Inflammation-related nomogram for predicting survival of patients with unresectable hepatocellular carcinoma received conversion therapy

BACKGROUND

The efficacy of conversion therapy for patients with unresectable hepatocellular carcinoma (HCC) is a common clinical concern.

AIM

To analyse the prognostic factors of overall survival (OS) in patients with unresectable HCC who received conversion therapy.

METHODS

One hundred and fifty patients who met the inclusion criteria were enrolled and divided into a training cohort (n = 120) and a validation cohort (n = 30). Using the independent risk factors in the training cohort, a nomogram model was constructed to predict OS for patients treated with transarterial chemoembolization following hepatic resection. The nomogram was internally validated with the bootstrapping method. The predictive performance of nomogram was assessed by Harrell’s concordance index (C-index), calibration plot and time-dependent receiver operating characteristic curves and compared with six other conventional HCC staging systems.

RESULTS

Multivariate Cox analysis identified that albumin, blood urea nitrogen, gamma-glutamyl transpeptidase to platelet ratio, platelet to lymphocyte ratio, macrovascular invasion and tumour number were the six independent prognostic factors correlated with OS in nomogram model. The C-index in the training cohort and validation cohort were 0.752 and 0.807 for predicting OS, which were higher than those of the six conventional HCC staging systems (0.563 to 0.715 for the training cohort and 0.458 to 0.571 for the validation cohort). The calibration plots showed good consistency between the nomogram prediction of OS and the actual observations of OS. Decision curve analyses indicated satisfactory clinical utility. With a total nomogram score of 196, patients were accurately classified into low-risk and high-risk groups. Furthermore, we have deployed the model into online calculators that can be accessed for free at https://ctmodelforunresectablehcc.shinyapps.io/DynNomapp/.

CONCLUSION

The nomogram achieved optimal individualized prognostication of OS in HCC patients who received conversion therapy, which could be a useful clinical tool to help guide postoperative personalized interventions and prognosis judgement.

Identification of circRNAs involved in the development of hepatocellular carcinoma after insufficient radiofrequency ablation

Previous studies have reported that circular RNAs (circRNAs) play a key role in the pathogenesis and progression of various diseases. In the present study, we aimed to identify potential circRNAs associated with the progression of hepatocellular carcinoma (HCC) after insufficient radiofrequency ablation (iRFA). A xenograft mouse iRFA model was initially established, and immunohistochemical staining (IHC) and polymerase chain reaction (PCR) were performed to confirm the expression of programmed cell death-ligand 1 (PD-L1) and vascular endothelial growth factor receptor-1 (VEGFR-1). CircRNA expression alterations were screened by next-generation sequencing (RNA-seq). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were conducted to predict the function of genes coding differentially expressed circRNAs. The selected circRNAs were validated utilizing PCR and Sanger sequencing. The relationships between circRNAs, microRNAs, PD-L1, and VEGFR-1 were predicted by bioinformatics. Overall, a total of 612 circRNAs were differentially expressed in iRFA-treated subcutaneous tumorigenesis tissue. Among them, 435 circRNAs were significantly upregulated and 177 circRNAs were downregulated. GO and KEGG analyses were employed to predict the functions of these circRNAs. Thereafter, quantitative reverse transcription PCR (qRT-PCR) assays determined that these seven circRNAs were overexpressed in the iRFA group, which was consistent with the RNA-seq results. Based on the bioinformatic analysis, seven circRNAs confirmed by Sanger sequencing were predicted to likely regulate PD-L1 and VEGFR-1 expression levels by functioning as sponges for microRNAs (miRNAs) and forming a circRNA-miRNA-PD-L1/VEGFR-1 regulatory network. Finally, IHC and qRT-PCR of PD-L1 and VEGFR-1 confirmed the activation of this pathway. Taken together, we report that differentially expressed circRNAs might simultaneously regulate PD-L1 and VEGFR-1 in the iRFA tissues, which provides a novel view of circRNAs in HCC progression after the iRFA procedure.

Increased interhemispheric functional connectivity in college students with non-clinical depressive symptoms in resting state

The underlying neural basis of non-clinical depressive symptoms (nCDSs) remains unclear. Interhemispheric functional connectivity has been suggested as one of the most robust characteristics of brain's intrinsic functional architecture. Here, we investigated the functional connectivity between homotopic points in the brain using the voxel-mirrored homotopic connectivity (VMHC) approach. We performed VMHC analysis on resting-state functional magnetic resonance imaging (rs-fMRI) data from 17 individuals with nCDSs and 20 healthy controls (HCs) who were enrolled from a sample of 1105 college students. We found increased VMHCs in the bilateral posterior cerebellum and fusiform gyrus in nCDSs subjects compared with HCs. Furthermore, receiver operating characteristic (ROC) curves indicated that VMHC values in the posterior cerebellum lobes could use to differente nCDSs from HCs [area under the curve (AUC), 0.756; p<0.01]. We suggest increased VMHCs indicate a possible compensatory mechanism involved in the pathophysiology of nCDSs. VMHC values of the posterior cerebellum lobes might serve as a reliable biomarker for identifying nCDSs.

Differentiation of central lung cancer from atelectasis: comparison of diffusion-weighted MRI with PET/CT

OBJECTIVE

Prospectively assess the performance of diffusion-weighted magnetic resonance imaging (DW-MRI) for differentiation of central lung cancer from atelectasis.

MATERIALS AND METHODS

38 consecutive lung cancer patients (26 males, 12 females; age range: 28-71 years; mean age: 49 years) who were referred for thoracic MR imaging examinations were enrolled. MR examinations were performed using a 1.5-T clinical scanner and scanning sequences of T1WI, T2WI, and DWI. Cancers and atelectasis were measured by mapping of the apparent diffusion coefficients (ADCs) obtained with a b-value of 500 s/mm(2).

RESULTS

PET/CT and DW-MR allowed differentiation of tumor and atelectasis in all 38 cases, but T2WI did not allow differentiation in 9 cases. Comparison of conventional T2WI and DW-MRI indicated a higher contrast noise ratio of the central lung carcinoma than the atelectasis by DW-MRI. ADC maps indicated significantly lower mean ADC in the central lung carcinoma than in the atelectasis (1.83±0.58 vs. 2.90±0.26 mm(2)/s, p<0.0001). ADC values of small cell lung carcinoma were significantly greater than those from squamous cell carcinoma and adenocarcinoma (p<0.0001 for both).

CONCLUSIONS

DW-MR imaging provides valuable information not obtained by conventional MR and may be useful for differentiation of central lung carcinoma from atelectasis. Future developments may allow DW-MR imaging to be used as an alternative to PET-CT in imaging of patients with lung cancer.

Variation in the diagnosis and management of patent ductus arteriosus in premature infants

OBJECTIVES

To determine variations in neonatology practice regarding the diagnosis and management of patent ductus arteriosus (PDA) in premature infants.

DESIGN

Standardized telephone interview of preferences and practices.

SUBJECTS

Canadian neonatologists in active clinical practice.

RESULTS

Of 136 eligible Canadian neonatologists, 100 respondents (74%) estimated the proportion of infants with suspected PDA who have echocardiography to be a median of 80% (range 0% to 100%), with considerable variation both within and between centres. Only two centres had written guidelines. More recent medical school graduates were significantly more likely to use echocardiography. Increased use of echocardiography was also significantly related to increased availability. Fluid restriction and indomethacin was used as initial therapy by 89% of respondents, with the indomethacin dose standardized for 83%; surgical ligation was used when indomethacin therapy was contraindicated or had failed. Personal guidelines directed decisions regarding therapy for the majority of neonatologists.

CONCLUSIONS

Among Canadian neonatologists, there is considerable variation regarding practices related to the diagnosis and management of PDA in premature infants. This variation may potentially affect the cost effectiveness of care for these patients.

Use of prescription medicines in Malaysia 2005

The National Medicines Use Survey (NMUS) which started in 2004 and is still ongoing was conducted with the intent to continuously and systematically collect data on the use of medicines, to provide an overview on the use of medicines in Malaysia. The objective of the NMUS is therefore to quantify the present state and time trends of medicines utilization at various levels of our health care system whether national, regional, local or institutional. From the data available, for the Year 2005, the most commonly used medicine in Malaysia were anti-diabetic medications, of which glibenclamide is the most common followed by metformin, were the top 2 of the list of drugs utilized in DDD/1000 population/day. Collectively, however, taking into account the various antihypertensives by therapeutic groups, anti-hypertensive medicines were more commonly used than anti-diabetics. Hypertension and diabetes mellitus are the two most prevalent chronic disorders in the country and thus, such high medicines utilization rates for these conditions are to be expected. From the general practice prescription data, it was estimated that a patient with hypertension was prescribed a median of only one (1) anti-hypertensive medication. This means, the vast majority of patients (81%) were on monotherapy, which is hardly sufficient to achieve treatment target. Clearly then, given the prevalence of hypertension, many patients were not on drug treatment at all, and of those treated, their drug treatment are likely to be inadequate.

Degradation of carbofuran in water by solar photocatalysis in presence of photosensitizers

The effect of the presence of photosensitizers, methylene blue (MB) and rose Bengal (RB), on the degradation of carbofuran (2,3-dihydro-2,2-dimethylbenzofuran-7-yl methylcarbamate) in water in a solar photocatalytic system was investigated. It was found that as compared to MB, RB generally showed a stronger effect on the decomposition of carbofuran under comparable conditions. Among the conditions studied, adding 2 x 10(-6) M of RB, that corresponding to 2% of the initial concentration of carbofuran solution in the system, rendered the most effective degradation of carbofuran. As a result, a carbofuran removal percentage of 69.9%, a mineralization efficiency of 28.0%, and a microtoxicity reduction of 65.0% could be achieved. The degradation and mineralization of carbofuran was found to follow the pseudo-first order reaction kinetics. The decomposition mechanism of carbofuran was further investigated through identification of the intermediates to elaborate the influence of dye photosensitizer on the solar photocatalysis of carbofuran in water. On the basis of the intermediates identified, including carbofuran phenol, 3-hydroxy carbofuran phenol, and substituted alcohols (3-phenoxy 1-propanol, 2-ethyl 1-hexanol, 2-butoxyl ethanol), it appears that hydrolysis and hydroxylation were the two key mechanisms for decomposing carbofuran during the process of solar photocatalysis with the aid of dye photosensitizer.

Studies on the antioxidative activities of Hsian-tsao (Mesona procumbens Hemsl) leaf gum

This study aimed at evaluating the antioxidative activity of crude hsian-tsao leaf gum extracted by sodium bicarbonate solutions and precipitated by 70% ethanol. The antioxidative activities, including the radical-scavenging effects, Fe(2+)-chelating ability, and reducing power as well as the inhibition of FeSO(4)-H(2)O(2)-induced malondialdehyde formation in rat tissue homogenate were studied in vitro. It was found that the antioxidative effect provided by hsian-tsao leaf gum was strongly concentration dependent. In general, the antioxidative activity increased with increasing gum concentration, to a certain extent, and then leveled off with further increase in gum concentration. A concentrtaion-dependent kinetics for the rate of change in antioxidative activity was proposed. The antioxidative activity constant (k) and the half-inhibition concentration (IC(50)) for each antioxidative reaction studied were calculated. From a comparison of the IC(50) values for different antioxidative reactions, it seemed that hsian-tsao leaf gum was more effective in scavenging superoxide radicals than chelating Fe(2+) or scavenging alpha,alpha-diphenyl-beta-picrylhydrazyl (DPPH) radicals. As compared to the commercial antioxidants, hsian-tsao leaf gum showed less scavenging effect on the DPPH radical and reducing power but better superoxide radical-scavenging effect and Fe(2+)-chelating ability than alpha-tocopherol and BHT.

A DSC study on the gel-sol transition of a starch and hsian-tsao leaf gum mixed system

Differential scanning calorimetric analysis was performed on the admixture of 4% hsian-tsao leaf gum and 8% wheat starch as a function of salt types and concentrations. The salt concentrations (C(s)) studied were 5-100 mM for sodium and potassium chloride, and 3.4-34 mM for calcium and magnesium chloride. It was found that hsian-tsao leaf gum or starch alone did not present a readily recognizable exothermic peak or endothermic peak during cooling or heating in DSC. However, mixing these two polymers promoted the intermolecular binding and subsequent gelation of the mixtures as evidenced by the DSC exothermic and endothermic peaks during cooling and heating, respectively. The setting and melting temperatures of such a mixed system shifted progressively to higher temperatures with increasing concentrations of added salts. It was considered that the aggregated mixed polymers formed thermally stable junction zones with higher binding energies. The thermal behavior change was more remarkable by the addition of K(+) than by Na(+), and by Ca(2+) than by Mg(2+). For monovalent cations, the DSC heating and cooling curves showed a single endothermic and exothermic peak. For divalent cations at low concentration, the DSC curves showed a single peak. However, with sufficient divalent cations, the DSC curves eventually developed a bimodal character. A mixed system with sufficient Ca(2+) could form firm gel that was difficult to remelt completely upon heating to 130 degrees C, indicating the possibility of the formation of ionic bonds through cross-links with the carboxyl groups in hsian-tsao leaf gum.

The performance and kinetic study of membrane anaerobic system in treating POME. Palm oil mill effluent

The application of the three known kinetic models on MAS (membrane anaerobic system) process treating the POME and the overall MAS treatment efficiency were investigated. The MAS consists of a cross-flow ultrafiltration membrane (Model Micro 240) for solid-liquid separation. Six steady states were attained over a range of mixed liquor suspended solids of 12,681 - 30,460 mg/l. The study showed a good fitting of the Monod Model (91.1%), Contois Model (98.5%) and Chen and Hashimoto Model (95%) for the MAS treating raw POME at organic loadings between 1.5 kgCOD/m3/d to 6.5 kgCOD/m3/d. The growth yield coefficient, Y, was found to be 0,604 kg VSS/kgCOD while the specific microorganism decay rate was 0.099 day(-1). The k values were in the range of 0,242 to 0.425 mg COD/mg VSS.d and the microm values were between 0.145 to 0.257 day(-1). Throughout the study, the removal efficiency of COD was 83.2 to 97.97%. The methane production rate was between 0.262 to 0.473 l/g-COD-utilised/d. The MAS treatment efficiency was greatly affected by SRT and OLRs. In the study, membrane fouling and polarization at the membrane surface played a significant role in the formation of the strongly attached cake layer limiting membrane permeability

Cefixime absorption kinetics after oral administration to humans

Cefixime (CFX) absorption kinetics after oral administration to humans was studied. Four distinct models, incorporating a delay of absorption and first-order elimination kinetics, i.e. first-order absorption (M1), zero-order absorption (M0), Michaelis-Menten type absorption (MM) and Michaelis-Menten type absorption with 'an absorption window' (MM-delta t) were used to fit concentration data of CFX in 10 Chinese men following an oral dose of 400 mg. r2 and AIC were selected as measures of goodness-of-fit. The results show that the MM-delta t model provided a better fit than the other three models. The kinetic parameters were estimated as follows: Vmax' = 10.80 +/- 3.80 mg.l-1.h-1; K(m)' = 88.31 +/- 2.75 micrograms.ml-1; delta t = 4.75 +/- 0.85 h; T1/2 = 4.20 +/- 0.92 h; Tmax = 5.20 +/- 0.92 h; and Cmax = 6.04 +/- 1.70 mg.l-1.