Are the results of surgical treatment of hepatocellular carcinoma poor if the tumor has spontaneously ruptured?

BACKGROUND

The aim of this study was to clarify whether the results of surgical treatment of ruptured hepatocellular carcinoma (HCC) are poorer than the results of surgical treatment of non-ruptured HCC.

METHODS

Out of a total of 224 HCC patients, the 6 patients with ruptured HCC were compared with 15 patients with non-ruptured HCC based on TNM stage IVA and having a Cancer of the Liver Italian Program (CLIP) score of 1 or 2.

RESULTS

There were no significant differences in clinical and pathological features between the two groups. The 1-year and 3-year overall survival rates were 69.3% and 21.2%, respectively, in the ruptured HCC group and 51.3% and 20.5%, respectively, in the non-ruptured HCC group. The 1-year and 3-year disease-free survival rates were 33.0% and 0%, respectively, in the ruptured HCC group and 38.9% and 15.6%, respectively, in the non-ruptured HCC group. The differences in survival rates between these two groups did not reach statistical significance.

CONCLUSION

Hepatic resection as definitive treatment after recovery from the initial insult of the rupture of HCC yields results similar to those obtained by surgical treatment of non-ruptured HCC at the same tumor stage and with the same degree of liver damage.

Deep learning-based image quality improvement of 18F-fluorodeoxyglucose positron emission tomography: a retrospective observational study

Background

Deep learning (DL)-based image quality improvement is a novel technique based on convolutional neural networks. The aim of this study was to compare the clinical value of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) images obtained with the DL method with those obtained using a Gaussian filter.

Methods

Fifty patients with a mean age of 64.4 (range, 19–88) years who underwent ¹⁸F-FDG PET/CT between April 2019 and May 2019 were included in the study. PET images were obtained with the DL method in addition to conventional images reconstructed with three-dimensional time of flight-ordered subset expectation maximization and filtered with a Gaussian filter as a baseline for comparison. The reconstructed images were reviewed by two nuclear medicine physicians and scored from 1 (poor) to 5 (excellent) for tumor delineation, overall image quality, and image noise. For the semi-quantitative analysis, standardized uptake values in tumors and healthy tissues were compared between images obtained using the DL method and those obtained with a Gaussian filter.

Results

Images acquired using the DL method scored significantly higher for tumor delineation, overall image quality, and image noise compared to baseline (P < 0.001). The Fleiss’ kappa value for overall inter-reader agreement was 0.78. The standardized uptake values in tumor obtained by DL were significantly higher than those acquired using a Gaussian filter (P < 0.001).

Conclusions

Deep learning method improves the quality of PET images.

Effect of alcohol ingestion on carcinogenesis by synthetic estrogen and progestin in the rat liver

We examined the effect of alcohol ingestion on hepatocarcinogenesis induced by oral administration of synthetic female hormones, 0.075 mg of ethynylestradiol (EE) and 6.0 mg of norethindrone acetate (NA), every day for 12 months in female Wistar rats. Administration of 10% ethanol in drinking water for 5 days a week every week resulted in the development of hepatocellular carcinoma (HCC) in 38.4% of the hormone-treated rats at 12 months, which is approximately 5 times the incidence of HCC observed following EE and NA treatment alone. The number of hyperplastic nodules was significantly higher than the number observed in the case of EE and NA treatment alone after 4 months of the experimental period. The additional alcohol treatment also increased the value of unoccupied nuclear estrogen receptors (ERn) at months 6 and 8 of the experimental period, and increased the value of total ERn in the rat liver after 6 months of the experimental period. This indicates that additional alcohol treatment may increase occupied ERn (estrogen-ER complex) in the rat liver. A 32P-postlabeling analysis of liver DNA revealed that the maximum number of extra spots consisting of modified nucleotides induced by EE and NA appeared earlier when the additional alcohol treatment was imposed. Consequently, alcohol affects the hepatocarcinogenesis by EE and NA, promoting not only the change in kinetics of ER, but also DNA adduct formation induced by EE and NA in the rat liver.

Urease-induced crystallizations of calcium phosphate and magnesium ammonium phosphate in synthetic urine and human urine

An aggregometer technique was used to study urease-induced crystallizations in synthetic urine and human urine from healthy subjects and patients with chronic spinal cord injuries. The two different phases of crystallization, calcium phosphate and magnesium ammonium phosphate, were easily evaluated with a single assay using this technique. The crystallization of calcium phosphate and magnesium ammonium phosphate varied markedly among the different urine specimens after incubation with urease. The turbidity curves from human urine were divided into four patterns. We assumed that the variations in the patterns of the turbidity curves appeared to be mainly due to differences in the composition of the urine and in the original pH, and that the calcium and magnesium concentrations were very important in the urinary constituents.

[Molecular analysis of sporadic colon cancer]

BACKGROUND

In Chile, colorectal cancer (CRC) is often diagnosed in late stages. Thus, surgical treatment must be complemented with chemotherapy. KRAS mutations and microsatellite instability have been detected in these tumors. However, the response to treatment in patients without KRAS mutations varies and requires a better understanding.

AIM

To determine the frequency and distribution of somatic point mutations in KRAS, BRAF and PIK3CA genes and microsatellite instability status (MSI) in patients with colon cancer (CC).

MATERIAL AND METHODS

A prospective observational study of patients undergoing surgery for colon cancer. Tumor-derived DNA was analyzed by polymerase chain reaction (PCR) for the most frequent mutations of KRAS, BRAF and PIK3CA. PCR was also used to analyze MSI.

RESULTS

Fifty-eight patients with sporadic CC were analyzed, 16 showed KRAS mutations (G12R, G12D, G12V, G13D) and out of the 42 patients that did not show any mutation, 10 had mutations in BRAF (V600E) and PIK3CA (E542K, E545D, E545K, Q546E, H1047R). BRAF mutations alone or in combination with PIK3CA mutations were observed in 27% of high MSI tumors and in 2% of tumors without instability (p < 0.049). A higher percentage of high MSI tumors were located in the right colon (p < 0.001), and showed BRAF mutation (p < 0.020).

CONCLUSIONS

The highest percentage of high MSI and BRAF mutations was observed in the right colon. Therefore, this study suggests the presence of different molecular features between right and left colon tumors that should be considered when defining the therapeutic management.

Mechanism of the LAI test in bladder cancer patients

To clarify the mechanism of the leukocyte adherence inhibition (LAI) test, 30 bladder cancer patients were studied by the fractionated LAI test in which peripheral lymphocytes were separated into monocyte rich and monocyte deplete fractions. The mean LAI reactivity of 30 bladder cancer patients on the monocyte rich fraction (43.2 +/- 20.3 per cent) was significantly higher than that of the corresponding patients on the standard LAI test (30.4 +/- 12.7 per cent), whereas the mean LAI reactivity of these patients on the monocyte deplete fraction (15.6 +/- 10.7%) was significantly lower than that on the standard LAI test of the same patients (respectively p less than 0.001 and p less than 0.01). It suggests that monocytes play an important role in the capillary LAI test. To further comprehend the mechanism of the LAI phenomenon, indicator cells involved in the LAI test were observed by transmission and scanning electron microscopy. The microvilli on the cell surface of nonadherent monocytes of bladder cancer patients were decreased in number and shortened in length but other populations of nonadherent cells were not remarkably changed. These observations showed that the bladder tumor antigens in extracts from tumors appear to have an influence on the microvilli of monocytes, specifically on monocytes from bladder cancer patients. These morphological changes correlate with the results from fractionated LAI assay and may result in the tumor antigen specific LAI reactivity observed in leukocytes of bladder cancer patients.

Congenital laryngeal atresia: two autopsy cases, one describing the use of computed tomography

Two autopsy cases of congenital laryngeal atresia (CLA) were studied. In the first case (a boy delivered at 37 weeks of gestation) the subglottic lumen was almost totally occupied by a dome shaped cricoid cartilage with a pharyngotracheal duct (PTD). No tracheoesophageal fistula (TEF) was found. In the second case (a girl born at 41 weeks of gestation) histology showed that the subglottic lumen was almost occluded by an epithelial lamina and a dome-shaped cricoid cartilage. Again no TEF was found. Both cases had PTD and showed normal development of the lungs. These deformities coincided with Smith & Bain's type II subglottic atresia. The anatomy of the lesion was confirmed by postmortem three-dimensional reconstruction CT, the use of which has not previously been reported.

Optimal phase analysis of electrocardiogram-gated computed tomography angiography in patients with Stanford type A acute aortic dissection

Objective

To determine the phase that facilitates flap observation of the ascending aorta in Stanford type A acute aortic dissection with perfused false lumen.

Methods

We reconstructed retrospective Electrocardiogram-gated Computed Tomography Angiography images of the ascending aorta of all 20 patients to 20 phases of curved-multiplanar reconstruction in 5% increment. One radiologist created and randomized 10 cross-sectional images of each phase for every patient and two radiologists scored these images on a 5-point scale depending on the degree of flap stoppage. We calculated the average score for each phase of each case and compared them among the three groups.

Results

Image scores were significantly better in the 65 %-100 % R-R interval group than those in the 5%-30 % (p < 2e-16) and 35 %-60 % R-R interval groups(p = 7.2e-10). Similar scores were observed in the Heart Rate > 70 group (p = 0.00039, 2.2e-14). Moreover a similar tendency was observed in the arrhythmia group (p = 0.0035, 0.294). No difference was found in the degree of flap stoppage in the 65 %-100 % R-R interval group between the Heart Rate > 70 and Heart Rate ≤ 70 groups (p = 0.466) and between the arrhythmia and non-arrhythmia groups (p = 0.1240).

Conclusion

In observing the ascending aorta, We obtained a good image at 65 %-100 % R-R interval and similar tendency was observed in the patients with arrhythmia.