A rat toxicological study of intra-arterial injection of Tirapazamine, a hypoxia-activating Cancer therapeutic agent, followed by hepatic artery ligation.

Background Tirapazamine's (TPZ) tolerability after an intra-arterial (IA) injection remains unclear. We investigated TPZ's safety and tolerability in rats by first injecting into the left hepatic artery and then performing a hepatic artery ligation, which recapitulates the transarterial embolization used clinically. Research design and methods: Forty-six rats in five groups were respectively injected with 0, 0.25, 0.50, 1.0, or more than 1.5 mL IA of TPZ (0.7 mg/mL) into the left hepatic artery and then subjected to hepatic artery ligation under laparotomy. Blood samples were collected four times daily up to day 15 after which the rats were euthanized and necropsied. The toxicity profile of IA injection of TPZ followed by hepatic artery ligation was then assessed. Results No significant changes to the rats' body weight and serum total bilirubin were observed. Serum alanine aminotransferase (ALT) levels increased slightly but remained below 100 U/L one day after treatment for most rats. Three rats in Groups 3 and 4 exhibited an over two-fold transient elevation of ALT. All ALT recovered to the baseline at day 14. Liver tissues were collected on day 15 using H&E staining. One rat in Group 3 showed ischemic coagulative necrosis in its liver tissue. Other sporadic pathological changes not related to TPZ doses were observed in Groups 2, 3, 4, and 5. Conclusion TPZ by IA injection followed by embolization is tolerated up to 7 mg/kg. This finding supports the strategy of administering an IA injection of TPZ followed by trans-arterial embolization to the liver.

Spiritual distress of patients living with cancer in Northern Vietnam.

BACKGROUND: Literature on the spirituality of cancer patients has been mainly focused on the experiences of western patients. Few studies explore the experience of Asian cancer patients, while no spiritual study on cancer patients has been conducted in Vietnam. PURPOSE: The purpose of this study was to survey the spiritual distress of cancer patients at two general hospitals in northern Vietnam. METHODS: This was a quantitative survey with a cross-sectional design. This study used purposive sampling with a fitting the inclusion criteria, alongside the Spiritual Distress Scale-Vietnam version (SDS-V). The data was collected by an investigator in two general hospitals in northern Vietnam. The study received approval from two research councils. RESULTS: The results demonstrated that the demographics of cancer patients in the study reflected the national data of Vietnam. Regarding the four exploratory dimensions, more than 50% of cancer patients expressed feeling hardship and sorrow, most did not feel loneliness, most patients reported a good relationship with others and God, while the majority of were afraid to discuss death. CONCLUSIONS: Due to impact of aging and poverty on the sample patients, further studies into the interconnectivity between economics and the spiritual health status of patients is recommended. Additionally, since the 132 Vietnamese cancer patients reported a positive relationship with others and God, healthcare professionals should study effective strategies to apply the above strengths in easing hardships for future cancer patients.

Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients.

BACKGROUND: Splenectomy has previously been found to increase the risk of cancer development, including lung, non-melanoma skin cancer, leukemia, lymphoma, Hodgkin's lymphoma, and ovarian cancer. The risk of cancer development in liver transplantation (LT) with simultaneous splenectomy remains unclear. AIM: To compare hepatocellular carcinoma (HCC) recurrence and de novo malignancy between patients undergoing LT with and without simultaneous splenectomy. METHODS: We retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with (n = 35) and without (n = 85) simultaneous splenectomy in the Tri-Service General Hospital. Univariate and multivariate Cox regression analyses for cancer-free survival and mortality were established. The comparison of the group survival status and group cancer-free status was done by generating Kaplan-Meier survival curves and log-rank tests. RESULTS: The splenectomy group had more hepatitis C virus infection, lower platelet count, higher -fetoprotein level, and longer operating time. Splenectomy and age were both positive independent factors for prediction of cancer development [hazard ratio (HR): 2.560 and 1.057, respectively, P < 0.05]. Splenectomy and hypertension were positive independent factors for prediction of mortality. (HR: 2.791 and 2.813 respectively, P < 0.05). The splenectomy group had a significantly worse cancer-free survival (CFS) and overall survival (OS) curve compared to the non-splenectomy group (5-year CFS rates: 53.4% vs 76.5%, P = 0.003; 5-year OS rate: 68.1 vs 89.3, P = 0.002). CONCLUSION: Our study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

Mimics of malignancy caused by concurrent imperforate hymen and transverse vaginal septum: an instructive case and review of the literature.

The coexistence of imperforate hymen and vaginal septum is rare and their ability to mimic malignant manifestations have not been frequently reported. This current case report describes a 13-year-old girl that presented with cyclic abdominal pain for 6 months. She was found to have a huge mass via abdominal plain film X-ray and sonography, with inexplicably high levels of serum carcinoembryonic antigen, cancer antigen (CA)-19-9 and CA-125. Pelvic computed tomography imaging disclosed two huge cystic lesions in the uterine and upper vaginal cavities. Surgical intervention conformed the diagnosis of a concurrent imperforate hymen and transverse vaginal septum, echoing the imaging findings of haematocolpometra. Her tumour marker levels gradually returned to normal after surgery. This rare case of concomitant imperforate hymen and transverse vaginal septum highlights that haematocolpometra, a benign disease that might mimic malignancy, should be taken into consideration in any adolescent females with an abdominal mass and amenorrhoea to ensure an early diagnosis and timely appropriate management.

Comparing hepatic resection and transarterial chemoembolization for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma: change for treatment of choice?

BACKGROUND: Compared to transarterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC), stage B in the Barcelona Clinic Liver Cancer (BCLC) classification, the role of hepatic resection remains unclear. The present study compared the long-term outcome of hepatic resection with TACE in the treatment of BCLC stage B HCC. METHODS: A total of 171 patients with BCLC stage B, Child's classification A (Child A), HCC were included in this retrospective study. Of these, 93 patients underwent hepatic resection (group I) and 73 patients received TACE (group II). We evaluated the long-term outcome and therapy-related mortality in both groups. The risk factors of mortality were assessed. The survival curve was analyzed by the Kaplan-Meier method. RESULTS: The 1-, 2-, and 3-year overall survival rates for the two groups after hepatic resection and TACE were 83%, 62%, 49% and 39%, 5%, 2%, respectively (P < 0.0001). We did not observe significant differences in the therapy-related mortality between the two groups (P = 0.78). Treatment modality and serum albumin level were independent risk factors for survival by Cox regression analysis. CONCLUSIONS: Our study demonstrated that hepatic resection for BCLC stage B, Child A HCC patients had better survival rates than TACE group. Thus, hepatic resection is indicated in selected patients with BCLC stage B.

Establishing the validity of a spiritual distress scale for cancer patients hospitalized in southern Taiwan.

The present study was conducted to establish the validity of the spiritual distress scale (SDS), a scale developed as part of a qualitative study in which 20 cancer patients were interviewed about spiritual needs in 2003-2004. The SDS has four domains: relationship with self, relationship with others, relationship with God, and attitude towards death A measurement study was conducted whereby 85 patients completed the SDS during their hospitalization in the oncology unit of a medical centre in southern Taiwan. The SDS, including four domains of sub-scales, was broader than other spiritual scales in the literature that only contained one or two domains and focused on the health area. The SDS has established the adequate content and construct validity. Further training of nurses for assessing spiritual distress of cancer patients using the SDS would be recommended for future study. The established content and construct validity of the SDS could be applied in oncology for nurses to assess spiritual distress of cancer patients.

Efficacy of integrating information literacy education into a women's health course on information literacy for RN-BSN students.

Information literacy, essential to evidences-based nursing, can promote nurses' capability for life-long learning. Nursing education should strive to employ information literacy education in nursing curricula to improve information literacy abilities among nursing students. This study explored the effectiveness of information literacy education by comparing information literacy skills among a group of RN-BSN (Registered Nurse to Bachelors of Science in Nursing) students who received information literacy education with a group that did not. This quasi-experimental study was conducted during a women's health issues course taught between March and June 2004. Content was presented to the 32 RN-BSN students enrolled in this course, which also taught skills on searching and screening, integrating, analyzing, applying, and presenting information. At the beginning and end of the program, 75 RN-BSN student self-evaluated on a 10 point Likert scale their attained skills in searching and screening, integrating, analyzing, applying, and presenting information. Results identified no significant differences between the experimental (n = 32) and control groups (n = 43) in terms of age, marital status, job title, work unit, years of work experience, and information literacy skills as measured at the beginning of the semester. At the end of the semester during which content was taught, the information literacy of the experimental group in all categories, with the exception of information presentation, was significantly improved as compared to that of the control group. Results were especially significant in terms of integrating, analyzing, and applying skill categories. It is hoped that in the future nursing students will apply enhanced information literacy to address and resolve patients' health problems in clinical settings.

A massive retroperitoneal neuroblastoma with stenosis of the inferior vena cava in a 5-month-old boy.

Neuroblastoma is the second most common retroperitoneal tumour in children after Wilms' tumour. When it originates in the retroperitoneum, neuroblastoma usually presents as an abdominal mass with clinical manifestations of nausea, vomiting and weight loss. Imaging studies of this tumour demonstrate a heterogeneous mass with an irregular capsule and visible calcifications. Encasement and compression of the abdominal vessels, especially the inferior vena cava, are often observed. However, stenosis of the inferior vena cava has never been reported to be associated with this tumour. Here, we present a case of a 5-month-old boy with a right retroperitoneal tumour with extensive encasement of the inferior vena cava and significant narrowing of its distal part between the venous bifurcation and the tumour capsule. To our knowledge, this is the first case of neuroblastoma with this manifestation in a child.

Marked elevation of hepatic transaminases in recipients of an orthotopic liver transplant from a brain-dead donor receiving extracorporeal membrane oxygenation.

BACKGROUND: Hemodynamic instability can lead to failure of donor organ procurement in brain-dead donors. Extracorporeal membrane oxygenation (ECMO) has been used in non-heart-beating donors to increase the donor pool, but the use of ECMO to salvage donor organs has been rarely used. We aimed to analyze postoperative liver function test results in patients receiving orthotopic liver transplants from ECMO-supported brain-dead donors. MATERIAL AND METHODS: We retrospectively reviewed the records of 43 recipients of orthotopic liver transplantation from May 2009 to June 2012. Six recipients received liver grafts from ECMO-maintained donors designated as the ECMO group (n=6). The remaining patients were assigned to the non-ECMO group (n=37). Complication and mortality rates and liver function test results on postoperative days 1, 3, 5, 7, and 14 were compared between the 2 groups. RESULTS: Serum glutamate oxaloacetate transaminase and serum glutamate pyruvate transaminase levels were significantly elevated on postoperative Day 1 in the ECMO group. There were no significant differences in the complication and overall survival rates between the 2 groups (P=0.411). CONCLUSIONS: Although serum transaminases markedly elevated on postoperative Day 1, ECMO successfully preserved potential liver grafts in hemodynamically unstable brain-dead donors.

Predictors of the outcomes of acute-on-chronic hepatitis B liver failure.

AIM: To identify the risk factors in predicting the outcome of acute-on-chronic hepatitis B liver failure patients. METHODS: We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus (ACLF-HBV) and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy. Their demographic, clinical, and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test, Fisher's exact test, and a multiple logistic regression analysis. RESULTS: The study included 113 patients (87 men and 26 women) with a mean age of 49.84 years. Fifty-two patients survived, and 61 patients died. Liver failure (85.2%), sepsis (34.4%), and multiple organ failure (39.3%) were the main causes of death. Multivariate analyses showed that Acute Physiology and Chronic Health Evaluation (APACHE) II scores ≥ 12 [odds ratio (OR) = 7.160, 95% CI: 2.834-18.092, P < 0.001] and positive blood culture (OR = 13.520, 95% CI: 2.740-66.721, P = 0.001) on the day of diagnosis and model for end-stage liver disease (MELD) scores ≥ 28 (OR = 8.182, 95% CI: 1.884-35.527, P = 0.005) after the first week of treatment were independent predictors of mortality. CONCLUSION: APACHE II scores on the day of diagnosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF-HBV patients.

Acute myelogenous leukemia and acute leukemic appendicitis: a case report.

Acute myelogenous leukemia (AML) can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leukemia relapse. Pathological findings of the appendix revealed transmural infiltrates of myeloblasts, which indicated a diagnosis of leukemia. Unfortunately, the patient died from progression of the disease on the 19th d after admission. Although leukemic cell infiltration of the appendix is uncommon, patients with leukemia relapse can present with symptoms mimicking acute appendicitis.

The inhibition of superoxide anion generation by neutrophils from Viscum articulactum.

Two new flavanones, (2S)-pinocembrin 7-O-[beta-D-apiosyl(1-->2)]-beta-D-glucoside (1), and (2S)-pinocembrin 7-O-[cinnamoyl(1-->5)-beta-D-apiosyl(1-->2)]-beta-D-glucoside (2) together with eighteen known compounds, which include five known flavanones, nine benzenoids, one inositol and three triterpenoids, were isolated and characterized from fresh Viscum articulactum. Structures of new compounds were determined by spectral analysis. Among them, oleanolic acid (18) showed a significant inhibition effect on superoxide anion generation by human neutrophils in response to formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP).