Third-Generation Capsule Endoscopy Outperforms Second-Generation Based on the Detectability of Esophageal Varices

Background and Aim. The third-generation capsule endoscopy (SB3) was shown to have better image resolution than that of SB2. The aim of this study was to compare SB2 and SB3 regarding detectability of esophageal varices (EVs). Methods. Seventy-six consecutive liver cirrhosis patients (42 men; mean age: 67 years) received SB3, and 99 (58 men; mean age, 67 years old) received SB2. All patients underwent esophagogastroduodenoscopy within 1 month prior to capsule endoscopy as gold standard for diagnosis. The diagnosis using SB3 and SB2 for EVs was evaluated regarding form (F0–F3), location (Ls, Lm, and Li), and the red color (RC) sign of EVs. Results. SB2 and SB3 did not significantly differ on overall diagnostic rates for EV. Sensitivity, specificity, positive predictive value, and negative predictive value of SB2/SB3 for EV diagnosis were, respectively, 65%/81%, 100%/100%, 100%/100%, and 70%/62%. However, the diagnostic rates for EV form F1 were 81% using SB3 and 52% using SB2 (P=0.009). Further, the diagnostic rates for Ls/Lm varices were 79% using SB3 and 81% using SB2, and, for Li, varices were 84% using SB3 and 52% using SB2 (P=0.02). Conclusion. SB3 significantly improved the detectability of EVs compared with SB2

Assessment of Outcome of Hepatic Arterial Infusion Chemotherapy in Patients with Advanced Hepatocellular Carcinoma by the Combination of RECIST and Tumor Markers

To assess the outcome of stable disease (SD) patients with advanced hepatocellular carcinoma (HCC) by tumor markers after the first course of hepatic arterial infusion chemotherapy (HAIC). The study subjects were 156 HCC patients treated with HAIC and classified as Child Pugh A, with no extrahepatic metastasis, and no history of sorafenib treatment. In the study and validation cohorts, the AFP and DCP ratios of patients who were considered SD to the first course of HAIC were analyzed by AUROC for a prediction of response to the second course of HAIC. The imaging response to the first course of HAIC was classified as partial response (PR), SD and progressive disease (PD) in 29 (18.8%), 80 (51.9%), and 44 (28.6%) patients respectively. For SD patients, the α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) ratios of patients who were considered SD to the first course of HAIC were analyzed by the receiver operating characteristic curve for prediction of response to the second course of HAIC in the study cohorts. The area under the curve of AFP ratio was 0.743. The area under the curve of DCP ratio was 0.695. The cut-off values of AFP and DCP ratios were 1.3 and 1.0, respectively. In the validation cohort, the accuracy of the prediction of response in this validation cohort (71.4%) showed no significant difference compared to that in the study cohort (72.4%) (p = 1.0). The results suggested that patients with a high tumor marker ratio could be switched to alternative therapeutic regimens despite the SD response to HAIC

The study patient flow diagram.

Labor analgesia (LA) is associated with the potential hazard of high-risk delivery, such as cesarean section (CS) and instrumental vaginal delivery (IVD), and adverse neonatal outcomes such as neonatal asphyxia and respiratory distress. The objective was to examine the impact of LA on mode of delivery and neonatal outcomes and to counsel pregnant women about a potentially higher risk and allow them to decide LA or non-LA. This retrospective cohort study containing 5,184 pregnant women analyzed the association between LA and both mode of delivery and neonatal outcomes. LA increased the risk of IVD (Adjusted Odds Ratio [AOR] 3.25, 95% confidence interval [95%CI] 2.51–4.20) but decreased that of CS (AOR 0.52, 95%CI 0.44–0.60). Two factors (advanced maternal age [AOR 1.70, 95%CI 1.33–2.17] and primipara [AOR 4.72, 95%CI 3.30–6.75]) increased the risk of IVD. We should carefully consider the indication of LA for cases with these two factors since LA can increase the risk of IVD and adverse neonatal outcomes.</div

STROBE statement—checklist of items that should be included in reports of observational studies.

STROBE statement—checklist of items that should be included in reports of observational studies.</p

The risk of labor analgesia against instrumental vaginal delivery and emergency cesarean section, and adverse neonatal outcomes at obstetrics inpatients.

The risk of labor analgesia against instrumental vaginal delivery and emergency cesarean section, and adverse neonatal outcomes at obstetrics inpatients.</p

Patients characteristics and association between labor analgesia group and Non-labor analgesia group at obstetrics inpatients.

Patients characteristics and association between labor analgesia group and Non-labor analgesia group at obstetrics inpatients.</p

Association among mode of delivery at obstetrics inpatients.

Association among mode of delivery at obstetrics inpatients.</p

A First Case of Hepatic Angiosarcoma Treated with Recombinant Interleukin-2

A 60 year-old woman was admitted to our hospital because of management of multiple liver tumors. According to image findings and liver biopsy, she was diagnosed as having epithelioid hemangioendothelioma of the liver accompanied by metastases in the spleen, lungs and bones. Based on the spread of the liver tumors and the extensive systemic metastases, she was considered inoperable. Instead, she received hepatic arterial infusion therapy using recombinant interleukin-2. However, she died due to liver failure about two months after admission. Autopsy revealed that the liver tumor was angiosarcoma. It is difficult to differentiate angiosarcoma from epithelioid hemangioendothelioma based on the image findings and pathological findings of percutaneous liver biopsy. Many cases are diagnosed as angiosarcoma at autopsy. There is no established effective treatment for hepatic angiosarcoma, because the tumor stage at the time of diagnosis is often progressive. To date, immunotherapy with recombinant interleukin-2 has been reported to be effective clinically for cutaneous angiosarcoma, such as of the scalp and facial skin. To our knowledge, there have been no reported cases of hepatic angiosarcoma treated with recombinant interleukin-2. Our case is important should recombinant interleukin-2 be considered effective for hepatic angiosarcoma in the future