Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients

Background: Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients. Aim: To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments. Methods: A retrospective multicentric study was performed enrolling 77 patients age ≥ 70-years-old with single hepatocellular carcinoma (≤ 30 mm), located in posterosuperior segments (4a, 7, 8). Patients were divided into liver resection and radiofrequency ablation groups and preoperative, peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching. Results: After propensity score matching, twenty-six patients were included in each group. Operative time and overall postoperative complications were higher in the resection group compared to the ablation group (165 min vs 20 min, P < 0.01; 54% vs 19% P = 0.02 respectively). A median hospital stay was significantly longer in the resection group than in the ablation group (7.5 d vs 3 d, P < 0.01). Ninety-day mortality was comparable between the two groups. There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1, 3, and 5 years. Conclusion: Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay, better quality of life and does not modify the overall and disease-free survival

Effect of cultivar and roller milling process on the level of phenolic compounds in Italian durum wheat

Phenolic compounds have many favourable effects on human health, arising from their antioxidant activity and capacity to protect critical macromolecules (such as chromosomal DNA, structural proteins and enzymes, low-density lipoproteins, and membrane lipids) from damages induced by active species of oxygen (Dreosti, 2000; Heim et al., 2002). The external layers of wheat caryopses contain interesting levels of various phenolic compounds, and bran extracts have a recognised antioxidant activity and are capable to inhibit lipid peroxidation in human low-density lipoprotein in vitro (Yu et al., 2005). Pasta, both dry and fresh (the latter showing a moisture level of 24-30%), stands out among the wheat-based foods for its typical sensory properties, able to be combined with a wide range of dressings. It is consumed mostly in Italy, but is known and appreciated all over the world. To fulfill nutritional expectations of consumers, whole-wheat pasta is also produced, although in amounts definitely lower than conventional pasta. It shows higher contents of fibre, vitamins and antioxidant substances than conventional pasta, but its consistency can be affected by bran fibre, which interferes with the gluten network (Sivam et al., 2010). The aim of this work has been to assess the feasibility of enrichment of fresh pasta with fluid extracts of phenolic compounds derived from bran. In this way, we intended to produce pasta with increased antioxidant properties, without the technological drawbacks of bran fibre. In particular, the aspects referring to dough characteristics (strength and tenacity to extensibility ratio, determined by Chopin alveograph) and sensory properties of final product have been considered and analysed. Methods involved quantitative descriptive sensory analysis, aroma profiling by Solid Phase Micro Extraction of volatile compounds coupled to Gas Chromatography/Mass Spectroscopy (SPME-GC/MS), and colorimetric determinations. Moreover, various extracting methods and different enrichment levels were evaluated. Every trial was performed in triplicate and submitted to statistical analysis. Regarding the extracting solvents, a preliminary evaluation indicated higher extracting capability of methanol, compared to acetone and ethanol, but only ethanol-derived extracts were selected for the enrichment trials due to their intended edible use. The obtained results indicated that all the extracting methods involving basic hydrolysis lead to higher concentrations of phenolic compounds (with an extracting capability of about 5 mg phenolic compounds, expressed as gallic acid, per g dry bran), as determined by Folin Ciocalteau reaction followed by spectrophotometric measures at 765 nm. However, the subsequent step of neutralization of the same extracting procedure produced NaCl or KCl, which affected the dough characteristics and altered the sensory characteristics of the final products, profiled by considering bulkiness, stickiness, firmness, salty taste, bitter taste, and wholemeal aroma. In particular, a significantly higher value (P < 0.05) of tenacity to extensibility ratio (alveographic P/L) was observed in dough enriched with hydrolised bran extracts, respect to control dough obtained by adding only water. Besides, significantly higher values of firmness, salty taste and wholemeal aroma were observed in pasta enriched with the same hydrolised extracts, while bitter taste did not appear significantly different, at P < 0.05. The colorimetric analysis showed that also colour of enriched pasta was significantly different from that of control, with higher values of both yellow index (b*) and brown index (100 – L). Better results were obtained by avoiding the initial hydrolysis step, which lead to enriched fresh pasta with sensory properties similar to the conventional types, but with enhanced antioxidant activity. In particular, saltiness and consistency were not statistically different from control, while the colorimetric indices appeared higher than in control, with a more intense brownish tone. Also the dough did not show significant differences in the alveographic P/L value (P < 0.05). The aroma profile, determined by SPME-GC/MS analysis of volatile compounds, appeared relatively poor, under the quantitative and qualitative point of view, respect to the usual profile of other cereal-based foods, such as bread. In particular, it was mainly characterized by alcohols (i.e. 1-butanol, 1-pentanol, 1-esanol) and aldehydes (esanal, eptanal, acetaldehyde). In fact, the origin of the volatile compounds observed was essentially imputable to oxidative phenomena related to kneading, in the absence of important biochemical reactions of fermentative or thermal nature due to leavening or baking. In conclusion, this research demonstrated the feasibility of the production of fresh pasta enriched with phenolic compounds derived from bran, assumed that the preliminary preparation of the edible phenolic extract carefully takes into account the best balance between extraction yield and technologic drawbacks

Effect of cultivar and roller milling process on the level of phenolic compounds in Italian durum wheat

Phenolic compounds have many favourable effects on human health, arising from their antioxidant activity and capacity to protect critical macromolecules (such as chromosomal DNA, structural proteins and enzymes, low-density lipoproteins, and membrane lipids) from damages induced by active species of oxygen (Dreosti, 2000; Heim et al., 2002). The external layers of wheat caryopses contain interesting levels of various phenolic compounds, and bran extracts have a recognised antioxidant activity and are capable to inhibit lipid peroxidation in human low-density lipoprotein in vitro (Yu et al., 2005). Pasta, both dry and fresh (the latter showing a moisture level of 24-30%), stands out among the wheat-based foods for its typical sensory properties, able to be combined with a wide range of dressings. It is consumed mostly in Italy, but is known and appreciated all over the world. To fulfill nutritional expectations of consumers, whole-wheat pasta is also produced, although in amounts definitely lower than conventional pasta. It shows higher contents of fibre, vitamins and antioxidant substances than conventional pasta, but its consistency can be affected by bran fibre, which interferes with the gluten network (Sivam et al., 2010). The aim of this work has been to assess the feasibility of enrichment of fresh pasta with fluid extracts of phenolic compounds derived from bran. In this way, we intended to produce pasta with increased antioxidant properties, without the technological drawbacks of bran fibre. In particular, the aspects referring to dough characteristics (strength and tenacity to extensibility ratio, determined by Chopin alveograph) and sensory properties of final product have been considered and analysed. Methods involved quantitative descriptive sensory analysis, aroma profiling by Solid Phase Micro Extraction of volatile compounds coupled to Gas Chromatography/Mass Spectroscopy (SPME-GC/MS), and colorimetric determinations. Moreover, various extracting methods and different enrichment levels were evaluated. Every trial was performed in triplicate and submitted to statistical analysis. Regarding the extracting solvents, a preliminary evaluation indicated higher extracting capability of methanol, compared to acetone and ethanol, but only ethanol-derived extracts were selected for the enrichment trials due to their intended edible use. The obtained results indicated that all the extracting methods involving basic hydrolysis lead to higher concentrations of phenolic compounds (with an extracting capability of about 5 mg phenolic compounds, expressed as gallic acid, per g dry bran), as determined by Folin Ciocalteau reaction followed by spectrophotometric measures at 765 nm. However, the subsequent step of neutralization of the same extracting procedure produced NaCl or KCl, which affected the dough characteristics and altered the sensory characteristics of the final products, profiled by considering bulkiness, stickiness, firmness, salty taste, bitter taste, and wholemeal aroma. In particular, a significantly higher value (P < 0.05) of tenacity to extensibility ratio (alveographic P/L) was observed in dough enriched with hydrolised bran extracts, respect to control dough obtained by adding only water. Besides, significantly higher values of firmness, salty taste and wholemeal aroma were observed in pasta enriched with the same hydrolised extracts, while bitter taste did not appear significantly different, at P < 0.05. The colorimetric analysis showed that also colour of enriched pasta was significantly different from that of control, with higher values of both yellow index (b*) and brown index (100 – L). Better results were obtained by avoiding the initial hydrolysis step, which lead to enriched fresh pasta with sensory properties similar to the conventional types, but with enhanced antioxidant activity. In particular, saltiness and consistency were not statistically different from control, while the colorimetric indices appeared higher than in control, with a more intense brownish tone. Also the dough did not show significant differences in the alveographic P/L value (P < 0.05). The aroma profile, determined by SPME-GC/MS analysis of volatile compounds, appeared relatively poor, under the quantitative and qualitative point of view, respect to the usual profile of other cereal-based foods, such as bread. In particular, it was mainly characterized by alcohols (i.e. 1-butanol, 1-pentanol, 1-esanol) and aldehydes (esanal, eptanal, acetaldehyde). In fact, the origin of the volatile compounds observed was essentially imputable to oxidative phenomena related to kneading, in the absence of important biochemical reactions of fermentative or thermal nature due to leavening or baking. In conclusion, this research demonstrated the feasibility of the production of fresh pasta enriched with phenolic compounds derived from bran, assumed that the preliminary preparation of the edible phenolic extract carefully takes into account the best balance between extraction yield and technologic drawbacks

The Complexity of the Tumor Microenvironment in Hepatocellular Carcinoma and Emerging Therapeutic Developments

This review explores various aspects of the HCC TME, including both cellular and non-cellular components, to elucidate their roles in tumor development and progression. Specifically, it highlights the significance of cancer-associated fibroblasts (CAFs) and their contributions to tumor progression, angiogenesis, immune suppression, and therapeutic resistance. Moreover, this review emphasizes the role of immune cells, such as tumor-associated macrophages (TAMs), myeloid-derived suppressor cells (MDSCs), and regulatory T-cells (Tregs), in shaping the immunosuppressive microenvironment that promotes tumor growth and immune evasion. Furthermore, we also focused only on the non-cellular components of the HCC TME, including the extracellular matrix (ECM) and the role of hypoxia-induced angiogenesis. Alterations in the composition of ECM and stiffness have been implicated in tumor invasion and metastasis, while hypoxia-driven angiogenesis promotes tumor growth and metastatic spread. The molecular mechanisms underlying these processes, including the activation of hypoxia-inducible factors (HIFs) and vascular endothelial growth factor (VEGF) signaling, are also discussed. In addition to elucidating the complex TME of HCC, this review focuses on emerging therapeutic strategies that target the TME. It highlights the potential of second-line treatments, such as regorafenib, cabozantinib, and ramucirumab, in improving overall survival for advanced HCC patients who have progressed on or were intolerant to first-line therapy. Furthermore, this review explores the implications of the Barcelona Clinic Liver Cancer (BCLC) staging and classification system in guiding HCC management decisions. The BCLC system, which incorporates tumor stage, liver function, and performance status, provides a framework for treatment stratification and prognosis prediction in HCC patients. The insights gained from this review contribute to the development of novel therapeutic interventions and personalized treatment approaches for HCC patients, ultimately improving clinical outcomes in this challenging disease