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Radiofrequency ablation (RFA) is recommended in Japan for patients with hepatocellular carcinomas (HCCs) one to three in number and ≤3 cm in size. The arfa® and VIVA® RFA systems are widely used for patients with HCC and this retrospective observational study aims to compare their performances. The study included 365 patients with HCCs one to three in number and ≤3 cm in size who underwent RFA using the arfa® system (arfa® group) or the VIVA® system (VIVA® group). The total bilirubin (T-Bil) level after RFA was higher in the arfa® group than in the VIVA® group. With a 3-cm electrode needle, the longest diameter (Dmax) and the shortest diameter were analyzed and found to be greater in the arfa® group than in the VIVA® group. Furthermore, Dmax with the 2.5-cm electrode needle was greater in the arfa® group than in the VIVA® group. Statistically significant differences in the ablation area and in the T-Bil value after RFA were observed between the groups; however, these differences are not considered clinical problems because the difference in the ablation area was only slight and the Child–Pugh score was the same between the groups. Thus, hepatologists can use either of the RFA systems based on their preference. [ABSTRACT FROM AUTHOR]

Butylated hydroxyanisole (BHA) and butylated hydroxy-toluene (BHT) were evaluated for possible promoting activity for urinary bladder carcinogenesis in male F344 rats initiated by N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN). The rats were treated with 0.01 or 0.05% BBN in the drinking water for 4 weeks and then administered 2% BHA or 1% BHT in the diet for 32 weeks. Surviving rats were killed at the end of week 36 of the experiment. The incidences of cancer and papilloma and the average number of cancers, papillomas and papillary or nodular hyperplasias (PN hyperplasias) per 10 cm of basement membrane were significantly increased in the group receiving BHA following initiation by 0.05% BBN compared with the group given BBN only. BHT also significantly increased these lesions of the bladder, but not the average number of cancers, in rats treated with 0.05% BBN. The ability of four antioxidants, BHA, BHT, sodium L-ascorbate (ascorbate) and ethoxyquin, to promote the induction of γ-glutamyllranspeplidase (γ-GT)-positive foci initiated by diethylnitrosamine (DENA) in the liver of F344 rats was tested. Rats were given a single i.p. injection of 200 mg/kg body weight of DENA, and 2 weeks later the animals were exposed to 2% BRA, 1% BHT, 5% ascorbate or 1% ethoxyquin, respectively, in the diet for 6 weeks. All animals were subjected to partial hepatectomy at the end of week 3. The number of γ-GT-positive foci in the groups fed either BHA, BBT or ethoxyquin after DENA were significantly decreased compared with the control group. These findings show that BRA and BHT are promoters for the urinary bladder carcinogenesis initiated by BBN, but that these and other antioxidants significantly inhibit the induction of γ-GT positive foci in the liver. [ABSTRACT FROM PUBLISHER]

A delayed diagnosis of polyarteritis nodosa may lead to critical limb-threatening ischemia (CLTI). A 74-year-old woman presented with left-foot pain and was treated with oral vasodilators and antiplatelet agents. However, the distal ischemia progressed to CLTI, including gangrene of the fingers and toes, and bilateral foot dropping appeared because of peroneal nerve paralysis. Angiography of the extremities revealed obstruction and stenosis of medium-sized arteries. Based on the progressive distal gangrene, mononeuropathy multiplex, and pathological findings of necrotic vasculitis, polyarteritis nodosa was diagnosed, and the patient's condition improved. A biopsy and neurological examination are essential for the appropriate diagnosis of PAN and immediate treatment.

An anionic π molecule can form an aggregate when a multi-interactivity is introduced, in sharp contrast to common anionic molecules that are generally difficult to stack on each other. We found that a multi-interactive ligand, 2,5,8-tri(4'-pyridyl)-1,3,4,6,7,9-hexaazaphenalenate (TPHAP - ) exhibited a large Stokes shift and an intramolecular charge transfer, both of which were sensitive to hydrogen-bonding media. An anionic potassium salt of TPHAP - in methanol formed various aggregation states depending on the concentration examined; this was revealed by steady-state spectroscopic and fluorescence lifetime measurements. Self-assembling cadmium ions and the ligands can create several morphological crystals that are controlled by the ligand concentration, among which three new structures were determined by single-crystal analysis. The X-ray structures obtained suggest that the aggregation states of the ligand in solution can be transferred to the solid system of the porous coordination networks., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Sorafenib, a multikinase inhibitor, is the first and only drug, which improves significantly the overall survival in patients with advanced hepatocellular carcinoma (HCC). However, many patients experience diverse side effects, some of them severe and unexpected. To date, acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib. Here, we report the case of a 43-year-old woman with hepatitis C virus-related advanced HCC. She received sorafenib, and later complained of a sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense. Laboratory examination showed mild elevation of transaminases, biliary enzymes, bilirubin, inflammation markers, and a marked peripheral eosinophilia. Abdominal computed tomography (CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris. Consequently, sorafenib treatment was stopped immediately, and steroid-pulse therapy was performed. Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings, eosinophilia, and liver functions. In summary, we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.

Sarcoidosis is a chronic multi-systemic granulomatous disease, and liver involvement frequently occurs. in most cases, no evidence of liver dysfunction is observed, and portal hypertension due to sarcoid liver diseases is a rareoccurrence. Moreover, no case of liver sarcoidosis has ever been reported with confirmation of the disease progression. Herein we describe a patient having hepatic sarcoidosis with severe portal hypertension and liver dysfunction. The diagnosis was histologically confirmed from granulomatous status to established liver cirrhosis over 10 years. A 46-year-old woman developed massive hematemesis due to the rupture of gastric cardial varices. She underwent emergency endoscopic injection sclerotherapy, and clear evidence of chronic hepatic failure. Twelve years ago, she was diagnosed as having sarcoidosis with respiratory clinicalsymptoms. Liver biopsy revealed asymptomatic incidental granulomas without fibrosis development. After a couple of years, features of liver dysfunction were manifest and progressed. Ten years after the first biopsy, a second liver biopsy was performed, and well established dense fibrosis was revealed. Although significant liver dysfunction with portal hypertension is rarely seen in sarcoidosis, this case indicates that we have to consider the possibility that sarcoidosis may cause end-stage liver cirrhosis.

Background: The present study was designed to examine whether serum uric acid (SUA) levels were associated with cardiometabolic risk factors and to determine optimal cut-offs for SUA to identify multiple risk factors among Japanese junior high school students., Methods and Results: A total of 958 students (518 boys and 440 girls, aged 12.1-15.0 years) who were enrolled between April 2005 and June 2008 were divided into 4 groups according to SUA quartiles. Compared with the lowest quartile of SUA, prevalence of abdominal obesity, hypertension, and dyslipidemia was significantly increased in the highest quartile in boys and that of abdominal obesity was increased in the highest quartile in girls. The adjusted odds ratios (95% confidence interval) of the highest quartile of SUA for 2 or more cardiometabolic risk factors were 2.59 (1.16-5.79) for boys and 1.54 (0.43-5.56) for girls. Receiver operating characteristic curve analysis demonstrated that the most appropriate cut-offs for SUA to identify multiple cardiometabolic risk factors were 6.4 mg/dl for boys and 4.9 mg/dl for girls., Conclusions: SUA was strongly associated with the prevalence of cardiometabolic risk factors among male Japanese junior high school students. The present study may provide insights into the role of SUA in the school screening system for the development of educational programs on prevention of lifestyle-related diseases among school children.

A 11-year-old girl was admitted for Ewing's sarcoma within the right pelvis. Hematological and biochemical indices were normal. Since this was considered a difficult case for operation, radiotherapy and chemotherapy were performed. Intra-arterial chemotherapy with cisplatin 130 mg, doxorubicin 33 mg and caffeine 1,600 mg was started. Then, 38 hours after the administration of drugs, the girl became drowsy and seizures appeared. Laboratory studies revealed serum sodium 113 mEq/l, urine sodium 125 mEq/l and plasma osmolality of 238 mOsm/kg H2O. The diagnosis was SIADH secondary to cisplatin, and the treatment was fluid restriction. Her serum sodium level rose to 134 mEq/l, and her consciousness became clear. Concurrent administration of cisplatin aimed to prevent renal dysfunction, but hyponatremia developed due to massive fluid administration. Especially for this case, caffeine was administered. In conclusion, early recognition of SIADH is imperative to effectively correct the fluid and electrolyte imbalance.