Recommended 10-Year Follow-Up Strategy for Small Hepatocellular Carcinoma After Radiofrequency Ablation: A Cost-Effectiveness Evaluation

INTRODUCTION

An optimal follow-up schedule for small (≤3-cm) hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) remains unclear in clinical guidelines. We aimed to assess the cost-effectiveness of follow-up strategies in patients with small HCC after RFA.

METHODS

In total, 11,243 patients were collected from global institutions to calculate recurrence rates. Subsequently, a Markov model covering a 10-year period was developed to compare 25 surveillance strategies involving different surveillance techniques (computed tomography [CT], magnetic resonance imaging or ultrasonography [US], and α-fetoprotein [AFP]) and intervals (3 or 6 months). The study endpoint was incremental cost-effectiveness ratio (ICER), which represented additional cost per incremental quality-adjusted life year. Sensitivity analysis was conducted by varying the values of input parameters to observe the ICER.

RESULTS

In a base case analysis, the dominant strategy was CT every 3 months during an initial 2 years, followed by semiannual CT, and then switch to biannual the combination of US screening and AFP testing after 5 years (m3_CT-m6_CT-m6_USAFP), with an ICER of $68,570.92 compared with the "not followed" strategy. One-way sensitivity analysis showed the ICER consistently remained below the willingness-to-pay threshold of $100,000.00. In a probabilistic sensitivity analysis, m3_CT-m6_CT-m6_USAFP was the most cost-effective approach in 95.6% of simulated scenarios at a willingness-to-pay threshold.

DISCUSSION

For small HCC after RFA, the recommended follow-up strategy is CT, with scans scheduled every 3 months for the first 2 years, every 6 months thereafter, and transition to biannual the combination of US screening and AFP testing after 5 years.

[Changes of proportion regarding consistent condom use and syphilis infection among low-fee female sex workers aged 35 and above]

Objective: To investigate the changes of proportion on both consistent condom use and syphilis infection among low-fee female sex workers aged 35 and above (LFSW), in order to provide evidence for targeted intervention strategies. Methods: A total of six cities-Liuzhou city and Pingnan couty of Guigang city of Guangxi Zhuang Autonomous Region, Jinghong city of Xishuangbanna Dai autonomous prefecture and Dali city of Dali Bai autonomous prefecture of Yunnan province, Zhangjiajie city and Jianghua Yao autonomous county of Yongzhou city Hunan province were involved in this study, with 60 eligible participants needed in each city, estimated through a pre-study. The first cross-sectional survey was completed from October 2012 to January 2013. Face-to-face questionnaire interview was carried out to collect information on socio-demography, work-related information and condom use situation. Blood was collected for syphilis testing. The second cross-sectional survey was carried out from June to September, 2015 under the same procedure. Results: A total of 371 and 403 eligible participants were included in the first and second survey, respectively. When comparing the two surveys, we noticed that the average age showed a slight change, from 42.4 years to 43.8 years old (t=3.537, P<0.001) and the average price for every commercial sex exchange increased from 36.8 RMB to 49.5 RMB (t=11.961, P<0.001). In the first survey, 46.9% (174/371) of the participants had more than two years of experience working as LFSW, compared to 61.3% (247/403) in the second survey (χ(2)=16.125, P<0.001). Also, 46.9% (174/371) of the participants consistently used condoms with clients in the past month in the first survey versus 64.3% (259/403) (χ(2)=23.641, P<0.001) in the second one. Rates of syphilis infection were found from 15.9% (59/371) in the first survey reduced to 7.2% (29/403) in the second survey (χ(2)=14.533, P<0.001). Conclusion: Compared with the first survey, the proportion of consistent condoms use showed an increase. Although the proportion of syphilis infection decreased in the second survey, the scope did not meet the criteria on syphilis, set by the government. Targeted intervention strategies on condom promotion and syphilis control should be implemented consistently in this population.

[Expression of thrombus regulatory protein and myeloperoxidasein peripheral blood of adult with obstructive sleep apnea hypopnea syndrome]

Objective:To investigate the expression of serum TM and MPO in adult patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Method: Ninety OSAHS patients who confirmed by PSG as OSAHS group. According to AHI, the patients were divided into 3 groups include heavy, medium and light, and 30 healthy outpatients were control group. The serum TM and MPO were determined by ELISA; TM and MPO were measured after comprehensive treatment in patients with severe OSAHS, and the correlation between TM, MPO and PSG were analyzed. Result: ①With the severity of OSAHS patients increased, the serum levels of TM and MPO increased gradually（F=20.761,21.433；P<0.01). There was no significant difference about the concentration of TM and MPO between light and control group（P>0.05）；The concentration of TM and MPO was significantly higher in heavy and medium group compared with light and control group（P<0.01）.②There was no correlation between serum levels of TM, MPO, BMI, age and sex in OSAHS patients(P>0.05). The serum concentration of TM was positively related to MPO. The serum concentrations of TM and MPO were positively correlated with AHI, but negatively with LSaO₂ (P<0.05). ③LSaO₂ was significantly increased, AHI and peripheral blood TM, MPO levels were significantly reduced in thirty severe OSAHS cases received the combined treatment(P<0.01).Conclusion:The increase of TM and MPO concentration in peripheral blood is one of characteristics of cardiovascular damage in patients with OSAHS. Combined detection of serum TM and MPO concentrations in patients with the disease is helpful for evaluation and risk assessment of cardiovascular disease.

[Electrophysiological subtypes and long term prognosis of Guillain-Barré syndrome]

OBJECTIVE

To assess the electrophysiological subtypes of Guillain-Barré syndrome (GBS) acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN), and long-term prognosis in northeastern China.

METHODS

One hundred and eighteen patients with GBS were recruited between 2010 and 2012 and retrospectively reviewed.

RESULTS

According to electrodiagnostic criteria, patients were classified as AMAN (49, 46.7%) or AIDP (39, 37.1%), or were unclassified (17, 16.2%). Between the AMAN and AIDP groups, age, sex, and clinical disability did not differ significantly, but the AMAN patients more frequently had preceding gastroenteritis. By 4 weeks after onset, 24.5% of the AMAN patients (12) and 33.3% of the AIDP patients (13) had regained the ability to walk; by 1 year, 77.6% of the AMAN patients (38) and 79.5% of the AIDP patients (31) could walk. Recovery was generally favorable in both subtypes. Immunotherapy was effective in patients with either AIDP or AMAN, and glucocorticoids and immunoglobulin treatment could achieve similar effect.

CONCLUSIONS

AMAN and AIDP are the main subtypes of GBS in northeastern China. The prognosis of patients with AMAN is similar to that of patients with AIDP. Different immunotherapies have similar effect on long term prognosis.

First Report of Nigrospora oryzae Causing Leaf Spot of Cotton in China

Cotton (Gossypium hirsutum L.) is widely cultivated for the important economic value of the fiber. In the summer of 2011, a leaf spot of cotton plants cv. Wanza40 was observed in 11 fields (total of about 4 ha) in Qianshan County in southwest Anhui Province, China. Approximately 30% of the plants in each field were symptomatic. Affected plants exhibited brown to reddish, irregular foliar lesions, each with a brown border near the vein of the leaves. A sign of fungal infection was a dark leaf mold observed on lesions on the abaxial surface of leaves. Sections of symptomatic leaf tissues were surface-sterilized (in 75% ethanol for 30 s, then 1% NaOCl for 1 min), rinsed three times in sterile distilled water, and plated onto potato dextrose agar (PDA). A fungus consistently recovered from symptomatic leaf samples produced colonies that were initially white and then became grayish brown with the onset of sporulation. Black, spherical to subspherical, single-celled conidia (10 to 12 × 14 to 16 μm) were borne on a hyaline vesicle at the tip of each conidiophore. Morphological characteristics of the fungus were similar to that of Nigrospora oryzae (2). The internal transcribed spacer (ITS) region of ribosomal DNA (rDNA) from a representative strain of the fungus, AHC-1, was amplified using the primers ITS1/ITS4 (4) and sequenced (GenBank Accession No. JQ864579). The ITS sequence had 99% identity with >553 bp of the ITS sequence of an N. oryzae isolate (GenBank Accession No. EU918714.1). On the basis of morphological data and ITS rDNA sequence, the isolate was determined to be N. oryzae. A pathogenicity test was performed on detached, young leaves of 4-month-old healthy cotton plants of cv. Wanza40. Six leaves were inoculated by placing a colonized agar piece (5 mm in diameter) from 7-day-old cultures of the fungus on pushpin-wounded leaves. Another six leaves treated with sterile PDA plugs served as a negative control treatment. Leaves were incubated in petri dishes and maintained at 25°C in a growth chamber programmed for 12 hours of fluorescent white light/day. After 5 days, brown to black lesions were observed on all inoculated leaves, whereas no symptoms developed on control leaves. N. oryzae was consistently reisolated from symptomatic leaves but not from the control leaves. N. oryzae is a weak pathogen on a wide range of plants, and has been described as the causal agent of lint rot on cotton (1,3), but to our knowledge this is the first report of N. oryzae causing a leaf spot of cotton in China. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases, Systematic Mycology and Microbiology Laboratory, ARS, USDA, Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , April 8, 2012. (2) H. J. Hudson. Trans. Br. Mycol. Soc. 46:355, 1963. (3) A. J. Palmatter et al. Plant Dis. 87:873, 2003. (4) T. J. White et al. In: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

First Report of Leaf Blight Caused by Nigrospora sphaerica on Curcuma in China

Curcuma (family Zingiberaceae) is commonly cultivated for the use of rhizomes within traditional Chinese medicines. In October 2009 and 2010, severe leaf blight was observed on Curcuma wenyujin Y.H. Chen & C. Ling (4) in fields located in Ruian, China. The area of cultivation in Ruian encompasses 90% of the production in Zhejiang Province. Disease incidence was approximately 90% of plants observed in affected fields. Early symptoms were yellow-to-brown, irregular-shaped lesions on the leaf margin or tip. After several days, lesions expanded along the mid-vein until the entire leaf was destroyed. Blighted leaves turned grayish to dark brown and withered, and severely affected plants died. Eight fungal isolates were recovered from symptomatic C. wenyujin leaves, collected from eight different fields, on potato dextrose agar (PDA). These fungal colonies were initially white, becoming light to dark gray and produced black, spherical to subspherical, single-celled conidia (14 to 17 × 12 to 15 μm), which were borne on a hyaline vesicle at the tip of the conidiophores. On the basis of these morphological features, the isolates appeared to be similar to Nigrospora sphaerica (2). Strain ZJW-1 was selected as a representative for molecular identification. Genomic DNA was extracted from the isolate, and the internal transcribed spacer (ITS) region of the ribosomal DNA (ITS1-5.8S-ITS2) was amplified using ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'-TCCTCCGCTTATTGATATGC-3') primers (3). The ITS region was further cloned and sequenced (GenBank Accession No. JF738028) and was 99% identical to N. sphaerica (GenBank Accession No. FJ478134.1). On the basis of morphological data and the ITS rDNA sequence, the isolate was determined to be N. sphaerica. Pathogenicity tests were conducted on four leaves of four C. wenyujin plants by placing agar pieces (5 mm in diameter) from 8-day-old cultures on pushpin-wounded leaves. An equal number of control plants were wounded and inoculated with noncolonized PDA agar pieces. Plants were placed in moist chambers at 25°C with a 12-h photoperiod. Brown-to-black lesions were observed on wounded leaves after 3 days and expanded to an average of 56 × 40 mm 15 days after inoculation. No symptoms developed on the control leaves. The pathogen was reisolated from the margins of necrotic tissues but not from the controls. The pathogen has been reported as a leaf pathogen on several hosts worldwide (1). To our knowledge, this is the first report of N. sphaerica as a leaf pathogen of C. wenyujin in China. Future research will focus primarily on management of this disease. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases, Systematic Mycology and Microbiology Laboratory, USDA-ARS, Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , March 31, 2011. (2) E. W. Mason. Trans. Brit. Mycol. Soc. 12:152, 1927. (3) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990. (4) J. Zhao et al. Molecules 15:7547, 2010.

Multimerization of a chimeric anti-CD20 single-chain Fv-Fc fusion protein is mediated through variable domain exchange

A series of single-chain anti-CD20 antibodies was produced by fusing single-chain Fv (scFv) with human IgG1 hinge and Fc regions, designated scFv-Fc. The initial scFv-Fc construct was assembled using an 18 amino acid (aa) linker between the antibody light- and heavy-chain variable regions, with the Cys residue in the upper hinge region (Kabat 233) mutagenized to Ser. Anti-CD20 scFv-Fc retained specific binding to CD20-positive cells and was active in mediating complement-dependent cytolysis. Size-exclusion HPLC analysis revealed that the purified scFv-Fc included multimeric as well as monomeric components. Variant scFv-Fcs were constructed incorporating four different hinges between the scFv and Fc regions, or three different linkers in the scFv domain. All formed multimers, with the highest level of multimerization found in the scFv-Fc with the shortest linker (8 aa). Elimination of an unusual salt bridge between residues L38 and H89 in the V(L)-V(H) domain interface failed to reduce the formation of higher order forms. Structural analysis of the scFv-Fc constructed with 18 or 8 aa linkers by pepsin or papain cleavage suggested the proteins contained a form in which scFv units had cross-paired to form a 'diabody'. Thus, domain exchange or cross-pairing appears to be the basis of the observed multimerization.

Sclerosing bone dysplasias: genetic and radioclinical features

Although knowledge of basic genetics in the field of sclerosing bone dysplasias is progressing, the radiologist still plays a pivotal role in the diagnosis of this relatively poorly understood group of disorders. Based on a target site approach, these anomalies are classified into three groups. Within each group, further differentiation can be made by distinctive clinical findings and by mode of inheritance: (a) dysplasias of endochondral bone formation: osteopetrosis (Albers-Schönberg disease), pycnodysostosis, enostosis, osteopoikilosis, osteopathia striata (Voorhoeve disease); (b) dysplasias of intramembranous bone formation: progressive diaphyseal dysplasia (Camurati-Engelmann disease) and variants, hyperostosis corticalis generalisata (Van Buchem disease) and variants; and (c) mixed sclerosing dysplasias: melorheostosis (Leri disease) and overlap syndromes.

Cross-sectional study of near-work and myopia in kindergarten children in Singapore

INTRODUCTION

In view of the high and increasing myopia rates amongst young Singaporean children, we aimed to assess the relationship between near-work and myopia in 414 pre-school children aged 4 to 6 years.

MATERIALS AND METHODS

We measured near-work indices such as tuition classes outside school and other possible risk factors via a questionnaire. We then measured myopia with a hand-held autorefractor.

RESULTS

Children who had 3 or more hours per week of near-work classes outside school had a higher rate [odds ratio 1.39 (95% confidence interval 1.02, 2.53)] of myopia.

CONCLUSIONS

This suggests that there may be an association between near-work and myopia, even at such a young age. Given the increasing emphasis on near-work in Singapore, it may be important to call for increased visual health awareness, although further studies will be needed to establish if near-work causes myopia.

The acute phase response in the Sudan plated lizard, Gerrhosaurus major

The Sudan plated lizard (Gerrhosaurus major), previously reported to be an afebrile species, was utilized in a series of experiments to test for various aspects of the acute phase response. Treatment of individuals with the antibiotic Baytril resulted in a slight (0.5 degree C) but significant reduction in mean selected body temperature (MSBT), while treatment with saline did not lower MSBT. Nonantibiotic treatment individuals had depressed plasma iron levels (86.6 +/- 22.4 micrograms Fe 100 ml-1 plasma) and treatment with Baytril produced a significant increase in plasma iron concentration (186.8 +/- 19.5 micrograms Fe 100 ml-1 plasma). Necropsy of randomly selected individuals indicated that animals obtained from the commercial supplier had Aeromonas, Arthrobacter, Pseudomonas and Salmonella infections and antibiotic treatment eliminated these infections. The growth rate of Aeromonas sobria is reduced when the bacteria are grown at 32 degrees C and reduced iron concentration compared to 34.5 degrees C and low iron concentration, which suggests that a fever response may not be beneficial in reducing bacterial growth. Saline injected, bacteria injected and antibiotic injected Gerrhosaurus major have high plasma zinc concentrations compared to the previously studied febrile species, Dipsosaurus dorsalis. This difference suggests that zinc concentrations in afebrile species deserve further study.

Effect of oxytocin on plasma testosterone levels in the male macaques (Macaca fascicularis)

The effect of oxytocin on testicular function was examined in the adult male long-tailed macaques (Macaca fascicularis). The monkeys were either infused with increasing concentrations of synthetic oxytocin (16-128 m.i.u./min for 3 h) or injected daily for a week with the same hormone (20 i.u., i.v.) and the plasma testosterone levels measured. The results of the present study show that acute infusion or chronic injection of oxytocin does not significantly affect the plasma testosterone levels, suggesting that systemic control of testicular endocrine function by oxytocin may be unimportant.

The adjuvant prognostic value of nuclear morphometry in stage I malignant melanoma of the skin. A multivariate analysis

In order to evaluate the adjuvant prognostic value to tumor thickness of other clinical, qualitative histologic and morphometric features, a multivariate analysis was performed in 68 patients with stage I cutaneous malignant melanoma and at least five years of follow-up. Stepwise linear regression analysis confirmed that tumor thickness is the most important prognostic factor; the only additional significant feature was the nuclear correlation coefficient (NCC), which is a measure for the roundness versus ellipsoidicity, regularity and homogeneity of the shape of the nuclei in tissue sections. In general, tumors with ellipsoid (spindle-shaped) nuclei were associated with a better prognosis, even in thick tumors, and tumors with predominantly round nuclei were associated with a poorer prognosis. If the NCC was below 0.94, the prognosis was good irrespective of the tumor thickness: all patients with such a low NCC have survived. Further analysis of this feature showed it to be strongly correlated with the nuclear axes ratio (longest axis divided by the shortest axis). The subtlety of the differences in nuclear shape makes it practically impossible to subjectively detect the significant prognostic level of ellipsoidity, especially in borderline cases. The advantage of the application of morphometry is that it allows the objective description of subjective impressions, and minor shape differences can be detected. The significant adjuvant prognostic value of nuclear morphometry to tumor thickness makes it worthwhile to consider these features together in future prognostic studies concerning malignant melanoma. Furthermore, inclusion of nuclear shape morphometry in clinical pathology reports seems advisable.

Evaluation of prognostic characteristics of stage I cutaneous malignant melanoma

The prognostic characteristics of stage I cutaneous malignant melanoma were evaluated. For this purpose, all patients with malignant melanomas diagnosed between January 1, 1967, and December 31, 1982, at the Department of Pathological Anatomy of the S.S.D.Z. were examined. Of the 187 total cases of malignant melanoma, 169 patients had stage I disease. Of these, 101 were not included in the investigation for the following reasons: carcinoma in situ (2), previous radiation treatment (1), localization in mucous membrane (2), microscopic sections unsuitable for morphometry and measurement of tumor thickness (11), follow-up period shorter than 60 months (61), lost for follow-up (12) and cause of death unrelated to melanoma (12). Of the remaining 68 patients, 46 had been alive without metastases for at least 60 months ("survivors") and 22 had died from metastases within 60 months ("nonsurvivors"). The following parameters were investigated: age, sex, localization, histologic type, level of invasion according to Clark and Breslow, ulceration, mitotic activity index, morphometric parameters (relating to nuclear shape and size) and number, size and localization of nucleoli. Wilcoxon's test and the chi-square test showed significant differences between survivors and nonsurvivors with regard to ulceration (P = 0.005), mitotic activity index (P = 0.006), histologic type (P = 0.03), level of invasion according to Clark (P = 0.004), Breslow tumor thickness (P = 0.003), standard deviation of nuclear contour index (P = 0.04) and nuclear correlation coefficient (P = 0.008). The results showed that tumor thickness of cutaneous malignant melanoma is the most significant prognostic parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of prolactin on steroid production by human luteal cells in vitro

The effects of prolactin on steroidogenesis were studied in dispersed luteal cells prepared from human corpora lutea of the menstrual cycle. Prolactin, at concentrations of 0.1-1000 ng/ml, had no effect on progesterone production by luteal cells during short-term incubation (3 h). However, in two out of five corpora lutea, higher concentrations of prolactin (100 and 1000 ng/ml) significantly reduced the oestradiol-17 beta production induced by human chorionic gonadotrophin (hCG; 10 i.u./ml); lower doses of prolactin had little effect. In the remaining corpora lutea, prolactin failed to affect either basal or hCG-induced production of oestradiol-17 beta. These results are discussed in relation to the mechanism by which prolactin influences human ovarian function.

Oxytocin may play a role in the control of the human corpus luteum

The effects of oxytocin on dispersed luteal cells from human corpora lutea of the menstrual cycle were studied. Oxytocin at a concentration of 4 mi.u./ml produced a slight increase in basal progesterone production. However, higher oxytocin concentrations (400 and 800 mi.u./ml) markedly inhibited both basal and human chorionic gonadotrophin-induced progesterone production. These data provide evidence for an effect of oxytocin on the human corpus luteum. In view of the inhibitory action of oxytocin, increased secretion of this hormone may be important in the demise of the corpus luteum at the end of the menstrual cycle.

Maintenance of pseudopregnancy by prolactin in indomethacin treated rats

1. The effects of bromocriptine and indomethacin on prolactin-induced pseudopregnancy were studied in pituitary grafted rats. 2.Administration of bromocriptine (a prolactin suppressant drug) at a total dose of 3 mg/kg body weight, given in 3 divided doses on day 5 of pseudopregnancy, effectively terminated it within 3 days. However, injection of indomethacin (a prostaglandin inhibitor) at a total dose of 6 mg/kg body weight, given in 3 divided doses, on the same day of pseudopregnancy had no significant effect on its duration. 3. It appears unlikely that the luteotrophic effect of prolactin on the corpus luteum is mediated by the stimulation of prostaglandin synthesis.

Maintenance of normal serum calcium level in the hyperprolactinaemic rat

The effect of experimentally induced chronic hyperprolactinaemia in male rats on the serum levels of calcium has been examined. Chronic elevation of circulating prolactin levels had no significant effect on the serum calcium levels and normal blood calcium homeostasis was still maintained.

Lack of effect of bromocriptine on serum levels of calcium in the rat

1. The effect of bromocriptine (a prolactin suppressant drug) on the serum levels of calcium was studied in the male rat. The drug was administered subcutaneously at a dosage of 100 microgram per 100 g body weight three times per day. 2. Chronic treatment with bromocriptine had no significant effect on the serum calcium levels. It appears that neither bromocroptine per se nor normal circulating prolactin levels exert any significant influence on blood calcium homeostasis.