Subclassification of advanced-stage hepatocellular carcinoma with macrovascular invasion: combined transarterial chemoembolization and radiotherapy as an alternative first-line treatment

Background/Aim The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend systemic therapy as the only first-line treatment for patients with BCLC stage C hepatocellular carcinoma (HCC) despite its heterogeneity of disease extent. We aimed to identify patients who might benefit from combined transarterial chemoembolization (TACE) and radiation therapy (RT) by subclassifying BCLC stage C. Methods A total of 1,419 treatment-naïve BCLC stage C patients with macrovascular invasion (MVI) who were treated with combined TACE and RT (n=1,115) or systemic treatment (n=304) were analyzed. The primary outcome was overall survival (OS). Factors associated with OS were identified and assigned points by the Cox model. The patients were subclassified into three groups based on these points. Results The mean age was 55.4 years, and 87.8% were male. The median OS was 8.3 months. Multivariate analysis revealed a significant association of Child-Pugh B, infiltrative-type tumor or tumor size ≥10 cm, main or bilateral portal vein invasion, and extrahepatic metastasis with poor OS. The sub-classification was categorized into low (point ≤1), intermediate (point=2), and high (point ≥3) risks based on the sum of points (range, 0–4). The OS in the low, intermediate, and high-risk groups was 22.6, 8.2, and 3.8 months, respectively. In the low and intermediate-risk groups, patients treated with combined TACE and RT exhibited significantly longer OS (24.2 and 9.5 months, respectively) than those who received systemic treatment (6.4 and 5.1 months, respectively; P<0.0001). Conclusions Combined TACE and RT may be considered as a first-line treatment option for HCC patients with MVI when classified into low- and intermediate-risk groups

Evaluation of persistent-mode operation in a superconducting MgB2 coil in solid nitrogen

We report the fabrication of a magnesium diboride (MgB2) coil and evaluate its persistent-mode operation in a system cooled by a cryocooler with solid nitrogen (SN2) as a cooling medium. The main purpose of SN2 was to increase enthalpy of the cold mass. For this work, an in situ processed carbon-doped MgB2 wire was used. The coil was wound on a stainless steel former in a single layer (22 turns), with an inner diameter of 109 mm and height of 20 mm without any insulation. The two ends of the coil were then joined to make a persistent-current switch to obtain the persistent-current mode. After a heat treatment, the whole coil was installed in the SN2 chamber. During operation, the resultant total circuit resistance was estimated to be \u3c7.4x10−14 Ω at 19.5 K±1.5 K, which meets the technical requirement for magnetic resonance imaging application

Use of tenofovir disoproxil fumarate is associated with a lower risk of hepatocellular carcinoma than entecavir in patients with chronic hepatitis B

In patients with chronic hepatitis B (CHB), entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are equally recommended as first-line treatment by the international guidelines. These two drugs have shown similar short and intermediate clinical outcomes, including virologic, biochemical, and histologic responses. However, there is considerable controversy as to whether ETV and TDF differ in reducing the risk of hepatocellular carcinoma (HCC) in patients with CHB despite many observational studies and meta-analyses being published. In this review, we summarize recent evidence comparing the preventive effects of these two drugs against HCC from the perspective that TDF is associated with a lower risk of HCC compared with ETV in patients with CHB

Optimize nucleot(s)ide analogues’ to prevent hepatocellular carcinoma in patients with chronic hepatitis B: a lesson from real-world evidence

The goal of antiviral treatment for chronic hepatitis B (CHB) is to reduce the risk of liver-related complications, including liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). It is not possible to eliminate hepatitis B virus from the host with currently available antiviral treatments; hence, a realistic goal is to decrease the risk of HCC as much as possible with an appropriate and timely antiviral treatment. For the past decades, real-world evidence has enlarged the field of CHB research. Presently, there is mounting evidence that randomized clinical trials are not technically and ethically possible to conduct. In this review, we focus on secondary prevention by antiviral treatment in patients with CHB, mainly based on real-world evidence

Low-Area Four-Channel Controlled Dielectric Breakdown System Design for Point-of-Care Applications

In this study, we propose a low-area multi-channel controlled dielectric breakdown (CDB) system that simultaneously produces several nanopore sensors. Conventionally, solid-state nanopores are prepared by etching or drilling openings in a silicon nitride (SiNx) substrate, which is expensive and requires a long processing time. To address these challenges, a CDB technique was introduced and used to fabricate nanopore channels in SiNx membranes. However, the nanopore sensors produced by the CDB result in a severe pore-to-pore diameter variation as a result of different fabrication conditions and processing times. Accordingly, it is indispensable to simultaneously fabricate nanopore sensors in the same environment to reduce the deleterious effects of pore-to-pore variation. In this study, we propose a four-channel CDB system that comprises an amplifier that boosts the command voltage, a 1-to-4 multiplexer, a level shifter, a low-noise transimpedance amplifier and a data acquisition device. To prove our design concept, we used the CDB system to fabricate four nanopore sensors with diameters of &lt;10 nm, and its in vitro performance was verified using &lambda;-DNA samples

Thiophene-fused coplanar sensitizer for dye-sensitized solar cells

We have designed and synthesized a novel ladder-type heteroacene dye consisting uniquely of thiophene segments as a photosensitizer for the dye-sensitized solar cells (DSSCs). The onset of the IPCE spectrum for the dye not only reaches up to 700 nm with a high IPCE (>60%) but also a solar energy-to-electricity conversion efficiency of 2.31% is achieved. Even though the efficiency is slightly lower than those of other dyes reported previously, this work opens up a new strategy to design heteroaromatic fused photosensitizers for DSSCs.close6