Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage

OBJECTIVES: This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease. METHODS: This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test. RESULTS: The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09-0.42;

In Vitro Activity Of Artemisia Annua L (asteraceae) Extracts Against Rhipicephalus (boophilus) Microplus [atividade In Vitro De Extratos De Artemisia Annua L (asteraceae) Sobre Rhipicephalus (boophilus) Microplus]

The activity of plant extracts on parasites may indicate groups of substances that are potentially useful for controlling Rhipicephalus (Boophilus) microplus. The aim of the present study was to investigate the in vitro action of Artemisia annua extracts on this tick. The concentrations of the sesquiterpene lactones artemisinin and deoxyartemisinin present in plant extracts were quantified via high-performance liquid chromatography. Four extracts produced from the concentrated crude extract (CCE) were evaluated on larvae using the impregnated paper method, with readings after 24 hours of incubation. The engorged females were immersed in the CCE and in its four derived extracts for five minutes, with incubation for subsequent analysis of biological parameters. The extracts were not effective on the larvae at the concentrations tested (3.1 to 50 mg.mL-1). The CCE showed greater efficacy on engorged females (EC50 of 130.6 mg.mL-1 and EC90 of 302.9 mg.mL-1) than did the derived extracts. These results tend to confirm that the action of artemisinin on engorged females of R. (B.) microplus is conditional to their blood intake. In this case, in vitro methods would be inadequate for effective evaluation of the action of A. annua on R. (B.) microplus.2013135Amaral, N.K., Guidelines for the evaluation of ixodicides against the cattle tick Boophilus microplus (Canestrini, 1887) (Acari: Ixodidae) (1993) Revista Brasileira De Parasitologia Veterinária, 2 (2), pp. 144-151(2009) Anuário Da Pecuária Brasileira, p. 360. , ANUALPEC, Sao Paulo: Angra FNP PesquisasBorges, L.M.F., Acao do extrato hexanico de frutos maduros de Melia azedarach (Meliaceae) sobre Boophilus microplus (Acari: Ixodidae) em bezerros infestados artificialmente (2005) Revista De Patologia Tropical, 34 (1), pp. 53-59Cala, A.C., (2010) Avaliação Da Atividade De Artemisia Annua L., Melia Azedarach L. E Trichilia Claussenii C. Sobre Nematódeos Gastrintestinais De Ovinos, p. 64. , Dissertacao (Mestrado)- Universidade Estadual Paulista, Faculdade de Ciencias Agrarias e Veterinarias, JaboticabalCeleghini, R.M.S., Desenvolvimento e validacao de metodologia analitica por CLAE-IR para determinacao de artemisinina em Artemisia annua L (2009) Química Nova, 32 (4), pp. 875-878Chagas, A.C.S., Efeito acaricida de oleos essenciais e concentrados emulsionaveis de Eucalyptus em Boophilus microplus (2002) Brazilian Journal of Veterinary Research and Animal Science, 39 (5), pp. 247-253Chagas, A.C.S., Sensibilidade do carrapato Boophilus microplus a solventes (2003) Ciência Rural, 33 (1), pp. 109-114Creek, D.J., Kinetics of ironmediated artemisinin degradation:Effect of solvent composition and iron salt (2005) Journal of Pharmaceutical Sciences, 94 (8), pp. 1820-1829Drummond, R.O., Boophilus annulatus and B. Microplus: Laboratory tests of insecticides (1973) Journal of Economic Entomology, 66 (1), pp. 130-133Ekanem, A.P., Brisibe, E.A., Effects of ethanol extract of Artemisia annua L. Against monogenean parasites of Heterobranchus longifilis (2010) Parasitology Research, 106 (5), pp. 1135-1139Fernandes, F.F., Freitas, E.P.S., Acaricidal activity of an oleoresinous extract from Copaifera reticulata (Leguminosae: Caesalpinioideae against larvae of the southern cattle tick, Riphicephalus (Boophilus) microplus (Acari:Ixodidae) (2007) Veterinary Parasitology, 147 (1-2), pp. 150-154Ferreira, J.F.S., Agrotechnological aspects of the anti-malarial plant Artemisia annua and its potential use in animal health in Appalachia (2006) International Symposium on Perfume, Aromatic and Medicinal Plants, (2-4), pp. 797-804. , Revue de Regions Arides - Numero special - Actes du seminaire international les Plants a Parfum, Aromatiques et Medicinales (English version: International Center for Agricultural Research in Dry AreasFerreira, J.F.S., Nutrient Deficiency in the Production of Artemisinin, Dihydroartemisinic Acid, and Artemisinic Acid in Artemisia annua L (2007) Journal of Agricultural and Food Chemistry, 55 (5), pp. 1686-1694Ferreira, J.F.S., Gonzalez, J.M., Chemical and biological stability of artemisinin in bovine rumen fluid and its kinetics in goats (Capra hircus) (2008) Revista Brasileira De Parasitologia Veterinária, 17 (SUPPL. 1), pp. 103-109Furlong, J., O carrapato dos bovinos e a resistencia: Temos o que comemorar? (2007) A Hora Veterinária, 159, pp. 26-32Grisi, L., Impacto economico das principais ectoparasitoses em bovinos no Brasil (2002) A Hora Veterinária, 21 (125), pp. 8-10Heimerdinger, A., Extrato alcoolico de Capim-cidreira (Cymbopogon citratus) no controle do Boophilus microplus em bovinos (2006) Revista Brasileira De Parasitologia Veterinária, 15 (1), pp. 37-39Idris, U.A., Adam, S.E., Tartour, G., The anthelmintic efficacy of Artemisia herba-alba against Haemonchus contortus infection in goats (1982) Animal Health Quarterly, 22 (3), pp. 138-143Iqbal, Z., Anthelmintic activity of Artemisia brevifolia in sheep (2004) Journal of Ethnopharmacology, 93 (2), pp. 265-268Keiser, J., Artesunate and artemether are effective fasciolicides in the rat model and in vitro (2006) Journal of Antimicrobial Chemotherapy, 57 (6), pp. 1139-1145Keiser, J., Efficacy and safety of artemether against a natural Fasciola hepatica infection in sheep (2008) Parasitology Research, 103 (3), pp. 517-522Keiser, J., Utzinger, J., Food-borne trematodiasis: Current chemotherapy and advances with artemisinins and synthetic trioxolanes (2007) Trends In Parasitology, 23 (11), pp. 555-562Klayman, D.L., Qinghaosu (Artemisinin): Na antimalarial drug from China (1985) Science, 228 (4703), pp. 1049-1055La-Scalea, M.A., Silva, H.S.R.C., Ferreira, E., Reducao voltametrica de artemisinina e sua interacao com grupo heme (hemina) (2007) Brazilian Journal of Pharmaceutical Sciences, 43 (3), pp. 371-383Martins, R.M., Estudio in vitro de la accion acaricida del aceite esencial de la graminea Citronela de Java (Cymbopogon winterianus Jowitt) en la garrapata Boophilus microplus (2006) Revista Brasileira De Plantas Medicinais De Botucatu, 8 (2), pp. 71-78Meshnick, S.R., Second-generation antimamalarial endoperoxides (1996) Parasitology Today, 12 (2), pp. 79-82Ribeiro, V.L.S., Acaricidal properties of extracts from the aerial parts of Hypericum polyanthemum on the cattle tick Boophilus microplus (2007) Veterinary Parasitology, 147 (1-2), pp. 199-203Rodrigues, R.A.F., Otimizacao do processo de extracao e isolamento do antimalarico artemisinina a partir de Artemisia annua L (2006) Química Nova, 29 (2), pp. 368-372Silva, H.S.R.C., (2006) Antimaláricos Potenciais: Pró-fármacos Poliméricos E Formas De Liberação Controlada De Artemisinina, p. 209. , Tese (Doutorado)-Universidade de Sao Paulo, Sao PauloSimoes, C.M., (2004) Farmacognosia: Da Planta Ao Medicamento, p. 1102. , 5. ed. Porto Alegre: Editora da UFRGSFlorianopolis: Editora da UFSCTaranto, A.G., Estudo sobre o mecanismo de acao da artemisinina e dos endoperoxidos, a mais nova classe de agents antimalaricos (2006) Sitientibus, 34, pp. 47-58Tariq, K.A., Anthelmintic activity of extracts of Artemisia absinthium against ovine nematodes (2009) Veterinary Parasitology, 160 (1-2), pp. 83-8

Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients?

Non-alcoholic steatohepatitis (NASH) has been associated with hepatocellular carcinoma (HCC) often arising in histologically advanced disease when steatohepatitis is not active (cryptogenic cirrhosis). Our objective was to characterize patients with HCC and active, histologically defined steatohepatitis. Among 394 patients with HCC detected by ultrasound imaging over 8 years and staged by the Barcelona Clinic Liver Cancer (BCLC) criteria, we identified 7 cases (1.7%) with HCC occurring in the setting of active biopsy-proven NASH. All were negative for other liver diseases such as hepatitis C, hepatitis B, autoimmune hepatitis, Wilson disease, and hemochromatosis. The patients (4 males and 3 females, age 63 ± 13 years) were either overweight (4) or obese (3); 57% were diabetic and 28.5% had dyslipidemia. Cirrhosis was present in 6 of 7 patients, but 1 patient had well-differentiated HCC in the setting of NASH without cirrhosis (fibrosis stage 1) based on repeated liver biopsies, the absence of portal hypertension by clinical and radiographic evaluations and by direct surgical inspection. Among the cirrhotic patients, 71.4% were clinically staged as Child A and 14.2% as Child B. Tumor size ranged from 1.0 to 5.2 cm and 5 of 7 patients were classified as early stage; 46% of all nodules were hyper-echoic and 57% were <3 cm. HCC was well differentiated in 1/6 and moderately differentiated in 5/6. Alpha-fetoprotein was <100 ng/mL in all patients. HCC in patients with active steatohepatitis is often multifocal, may precede clinically advanced disease and occurs without diagnostic levels of alpha-fetoprotein. Importantly, HCC may occur in NASH in the absence of cirrhosis. More aggressive screening of NASH patients may be warranted

Ocorrência De Phytophthora Nicotianae Em Mamoneira (ricinus Communis L.) No Brasil

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