Search

Please see the Editorial Comment by Joanna Kee-Sampson discussing this article. BACKGROUND. Transarterial chemoembolization (TACE) has synergistic properties when combined with ablative therapies f...

Purpose To evaluate long-term effects of yttrium-90 (90Y) transarterial radioembolization (TARE) for unresectable hepatic metastases of neuroendocrine tumors (NETs). Materials and Methods Retrospective analysis of 93 patients (47 women, 46 men; mean age 59 y) who underwent resin-based 90Y TARE was performed. Variables associated with overall survival were analyzed using univariate and multivariate models. Changes in serologic values and imaging characteristics were assessed with long-term follow-up. Results Unilobar TARE was performed in 48 patients, and staged bilobar TARE was performed in 45 patients. In multivariate analysis, ascites (P = .002) and extrahepatic metastases (P = .038) at baseline were associated with poor survival. Among 52 patients who had > 1 year of follow-up, significant increases in alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were observed; however, only 4 patients experienced grade 3 serologic toxicities. Imaging signs of cirrhosis-like morphology and portal hypertension were observed in 15 of 52 patients, more frequently in patients treated with bilobar TARE compared with unilobar TARE. Patients treated with bilobar TARE exhibited significantly increased hepatobiliary enzymes and decreased platelet count. Sustained increases in liver enzymes were observed in patients with > 4 years of follow-up. No radioembolization-related liver failure or grade 4 toxicity was observed. Conclusions 90Y radioembolization using resin microspheres demonstrated a high safety profile for NET liver metastases, with low-grade, although sustained, long-term liver toxicity evident > 4 years after treatment. Bilobar treatment suggested a trend for treatment-related portal hypertension. Ongoing research will help define parameters for optimizing durable safety and efficacy of radioembolization in this setting.

To evaluate yttrium-90 (Y90) radioembolization outcomes across Child-Pugh scores in patients with advanced hepatocellular carcinoma (HCC).From April 2005 to December 2018, 106 consecutive patients with BCLC Stage C HCC who underwent Y90 radioembolization were retrospectively analyzed. Exclusion criteria included additional malignancy (n = 7), death unrelated to liver disease (n = 2), metastases (n = 2), or lack of follow-up data (n = 4). Ninety-one patients were analyzed. Overall survival (OS) was calculated using the Kaplan-Meier method and compared between groups with the log-rank test. Cox regression modeling was used to evaluate the prognostic factors for survival.Mean age was 63 years and 85.7% were male. HCV infection was the most common etiology of liver disease (58.2%). Sixty-four (70.3%) patients were Child-Pugh A, 19 (20.9%) patients were B7, and eight (8.8%) patients were B8-9. Median OS after radioembolization was 20.2 [95% confidence interval (CI) 13.0-27.4], 6.0 (95% CI 4.4-7.6), and 5.5 (95% CI 2.5-8.5) months for Child-Pugh A, B7, and B8/9 groups, respectively (P 0.001 for B7 vs. A; P = 0.537 for B7 vs. B8/9). The multivariable Cox regression analysis showed that Eastern Cooperative Oncology Group (ECOG) score (P 0.001), Child-Pugh class (P = 0.005), tumor morphology pattern (P = 0.012), and Y90 delivery location (P = 0.020) were significant independent predictors of overall survival.Outcomes from Y90 for BCLC C HCC for Child-Pugh B7 patients were equivalent to B8/9 patients and significantly worse compared to Child-Pugh A patients. Although further research is warranted, these results suggest continued cautious patient selection for radioembolization in advanced HCC.

Objectives The purpose of this study was to investigate the incidence of and the risk factors for arteriopathy in hepatic arteries after transarterial chemo-lipiodolization in patients with hepatocellular carcinoma and the subsequent treatment strategy changes due to arteriopathy. Patients and methods A total of 365 arteries in 167 patients (126 men and 41 women; mean age, 60.4 ± 15.0 [SD] years [range: 18–87 years]) were evaluated for the development of arteriopathy after chemo-lipiodolization with epirubicin- or doxorubicin-Lipiodol® emulsion. The development of arteriopathy after chemo-lipiodolization was assessed on arteriograms performed during subsequent transarterial treatments. The treatment strategy changes due to arteriopathy, including change in the chemo-lipiodolization method and the application of alternative therapies was also investigated. Univariate and multivariate binary logistic regression models were used to identify risk factors for arteriopathy and subsequent treatment strategy change. Results One hundred two (27.9%) arteriopathies were detected in 62/167 (37.1%) patients (45 men, 17 women) with a mean age of 63.3 ± 7.1 [SD] years (age range, 50–86 years). The incidence of arteriopathy was highly patient dependent, demonstrating significant correlation in a fully-adjusted multivariate regression model (P Conclusion The incidence of arteriopathy after chemo-lipiodolization is 27.9%. Among them, 29.4% result in a change in treatment strategy.

To examine the association of transjugular intrahepatic portosystemic shunt (TIPS) creation with muscle gains and patient mortality, and to identify the timeframe of these changes.Patients with cirrhosis undergoing TIPS creation with available abdominal computed tomography before and after TIPS from 2004-2015 were included (n = 76). The primary indications for TIPS included refractory ascites (52.6%) or variceal bleeding (47.4%). Axial truncal muscle area and attenuation were measured at the L4 level using free-hand region of interest technique, and pre- and post-TIPS values were compared. The association of TIPS-related muscle changes with mortality was evaluated using Cox multiple regression. Logistic regression analysis was performed to evaluate associations of baseline muscle area and clinical variables with post-TIPS changes.TIPS creation was associated with significant increases in psoas, paraspinal, and total muscle areas (P.001, 0.004, and 0.002), and psoas muscle attenuation (P = .022) at a median of 13.5 months after TIPS. Maximal muscle gains occurred within 6 months after TIPS creation (P.001). Muscle gain at 1-year after TIPS was independently associated with lower mortality (psoas hazard ratio [HR] 0.14, P = .016; paraspinal HR 0.15, P = .016; abdominal HR 0.05, P = .005; core HR 0.06, P = .001; and total HR 0.05, P = .003). Baseline demographic or clinical variables were not associated with muscle gain after TIPS.TIPS creation was strongly associated with truncal muscle gains and attenuation in patients with cirrhosis. Maximal muscle gain occurred within 6 months after TIPS creation. TIPS-related increased muscle mass was independently associated with lower patient mortality.

Starting from the standard supersymmetry algebra, an infinite Lie algebra is constructed by introducing commutators of fermionic generators as members of the algebra. From this algebra a finite Lie algebra results for fixed momentum analogous to the Wigner analysis of the Poincare algebra. It is shown that anticommutation of the fermionic charges plays the role of a constraint on the representation. Also, it is suggested that anticommuting parameters can be avoided by using this infinite Lie algebra with fermionic generators modified by a Klein transformation.

We exhibit generalized parastatistical double commutation relations which allow a solution less restrictive than Green’s ansatz. This leads to local interaction terms in the Lagrangian consistent with an internal symmetry among Green indices. The generalized commutation relations are covariant under this symmetry transformation rather than invariant. The formulation may be applicable to the generation problem as well as supersymmetric model building.

An explicit use of local commutativity is made in the derivation of the Kallen-Lehmann spectral representation of the vacuum expectation value of the two-point function, under the usual axioms (I)-(III) of quantum field theory (see Sect. 1). This affords an alternative proof of the relation between spin and statistics. Confining ourselves to the case of spin 0 and spin 1/2 fields, it is found that while the spectral representation of the former is unchanged from that ofKallen andLehmann, for the latter two further spectral functions should be added which represent parity violating terms. Some properties of the spectral functions due to the various invariance principles such asTCP andT, C andP, invariances are discussed.

Assuming that the current algebra of Gell-Mann and the PCAC (partially conserved axial-vector current) are valid approximations, and that aspecific form of the LSZ reduction formula for pion-nucleon scattering amplitude has a small variation for the change of pion 4-momentumkμ from (0, 0, 0, iμπ) tokμ=0, we derive two simple relations between the axial-vector coupling constant renormalizationgA and the pion-nucleon scattering lengths. (Equations (7) and (8) in the text.) Both are satisfied quite well by the experimental values, and are shown to be intimately related with the Adler-Weisberger relation and the consistency condition of Adler. In a similar way, the scattering lengths of pion-baryon, pion-kaon and kaon-nucleon systems are predicted. The assumption of the generalized form of PCAC in theSU3 context leads to the prediction of the meson-baryon scattering lengths. They are identical to those which are calculated by the model of the vector-meson exchange with the universalF-type coupling.

The validity of the octet model with complete symmetry was tested for baryon pair production in antiproton-proton collisions. Calculations of the transition amplitudes from the S matrix lead to an inequality. Using experimental values for reduced cross sections for pp yields XY processes and assuming charge-conjugation and time-reversal invariance, it is shown that the prediction of the octet model with complete symmetry is not in agreement with experiment. The relations among the transition amplitudes for meson pair production in the Sakata model are also obtained. (L.B.S.)

Thermodynamical relations in quantum field theory will be discussed. This gives a possibility to decide whether or not the interactions are renormalizable, i.e., of the first or the second kind. The renormalization procedure is elucidated by formulating the perturbational calculation. The possibility for proceeding to the non-perturbational method is also pointed out. These general considerations are applied to find out the interaction effects in the multiple production phenomena, which have been disregarded in Fermi-Landau’s statistical theory.

Success in treating and preventing infection and vascular disease has led to a significant increase in the number of people over the age of 65. This increase in the elderly population has focused attention on normal changes of the aging brain and the chronic disorders that may develop during the aging process. Clearly, such disorders are not inevitable consequences of aging, but they are present to a greater extent in aged individuals. The two common conditions which fall into this category are parkinsonism and Alzheimer’s disease. Both of these devastating diseases of the nervous system are degenerative disorders of unknown origin. In each, multiple etiologies, including viral or immunologic causes, have been implicated but never proven. Both conditions reflect pathologic changes in relatively limited pathways within the central nervous system. In Alzheimer’s disease and, to a much lesser extent, Parkinson’s disease, changes are noted which are known to occur in healthy older individuals. Thus, both conditions may represent accelerated aging of specific neuronal pathways. In order to understand the quantitative alterations in the brain of patients with these disorders, it is necessary to define the extent to which normal individuals demonstrate alterations in the number of neurons, in microscopic pathology, and in neurotransmitter metabolism during the aging process.

A multipotential stem-cell-type cell line (RT4-AC) isolated from a rat peripheral neurotumor differentiates in culture into two neuronal-type cells (RT4-B and RT4-E) or into a glial-type cell (RT4-D). The neuronal classification of RT4-B and RT4-E cells is based on their positive response to veratridine in the tetrodotoxin-sensitive Na+-influx and Rb+-efflux assays and on the action potential observed upon hyperpolarized stimulation. In addition, these neuronal cell types do not synthesize two glial proteins, S100 protein (S100P) and glial fibrillary acidic protein (GFAP). The glial classification of RT4-D is based on the syntheses of S100P and GFAP. Additionally, RT4-D does not display veratridine-activated Na+ influx and Rb+ efflux nor action potential. The stem cell type, RT4-AC, expresses both neuronal and glial properties to a lesser degree. In the neuronal-type cell lines of the RT4 family (RT4-B and RT4-E), the large veratridine-activated Na+ influx can further be stimulated by scorpion toxin. The Na+ influx of the stem cell (RT4-AC), however, is only slightly stimulated by veratridine alone, but greatly stimulated by the addition of veratridine and scorpion toxin. These observations suggest that a progressive differentiation of voltage-dependent Na+ channels may have occurred by the cell-type conversion from the stem cell type to the neuronal cell types. The exact nature of the change in Na+ channels is currently not known.

SU(6) isoscalar factors for the product 405×56→56, 70 are calculated. SU(3) isoscalar factors for the products 27×10→10, 8 and 10×8→8 are also tabulated.