Multimodality Treatment with Conventional Transcatheter Arterial Chemoembolization and Radiofrequency Ablation for Unresectable Hepatocellular Carcinoma

Background/Aims: To evaluate the efficacy of multimodality treatment consisting of conventional transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in patients with non-resectable and non-ablatable hepatocellular carcinoma (HCC). Methods: In this retrospective study, 85 consecutive patients with HCC (59 solitary, 29 multifocal HCC) received TACE followed by RFA between 2001 and 2010. The mean number of tumors per patient was 1.6 +/- 0.7 with a mean size of 3.0 +/- 0.9 cm. Both local efficacy and patient survival were evaluated. Results: Of 120 treated HCCs, 99 (82.5%) showed a complete response (CR), while in 21 HCCs (17.5%) a partial response was depicted. Patients with solitary HCC revealed CR in 91% (51/56); in patients with multifocal HCC (n = 29) CR was achieved in 75% (48 of 64 HCCs). The median survival for all patients was 25.5 months. The 1-, 2-, 3- and 5-year survival rates were 84.6, 58.7, 37.6 and 14.6%, respectively. Statistical analysis revealed a significant difference in survival between Barcelona Clinic Liver Cancer (BCLC) A (73.4 months) and B (50.3 months) patients, while analyses failed to show a difference for Child-Pugh score, Cancer of Liver Italian Program (CLIP) score and tumor distribution pattern. Conclusion: TACE combined with RFA provides an effective treatment approach with high local tumor control rates and promising survival data, especially for BCLC A patients. Randomized trials are needed to compare this multimodality approach with a single modality approach for early-stage HCC. Copyright (C) 2011 S. Karger AG, Base

Tumor and circulating biomarkers in patients with second-line hepatocellular carcinoma from the randomized phase II study with tivantinib

ARQ 197-215 was a randomized placebo-controlled phase II study testing the MET inhibitor tivantinib in second-line hepatocellular carcinoma (HCC) patients. It identified tumor MET as a key biomarker in HCC. Aim of this research was to study the prognostic and predictive value of tumor (MET, the receptor tyrosine kinase encoded by the homonymous MNNG-HOS transforming gene) and circulating (MET, hepatocyte growth factor [HGF], alpha-fetoprotein [AFP], vascular endothelial growth factor [VEGF]) biomarkers in second-line HCC. Tumor MET-High status was centrally assessed by immunohistochemistry. Circulating biomarkers were centrally analyzed on serum samples collected at baseline and every 4-8 weeks, using medians as cut-off to determine High/Low status. Tumor MET, tested in 77 patients, was more frequently High after (82%) versus before (40%) sorafenib. A significant interaction (p = 0.04) between tivantinib and baseline tumor MET in terms of survival was observed. Baseline circulating MET and HGF (102 patients) High status correlated with shorter survival (HR 0.61, p = 0.03, and HR 0.60, p = 0.02, respectively), while the association between AFP (104 patients) or VEGF (103 patients) status and survival was non-significant. Conclusions: Tumor MET levels were higher in patients treated with sorafenib. Circulating biomarkers such as MET and HGF may be prognostic in second-line HCC. These results need to be confirmed in larger randomized clinical trials

The effect of music-induced emotion on visual-spatial learning in people with Parkinson's disease: A pilot study

Introduction: Emotional states have been shown to influence cognitive processes including visual-spatial learning. Parkinson's Disease (PD), besides manifesting with the cardinal motor symptoms, presents cognitive and affective disturbances. Here we aimed at investigating whether manipulation of the emotional state by means of music was able to influence the performance of a visual-spatial learning task in a group of PD participants. Methods: Ten PD patients and 11 healthy elderly (ELD) were asked to perform a visual-spatial learning task while listening two musical pieces evoking a neutral emotion or fear. Targets were presented on a screen in a preset order over four blocks and subjects were asked to learn the sequence order by attending to the display. At the end of each block, participants were asked to verbally recall the sequence and a score was assigned (Verbal Score, VS). Results: Analysis of variance-type statistic test on the VS disclosed a significant effect of Music and sequence Blocks (p = 0.01 and p < 0.001, respectively) and a significant interaction between Group and sequence Blocks. Sequence learning occurred across the training period in both groups, but PD patients were slower than ELD and at the end of the training period learning performance was worse in PD with respect to ELD. In PD patients, like in ELD, fear-inducing music has a detrimental effect on visual-spatial learning performances, which are slower and decreased. Conclusion: These findings confirm an impairment in visual-spatial learning in PD and indicates that the emotional state influences this learning ability similarly to healthy controls

A New SteatoScore in the Evaluation of Non-Alcoholic Liver Disease in Oncologic Patients

PurposeThe aims of this study were to evaluate the reproducibility of a new multi-parametric steatoscore (new SteatoScore) in oncologic patients with non-alcoholic fatty liver disease (NAFLD) and to compare it with computed tomography (CT). Materials and MethodsFifty-one (31 men, 20 women) oncologic patients, with a mean age and weight of 63.9 years and 78.33 kg, respectively, were retrospectively enrolled in the study. Patients underwent ultrasound (US) and computed tomography (CT) examinations as part of their oncologic follow-up protocol. US examinations were performed by using a 3.5-MHz convex probe. During the US examination, three standardized clips were obtained in each patient. Two operators performed all measurements, one of whom repeated the processing twice in 1 year. Hepatic/renal ratio (HR), attenuation rate (AR), diaphragm visualization (DV), hepatic/portal vein ratio (HPV), and portal vein wall visualization (PVW) were acquired and calculated by using Matlab and inserted in a multi-parametric algorithm called new SteatoScore. On unenhanced CT scan, hepatic attenuation (HA), liver-spleen difference (L-S), and liver/spleen ratio (L/S) were measured by placement of a region of interest (ROI) within liver and spleen parenchyma, avoiding areas with vessels and biliary ducts. ResultsThe intra-observer variability was greater than the inter-observer one, with intraclass correlation coefficient (ICC) values of 0.94 and 0.97, respectively. Correlation between single US and CT parameters provided an agreement in no case exceeding 50%. New SteatoScore showed high reproducibility, and high coefficient of correlation with L-S (R = -0.64; p < 0.0001) and L/S (R = -0.62; p < 0.0001) at CT. ConclusionNew SteatoScore has a high reproducibility and shows a good correlation with unenhanced CT in evaluation of oncologic patients with NAFLD

The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study

Aims: To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. Methods: Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. Results: Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59–3.87), large for gestational age (OR 3.99, 95% CI 2.40–6.63), fetal malformation (OR 2.66, 95% CI 1.00–7.18), and respiratory distress (OR 4.33, 95% CI 1.33–14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00–2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04–3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02–2.27) and obesity (OR 1.62, 95% CI 1.04–2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21–2.33 for obese; OR 1.38 95% CI 1.03–1.87 for overweight). Conclusions: A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity

p 159analysis of early tumor shrinkage and depth of response in metastatic pancreatic cancer patients treated with first line modified folfirinox or gemcitabine nab paclitaxel

n/

Efeito dos dias em confinamento e sexo sobre o peso vivo e as características de carcaça, medidas por ultra-sonografia

Existem poucos dados na literatura sobre as alterações na composição corporal de bovinos Nelore e seus cruzamentos, especialmente em relação a novilhas (NOV) e machos inteiros (MI). A ultra-sonografia é uma ferramenta útil para obter essa informação de forma fácil, com mínimo distúrbio ao animal e a baixo custo. Efeitos do sexo e dias de confinamento sobre o peso vivo (PV) e a área do músculo Longissimus dorsi (AOLU) e a espessura de gordura subcutânea (EGSU) medidas por ultra-som, foram avaliadas em 27 novilhas e 27 machos inteiros, F1 Piemontês ;´; Nelore. NOV e MI com PV inicial de 256 ± 5,6 e 265 ± 5,6 kg, respectivamente, foram confinados com uma dieta contendo 77% de NDT, durante 131 dias. O PV, a AOLU e a EGSU foram avaliadas a cada 28 dias aproximadamente. Foi observada uma interação entre sexo e dias de confinamento para todas as características avaliadas. O PV aumentou linearmente com os dias de confinamento e MI apresentaram maior PV que as NOV desde o início do experimento. A AOLU média inicial foi 55,8 e 55,5 cm² nas NOV e MI, respectivamente, aumentando linearmente até o final do confinamento (78,7 e 82,8 cm², respectivamente). Em relação ao efeito do sexo, MI tiveram maior AOLU que NOV somente na última medida. A EGSU inicial foi 0,04 e 0,4 mm para MI e NOV, respectivamente e aumentaram linearmente durante e período de confinamento (2,4 e 4,3 mm, respectivamente). NOV tiveram maior EGSU desde o início até o final do período experimental. MI tiveram maiores taxas de crescimento do PV e AOLU que NOV, no entanto, estas tiveram maior taxa de crescimento da EGSU.There is a paucity of information in the literature on body composition changes in Nellore cattle and its crosses, mainly on heifers and intact males. Ultrasound is a useful, low cost tool to easily obtain this information, with minimal animal stress. Effects of sex and days on feed on live weight (LW) and ultrasound Longissimus muscle area (ULMA) and subcutaneous fat thickness (UFAT) measurements were evaluated in F1 Piedmont ;´; Nelore, 27 heifers (HF) and 27 intact males (IM). HF and IM had an initial LW of 256 ± 5.6 and 265 ± 5.6 kg, respectively, and were fed a diet containing 77% TDN for 131 days. LW, ULMA, and UFAT were evaluated at 28-d intervals. Interactions between sex and days on feed were found for all traits studied. LW increased linearly with days on feed, and IM had greater LW than HF throughout the trial. Mean initial ULMA was 55.8 and 55.5 cm² for HF and IM, respectively, and increased linearly until the end of the experiment (78.7 and 82.8 cm², respectively). IM showed higher ULMA than HF only in the last measurement. Initial UFAT averaged 0.04 and 0.4 mm for IM and HF, respectively, and increased linearly during the feeding period (2.4 and 4.3 mm, respectively). UFAT was higher n HF than in IM during the entire experimental period. IM showed faster growth rates and protein accretion than HF in the Longissimus muscle. HF showed faster subcutaneous fat accretion

Efeito dos dias em confinamento e sexo sobre o peso vivo e as características de carcaça, medidas por ultra-sonografia

Existem poucos dados na literatura sobre as alterações na composição corporal de bovinos Nelore e seus cruzamentos, especialmente em relação a novilhas (NOV) e machos inteiros (MI). A ultra-sonografia é uma ferramenta útil para obter essa informação de forma fácil, com mínimo distúrbio ao animal e a baixo custo. Efeitos do sexo e dias de confinamento sobre o peso vivo (PV) e a área do músculo Longissimus dorsi (AOLU) e a espessura de gordura subcutânea (EGSU) medidas por ultra-som, foram avaliadas em 27 novilhas e 27 machos inteiros, F1 Piemontês ;´; Nelore. NOV e MI com PV inicial de 256 ± 5,6 e 265 ± 5,6 kg, respectivamente, foram confinados com uma dieta contendo 77% de NDT, durante 131 dias. O PV, a AOLU e a EGSU foram avaliadas a cada 28 dias aproximadamente. Foi observada uma interação entre sexo e dias de confinamento para todas as características avaliadas. O PV aumentou linearmente com os dias de confinamento e MI apresentaram maior PV que as NOV desde o início do experimento. A AOLU média inicial foi 55,8 e 55,5 cm² nas NOV e MI, respectivamente, aumentando linearmente até o final do confinamento (78,7 e 82,8 cm², respectivamente). Em relação ao efeito do sexo, MI tiveram maior AOLU que NOV somente na última medida. A EGSU inicial foi 0,04 e 0,4 mm para MI e NOV, respectivamente e aumentaram linearmente durante e período de confinamento (2,4 e 4,3 mm, respectivamente). NOV tiveram maior EGSU desde o início até o final do período experimental. MI tiveram maiores taxas de crescimento do PV e AOLU que NOV, no entanto, estas tiveram maior taxa de crescimento da EGSU.There is a paucity of information in the literature on body composition changes in Nellore cattle and its crosses, mainly on heifers and intact males. Ultrasound is a useful, low cost tool to easily obtain this information, with minimal animal stress. Effects of sex and days on feed on live weight (LW) and ultrasound Longissimus muscle area (ULMA) and subcutaneous fat thickness (UFAT) measurements were evaluated in F1 Piedmont ;´; Nelore, 27 heifers (HF) and 27 intact males (IM). HF and IM had an initial LW of 256 ± 5.6 and 265 ± 5.6 kg, respectively, and were fed a diet containing 77% TDN for 131 days. LW, ULMA, and UFAT were evaluated at 28-d intervals. Interactions between sex and days on feed were found for all traits studied. LW increased linearly with days on feed, and IM had greater LW than HF throughout the trial. Mean initial ULMA was 55.8 and 55.5 cm² for HF and IM, respectively, and increased linearly until the end of the experiment (78.7 and 82.8 cm², respectively). IM showed higher ULMA than HF only in the last measurement. Initial UFAT averaged 0.04 and 0.4 mm for IM and HF, respectively, and increased linearly during the feeding period (2.4 and 4.3 mm, respectively). UFAT was higher n HF than in IM during the entire experimental period. IM showed faster growth rates and protein accretion than HF in the Longissimus muscle. HF showed faster subcutaneous fat accretion

Efeito dos dias em confinamento e sexo sobre o peso vivo e as características de carcaça, medidas por ultra-sonografia

Existem poucos dados na literatura sobre as alterações na composição corporal de bovinos Nelore e seus cruzamentos, especialmente em relação a novilhas (NOV) e machos inteiros (MI). A ultra-sonografia é uma ferramenta útil para obter essa informação de forma fácil, com mínimo distúrbio ao animal e a baixo custo. Efeitos do sexo e dias de confinamento sobre o peso vivo (PV) e a área do músculo Longissimus dorsi (AOLU) e a espessura de gordura subcutânea (EGSU) medidas por ultra-som, foram avaliadas em 27 novilhas e 27 machos inteiros, F1 Piemontês ;´; Nelore. NOV e MI com PV inicial de 256 ± 5,6 e 265 ± 5,6 kg, respectivamente, foram confinados com uma dieta contendo 77% de NDT, durante 131 dias. O PV, a AOLU e a EGSU foram avaliadas a cada 28 dias aproximadamente. Foi observada uma interação entre sexo e dias de confinamento para todas as características avaliadas. O PV aumentou linearmente com os dias de confinamento e MI apresentaram maior PV que as NOV desde o início do experimento. A AOLU média inicial foi 55,8 e 55,5 cm² nas NOV e MI, respectivamente, aumentando linearmente até o final do confinamento (78,7 e 82,8 cm², respectivamente). Em relação ao efeito do sexo, MI tiveram maior AOLU que NOV somente na última medida. A EGSU inicial foi 0,04 e 0,4 mm para MI e NOV, respectivamente e aumentaram linearmente durante e período de confinamento (2,4 e 4,3 mm, respectivamente). NOV tiveram maior EGSU desde o início até o final do período experimental. MI tiveram maiores taxas de crescimento do PV e AOLU que NOV, no entanto, estas tiveram maior taxa de crescimento da EGSU.There is a paucity of information in the literature on body composition changes in Nellore cattle and its crosses, mainly on heifers and intact males. Ultrasound is a useful, low cost tool to easily obtain this information, with minimal animal stress. Effects of sex and days on feed on live weight (LW) and ultrasound Longissimus muscle area (ULMA) and subcutaneous fat thickness (UFAT) measurements were evaluated in F1 Piedmont ;´; Nelore, 27 heifers (HF) and 27 intact males (IM). HF and IM had an initial LW of 256 ± 5.6 and 265 ± 5.6 kg, respectively, and were fed a diet containing 77% TDN for 131 days. LW, ULMA, and UFAT were evaluated at 28-d intervals. Interactions between sex and days on feed were found for all traits studied. LW increased linearly with days on feed, and IM had greater LW than HF throughout the trial. Mean initial ULMA was 55.8 and 55.5 cm² for HF and IM, respectively, and increased linearly until the end of the experiment (78.7 and 82.8 cm², respectively). IM showed higher ULMA than HF only in the last measurement. Initial UFAT averaged 0.04 and 0.4 mm for IM and HF, respectively, and increased linearly during the feeding period (2.4 and 4.3 mm, respectively). UFAT was higher n HF than in IM during the entire experimental period. IM showed faster growth rates and protein accretion than HF in the Longissimus muscle. HF showed faster subcutaneous fat accretion