Association of the modified Glasgow prognostic score and prognostic nutritional index with duration of oral anamorelin administration in patients with cancer cachexia: a retrospective cohort study.

BACKGROUND: The modified Glasgow Prognostic Score (mGPS) and Prognostic Nutritional Index (PNI) are indicators of nutritional status in cancer patients; however, the effects of baseline mGPS and PNI on the duration of administration of the ghrelin receptor agonist anamorelin, which is used to treat cachexia in patients with cancer, are unclear. This study aimed to clarify the association of mGPS and PNI with the duration of oral anamorelin administration for patients who did not have beneficial effects from anamorelin. METHODS: The attending physician determined the duration of oral anamorelin administration based on discontinuation due to cancer progression, poor efficacy, adverse events, or death. RESULTS: The 12-week continuation rate of oral anamorelin was 30.4%. Univariate analysis revealed that an Eastern Cooperative Oncology Group performance status (ECOG-PS) of ≥2 (P < .001), concurrent chemotherapy (P = .002), albumin level (P = .005), C-reactive protein level (P = .013), and a mGPS of 2 (P = .014) were statistically significant predictors of the 12-week continuation rate of oral anamorelin. In the multivariate analysis, a mGPS of 2 remained a significant risk factor, and the ECOG-PS and concurrent chemotherapy had no effect on the association between the mGPS and 12-week continuation rate of oral anamorelin. CONCLUSION: Patients with a mGPS of 2, compared with mGPS of 0 or 1, are less likely to maintain oral anamorelin therapy, regardless of the ECOG-PS or concurrent chemotherapy. Therefore, it is necessary to consider initiating anamorelin administration at mGPS 0 or 1.

Comparison of perivascular astrocytic structure between white matter and gray matter of rats.

Regional differences in perivascular glial structures were investigated between the white matter (hippocampal fimbria, corpus callosum, cerebellar medulla) and the gray matter (cerebral cortex) of adult rats. Sparser vascular distribution, perivascular glial rows and cylinder-like segmented astrocytic endings were characteristic in the white matter. The perivascular astrocytic processes covered microvessels extensively in the white matter. Comparison of transverse microvessel sections by transmission electron microscopy (TEM) between the two sites revealed significantly larger perivascular astrocytic spaces in the white matter.

Three-dimensional electron microscopic studies of the transitional oligodendrocyte associated with the initial stage of myelination in developing rat hippocampal fimbria.

We identified the transitional oligodendrocyte and their processes of rat hippocampal fimbria associated with the initial stage of myelination in both the morphological and functional classifications by means of three-dimensional ultrastructural analysis. Transitional oligodendrocytes appeared around P7, and their cell bodies were morphologically an intermediate form between the light and medium oligodendrocytes described by Mori and Leblond [J. Comp. Neurol. 139 (1970) 1]. Three phenotypes of the transitional oligodendrocytic processes were recognized. Spiral wrapping processes were ensheathing processes, club-like processes were nonensheathing processes, and sheet-like processes were possibly the transmuting form between the nonensheathing and ensheathing processes. Club-like processes were the major part of the nonensheathing processes, and most likely function as sensors to perceive axon maturation and find target axons. Multivesicular bodies that appeared to be associated with the initial ensheathment were observed in the transitional oligodendrocytic processes, suggesting that their roles are crucial in myelinogenesis.

Protective effect of FK506 and thromboxane synthase inhibitor on ischemia-reperfusion injury in non-heart-beating donor in rat orthotopic liver transplantation.

The study investigated the possibility of pharmacologically modulating hepatic allograft function from non-heart-beating donors (NHBDs) using male Lewis rats. The donors were divided into 4 groups: Group 1 in which the vehicle was administered, Group 2 in which FK506 (tacrolimus; a powerful immunosuppressive agent) was administered, Group 3 in which OKY046 (a specific thromboxane synthetase inhibitor) was administered and Group 4 in which FK506 and OKY046 were administered. The recipients received orthotopic liver transplantation. The survival rates differed significantly between the recipients that had received liver transplantation from Groups 1 and 4. The serum liver enzyme and inflammatory cytokine concentrations of the recipients which had received liver transplantation from Groups 2, 3 and 4 were significantly lower than those of the recipients that had received liver transplantation from Group 1. Although there was no significant difference, all parameters were better in the recipients that had received transplantation from Group 4 than those that had received transplantation from Groups 2 and 3. The action mechanisms of FK506 and OKY046 are completely different. Therefore, concomitant use of FK506 and OKY046 might have additive effects on liver transplantation from NHBDs. In conclusion, we demonstrated that pretreatment of NHBDs using FK506 and OKY046 ameliorated graft viability.

Arterial infusion chemotherapy for the patient of unresectable pancreatic carcinoma with multiple liver metastases: a case report.

INTRODUCTION: Despite various treatment trials for unresectable pancreatic carcinoma with liver metastases, the outcome has not been satisfactory. This paper reports a case of pancreatic carcinoma with multiple liver metastases that responded well to arterial infusion chemotherapy. CASE REPORT: A 65-year-old male was diagnosed with multiple liver tumors, and needle biopsy revealed adenocarcinoma. With endoscopic ultrasonography, a tumor in the pancreatic head was detected, and pancreatic carcinoma with multiple liver metastases was diagnosed. He received arterial infusion chemotherapy: cisplatin at a dose of 10 mg/body/day and 500 mg/body/day of 5-fluorouracil After 14 days administration, liver metastases had decreased in number and size, but thereafter, because of hepatic arterial occlusion, the same dose of drugs was administered intravenously. The patient was discharged from the hospital and was given chemotherapy 3 days a week on an outpatient basis. Although the chemotherapy was effective, it was stopped because of severe general fatigue 5 months after discharge. His general status continued to gradually worsen, and he died 12 months after diagnosis. CONCLUSIONS: Prognosis of pancreatic carcinoma with liver metastases is poor; however, transarterial infusion chemotherapy may be effective to improve the prognosis and quality of life of the patients.

A case of adenomatous hyperplasia in the liver with chronic hepatitis C that transformed into hepatocellular carcinoma.

We report a rare case of adenomatous hyperplasia (AH) with malignant transformation, which was observed initially in the liver with chronic hepatitis C. A 47-year-old man was admitted to the hospital and chronic active hepatitis was diagnosed using fine needle biopsy, in addition abdominal computed tomography (CT) and ultrasonography showed multiple and hypovascular liver mass. Needle biopsy of the nodules showed AH. Despite transcatheter arterial embolization and percutaneous ethanol injection therapy (PEIT), the patient was readmitted due to enlargement of the nodules and elevation of alpha-fetoprotein 9 months later. On readmission, the nodules in the liver showed early-stage well-differentiated hepatocellular carcinoma (HCC) histopathologically, that were strongly stained on CT-arteriography and were stained less than the surrounding liver on CT-arterial portography, indicating arterial supply in the nodules and malignant transformation. Thereafter, the patient developed jaundice, and enhanced CT and magnetic resonance imaging showed multiple nodules, which occupied most of the liver, and needle biopsy revealed typical well-differentiated HCC. The patient died of hepatic failure 3 years after the initial admission. In this case, it was confirmed that AH transformed into HCC, which showed a multiple tumor on pathological diagnosis. It has been reported that borderline lesions are curable by less aggressive procedures such as enucleation and PEIT. However, such procedures may not be useful for this type of HCC, which rapidly developed from borderline lesions of the liver.

Efficacy of only left side approach in a case of unsuccessful reconstruction of the right hepatic artery after left hepatic lobectomy with caudal lobectomy.

We report two cases that underwent extended left hepatic lobectomy combined with resection of the caudate lobe and extrahepatic bile duct only from the left side approach for hilar cholangiocarcinoma. The first case was a 54-year-old man and the second one was a 63-year-old man. Both patients had hilar cholangiocarcinoma with predominant left hepatic duct involvement and required resection and reconstruction of the right hepatic artery as well as left hepatic lobectomy. In both cases, the right hepatic lobe was never mobilized to protect the mechanical damage in the remnant liver and keep co-lateral blood supply route to the remnant liver from the diaphragm or retroperitoneum. Although arterial blood flow to the remnant right hepatic lobe was unfortunately insufficient after reconstruction of the right hepatic artery, the postoperative course was uneventful. The postoperative angiography showed co-lateral arterial blood supply to the right lobe via the subdiaphragmatic artery. In case of extended left hepatic lobectomy combined with resection of the caudate lobe and right hepatic artery, ipsilateral approach (approach only from the left side) is recommended.

Heat shock protein 70 induction in hepatocytes after right portal vein embolization.

BACKGROUND/AIMS: Preoperative right portal vein embolization enhances remnant liver function following massive hepatectomy. Several studies have reported an increase in the volume of the left hepatic lobe after right portal vein embolization, but little information exists regarding heat shock protein induction in hepatocytes after right portal vein embolization. The objective of this study is to determine whether heat shock protein is induced in hepatocytes after right portal vein embolization in patients who underwent extended right hepatic lobectomy. METHODOLOGY: Four patients with gallbladder cancer and one patient with intrahepatic cholangiocellular carcinoma who underwent extended right hepatic lobectomy combined with caudate lobectomy and resection of the extrahepatic bile duct after right portal vein embolization were enrolled in this study. Operation was performed 21-36 days after right portal vein embolization. At operation, small liver specimens were taken immediately after laparotomy from both the right anterior segment (embolized lobe) and lower part of the left medial segment (non-embolized lobe) and heat shock protein 70 was induction in these specimens was measured by Western blotting. RESULTS: Heat shock protein 70 was induced in the left lobe relative to the right lobe in four patients, three of whom had an uneventful postoperative course. CONCLUSIONS: This paper is the first report to show the induction of heat shock protein 70 in the non-embolized hepatic lobe after right portal vein embolization in the clinical cases.

Living donor liver transplantation for giant hepatic hemangioma with Kasabach-Merritt syndrome with a posterior segment graft.

We present a case of a giant hepatic hemangioma with Kasabach-Merritt syndrome, which was cured by living donor liver transplantation. A 48-year-old woman complained of abdominal fullness and appetite loss. The laboratory data showed disseminated intravascular coagulation and a morphologic evaluation revealed a giant hepatic hemangioma involving both lobes of the liver. Living donor liver transplantation was indicated for Kasabach-Merritt syndrome and an unresectable liver tumor. A posterior segment graft was used because the remnant liver volume of the donor might have been too small to sustain the liver function of the donor. The postoperative course was uneventful, and the recipient was discharged from hospital on day 15 after the transplantation without complications.