Search

Abstract Hepatocellular cancer (HCC) therapy is in need for an ideal companion diagnostic. Preclinical experimental studies have identified the insulin receptor (IR) and its synergistic counterpart, the IGF1 receptor (IGF1R), as relevant in HCC development, and the ligands IGF1 and IGF2 have been found to be elevated in HCC. This study aimed to bridge the gap to the clinical setting and explore whether the IR or the IGF1R would be of prognostic significance and would be associated with clinicopathologic parameters in HCC patients. In our retrospective cohort study located at the University Hospital Schleswig-Holstein, Campus Kiel, Germany, HCC samples of 139 patients were examined for IR and IGF1R expression by immunohistochemistry. A HistoScore was correlated with clinicopathological characteristics and survival. IR overexpression was frequently observed and was associated with clinicopathological parameters and survival. Membranous IR expression was associated with worse tumor specific survival (p = 0.043). Intriguingly, membranous IR expression was associated with worse tumor specific survival (p = 0.017) in the subgroup of patients undergoing sorafenib therapy. IGF1R expression was not associated with survival. In conclusion, our results suggest that membranous IR expression plays a role in HCC prognosis and treatment resistance, inspiring future validation as a potential companion diagnostic in HCC.

A new arboreal species of the microhylid genus Cophixalus Boettger, 1892 is described from montane rainforest on Papua New Guinea’s central cordillera. With a male SUL exceeding 44.0 mm, the new species is among the largest members of the genus; the only other Papuan species known to reach this size is C. riparius Zweifel, 1962. The new species differs from C. riparius in a small number of mensural characters and by its distinct advertisement call, a single explosive ‘bark’ uttered singly or in rapid series. In contrast, calls of C. riparius recorded near the type locality are a series of drawn out, rasping croaks. Calls of the two species are analysed and compared. The two species also appear to have different ecologies, with the new species found only high in trees, while C. riparius is often encountered in vegetation on or near the forest floor. Examination of osteological features revealed the presence of cartilaginous procoracoids in both species, representing the first records of procoracoids in the speciose genus Cophixalus. Lack of procoracoids is traditionally considered an important diagnostic character for defining Cophixalus but both species also lack clavicles, a character considered diagnostic for Cophixalus and a key feature distinguishing the genus from the closely related Oreophryne Boettger, 1895. Because preliminary published genetic data indicate that they are nested within Cophixalus, we retain both species in that genus until a comprehensive molecular phylogeny of Cophixalus and related genera, particularly Oreophryne, is completed.

The microhylid genus Oreophryne reaches its greatest diversity in the New Guinea region, where more than 60 species have been documented to date. Most Oreophryne are small (

Melanesia, centred on the vast tropical island of New Guinea, is shown to have the most diverse and intact insular frog fauna in the world.

Abstract Introduction Direct intrahepatic portosystemic shunt creation is a feasible and safe alternative for transjugular intrahepatic portosystemic shunt creation. It needs equipment like endovascular ultrasound with restricted availability. We performed the procedure percutaneously with a common interventional armamentarium to make it more feasible. Methods Retrospective analysis of 8 percutaneous DIPS insertions between 2016 and 2020. Results The procedure was successful in 8/8 patients. There was no short-term death reported within 30 days. The longest reported patency is 5 years. Conclusion Percutaneous DIPS creation is a feasible alternative for failed TIPS. Percutaneously the procedure can be completed faster than conventional DIPS using only minimal puncture equipment. Level of evidence Level 4, Case Series.

Abstract Background Splenosis is the heterotopic autotransplantation of splenic tissue after severe splenic trauma and/or splenectomy. The epidemiology is elusive, but splenosis is frequently misdiagnosed as malignant tumors of gastrointestinal, gynecological, or hematological origin before the correct diagnosis is ultimately found. We herein report a rare case of combined, extensive intraabdominal and intrathoracic splenosis initially presenting as pleural mesothelioma. Case presentation A 63-year-old Caucasian male presented with dyspnea and recurring thoracic pain. Initial X-ray and computed tomography scans showed disseminated intrathoracic and intraabdominal lesions. Consequently, thoracoabdominal mesothelioma or a polytopically metastasized cancer of unknown origin was suspected. A thorough examination of the patient’s medical history and contrast-enhanced ultrasound by a skilled examiner revealed the diagnosis of extensive abdominal and thoracic splenosis as a consequence of an abdominal gunshot wound with a ruptured diaphragm several decades earlier. Timely diagnosis by noninvasive measures prevented the patient from potential complications of harmful diagnostic procedures, including nuclear imaging and biopsies. The patient is currently treated for hepatitis C and chronic obstructive lung disease, whereas no specific treatment for splenosis is required. Conclusions We present a case of rare intrathoracic and intraperitoneal splenosis mimicking mesothelioma. Contrast-enhanced ultrasound and thorough patient history were used for diagnosis and prevented this patient from having to undergo potentially harmful diagnostics. Splenosis can occur after splenic trauma and, consequently, needs to be considered as a rare differential diagnosis to malignant tumors of various origins when a matching patient history is obtained.

Abstract We describe a new species of the asterophryine microhylid genus Xenorhina from the lowlands of northwestern Papua New Guinea. It is a medium-sized species (SUL of two males 29.2 and 29.9 mm; of four females 29.9–33.0 mm) that can be distinguished from congeners by having a single short, triangular odontoid spike (palatal tooth) on each vomeropalatine bone, moderately short legs (TL/SUL 0.40–0.44) and ventral surfaces heavily spotted with reddish-brown blotches or reticula. The advertisement call comprises 7–10 loud, melodious hooting notes lasting 141–165 ms and produced at a repetition rate of 2.19–2.35 notes/s. Description of this species brings to 41 the number of Xenorhina known from New Guinea and surrounding islands.

We describe six new species of the microhylid frog genus Xenorhina from the southern slopes of Papua New Guinea’s central cordillera and adjacent lowlands, based on a combination of morphological (including osteology) and bioacoustic features. All of the new species are fossorial or terrestrial inhabitants of tropical rainforest habitats and belong to a group of Xenorhina having a single, enlarged odontoid spike on each vomeropalatine bone. Advertisement calls and habitat preferences are described for each species, one of which is amongst the smallest hitherto members of the genus. Description of these six species brings the total number of Xenorhina known to 40 and emphasises the importance of the high-rainfall belt that extends along the southern flanks of New Guinea’s central cordillera as a hotspot of Melanesian amphibian diversity.

Abstract Background Aspergillus fumigatus infections frequently occur after solid organ transplantation. Yet, a fungal thrombosis after liver transplantation is an exceptional finding. Case presentation We report on a 44-year-old female with an aspergillosis after liver transplantation for autoimmune hepatitis. On postoperative day (pod) 7, seizures occurred and imaging diagnostics revealed an intracranial lesion. Anidulafungin was initiated in suspicion of mycosis and switched to voriconazole on suspicion of an Aspergillus spp. infection. Progression of the cerebral lesion prompted craniotomy (pod 48) and the aspergillosis was verified. The patient was discharged with oral voriconazole therapy. Re-admission was necessary with acute-on-chronic renal failure after a tacrolimus overdose on pod 130. The patient received a pelvic angiography due to a temperature difference in the legs. It showed a complete iliac artery thrombosis which was subsecutively surgically removed. The histopathological examination revealed an Aspergillus fumigatus conglomerate. The patient died on pod 210 due to systemic aspergillosis. Conclusion The acute development of focal neurologic deficits is common in patients with an aspergillosis of the brain. Nevertheless, arterial thrombosis after Aspergillus fumigatus is less frequent and, to the best of our knowledge, its occurrence after liver transplantation has not yet been reported so far. Due to its rarity, we added a review of the literature to this manuscript.

Background Lenvatinib is approved as first-line treatment for patients with advanced hepatocellular carcinoma (HCC). The efficacy of lenvatinib in Caucasian real-world patients is insufficiently defined. The purpose of this study was to evaluate the efficacy of lenvatinib in a multi-center cohort (ELEVATOR) from Germany and Austria. Methods A retrospective data analysis of 205 patients treated with first-line systemic lenvatinib at 14 different sites was conducted. Overall survival, progression free survival, overall response rate and adverse event rates were assessed and analyzed. Results Patients receiving lenvatinib in the real-world setting reached a median overall survival of 12.8 months, which was comparable to the results reported from the REFLECT study. Median overall survival (mOS) and progression free survival (mPFS) was superior in those patients who met the inclusion criteria of the REFLECT study compared to patients who failed to meet the inclusion criteria (mOS 15.6 vs 10.2 months, HR 0.55, 95% CI 0.38-0.81, p=0.002; mPFS 8.1 vs 4.8 months HR 0.65, 95% CI 0.46-0.91, p=0.0015). For patients with an impaired liver function according to the Albumin-Bilirubin (ALBI) grade, or reduced ECOG performance status ≥2, survival was significantly shorter compared to patients with sustained liver function (ALBI grade 1) and good performance status (ECOG performance status 0), respectively (HR 1.69, 95% CI 1.07-2.66, p=0.023; HR 2.25, 95% CI 1.19-4.23, p=0.012). Additionally, macrovascular invasion (HR 1.55, 95% CI 1.02-2.37, p=0.041) and an AFP ≥200 ng/mL (HR 1.56, 95% CI 1.03-2.34, p=0.034) were confirmed as independent negative prognostic factors in our cohort of patients with advanced HCC. Conclusion Overall, our data confirm the efficacy of lenvatinib as first-line treatment and did not reveal new or unexpected side effects in a large retrospective Caucasian real-world cohort, supporting the use of lenvatinib as meaningful alternative for patients that cannot be treated with IO-based combinations in first-line HCC.

We describe three new species of the microhylid frog genus Choerophryne from the mountains and foothills of southern and northeastern Papua New Guinea. All three species lack elongated snouts and all are arboreal calling from elevated perch sites between ~1 and 10 m above the forest floor. Advertisement calls and habitat preferences are described for each species. Descriptions of these three frogs brings the total number of Choerophryne recognized to 34 but numerous additional species undoubtedly remain to be discovered in poorly-surveyed mountainous regions of New Guinea.