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Background: Although spontaneous tumour rupture is a life-threatening complication of hepatocellular carcinoma (HCC), staged hepatectomy for HCC controlled after transcatheter arterial embolization (TAE) could provide a better prognosis. Laparoscopic liver resection (LLR) has been accepted worldwide and has been expanded from minor resection to anatomical major resection. We herein report the first case of pure laparoscopic left hepatectomy for ruptured HCC controlled after TAE., Case Report: A 66-year-old man was transferred to our Institute because of abdominal pain and decreased consciousness. Ruptured HCC in segment IV and massive intra-abdominal haemorrhage were diagnosed. Emergency TAE was performed, achieving haemostasis. Reduction of intra-abdominal haemorrhage was confirmed at the 3-month follow-up, and no intrahepatic metastasis or peritoneal dissemination was present. Therefore, we performed elective laparoscopic left hepatectomy for the remaining HCC 110 days after TAE. Although dense adhesion was found in the upper right peritoneal cavity and greater omentum enveloping the remaining haemorrhage on the underside of the liver, there was no disseminated involvement in the peritoneal cavity. The operative time was 194 minutes, and intraoperative blood loss was 100 g. The postoperative course was uneventful, and the patient was discharged on postoperative day 6., Conclusion: Major LLR may be an option for staged hepatectomy in patients with ruptured HCC controlled after TAE., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver. As of 2017, many clinical, radiological and surgical features have been largely documented. On the other hand, little is still known about the correlation of FNH with hepatocellular carcinoma, nor the preferable modality of treatment. Our aim was to elucidate the latter topic., Materials and Methods: We investigated the pertinent literature available as of 2017 through four popular search engines (PubMed, Science Direct, Scopus and Google Scholar). Four main approaches were selected: conservative treatment, surgery, radiofrequency ablation (RFA) and transarterial embolization (TAE)., Results: We found most works to be on conservative and surgical approaches. On the contrary, only one article has been published for RFA to date. Seventeen articles dealt with TAE., Conclusion: TAE currently represents the most cogent and successful alternative to surgery., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Although transarterial chemoembolization is considered the standard of care for intermediate hepatocellular carcinoma patients, robust data in favor of a clear superiority of chemoembolization (with chemotherapy injection) over bland embolization are lacking., Objective: The objective of this article is to systematically analyze the results provided by randomized controlled trials comparing these two treatments in hepatocarcinoma patients., Methods: A computerized bibliographic search on the main databases was performed. Survival rates assessed at one, two, and three years, objective response, one-year progression-free survival, and severe adverse event rate were analyzed. Comparisons were performed by using the Mantel-Haenszel test in cases of low heterogeneity or DerSimonian and Laird test in cases of high heterogeneity., Results: Six trials with 676 patients were included. No difference in one-year (risk ratio: 0.93, 0.85-1.03, p  = 0.16), two-year (risk ratio: 0.88, 0.74-1.06, p  = 0.18) and three-year survival (risk ratio: 0.97, 0.74-1.27, p  = 0.81) was observed. Objective response and one-year progression-free survival showed no significant difference between the two treatments ( p  = 0.36 and p  = 0.40, respectively). A statistically significant increase in severe toxicity after chemoembolization was found (risk ratio: 1.44, 1.08-1.92, p  = 0.01), although this result could be affected by the heterogeneity of techniques adopted., Conclusions: Our meta-analysis demonstrates a non-superiority of transarterial chemoembolization with respect to bland embolization in hepatocarcinoma patients.

Delayed post-pancreaticoduodenectomy hemorrhage (PPH) is a rare but life threatening complication with high mortality. In this retrospective study, we aimed to evaluate the safety, efficacy and utility of interventional treatment of delayed PPH. From January 2008 to December 2013, 357 patients underwent pancreaticoduodenectomy (PD). 21 patients (5.9%) suffered from the delayed PPH. 18 patients underwent diagnostic angiography and endovascular treatment, either transcatheter arterial embolization (TAE, n = 10) or covered stent placement (CSP, n = 8), and 3 patients underwent laparotomy. The mean time of hemorrhage was 21.4 days. In 10 patients received TAE treatments, 3 got liver damage and 2 presented liver abscesses with 1 died of severe infection and multi-organ failure. Re-bleeding was occurred in 4 of 10 TAE patients. 8 patients received CSP got thoroughly bleeding control and without any ischemic or re-bleeding complications. 2 of 3 laporotomy patients presented hemorrhage recurrence. In all 6 re-bleeding patients, 2 were saved by CSP, while the other 4 died (TAE in 3 and conservative treatment in 1). Early intervention plays an important role of saving patients from delayed PPH. The CSP is considered a fist-line treatment for delayed PPH and an appropriate solution for hemorrhage recurrence. TAE only could be performed in whom placing a covered stent is technically difficult.

Introduction: Neuroendocrine tumors (NETs) with liver metastases have a poor prognosis. Somatostatin analogues and chemotherapy are used with some success. Transarterial Embolization (TAE) is increasingly used to improve symptom control and reduce tumor size. Aim(s): To investigate outcome of patients treated with TAE in the last five years. Materials and methods: We identified all patients who received TAE within the last five years. We looked at case notes for: demographics, type of NET, treatment received and symptoms. We determined the number of TAE treatments per patient, symptoms, biochemical and radiological improvement. Mean survival time defined as from time TAE to date of death or most recent follow-up. Results: Twenty-two patients received TAE (13F/9F). Sixteen carcinoid - one bronchial, four small bowel, two large bowel, two pancreas, seven unknown primary, one of ovarian origin, two pancreatic, one stomach. All patients reported symptom improvement, mean no. of diarrhoea episodes fell from 6.1 (1-10) to 1.8 (0-5), mean no. flushing episodes fell 4.1 (1-10) to 0.6 (0-3). The percentage decrease in 5HIAA in the nine patients available mean % 5HL4A decrease 45% (21.6-85.5). RECIST criteria - 17 stable disease, four partial response and two progressive disease. One-year survival 100%, mean survival from diagnosis 49.3 months. Mean survival after TAE was 26.6 months (12-48). Conclusion: TAE improves symptoms, and there is objective evidence of improvement in radiology and biochemistry. Further studies needed to determine effect on survival. [ABSTRACT FROM AUTHOR]

Introduction: Trans-arterial embolization (TAE) and chemoembolization (TACE) have been shown to be effective in patients (pts) with liver metastases (LM) from gastroenteropancreatic neuroendocrine tumor (GEP NET). TAE and TACE goal is to reduce blood flow to the tumor resulting in ischemia and necrosi. Aim(s): Which procedure, among TAE and TACE, represent the best option in NET pts is still debated. Criteria to predict response to TAE/TACE other than objective tumor response are not defined. This challenge represents the purpose of this retrospective investigation. Materials and methods: Forty pts (26 M, 14 F; mean age 61 yrs) with GEP NET with LM, 16 of whom with a functioning tumor were investigated. TAE was performed in 27 and TACE in 18 pts. Contrast-enhanced CT scans were performed at baseline and then after two and six months by these procedures. Change in tumor size and degree of devascularization, as compared to the baseline evaluation, were considered. Results: Six months after treatment, the mean percent per lesion size reduction was 58.8% for TAE and 52.7% for TACE, without any statistically significant difference. Degree of devascularization was found to be significantly higher in TAE- than in TACE-treated pts and correlated with the rate of control of endocrine syndrome in functioning NET (p<0.05). Conclusion: In pts with NET and LM, TAE better than TACE reduces degree of vascularization of liver lesions and controls endocrine syndromes, while the two procedures are equally effective in inducing tumor responses. [ABSTRACT FROM AUTHOR]

TFDP3 has been previously identified as an inhibitor of E2F molecules. It has been shown to suppress E2F1-induced apoptosis dependent P53 and to play a potential role in carcinogenesis. However, whether it indeed helps cancer cells tolerate apoptosis stress in cancer tissues remains unknown. TFDP3 expression was assessed by RT-PCR, in situ hybridization and immunohistochemistry in normal human tissues, cancer tissues and prostate cancer tissues. The association between TFDP3 and E2F1 in prostate cancer development was analyzed in various stages. Apoptosis was evaluated with annexin-V and propidium iodide staining and flow-cytometry. The results show that, in 96 samples of normal human tissues, TFDP3 could be detected in the cerebrum, esophagus, stomach, small intestine, bronchus, breast, ovary, uterus, and skin, but seldom in the lung, muscles, prostate, and liver. In addition, TFDP3 was highly expressed in numerous cancer tissues, such as brain-keratinous, lung squamous cell carcinoma, testicular seminoma, cervical carcinoma, skin squamous cell carcinoma, gastric adenocarcinoma, liver cancer, and prostate cancer. Moreover, TFDP3 was positive in 23 (62.2%) of 37 prostate cancer samples regardless of stage. Furthermore, immunohistochemistry results show that TFDP3 was always expressed in coordination with E2F1 at equivalent expression levels in prostate cancer tissues, and was highly expressed particularly in samples of high stage. When E2F1 was extrogenously expressed in LNCap cells, TFDP3 could be induced, and the apoptosis induced by E2F1 was significantly decreased. It was demonstrated that TFDP3 was a broadly expressed protein corresponding to E2F1 in human tissues, and suggested that TFDP3 is involved in prostate cancer cell survival by suppressing apoptosis induced by E2F1., (Copyright © 2013 Elsevier B.V. All rights reserved.)

To develop antigen-specific immunotherapies for autoimmune diseases, knowledge of the molecular structure of targeted immunological hotspots will guide the production of reagents to inhibit and halt production of antigen specific attack agents. To this end we have identified three noncontiguous segments of the Torpedo nicotinic acetylcholine receptor (AChR) α-subunit that contribute to the conformationally sensitive immunological hotspot on the AChR termed the main immunogenic region (MIR): α(1-12), α(65-79), and α(110-115). This region is the target of greater than 50% of the anti-AChR Abs in serum from patients with myasthenia gravis (MG) and animals with experimental autoimmune myasthenia gravis (EAMG). Many monoclonal antibodies (mAbs) raised in one species against an electric organ AChR cross react with the neuromuscular AChR MIR in several species. Probing the Torpedo AChR α-subunit with mAb 132A, a disease inducing anti-MIR mAb raised against the Torpedo AChR, we have determined that two of the three MIR segments, α(1-12) and α(65-79), form a complex providing the signature components recognized by mAb 132A. These two segments straddle a third, α(110-115), that seems not to contribute specific side chains for 132A recognition, but is necessary for optimum antibody binding. This third segment appears to form a foundation upon which the three-dimensional 132A epitope is anchored., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the performance of the Abbott ARCHITECT enzymatic assay for magnesium (3P68) in serum/plasma and urine against analytical goals based on biological variation., Methods: Analytical performance was evaluated according to CLSI protocols. Precision was examined using commercial chemistry controls. Accuracy was assessed against NIST SRM 956c, electrolytes in human serum. Correlation with the arsenazo Mg assay (7D70) was completed using patient samples (plasma, N = 101; urine, N = 90). Common interferences were examined in pooled patient specimens with high and low magnesium concentrations., Results: The enzymatic Mg assay displayed imprecision of 1.7% at 0.72 mmol/L and 1.4% at 1.80 mmol/L (20 days, one calibration, one reagent lot). The linear range was verified between 0.18-7.0 mmol/L (plasma) and 0.01-10.69 mmol/L (urine). Results of the enzymatic assay (x) correlated well with the predicate assay (y) with the relationships y = 0.891x + 0.035, R = 0.967 (plasma) and y = 1.181x + 0.086, R = 0.997 (urine). Mean bias of the NIST SRM 956 c samples was -1.4%. This method showed minimal interference by hemoglobin (3g/L as hemolysate), lipemia (20 g/L Intralipid), unconjugated bilirubin (531 μmol/L), and ascorbate (680 μmol/L)., Conclusions: The ARCHITECT Magnesium assay 3P68 achieved the desirable analytical quality specification of 4.8% for total allowable error. In comparison to the 7D70 assay, notable improvements are seen in precision, 30-day calibration stability, and minimal interference by hemolyzed and lipemic samples., (© 2013.)

Objectives: We have developed a one-step nucleic acid dipstick assay (NADA) for visually detecting polymerase chain reaction (PCR) products within 3min. "One-step" means that there were no additional procedures between amplification and detection., Methods: This method was achieved through the use of asymmetric PCR and specially designed probes with appropriate melting temperature values. We initially combined one-step NADA with asymmetric capillary convective PCR (ACCPCR), an easy and rapid nucleic acid amplification technique, to construct an on-site nucleic acid diagnostic platform., Results: We developed a diagnostic assay for the hepatitis B virus based on the ACCPCR-NADA platform to verify its feasibility. It exhibited an analytical sensitivity of three copies per test and a broad detection spectrum including genotype A-I. It also showed 97.9% sensitivity and 100% specificity based on the results observed using 67 serum samples with the Roche COBAS AmpliPrep/COBAS TaqMan (COBAS) system as the standard for comparison., Conclusion: The results provide evidence for the feasibility of using an ACCPCR-NADA platform in practical applications, especially in on-site test., (© 2013.)

Terminalia actinophylla has been used for anti-diarrheic and haemostatic purposes in Brazil. The fly spot data obtained after exposure of marker-heterozygous Drosophila melanogaster larvae to T. actinophylla ethanolic extract (TAE) in the standard (ST) and high bioactivation (HB) crosses revealed that TAE did not induce any statistically significant increment in any spot categories. Differences between the two crosses are related to cytochrome P450 (CYPs) levels. In this sense, our data pointed out the absence of TAE-direct and indirect mutagenic and recombinagenic action in the Somatic Mutation and Recombination Test (SMART). When the anti-genotoxicity of TAE was analyzed, neither mitomycin C (MMC) nor ethylmethanesulfonate (EMS) genotoxicity was modified by the post-exposure to TAE, which suggests that TAE has no effect on the mechanisms involved in the processing of the lesions induced by both genotoxins. In the mwh/flr(3) genotype, co-treatment with TAE may lead to a significant protection against the genotoxicity of MMC and a weak but significant effect in the toxic genetic action of EMS. The overall findings suggested that the favorable modulations by TAE could be, at least in part, due to its antioxidative potential., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A point mutation (V617F) of tyrosine kinase Janus kinase 2 (JAK2) is found in the majority of patients with myeloproliferative neoplasms (MPNs) and an aberrant signaling pathway induced by constitutively active JAK2 V617F mutant is a hallmark of MPNs. Cells transformed by JAK2 V617F mutant exhibited resistance to anti-cancer drugs such as cisplatin (CDDP), mitomycin C (MMC) and bleomycin (BLM). We first found that the expression of FANCC, a member of the Fanconi anemia (FA) proteins, was significantly induced by JAK2 V617F mutant through activation of signal transducers and activators of transcription 5 (STAT5). In addition, monoubiqitination and foci formation of FANCD2, which are critical for activation of the FA pathway, were increased in cells transformed by JAK2 V617F mutant, compared to cells expressing wild-type JAK2. Interestingly, knockdown of FANCC in cells expressing JAK2 V617F mutant induced not only the reduction of monoubiqitination and foci formation of FANCD2 but also the enhancement of sensitivity to DNA damage induced by CDDP and MMC but not BLM. Taken together, FANCC is most likely to be critical for resistance to DNA cross-linking drug-induced DNA damage in cells transformed by JAK2 V617F mutant., (© 2013.)

Background: Patterns of care of physician specialists may differ for patients with hepatocellular carcinoma (HCC). Reasons underlying variations are poorly understood. One source of variation may be disparate referral rates to specialists, leading to differences in cancer-directed treatments., Study Design: Surveillance, Epidemiology, and End Results (SEER)-linked Medicare database was queried for patients with HCC, diagnosed between 1998 and 2007, who consulted 1 or more physicians after diagnosis. Visit and procedure records were abstracted from Medicare billing records. Factors associated with specialist consult and subsequent treatment were examined., Results: There were 6,752 patients with HCC identified; 1,379 (20%) patients had early-stage disease. Median age was 73 years; the majority were male (66%), white (60%), and from the West region (56%). After diagnosis, referral to a specialist varied considerably (hepatology/gastroenterology, 60%; medical oncology, 62%; surgery, 56%; interventional radiology [IR], 33%; radiation oncology, 9%). Twenty-two percent of patients saw 1 specialist; 39% saw 3 or more specialists. Time between diagnosis and visitation with a specialist varied (surgery, 37 days vs IR, 55 days; p = 0.04). Factors associated with referral to a specialist included younger age (odds ratio [OR] 2.16), Asian race (OR 1.49), geographic region (Northeast OR 2.10), and presence of early-stage disease (OR 2.21) (all p < 0.05). Among patients with early-stage disease, 77% saw a surgeon, while 50% had a consultation with medical oncologist. Receipt of therapy among patients with early-stage disease varied (no therapy, 30%; surgery, 39%; IR, 9%; chemotherapy, 23%). Factors associated with receipt of therapy included younger age (OR 2.48) and early-stage disease (OR 2.20)., Conclusions: After HCC diagnosis, referral to a specialist varied considerably. Both clinical and nonclinical factors were associated with consultation. Disparities in referral to a specialist and subsequent therapy need to be better understood to ensure all HCC patients receive appropriate care., (Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Dural arteriovenous fistulas (DAVFs) are arteriovenous shunts from a dural arterial supply to a dural venous channel, typically supplied by pachymeningeal arteries and located near a major venous sinus. A retrospective review was conducted to present the results of endovascular obliteration of DAVFs, with particular emphasis of newer liquid embolic agents, including Onyx-18 (MV3, Irvine, California, USA)., Methods: A review of the literature was performed, and a presentation of the number of treatments, complications, and outcomes is included here. The number of arterial embolizations and need for transvenous embolization, open surgery, and radiosurgery was assessed as well as normalization of retrograde cortical venous drainage., Results: Thirty-nine patients (22 men and 17 women) underwent endovascular treatment of DAVFs at our institution from 2001 to 2009. Ages ranged from 39 to 71 years (mean, 48 years). Seventy-nine percent of patients had retrograde cortical venous drainage. The average number of embolizations in all patients was 2.1. Twelve patients underwent 40 embolization treatments with Onyx, with an obliteration rate of 75% and cortical venous drainage obliteration rate of 85%. Seventy-one percent (28/39) of patients had complete treatment of the fistula: 21 by purely endovascular treatment and 7 with endovascular therapy followed by craniotomy, as well as seven patients who underwent stereotactic radiosurgery after embolization., Conclusions: Endovascular management of DAVFs is a safe and effective method of treating these complex lesions., (Copyright © 2013 Elsevier Inc. All rights reserved.)