Arterial chemoembolization for patients with hepatocellular carcinoma and elevated lactate dehydrogenase is associated with low survival: a cohort study.

PURPOSE: Serum lactate dehydrogenase (LDH) concentration has been used for the evaluation and prediction of prognosis of several tumors, including hepatocellular carcinoma (HCC). However, the relationship between changes in LDH after treatment (ΔLDH) and prognosis is still unclear. Herein, we aimed to determine this association in patients with HCC. METHODS: Multivariate adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for HCC were obtained by Cox proportional hazard regression models. As for ΔLDH and overall survival (OS), the nonlinear relationship was evaluated through a restricted cubic spline regression analysis, and threshold effects were further calculated using a two-piece-wise Cox proportional hazard model. RESULTS: The study finally selected 749 patients with HCC treated by transarterial chemoembolization (TACE) for the secondary analysis. Considering the ΔLDH within ± 80 U/L group as the baseline, the risk of death in the ΔLDH ≥ 80 U/L group was significantly increased by 131% (95% CI: 1.74-3.06), and the risk of death in the ΔLDH ≤- 80 U/L group was increased by 24% (HR: 1.23, 95% CI: 0.99-1.55). However, this difference was not statistically significant. Furthermore, with ΔLDH = 0 (100 U/L) as the turning point, an upward U-shaped curve could be formed between ΔLDH and OS. After adjusting for confounders, ΔLDH still had a significant effect on the threshold of OS (P = 0.021). CONCLUSION: After TACE, with the increase of LDH index, HCC patients will be closely related to worse OS.

Insulin-related lipohypertrophy: ultrasound characteristics, risk factors, and impact of glucose fluctuations.

BACKGROUND: Lipohypertrophy (LHT) has been suggested as an outcome of the adipogenic effects of insulin injection-related tissue trauma. It commonly occurs in the clinical setting, but the current understanding of LHT by the medical staff and diabetes patients remains insufficient; moreover, it has not garnered attention as a research topic. OBJECTIVE: To investigate the ultrasound characterization of LHT, to identify the factors associated with LHT development by assessing the prevalence of LHT and compare the accuracy of clinical palpation with that of ultrasonography in LHT detection, and to further evaluate the possible impact of LHT on patients' blood glucose fluctuations. METHOD: A cross-sectional study was conducted in 120 patients with type 2 diabetes. Patients' general information were obtained using a questionnaire, and the patients were evaluated for LHT by ultrasonography and clinical palpation of the abdomen. The patients were instructed to inject equal amounts of insulin in tissues with LHT and in normal adipose tissues (NATs) in two non-consecutive d in a selected week; the possible effect of LHT on patients' blood glucose fluctuations was assessed using a continuous glucose monitoring system. RESULTS: LHT has characteristic ultrasonic signs. We found a high rate of missed LHT detection on clinical palpation compared with that on ultrasonography (P < 0.05). The duration of insulin treatment, rotation of injection sites, frequency of needle reuse, and number of insulin injections per day were the primary factors influencing the development of LHT (P < 0.05). Compared with NATs, LHT tissues showed extremely elevated amplitude of glycemic excursion, mean blood glucose levels, standard deviation of blood glucose levels and postprandial glucose excursion, and large fluctuations in blood glucose levels (P < 0.05). CONCLUSION: Ultrasonography can more accurately detect LHT than can clinical palpation. LHT development is associated with several factors and can lead to significant fluctuations in blood glucose levels; thus, sufficient attention should be paid to investigating the underlying mechanism of LHT.

A Five-gene Signature for Predicting the Prognosis of Colorectal Cancer.

BACKGROUND: Colorectal cancer (CRC) is a kind of tumor with high incidence and its treatment situation is still very difficult despite the constant renewal and development of treatment methods. OBJECTIVE: To assist the prognosis, monitoring and survival of CRC patients with a model. METHODS: In this study, we established a new prognostic model for CRC. Four groups of CRC data were accessed from the GEO database, and then differential analysis (logFoldChange>1, adjust- P<0.05) was carried out by using the limma package along with the RobustRankAggreg package used to identify the overlapping differentially expressed genes (DEGs). Univariate and multivariate Cox regression analyses were performed on the DEGs to screen the genes related to the patient's prognosis, and a five-gene prognostic prediction model (including RPX, CXCL13, MMP10, FABP4 and CLDN23) was constructed. Then, we further plotted ROC curves to evaluate the predictive performance of the five-gene prognostic signature in the TCGA data sets (the AUC values of 1, 3, 5-year survival were 0.68, 0.632, 0.675, respectively) and an external independent data set GSE2962 (the AUC values of 1, 3, 5-year survival were 0.689, 0.702, 0.631, respectively). RESULTS: The results showed that the model could effectively predict the prognosis of CRC patients, which provides a robust predictive model for the prognosis of CRC patients. CONCLUSION: The model could effectively predict the prognosis of CRC patients, which provides a robust predictive model for the prognosis of CRC patients.

Prediction of posthepatectomy liver failure using transient elastography in patients with hepatitis B related hepatocellular carcinoma.

BACKGROUND: It is essential to accurately predict Postoperative liver failure (PHLF) which is a life-threatening complication. Liver hardness measurement (LSM) is widely used in non-invasive assessment of liver fibrosis. The aims of this study were to explore the application of preoperative liver stiffness measurements (LSM) by transient elastography in predicting postoperative liver failure (PHLF) in patients with hepatitis B related hepatocellular carcinoma. METHODS: The study included 247 consecutive patients with hepatitis B related hepatocellular carcinoma who underwent hepatectomy between May 2015 and September 2015. Detailed preoperative examinations including LSM were performed before hepatectomy. The endpoint was the development of PHLF. RESULTS: All of the patients had chronic hepatitis B defined as the presence of hepatitis B surface antigen (HBsAg) for more than 6 months and 76 (30.8%) had cirrhosis. PHLF occurred in 37 (14.98%) patients. Preoperative LSM (odds ratio, OR, 1.21; 95% confidence interval, 95% CI: 1.13-1.29; P < 0.001) and international normalized ratio (INR) (OR, 1.07; 95% CI: 1.01-1.12; P < 0.05) were revealed to be independent risk factors for PHLF, and a new model was defined as LSM-INR index (LSM-INR index = 0.191*LSM + 6.317*INR-11.154). The optimal cutoff values of LSM and LSM-INR index for predicting PHLF were 14 kPa (AUC 0.86, 95% CI: 0.811-0.901, P < 0.001) and -1.92 (AUC 0.87, 95% CI: 0.822-0.909, P < 0.001), respectively. CONCLUSIONS: LSM can be helpful for surgeons to make therapeutic decisions in patients with hepatitis B related hepatocellular carcinoma.

Expression patterns of three regulation enzymes in glycolysis in esophageal squamous cell carcinoma: association with survival.

Enhanced glycolysis is a common trait of many types of human cancers. This study was to detect the expression pattern of three regulatory enzymes during glycolysis in esophageal squamous cell carcinoma (ESCC) and to investigate their correlation with patients' outcome based on banked pathology material. A total of 141 surgically resected specimens of primary ESCC patients without prior treatments were retrospectively recruited from the First Affiliated Hospital of Wenzhou Medical College Hospital from 2007 to 2009. Expression of HK1, PFKB, and PKM2 in ESCC specimens was analyzed by immunohistochemical staining and Western blotting analysis. HK1-shRNA was used to knock down HK1 expression in ESCC cells, and the functional significance was assessed by CCK8 assay. It was found that the expression of two glycolytic enzymes, HK1 and PKM2, was associated with disease progression, invasion, and poor survival of patients with ESCC. Silence of HK1-inhibited cell proliferation in vitro and suppressed phospho-S6 kinase expression. Our findings suggest that activation of key enzymes in glycolysis might serve as potential therapeutic targets and/or prognostic factors for patients with ESCC.