Cholangiographic Features in the Diagnosis and Management of Obstructive Icteric Type Hepatocellular Carcinoma

In 11 years and 3 months, 2037 patients with HCC were seen and 48 patients (2.4%) were diagnosed to have obstructive icteric type HCC. Five patients were terminally ill and were not investigated further. Forty three patients were initially investigated by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiogram (PTC) and classified as having obstructive icteric type 1, 2, or 3 HCC based on the cholangiographic findings. The obstruction in type 1 HCC was due to intraluminal tumour casts and/or tumour fragments obstructing the hepatic ductal confluence or common bile duct, while intraluminal blood clots, from haemobilia, filling the biliary tree was the cause in type 2 HCC. The pathology in type 3 HCC was extraluminal obstruction by extensive tumour encasement of the intra–hepatic biliary ductal system and/or extrinsic compression of the hepatic and common bile ducts by tumour(s) and/or malignant lymph nodes. At the initial ERC/PTC, 10 patients (5 resected, 50%) had obstructive icteric type 1 and 23 patients (0 resected) had obstructive icteric type 3 HCC. Of the 10 patients initially classified according to cholangiography to have obstructive icteric type 2 HCC, subsequent investigations revealed that 6 patients had type 1 HCC (4 resectable, 67%) and 4 patients had type 3 HCC (0 resectable). The classification of the obstructive icteric type HCC into types 1, 2, and 3, based on the initial cholangiographic appearances has simplified and rationalized our management strategy for this condition

Left ventricular function after valve repair for chronic mitral regurgitation: Predictive value of preoperative assessment of contractile reserve by exercise echocardiography

Objectives.We evaluated the value of preoperative assessment of left ventricular contractile reserve in predicting ventricular function after valve repair for minimally symptomatic mitral regurgitation.Background.The optimal timing for operation in minimally symptomatic patients with significant mitral regurgitation is controversial. Accurate preoperative assessment of left ventricular function is difficult, and the ability to predict postoperative function is limited. Previous studies in patients undergoing mitral valve replacement may not be applicable in the present era of valve repair.Methods.We performed exercise echocardiography in 139 patients with isolated mitral regurgitation and no coronary disease, 74 of whom subsequently underwent uncomplicated valve repair. We measured rest left ventricular end-systolic dimension, end-systolic wall stress and positive first derivative of left ventricular pressure (dP/dt). End-diastolic and end-systolic volumes and ejection fraction were measured preoperatively at rest, immediately after exercise and postoperatively.Results.Ejection fraction decreased postoperatively to 55 ± 10% from a rest preoperative value of 64 ± 9% (p < 0.001). Compared with patients with a postoperative ejection fraction ≥50% (n = 56), patients with postoperative ejection fraction <50% (n = 18) had a significantly lower preoperative exercise ejection fraction (57 ± 11% vs. 73 ± 9%, p < 0.0005), a larger exercise end-systolic volume index (32 ± 8 vs. 18 ± 7 cm3/m2, p < 0.0005) and a lower change in ejection fraction with exercise (−4 ± 8% vs. 9 ± 10%, p < 0.005). Preoperative rest indexes, including dP/dt, end-systolic wall stress and end-systolic volume index were less predictive, whereas exercise capacity, rest ejection fraction and end-systolic dimension were not predictive of postrepair ejection fraction. An exercise end-systolic volume index >25 cm3/m2 was the best predictor of postoperative dysfunction, with a sensitivity and specificity of 83%.Conclusions.In minimally symptomatic patients with mitral regurgitation, latent ventricular dysfunction may be indicated by a limited contractile reserve, manifest at exercise as an inadequate increase in ejection fraction and a larger end-systolic volume. These variables may also be used to predict left ventricular function after repair

Bitter Melon (Momordica charantia) Extract Inhibits Tumorigenicity and Overcomes Cisplatin-Resistance in Ovarian Cancer Cells Through Targeting AMPK Signaling Cascade

OBJECTIVE: Acquired chemoresistance is a major obstacle in the clinical management of ovarian cancer. Therefore, searching for alternative therapeutic modalities is urgently needed. Bitter melon (Momordica charantia) is a traditional dietary fruit, but its extract also shows potential medicinal values in human diabetes and cancers. Here, we sought to investigate the extract of bitter melon (BME) in antitumorigenic and cisplatin-induced cytotoxicity in ovarian cancer cells. METHODS: Three varieties of bitter melon were used to prepare the BME. Ovarian cancer cell lines, human immortalized epithelial ovarian cells (HOSEs), and nude mice were used to evaluate the cell cytotoxicity, cisplatin resistance, and tumor inhibitory effect of BME. The molecular mechanism of BME was examined by Western blotting. RESULTS: Cotreatment with BME and cisplatin markedly attenuated tumor growth in vitro and in vivo in a mouse xenograft model, whereas there was no observable toxicity in HOSEs or in nude mice in vivo. Interestingly, the antitumorigenic effects of BME varied with different varieties of bitter melon, suggesting that the amount of antitumorigenic substances may vary. Studies of the molecular mechanism demonstrated that BME activates AMP-activated protein kinase (AMPK) in an AMP-independent but CaMKK (Ca2+/calmodulin-dependent protein kinase)-dependent manner, exerting anticancer effects through activation of AMPK and suppression of the mTOR/p70S6K and/or the AKT/ERK/FOXM1 (Forkhead Box M1) signaling cascade. CONCLUSION: BME functions as a natural AMPK activator in the inhibition of ovarian cancer cell growth and might be useful as a supplement to improve the efficacy of cisplatin-based chemotherapy in ovarian cancer.published_or_final_versio

A numerical study of multi-soliton configurations in a doped antiferromagnetic Mott insulator

We evaluate from first principles the self-consistent Hartree-Fock energies for multi-soliton configurations in a doped, spin-1/2, antiferromagnetic Mott insulator on a two-dimensional square lattice. We find that nearest-neighbor Coulomb repulsion stabilizes a regime of charged meron-antimeron vortex soliton pairs over a region of doping from 0.05 to 0.4 holes per site for intermediate coupling 3 < U/t <8. This stabilization is mediated through the generation of ``spin-flux'' in the mean-field antiferromagnetic (AFM) background. Holes cloaked by a meron-vortex in the spin-flux AFM background are charged bosons. Our static Hartree-Fock calculations provide an upper bound on the energy of a finite density of charged vortices. This upper bound is lower than the energy of the corresponding charged stripe configurations. A finite density of charge carrying vortices is shown to produce a large number of unoccupied electronic levels in the Mott-Hubbard charge transfer gap. These levels lead to significant band tailing and a broad mid-infrared band in the optical absorption spectrum as observed experimentally. At very low doping (below 0.05) the doping charges create extremely tightly bound meron-antimeron pairs or even isolated conventional spin-polarons, whereas for very high doping (above 0.4) the spin background itself becomes unstable to formation of a conventional Fermi liquid and the spin-flux mean-field is energetically unfavorable. Our results point to the predominance of a quantum liquid of charged, bosonic, vortex solitons at intermediate coupling and intermediate doping concentrations.Comment: 12 pages, 25 figures; added references, modified/eliminated some figure

On the Incommensurate Phase of Pure and Doped Spin-Peierls System CuGeO_3

Phases and phase transitions in pure and doped spin-Peierls system CuGeO_3 are considered on the basis of a Landau-theory. In particular we discuss the critical behaviour, the soliton width and the low temperature specific heat of the incommensurate phase. We show, that dilution leads always to the destruction of long range order in this phase, which is replaced by an algebraic decay of correlations if the disorder is weak.Comment: 4 pages revtex, no figure

Boundary work: An interpretive ethnographic perspective on negotiating and leveraging cross-cultural identity

The complexity of global organizations highlights the importance of members’ ability to span diverse boundaries that may be defined by organization structures, national borders, and/or a variety of cultures associated with organization, nation-based societal and work cultures, industries, and/or professions. Based on ethnographic research in a Japan–US binational firm, the paper describes and analyzes the boundary role performance of the firm\u27s Japanese members. It contributes toward theory on boundary spanning by introducing a “cultural identity negotiation” conceptual framework. We show boundary spanning as a process shaped through the interplay of the contextual issues that make a boundary problematic; an individual\u27s multiple repertoires of cultural knowledge; and the individual boundary spanner\u27s “negotiation”, through interaction with others, of his/her cultural identities – the sense of “who I am” as a cultural being that is fundamental to an individual\u27s self-concept. At the same time, we make transparent the epistemological and methodological foundations of an interpretive ethnographic approach, demonstrating its value for understanding complex organizational processes. Research findings have practical implications for the selection and training of an organization\u27s employees, particularly of persons who may be considered “bicultural”

Similar expression to FGF (Sef) inhibits fibroblast growth factor-induced tumourigenic behaviour in prostate cancer cells and is downregulated in aggressive clinical disease.

BACKGROUND: The fibroblast growth factor (FGF) axis is an important mitogenic stimulus in prostate carcinogenesis. We have previously reported that transcript level of human similar expression to FGF (hSef), a key regulator of this pathway, is downregulated in clinical prostate cancer. In this study we further analysed the role of hSef in prostate cancer. METHODS: hSef function was studied in in vitro and in vivo prostate cancer models using stable over-expression clones. Protein expression of hSef was studied in a comprehensive tissue microarray. RESULTS: Stable over-expression of hSef resulted in reduced in vitro cancer cell proliferation, migration and invasive potential. In an in vivo xenograft model, the expression of hSef significantly retarded prostate tumour growth as compared with empty vector (P=0.03) and non-transfected (P=0.0001) controls. Histological examination further showed a less invasive tumour phenotype and reduced numbers of proliferating cells (P=0.0002). In signalling studies, hSef inhibited FGF-induced ERK phosphorylation, migration to the nucleus and activation of a reporter gene. Constitutively active Ras, however, was able to reverse these effects, suggesting that hSef exerts an effect either above or at the level of Ras in prostate cancer cells. In a large tissue microarray, we observed a significant loss of hSef protein in high-grade (P<0.0001) and metastatic (P<0.0001) prostate cancer. CONCLUSIONS: Considered together, the role of hSef in attenuating FGF signalling and evidence of downregulation in advanced tumours argue strongly for a tumour suppressor function in human prostate cancer