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Acacia catechu Willd. is a plant diffused in India and other Asian countries, where it is used as a traditional medicine for the treatment of several ailments including diarrhea, one of the most common pathologies worldwide. In this study, we determined the chemical composition of Acacia catechu Willd. extract (AC) and evaluated its effect on spontaneous and induced contractility in isolated guinea pig ileum and proximal colon. Preliminary data about its antimicrobial effect against some pathogen agents versus some microbiota intestinal strain have been also reported. Chemical analysis revealed the presence of catechins, such as (-)-Epicatechin and (+)-Catechin. AC extract reduced frequency and amplitude of colon smooth muscle spontaneous contractility, in a concentration-dependent manner. A weaker effect of the extract was exerted toward ileum smooth muscle spontaneous contractility. The observed calcium antagonistic effect was more potent in proximal colon than in ileum. The extract showed a noncompetitive reversible antagonism to carbachol, both in proximal colon and ileum, with a higher potency in proximal colon. The antimicrobial effects of AC extract were observed toward Campylobacter jejuni, Escherichia coli, and Salmonella spp., while Bifido and Lactobacillus were not affected by treatment. These effects, however, occurred at concentrations fivefold higher than those inhibiting ileum and colon contractility. In conclusion, our results suggest that AC affects intestinal contractility without affecting intestinal bacterial flora and this may result in clinical benefits in patients suffering from nonbacterial diarrhea.

Background: Clinical phenotypes of small and large hepatocellular carcinomas (HCCs) are not well characterized., Aim: To evaluate the characteristics of small HCCs diagnosed by screening., Method: A cohort of 430 small HCCs that were diagnosed through screening, were dichotomized according to a size of ≤ 3 cm or >3 cm maximum tumor diameter and compared for radiological and blood-test parameters., Results: There were 330 males and 100 females. A higher percent of females had smaller tumors. The majority of patients had single tumors, but 15% of those with larger tumors had portal vein thrombosis (PVT) compared to 5% of those with smaller tumors. Significant differences between the tumor-size groups included alpha-fetoprotein (AFP) values and platelet counts, with thrombocytopenia and elevated bilirubin levels being associated with smaller tumors. In comparing PVT-positive and PVT-negative patients, AFP levels and platelet counts were also significantly different between the 2 groups. A mean multinomial multiple logistic regression model was developed for maximum tumor diameter plus PVT., Conclusions: The finding of larger tumors being associated with normal platelets and bilirubin levels in comparison to smaller tumors having thrombocytopenia reveals 2 different patterns of HCC presentation., (Copyright © 2012 S. Karger AG, Basel.)

Background: Survival in HCC depends on diagnosis at early tumor stage, best achieved through surveillance radiology. There is also a need for complementary serum tests., Methods: We evaluated baseline liver function parameters from a cohort of 231 HCC patients who were diagnosed by surveillance. They were ordered according to their tumor mass and trends in the data were analyzed., Results: Trends in serum GGTP levels increased linearly with increases in small tumor mass, but the patterns for AFP levels were more complex and elevated only with larger tumor mass. ALKP levels were elevated in association with small tumors and further increased with increasing tumor mass. The relationships of serum AFP to GGTP, of albumin to bilirubin and of ALKP to bilirubin, helped identify tumor mass phenotypes. There was an especially important relationship between serum bilirubin and AFP, suggesting that HCC growth and liver factors were interdependent., Conclusions: Small HCCs demonstrated several phenotypic sub-groups, with serum GGTP and ALKP increasing and albumin decreasing in many patients with increasing tumor mass.

Transplantation is the treatment of choice for hepatocellular carcinoma (HCC) meeting the Milan criteria. HCC and chronic liver diseases have distinct natural histories for which an equitable transplant policy must account. We enrolled and prospectively followed at a single center 206 consecutive HCC patients that presented within the Milan criteria. Patients were treated per the Barcelona Clinic Liver Cancer (BCLC) algorithm; 95% received resection, ablation, or transarterial chemoembolization. The median follow-up was 16 months. Progression occurred in 84 patients, and 8 patients died. Risk factors for the time to disease progression (death or progression beyond T2) were analyzed in 170 patients with a complete data set. Risk factors with the strongest relationship to progression included tumor diameter and tumor persistence/recurrence after local therapy (hazard ratios of 1.51 and 2.75, respectively, when transplanted patients were censored at the time of transplantation and hazard ratios of 1.53 and 3.66, respectively, when transplantation was counted as an event; P < or = 0.0001). To evaluate the current Model for End-Stage Liver Disease (MELD) exception, we compared the expected progression rate (PR) with our observed PR in 133 stage T2 patients. The current policy resulted in a large overestimation of the PR for T2 HCC and an unsatisfactory performance [Harrell's concordance index (C index) = 0.60, transplant censored; C index = 0.55, transplant as progression]. Risk factors for progression that were identified by univariate analysis were considered for multivariate analysis. With these risk factors and the patients' natural MELD scores, an adjusted model applicable to organ allocation was generated, and this decreased the discrepancy between the expected and observed PRs (C index = 0.66, transplant censored; C index = 0.69, transplant as progression). In conclusion, the current MELD exception largely overestimates progression in T2 patients treated according to the BCLC guidelines. The tumor response to resective or ablative treatment can predict tumor progression beyond the Milan criteria, and it should be taken into account in models designed to prioritize organ allocation., ((c) 2010 AASLD.)

Background: The clinical usefulness of alpha-fetoprotein (AFP) in hepatocellular carcinoma (HCC) management is debatable., Objectives: To assess, in a large multi-centric survey, diagnostic and prognostic reliability of AFP, predictive factors, and any correlation with the tumor immunophenotype., Methods: A total of 1,158 patients with HCC were analyzed with reference to serum AFP levels at diagnosis. We evaluated: HCC grading, histotype, and size; Okuda, tumor-nodes-metastases (TNM), and Child-Pugh scores; liver function, symptoms, presence of metastases or portal thrombosis, etiology, survival, and treatment. In 66 patients with histological diagnosis, the pathologists evaluated p53 overexpression, MIB 1 labeling index, BCL-2 positive cells (index of apoptosis), and CD44 (adhesion molecule) positivity., Results: Patients were divided into three AFP groups: normal (<20 ng/mL) [46%], elevated (21-400 ng/mL) [36%], and diagnostic (>400 ng/mL) [18%]. Statistical correlations were significant for: weight loss (p= 0.0056), pain (p= 0.0025), Child-Pugh score (p= 0.001), tumor size, Okuda's and TNM stages, metastases, thrombosis, type of treatment (all p < 0.0001), and female sex (p < 0.004). AFP correlated with survival overall, in patients untreated, transplanted, or undergoing locoregional treatments; but not in those surgically treated. In the discriminant analysis, the related variables were size, female sex, Child-Pugh score, TNM staging (steps 1-4). When using the receiver operating characteristic curve, the prognostic reliability of AFP was limited with area under the curve of 0.59. Finally, patients with low expression of BCL2 had high AFP levels (p < 0.05). AFP positively correlated with Edmonson score (p < 0.0001)., Conclusion: The evaluation of this large series of HCC patients allowed us to: confirm the low sensitivity (54%) of AFP in the diagnosis of HCC and its prognostic value, albeit limited, being tumor size, female sex (intriguingly enough), Child-Pugh score, and TNM staging independent predictors.