Therapeutic benefits of combined sorafenib for intermediate hepatocellular carcinoma unresponsive to transarterial chemoembolization in a Chinese population.

OBJECTIVE: Transarterial chemoembolization (TACE) is the treatment modality for intermediate, or Barcelona Clinic Liver Cancer stage B, hepatocellular carcinoma (HCC), but its beneficial effect on outcomes is still unsatisfactory. This study aimed to assess the outcomes of combined TACE and sorafenib for patients with intermediate HCC. METHODS: Patients with intermediate HCC who were receiving TACE alone (the monotherapy group), or combined TACE and sorafenib (the combined therapy group) from January 2013 to June 2018 were enrolled. RESULTS: Altogether 64 patients were enrolled, of whom 34 were assigned to the monotherapy group and 30 to the combined therapy group. A prolonged time-to-progression (TTP) (mean 14.46 mo vs 6.39 mo, P = 0.001) was noted in the combined therapy group compared with the monotherapy group. Overall survival (OS) (mean 18.96 mo vs15.44 mo, P = 1.000) between the two groups did not differ significantly. After adjustment, there were no significant differences in the 12-18 month mortality rate between the two groups. CONCLUSION: Patients with intermediate HCC receiving combined TACE and sorafenib had a better TTP, but not OS, than those receiving TACE alone.

The therapeutic benefits of combined sorafenib and transarterial chemoembolization for advanced hepatocellular carcinoma.

OBJECTIVE: Systemic therapy, such as sorafenib, has been used clinically to treat patients with advanced stage or Barcelona Clinic Liver Cancer staging system (BCLC) stage C hepatocellular carcinoma (HCC). The aim of the study was to evaluate the therapeutic benefit of combined sorafenib and transarterial chemoembolization (TACE) in this group of patients. METHODS: Data on patients with HCC at BCLC stage C from August 2012 to September 2017 were collected. Patients who were given sorafenib alone were classified as the monotherapy group and those taking sorafenib and TACE were classed as the combined therapy group. RESULTS: A total of 118 patients were enrolled. There were 65 and 53 patients in the monotherapy and the combined therapy group, respectively. The groups' general characteristics were similar. Compared with the monotherapy group the combined therapy group experienced prolonged time-to-progression (TTP) (mean 6.42 mo vs 3.63 mo, P = 0.003) and overall survival (OS) (mean 11.21 mo vs 5.98 mo, P = 0.001). A subgroup analysis found that patients with macroscopic vascular invasion (MVI) also had prolonged TTP and OS in the combined therapy group than the monotherapy group (mean TTP, 7.93 mo vs 3.43 mo, P = 0.007; mean OS, 13.41 mo vs 5.50 mo, P = 0.001), however, these significant differences did not exist for those with extrahepatic spread (EHS). CONCLUSION: Combined sorafenib and TACE therapy has significant better outcomes than sorafenib alone in patients with stage C HCC, particularly those with MVI.

Sorafenib treatment on Chinese patients with advanced hepatocellular carcinoma: A study on prognostic factors of the viral and tumor status.

Sorafenib is of proven efficacy in treating patients of hepatocellular carcinoma (HCC). Our study was aimed to determine the factors influence the sorafenib efficacy.We evaluated data of HCC patients receiving sorafenib from June 2012 to October 2016. All HCC cases were of the Barcelona Clinic Liver Cancer (BCLC) classification stage C. The exclusion criteria: those of BCLC classification stage A or B, with the absence or co-infection of hepatitis B (HBV) and hepatitis C (HCV). The presence of HBV, HCV, macoscopic vascular invasion (MVI) or extrahepatic spread (EHS) was recorded for each patient. Time-to-progression (TTP) and overall survival (OS) were analyzed.Among a total of 90 HCC patients, 48 (53.3%) had HBV infection, 42 (46.7%) had HCV infection, 51 (56.7%) had MVI, and 39 (43.3%) had EHS. Patients with HCV infection showed better TTP and OS than those with HBV infection. Patients with EHS had a longer TTP and OS than those with MVI. For patients with HBV infection, those with EHS had a longer TTP (mean 4.60 vs 2.64 months, P = .002) and OS (mean 6.65 vs 4.53 months, P = .045) compared to those with MVI. Among those with MVI, patients with HBV infection had a poorer TTP (mean 2.64 vs 4.74 months, P = .019) and shorter OS (mean 4.53 vs 7.00 months, P = .059) compared to those with HCV infection.HCC patients with HCV infection or with the presence of EHS showed better sorafenib efficacy.

Alcohol and tea consumption are associated with asymptomatic erosive esophagitis in Taiwanese men.

OBJECTIVE: Asymptomatic erosive esophagitis (AEE) is commonly found in men, and might be a risk factor of developing esophageal adenocarcinoma. We aimed to determine if specific dietary habits increase the risk of AEE in asymptomatic Taiwanese men. METHODS: We recruited male adults undergoing upper gastrointestinal endoscopy for health check. We excluded subjects with reflux symptoms, or taking anti-reflux medications or drugs that potentially impair lower esophageal sphincter function or cause mucosal injury. The frequency of consuming reflux-provoking diets including alcohol, tea, coffee, tomato/citric juice, chocolate, sweet food, and spicy food was assessed. The erosive esophagitis was diagnosed based on the Los Angeles Classification after endoscopy. Frequent consumption of a specific diet was defined as ≥4 days/week of consuming that diet. RESULTS: A total of 1256 participants were recruited. After excluding 424 ineligible subjects, AEE was identified in 180 (22%) among 832 asymptomatic subjects. The risk of AEE increased with the number of days per week of consuming alcohol or tea: nondrinkers (19%, 17%), occasional drinkers (<1 day/week; 19%, 15%), regular drinkers (1-3 days/week; 26%, 21%), frequent drinkers (4-6 days/week; 32%, 22%), and daily drinkers (42%, 28%), respectively (trend test P < 0.001 for both). Multivariate analysis showed that hiatus hernia (adjusted odds ratio (aOR) 5.0, 95% confidence interval (CI) 2.6-9.6), drinking alcohol ≥4 days/week (aOR 2.3, 95% CI 1.3-4.0), and drinking tea ≥4 days/week (aOR 1.6, 95% CI 1.1-2.3) are independent risk factors of AEE. The risk of AEE was 3.8 times greater for those drinking both alcohol and tea ≥4 days/week than the non-drinkers. CONCLUSIONS: Frequent alcohol and tea consumption increased the risk of AEE in Taiwanese men.

Transarterial embolization of metastatic mediastinal hepatocellular carcinoma.

This paper introduces an innovative treatment for extra-hepatic metastasis of hepatocellular carcinoma. A 71-year-old patient had a stable liver condition following treatment for hepatocellular carcinoma, but later developed symptomatic mediastinal metastasis. This rapidly growing mediastinal mass induced symptoms including cough and hoarseness. Serial sessions of transarterial embolization (TAE) successfully controlled this mediastinal mass with limited side effects. The patient's survival time since the initial diagnosis of the mediastinal hepatocellular carcinoma was 32 mo, significantly longer than the 12 mo mean survival period of patients with similar diagnoses: metastatic hepatocellular carcinoma and a liver condition with a Child-Pugh class A score. Currently, oral sorafenib is the treatment of choice for metastatic hepatocellular carcinoma. Recent studies indicate that locoregional treatment of extra-hepatic metastasis of hepatocellular carcinomas might also significantly improve the prognosis in patients with their primary hepatic lesions under control. Many effective locoregional therapies for extrahepatic metastasis, including radiation and surgical resection, may provide palliative effects for hepatocellular carcinoma-associated mediastinal metastasis. This case report demonstrates that TAE of metastatic mediastinal hepatocellular carcinoma provided this patient with tumor control and increased survival time. This finding is important as it can potentially provide an alternative treatment option for patients with similar symptoms and diagnoses.

Effect of electroacupuncture on St. 36 (Zusanli) and LI. 10 (Shousanli) acupuncture points on heart rate variability.

Electrical stimulation of St. 36 (Zusanli) has been shown to enhance the regularity of gastric myoelectrical activity in healthy subjects. However, the underlying mechanism by which acupuncture alters gastric myoelectrical activity is still not clear. To elucidate the possible role of the autonomic nervous system in mediating the effect of acupuncture, we monitored heart rate variability (HRV), a widely used index of vagal discharge at the sinoatrial node of the heart before, during and after electroacupuncture. In this study, we applied two different frequencies (2 Hz and 100 Hz) of electrical stimulation at St. 36 (Zusanli) and LI. 10 (Shousanli) in 15 healthy volunteers. Low frequency (LF, sympathetic activity), high frequency (HF, vagal activity) and LF/HF ratio (sympathovagal balance) were analyzed and compared at the two different frequencies. The results showed an increase in the LF/HF ratio (indicating greater sympathetic activity) during the post-acupuncture period using 2 Hz of electrical stimulation at St. 36 (Zusanli). However, the overall change was not statistically significant. In addition, the power of LF and HF did not change significantly with electroacupuncture at St. 36 (Zusanli) and LI. 10 (Shousanli). In conclusion, applying 2 Hz or 100 Hz electroacupuncture at St. 36 (Zusanli) or LI. 10 (Shousanli) did not affect cardiovagal activity in normal volunteers. This phenomenon might be due to a difference in presentation in the autonomic nervous system between cardiac and abdominal vagal activity.

Aromatherapy for reducing colonoscopy related procedural anxiety and physiological parameters: a randomized controlled study.

BACKGROUND/AIMS: Colonoscopy is generally tolerated, some patients regarding the procedure as unpleasant and painful and generally performed with the patient sedated and receiving analgesics. The effect of sedation and analgesia for colonoscopy is limited. Aromatherapy is also applied to gastrointestinal endoscopy to reduce procedural anxiety. There is lack of information about aromatherapy specific for colonoscopy. In this study, we aimed to performed a randomized controlled study to investigate the effect of aromatherapy on relieve anxiety, stress and physiological parameters of colonoscopy. METHODOLOGY: A randomized controlled trail was carried out and collected in 2009 and 2010. The participants were randomized in two groups. Aromatherapy was then carried out by inhalation of Sunflower oil (control group) and Neroli oil (Experimental group). The anxiety index was evaluated by State Trait Anxiety Inventory-state (STAI-S) score before aromatherapy and after colonoscopy as well as the pain index for post-procedural by visual analogue scale (VAS). Physiological indicators, such as blood pressure (systolic and diastolic blood pressure), heart rate and respiratory rate were evaluated before and after aromatherapy. RESULTS: Participates in this study were 27 subjects, 13 in control group and 14 in Neroli group with average age 52.26 +/- 17.79 years. There was no significance of procedural anxiety by STAI-S score and procedural pain by VAS. The physiological parameters showed a significant lower pre- and post-procedural systolic blood pressure in Neroli group than control group. CONCLUSIONS: Aromatic care for colonoscopy, although with no significant effect on procedural anxiety, is an inexpensive, effective and safe pre-procedural technique that could decrease systolic blood pressure.

Atropine-induced HRV alteration is not amended by electroacupuncture on Zusanli.

Acupuncture is known to influence autonomic nervous activity. Acupuncture on Zusanli points has been shown to enhance the regularity of gastric myoelectrical activity and accelerate gastric emptying, partly through the vagal pathway, in dogs. The aim of this study was to evaluate whether atropine-induced autonomic nervous alteration, measured by heart rate variability (HRV), could be amended by electroacupuncture on Zusanli points. HRV measurements were recorded in 15 healthy volunteers before, during and after electroacupuncture. Each subject was studied for three sessions in a randomized sequence, which included electroacupuncture on the Zusanli (St 36) points with or without premedication of atropine and placebo stimulation on a non-acupoint. The analysis of low frequency (LF), high frequency (HF) and LF/HF ratios were compared between different sessions. Serum levels of gastrin, motilin and pancreatic polypeptide (PP) levels were also measured. There was an increase in the LF/HF ratio (indicating increased sympathetic activity) during the post-acupuncture period with 2 Hz of electrical stimulation on the Zusanli acupoints. When IV atropine was used immediately before the electroacupuncture, there was a decrease in the LF power and HF power during the acupuncture and post-acupuncture periods. In addition, there was a significant increase in the LF/HF ratio during the acupuncture and post-acupuncture periods. There was a significant decrease in serum PP in the post-acupuncture period after premedication with IV atropine. In conclusion, atropine-induced HRV change might be mediated via the vagal pathway. However, atropine-induced HRV alteration is not amended by electroacupuncture on Zusanli points.

The effect of different frequency electrical acu-stimulation on gastric myoelectrical activity in healthy subjects.

BACKGROUND/AIMS: Acupuncture has been used to treat gastrointestinal symptoms in oriental countries for many years. The underlying mechanism is still not fully understood. METHODOLOGY: Fifteen healthy male volunteers were enrolled into this study. A cutaneous electrogastrography recording was obtained. Two frequencies (2 Hz and 100 Hz) of electrical stimulation were applied to Zusnali or Shousanli point in different sessions. Another non-acu-point (2 cm lateral to Zusanli) without electrical stimulation was used for a control study. RESULTS: There was a significant increase in the percentage of normal frequency during 2 Hz of electrical stimulation on Zusnali (baseline vs. acupuncture, 82.49 +/- 12.87% vs. 93.18 +/- 8.40%, p < 0.01). The percentage of normal frequency did not change significantly, during or after acupuncture, with 100 Hz of electrical stimulation on Zusnali, or 2 Hz and 100 Hz of electrical stimulation on Shousanli. In addition, the percentage of tachygastric frequency and power ratio also changed significantly during 2 Hz of electrical stimulation on Zusnali. However, the change in the percentage of bradygastria and dominant frequency was not statistically significant among all five study sessions during each stage. CONCLUSIONS: The results of this study demonstrated that electrical stimulation, with a frequency of 2 Hz, on Zusanli might enhance the regularity of gastric myoelectrical activity. The effect of acupuncture on gastric myoelectrical activity was acu-point-specific, and that effect was observed with 2 Hz but not 100 Hz electrical stimulation.

Cutaneous electrical stimulation of acupuncture points may enhance gastric myoelectrical regularity.

BACKGROUND/AIM: Cutaneous electrical stimulation has been reported to be as effective as electroacupuncture. The aim of this study was to test whether cutaneous electrical stimulation had the same effect as electroacupuncture to enhance the regularity of myoelectrical activity. METHODS: Fifteen healthy male volunteers were enrolled for this study. Electrogastrography (EGG) was performed for 30 min at the baseline, 30 min during electroacupuncture or cutaneous electrical stimulation, and for an additional 30 min thereafter. RESULTS: During 3 Hz of electroacupuncture on the Zusanli point, there was a significant increase in the percentage of normal frequency. The percentage of normal frequency in the post-acupuncture period was also increased, but it was not statistically significant when compared to the baseline. There was a significant decrease in the tachygastric and bradygastric rhythm during electroacupuncture on the Zusanli points. There were similar changes of EGG parameters with cutaneous electrical stimulation on the Zusanli points. The percentage of normal frequency during cutaneous electrical stimulation increased significantly. However, the percentage of normal frequency in the post-cutaneous electrical stimulation period was similar to the baseline. There was a significant decrease in the percentage of tachygastric rhythm during cutaneous electrical stimulation on the Zusanli points. However, there was no significant change in the percentage of bradygastric rhythm during and after the cutaneous electrical stimulation periods. CONCLUSIONS: The effect of cutaneous electrical stimulation on the percentage of normal frequency and tachygastria is similar to electroacupuncture. Nonetheless, the changes of the percentage in bradygastria are not significant.

Atropine-induced gastric dysrhythmia is not normalized by electroacupuncture.

Acupuncture has been shown to improve the regularity of gastric myoelectric activity. The aim of this study was to evaluate whether atropine-induced gastric dysrhythmia can be normalized by electroacupuncture. Fifteen healthy male volunteers were enrolled for this study. Each subject was studied for three sessions in a randomized sequence which included electroacupuncture on the Zusanli (St 36) points with or without premedication with atropine and a placebo stimulation on a nonacupoint. Cutaneous EGG was performed for 30 min at the baseline, 30 min during acupuncture, and for an additional 30 min after acupuncture. Serum gastrin, motilin, and human pancreatic polypeptide (hPP) levels were also measured. When applying 2 Hz of electrical stimulation on the Zusnali point, there was a significant increase in the percentage of normal frequency (2-4 cpm) during acupuncture (baseline versus acupuncture, 82.09 +/- 12.37% versus 93.08 +/- 8.17%, P < 0.01). There was a significant decrease in the percentage of bradygastria as well as tachygastria during 2 Hz of electrical stimulation on the Zusnali point. Using intravenous atropine immediately before electroacupuncture, the percentage of normal frequency during acupuncture and postacupuncture periods decreased significantly (baselines versus acupuncture and postacupuncture, 83.86 +/- 13.79% versus 55.07 +/- 29.44% and 56.76 +/- 33.44%, P < 0.01). There was a significant decrease in serum PP after intravenous atropine. This observation indicated that atropine-induced gastric dysrhythmia might be mediated partly via the vagal pathway. However, atropine-induced gastric dysrhythmia is not normalized by electroacupuncture.