Sorafenib Prevents Escape from Host Immunity in Liver Cirrhosis Patients with Advanced Hepatocellular Carcinoma

Purpose. It has been reported that Th2 cytokines downregulate antitumor immunity, while activation of type T cells promotes antitumor immunity. The aim of this paper was to evaluate host immunity in liver cirrhosis (LC) patients with advanced hepatocellular carcinoma (aHCC) receiving sorafenib therapy. Methods. Forty-five adult Japanese LC patients received sorafenib for aHCC between 2009 and 2011 at our hospital. Sorafenib was administered at a dose of 200–800 mg/day for 4 weeks. Blood samples were collected before and after treatment. Results. Eleven patients were treated with sorafenib at 200 mg/day (200 group), 27 patients received sorafenib at 400 mg/day (400 group), and 7 patients were given sorafenib at 800 mg/day (800 group). There was no significant change in the percentage of Th1 cells after treatment in any group. However, the percentages of Th2 cells and regulatory T cells were significantly decreased after treatment in the 400 group and 800 group compared with before treatment, although there was no significant change after treatment in the 200 group. Conclusions. These results indicate that treatment with sorafenib might induce Th1 dominance and prevent the escape of tumor cells from the host immune system in LC patients with aHCC

Exploring the Potential of Pennebaker’s Writing Paradigm on Betrayal Trauma Sequelae

In Pennebaker's writing paradigm, participants are instructed either to write about emotional events or neutral topics. Those assigned to the emotional writing condition typically display physical and psychological health improvements as compared to those who write about something neutral (Pennebaker, 1997; Smyth, 1998). Up until now, the writing paradigm has for the most part been applied to events which have been described as emotional but not specifically traumatic and those few studies that have looked at the effect of writing about traumatic experiences have only involved one-time non-complex traumas. There is evidence that the consequences of one-time traumas are different than those of continuous, complex traumas, such as child abuse. Furthermore, betrayal trauma theory (Freyd, 1996, 2001) distinguishes traumas on the basis of two event dimensions which may elicit different reactions: life-threat (e.g. major car accident; violent rape by a stranger) and social betrayal (e.g. abuse by a close other). Betrayal trauma is perpetrated by someone who is close to the victim and/or upon whom the victim is dependent. Such events are associated with unawareness and impaired memory for the trauma, presumably for the purpose of preserving the victim-perpetrator relationship. Exposure to betrayal trauma has been associated with various negative sequelae. The primary objective of this study was to investigate the generalizability of Pennebaker's Paradigm to betrayal trauma. A secondary goal of the study was to help elucidate the mechanism behind this phenomenon by analyzing the content of the essays using Pennebaker's Linguistic Inquiry and Word Count (LIWC; Pennebaker, Francis & Booth, 2001), and rating the essays in terms of characteristics hypothesized to play important roles in the effect of writing, such as coherence, presence of emotion words, narrative point of view, and development over time. Sixty-five physically symptomatic university undergraduates (51 female, 14 male; mean age = 19.94 years, SD = 3.86) were randomly assigned to one of two writing conditions. Participants in the traumatic condition were asked to write about a distressing interpersonal event they experienced during childhood and those in the neutral condition were asked to write about how they spent their time during the previous day. They wrote about their assigned topic twice, one week apart. All participants were administered abuse inventories, and pre and posttest physical and psychological health questionnaires. Over 50% of all participants reported having experienced at least one betrayal trauma and women reported more betrayal trauma than men. Betrayal trauma and health measures were found to be negatively related. A significant gender by writing condition interaction emerged, which revealed that, in general, women in the trauma writing condition benefited more than men. Closer examination of the content and structure of the essays revealed interesting patterns between certain writing components and outcome measures. These findings suggest that it would be fruitful to consider the type of trauma experienced by a person when determining the best intervention. In addition, directing the writing process to include those components found to be related to outcomes may enhance the effectiveness of a writing intervention. This needs to be tested in a controlled experimental trial. Future research is also recommended to replicate these findings in a larger and less homogenous population.This study was made possible in part by the funding from the University of Oregon Foundation Fund for Research on Trauma and Oppression (PI, J. Freyd), University of Oregon Graduate Education Committee