Cooperative role of thrombopoietin and vascular endothelial growth factor-a in the progression of liver cirrhosis to hepatocellular carcinoma

Primary thrombopoietic mediator thrombopoietin (THPO) is mainly produced by the liver; it may act as a growth factor for hepatic progenitors. Principal angiogenesis inducer vascular endothelial growth factor-A (VEGF-A) is critical for the complex vascular network within the liver architecture. As a cross-regulatory loop between THPO and VEGF-A has been demonstrated in the hematopoietic system, the two growth factors were hypothesized to cooperatively contribute to the progression from liver cirrhosis (LC) to hepatocellular carcinoma (HCC). The mRNA and protein expression levels of THPO, VEGF-A, and their receptors were examined, compared, and correlated in paired cancerous and LC tissues from 26 cirrhosis-related HCC patients, using qRT-PCR and immunohistochemistry. THPO and VEGF-A were alternatively silenced by small interfering RNA (siRNA) in human liver cancer cell lines Huh7 and HepG2. THPO and VEGF-A expressions significantly increased in tumor versus LC tissues. HCC and paired LC cells expressed similar levels of THPO receptor (R), whereas vascular endothelial growth factor receptor (VEGFR) -1 and VEGFR-2 levels were higher in HCC than in corresponding LC tissue samples. A significant linear correlation emerged between THPO and VEGF-A transcripts in HCC and, at the protein level, THPO and THPOR were significantly correlated with VEGF-A in tumor tissues. Both HCC and LC expressed similar levels of gene and protein hypoxia inducible factor (HIF)-1α. Positive cross-regulation occurred with the alternative administration of siRNAs targeting THPO and those targeting VEGF-A in hypoxic liver cancer cell lines. These results suggest THPO and VEGF-A might act as interdependently regulated autocrine and/or paracrine systems for cellular growth in HCC. This might be clinically interesting, since new classes of THPOR agonistic/antagonistic drugs may provide novel therapeutic options to correct the frequent hemostatic abnormality seen in HCC patients

Notas sobre moscas necrófagas (Diptera: Caliptratae) associadas a carcaças de peixe na Amazônia Colombiana

In recent years, there has been an increasing number of studies on carrion fly communities due to their medical importance and as a consequence of the large number of studies on forensic entomology. Surprisingly few studies have adressed with the asynantropic flies of the Amazon, and none were done in Colombia. A faunistic study of asynantropic flies of the families Calliphoridae, Sarcophagidae, Muscidae and Fannidae in three different landscapes of the Colombian Amazon is presented, trapping effectiveness is assessed, and the first record of Mesembrinella batesi (Aldrich, 1922) and Fannia femoralis (Stein, 1897) from Colombia is reported.Apesar de existir uma quantidade considerável de estudos sobre dípteros decompositores devido a sua importância medica e ao avanço da entomologia forense, poucos dizem respeito as moscas asinantrópicas na Amazônia e nada foi feito na Colômbia. No presente trabalho é feito um estudo faunístico sobre moscas, principalmente das famílias Calliphoridae, Sarcophagidae, Muscidae e Fanniidae em três diferentes paisagens da Amazônia Colombiana, além do primeiro registro das espécies Mesembrinella batesi (Aldrich, 1922) e Fannia femoralis (Stein, 1897) para Colômbia e avaliação da amostragem utilizada

Liver transplantation for symptomatic centrohepatic biliary cystadenoma

Biliary cystadenoma is a rare benign cystic tumor of the liver. The mainstay of treatment is complete resection, either by enucleation or by formal hepatectomy, since incomplete removal entails not only constant recurrence but also the risk of malignant transformation to cystadenocarcinoma. A case of symptomatic centrohepatic biliary cystadenoma involving the main vasculobiliary structures of the liver is reported. After an unsuccessful attempt at resection resulting in an intrahepatic biliary injury, relief of jaundice and radical excision were achieved by total hepatectomy and liver transplantation. The patient is now alive and well 4 years after transplant, disease-free, with normal liver and renal function while receiving everolimus monotherapy. This is the first report of liver transplantation performed for the treatment of this tumor. With the case on the background, diagnostic aspects and available therapeutic strategies for biliary cystadenoma are reviewed and discussed. © 2011

Posthepatectomy liver failure after simultaneous versus staged resection of colorectal cancer and synchronous hepatic metastases

BACKGROUND: Posthepatectomy liver failure (PHLF) is the third most frequent complication and the major cause of postoperative mortality after resection of colorectal cancer liver metastases (CRLM). In case of synchronous resectable CRLM, it is still unclear if surgical strategy (simultaneous versus staged resection of colorectal cancer and hepatic metastases) influences the incidence and severity of PHLF. The aim of this study was to evaluate the impact of surgical strategy on PHLF and on the early and long-term outcome. PATIENTS AND METHODS: Retrospective study on 106 consecutive patients undergoing hepatectomy for synchronous CRLM between 1997 and 2012. RESULTS: Of 106 patients, 46 underwent simultaneous resection and 60 had staged hepatectomy. The rate of PHLF was similar between groups (16.7% vs 15.2%; p=1) and subgroup analysis restricted to patients undergoing major hepatectomy confirmed this observation (31.8% vs 23.8%; p=0.56). Propensity-score analysis showed that pre-operative total bilirubin level and the amount of intra-operative blood transfusion were independently associated with an increased risk of PHLF. Nevertheless, the risk of severe PHLF (grade B – C) was increased in patients who underwent simultaneous resection and major hepatectomy (OR: 4.82; p=0.035). No significant differences were observed in severe (Dindo – Clavien 3 – 4) postoperative morbidity (23.9% vs 20.0%; p=0.64) and survival (3 and 5-year survival: 55% and 34% vs 56% and 33%; p=0.83). CONCLUSIONS: The risk of PHLF is not associated with surgical strategy in the treatment of synchronous CRLM. Nevertheless, the risk of severe PHLF is increased in patients undergoing simultaneous resection and major hepatectomy

Le malattie professionali da radiazioni ottiche artificiali (ROA)

Introduzione: Con l\u2019entrata in vigore delle disposizioni di cui al Capo V del Titolo VIII del D.Lgs. 81/08 viene ad essere garantita dal legislatore la piena tutela della sicurezza e della salute dei lavoratori esposti a radiazioni ottiche artificiali (ROA). Obiettivi e metodi: Gli autori prendono in esame, sulla base dei dati della letteratura sull\u2019argomento, gli effetti sulla salute conseguenti all\u2019esposizione occupazionale a ROA. Risultati: Le patologie croniche correlate con esposizione a ROA nel range dello spettro fra 220 e 310 nm (UV) sono rappresentate da congiuntiviti e cheratocongiuntiviti croniche. Le patologie oncologiche della cute correlabili con l\u2019esposizione a RUV sono rappresentate dai carcinomi cutanei basocellulari e spinocellulari e dai melanomi cutanei. L\u2019effetto biologico delle radiazioni ottiche infrarosse (lunghezza d\u2019onda compresa fra 780 nm e 1 mm) \ue8 essenzialmente di natura termica. L\u2019esposizione a luce blu (lunghezza d\u2019onda compresa fra 380 e 550 nm) causa danni esclusivamente retinici ed \ue8 considerata responsabile dello sviluppo di quadri di Degenerazione Maculare Senile (AMD). Pur in presenza di dati sperimentali di laboratorio, non esistono tuttavia al momento dati epidemiologici che documentino i danni retinici da luce blu. Conclusioni: Nello studio vengono illustrati i criteri medico-legali per lo studio del nesso di causalit\ue0 fra esposizione professionale a ROA e danno, nonch\ue9 la metodologia e i momenti procedurali necessari per l\u2019iter valutativo. Vengono quindi presi in esame gli elenchi delle malattie professionali attribuite all\u2019esposizione a ROA presenti nel DM9 aprile 2008 e nel DM13 dicembre 2009. Infine gli autori propongono, sulla base di Linee Guida e dati della letteratura scientifica sull\u2019argomento, protocolli di sorveglianza sanitaria per la tutela della salute dei lavoratori esposti al rischio specifico.\uabOccupational diseases caused by artificial optical radiations (AOR)\ubb. Background: Italian national legislation guarantees safety and health for workers exposed to Artificial Optical Radiations (AOR) by Legislative Decree 81/2008. Objectives and methods: Effects and damages to health resulting from AOR exposure were analyzed from literature data. Results: Ultraviolet Radiations (UV), particularly those in the wavelength range between 220 and 310 nm, causes chronic conjunctivitis and kerato-conjunctivitis. Skin cancer caused by UV exposure included Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma. As regards Infrared Radiations (portion of the spectrum between 780 nm and 1 mm), the biological effect is essentially of thermal nature. Exposure to Blue Light (portion of the spectrum of visible light radiation in a wavelength range between 380 and 550 nm) causes exclusively retinal damage and is considered to be responsible for the development of situations of Age-relatedMacular Degeneration (AMD). Even if experimental data are available, at the present time there is still no epidemiological evidence of retinal damage caused by blue light. Conclusions: The forensic criteria for investigating the causality link between occupational exposure to AOR and damage, and the methodology necessary for the assessment process, are reported.Two lists of occupational diseases which were included in the ItalianMinisterial Decrees, issued respectively on April 2008 and 11 December 2009, are also considered. Lastly, on the basis of the current existing guidelines and scientific evidence, the authors propose occupational health surveillance protocols for workers exposed to AOR risk