recipient was 87.5% and that of the graft was 75%. On the fifth postoperative day, the living graft weight increased by 100%, the liver cell showed an active proliferation with a diploid of deoxyribonuclease (DNA), and the liver cells in DNA-synthetic phase accounted for 22.6 +/- 2.75%, significantly exceeding 12.22% +/- 1.48% of the normal rat hepatocytes (P < 0.001). It may be concluded that the rat APOLT is a more ideal animal model.

Differential diagnosis between hepatic focal nodular hyperplasia and hepatocellular carcinoma with negative alhpa-fetoprotein

OBJECTIVE

To study the differential diagnosis between hepatic focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC) with negative alpha-feto protein.

METHODS

To analyse retrospectively the clinical and imaging materials of 18 patients with FNH and 254 patients with AFP negative HCC proven by operation and pathology during March 1996 to March 1999 in our institute.

RESULTS

Patients with FNH were largely younger (66.7% under 40 years), discovered accidentally (66.7%), and without hepatitis background (83.3%). Majority of them had a normal liver function (72.0%). A big central artery was found in the lesion with high velocity and low resistant index in 71.4% of patients by color Doppler ultrasound. CT scan showed transient immediate enhancement in 85.7% of patients after bolus injection, being homogeneous (53.3%) and isodensity (73.3%) in the portal vein phase. MR imaging demonstrated early vigorous enhancement (83.3%) and homogenous (66.7%) lesion. In contrast, patients with AFP negative HCC were generally older (85.8% over 40 years), with symptoms (74.0%). A color flow with high velocity and high resistant index was found by color Doppler ultrasound. CT scan showed early heterogenous enhancement (96.6%) after bolus injection and being hypodensity in portal vein phase. MR imaging indicated early heterogeneous enhancement (91.7%).

CONCLUSION

FNH shows some typical clinical and imaging features. Therefore, it is feasible to be differentiated from HCC with negative AFP in some of the patients.

Study on small hepatocellular carcinoma and its extension

This paper summarizes the "study on small hepatocellular carcinoma and its extension" in Liver Cancer Institute, Zhongshan Hospital of Shanghai Medical University during the past 25 years. The results indicated that it was an important approach to obtain long-term HCC survivors, of the 239 patients with 5-year survival, small HCC resection accounted for 51.4%. It was an effective approach to improve the prognosis of HCC in the entire series, the 5-year survival of inpatients treated in authors' institution was 4.8% in 1958-1970, 12.2% in 1971-1983, and 46.7% in 1984-1995; which were correlated to the increase proportion of small HCC resection in the series; it was more effective as compared to large HCC resection, the 5 year survival was 61.3% (n = 645) versus 33.6% (n = 950). Extensions of small HCC study included early detection and treatment of small recurrent HCC, of the 147 patients with re-resection, the 5-year survival was 48.9% calculated from the time of first resection. Another extension was conversion of large HCC into small HCC, using multimodality combination treatment, 72 out of the 663 patients with surgically verified unresectable HCCs have been converted to resectable, 5-year survival being 62.1%, which was comparable to that of small HCC resection. Studies on related basic aspect of small HCC such as cell origin of recurrence, and molecular aspect of small HCC, indicated that biological characteristics, particularly the tumor invasiveness, remained the key link for further prolong survival after small HCC resection. Recently, a "patient-like" human HCC metastatic model in nude mice has been established. Experimental interventions have also been tried. Clinical trials for prevention of recurrence after small HCC resection have shown preliminary encouraging results. However, the "cost-effectiveness" of screening, the invasiveness of HCC, the multicentric origin, the coexisted Child C cirrhosis, etc., remained great challenge.