Immediate postpartum cessation of tenofovir did not increase risk of virological or clinical relapse in highly viremic pregnant mothers with chronic hepatitis B infection.

Background & Aims: Peripartum prophylaxis (PP) with tenofovir disoproxil fumarate (TDF) is the standard of care to prevent mother-to-child transmission of chronic hepatitis B (CHB) infection in mothers who are highly viremic. We investigated the maternal and infant outcomes in a large Chinese cohort of TDF-treated CHB pregnant participants. Methods: In this prospective study, treatment-naive mothers with CHB and highly viremic (HBV DNA ≥200,000 IU/ml) but without cirrhosis were treated with TDF at 24-28 weeks of pregnancy. In accordance with Chinese CHB guidelines, TDF was stopped at delivery or ≥4 weeks postpartum. Serum HBV DNA and alanine aminotransferase were monitored every 6-8 weeks to determine virological relapse (VR). Infants received standard neonatal immunization, and HBV serology was checked at 7-12 months of age. Results: Among 330 participants recruited (median age 30, 82.7% HBeAg+, median HBV DNA 7.82 log IU/ml), TDF was stopped at delivery in 66.4% and at ≥4 weeks in 33.6%. VR was observed in 98.3%, among which 11.6% were retreated with TDF. Timing of TDF cessation did not alter the risk of VR (99.0 vs. 96.9%), clinical relapse (19.5 vs. 14.3%), or retreatment (12.6 vs. 10.1%) (all p > 0.05). A similar proportion of patients developed alanine aminotransferase flare five times (1.1 vs. 2.1%; p = 0.464) and 10 times (0.5 vs. 0%; p = 0.669) above the upper limit of normal (ULN) in the early withdrawal and late withdrawal groups, respectively. No infants developed HBsAg-positivity. Conclusions: PP-TDF and neonatal immunization were highly effective in preventing mother-to-child transmission of HBV in mothers who are highly viremic. Timing of cessation of PP-TDF did not affect the risk of VR or retreatment. Impact and Implications: In pregnant mothers with chronic hepatitis B infection who are started on peripartum tenofovir to prevent mother-to-child-transmission (MTCT), the optimal timing for antiviral withdrawal during the postpartum period remains unknown. This prospective study demonstrates that stopping tenofovir immediately at delivery, compared with longer treatment duration of tenofovir, did not lead to an increased risk of virological relapse, retreatment, or transmission of the virus to the baby. Shortening the duration of peripartum antiviral prophylaxis from 12 weeks to immediately after delivery can be considered. The immediate withdrawal of peripartum tenofovir, combined with standard neonatal immunization schemes, is 100% effective in preventing MTCT among pregnant mothers with CHB who are highly viremic, with a high rate of vaccine response in infants.

Aqueous extracts of Fructus Ligustri Lucide induce gastric carcinoma cell apoptosis and G2/M cycle arrest.

OBJECTIVE: Previous studies have shown that Fructus Ligustri Lucide (FLL) can be used to anti-cancer. However, the mechanism by which FLL mediate this effect is unclear. In the present study, aqueous extracts of FLL induced cell apoptosis in human gastric carcinoma cell was investigated. METHODS: The cell viability was detected by the CCK8 assay. The cell apoptosis was assessed by annexin V-PI double-labeling staining and hoechst 33342 staining. The protein expression of cell cycle regulators and tumor suppressors were analyzed by western blotting. RESULTS: Treatment of human gastric carcinoma cells with FLL induced cell death in a dose- and time-dependent manner by using CCK8 assay. Consistent with the CCK8 assay, the flow cytometry results showed that the proportion of the early and terminal phase of apoptosis cells had gained after FLL treatment as compared to untreated group. Moreover, human gastric carcinoma cells were exposed to the aqueous extracts of FLL for 48 h, which resulted in an accumulation of cells in G2/M phase. Apoptotic bodies were clearly observed in human gastric carcinoma that had been treated with FLL for 48 h and then stained with Hochest 33342. Treatment of gastric carcinoma cells with increasing doses of FLL and increasing durations significantly increased the protein expression of Bax and Caspase3, decreased the anti-apoptotic Bcl-2 level. The expression of CDC2 and cdc25C were downregulated upon FLL treatment in human gastric carcinoma. In contrast, p53 and p21 were obviously upregulated by FLL treatment in a concentration-dependent manner. CONCLUSIONS: These results confirmed that FLL could induce apoptosis in human gastric carcinoma, the underlying molecular mechanisms, at least partially, through activation p21/p53 and suppression CDC2/cdc25C signaling in vitro.

Accuracy of 16-row multislice computerized tomography angiography for assessment of intracranial aneurysms.

BACKGROUND: Sixteen-row multislice CT has great potential for use in vascular studies. The aim of the study was to assess the diagnostic accuracy of 16-row multislice CTA in detecting intracranial aneurysms compared with 2D-DSA and surgical findings. METHODS: One hundred fifty-two consecutive patients were included in the study and successively underwent 16-slice CTA, 2D-DSA, and surgery in some patients. This was performed with a 16-row multislice CT machine, detector slice of 0.75 mm, reconstruction interval of 0.40 mm, and timing determined by bolus trigger. The 16-slice CTA and 2D-DSA results were evaluated independently by 3 different neuroradiologists who performed aneurysm detection using MIP, SSD, and VRT. RESULTS: With the combination of 16-slice CTA, 2D-DSA, and intraoperative findings, 92 aneurysms were detected in 86 of the 152 patients. Two aneurysms were missed when 16-slice CTA was used. Three aneurysms were not clearly depicted at 2D-DSA, but proven at surgery. There was no statistically significant difference in sensitivity between 16-slice CTA and 2D-DSA (P = 1.0). The sensitivity of 16-slice CTA for detecting aneurysms <4 mm, between 4 and 10 mm, and >10 mm was 96% (95% CI: 79.6%-99.9%), 98.1% (95% CI: 89.7%-100%), and 100% (95% CI: 78.2%-100%), respectively, on a per-aneurysm basis. The sensitivity, specificity, and accuracy of 16-slice CTA for detecting aneurysms were 97.8% (95% CI: 92.4%-99.7%), 100% (95% CI: 94.6%-100%), and 98.7% (95% CI: 95.5%-99.8%), respectively, on a per-aneurysm basis. CONCLUSION: Sixteen-slice CTA shows promising diagnostic accuracy that appears to be comparable with 2D-DSA for the detection of suspected intracranial aneurysms, and 16-slice CTA is sensitive enough to replace 2D-DSA in detecting aneurysms.

Multi-slice spiral CT angiography in evaluating donors of living-related liver transplantation.

BACKGROUND: During the past years, the number of liver transplantation has increased greatly, but the number of available organs has not increased. In view of the critical shortage of organs, the indications for living-related liver transplantation (LRLT) have broadened since experience with the procedure has been achieved. This study was undertaken to assess the value of multi-slice spiral CT (MSCT) angiography in evaluating the hepatic arterial and veinous anatomy of potential donors for LRLT. METHODS: MSCT was performed after intravenous injection of contrast material at 3 ml/s. The total dose was calculated as 2 ml/kg. Twenty LRLT donors (2 men and 18 women) were subjected to MSCT angiography of hepatic blood vessels. These were generated by volume rendering and maximum intensity projection, while curved planar reformation was added in 5 patients. RESULTS: We identified 10 important hepatic vascular variants in 9 of the 20 donors (4 arterial, 4 venous, and 2 portal venous variants). In hepatic arterial variants, two had a replaced right hepatic artery arising from the superior mesenteric artery, an accessory right hepatic artery from the superior mesenteric artery and a replaced left hepatic artery arising from the left gastric artery. In hepatic venous variants, three had an accessory inferior right hepatic vein and one had two accessory inferior right hepatic veins. In hepatic portal venous variants, two had trifurcation of the main portal vein. CONCLUSIONS: As a non-invasive and reliable method, MSCT angiography is of value in the clinical evaluation of LRLT donors. MSCT angiography should be recommended as a routine preoperative examination for potential LRLT donors.

Spiral CT localization of pancreatic functioning islet cell tumors.

BACKGROUND: Surgeons are always concerned about the localization of pancreatic functioning islet cell tumor. If the tumor is accurately localized before operation, resection of the pancreatic body and tail without intention can be avoided. The purpose of this study was to evaluate spiral CT localization of pancreatic functioning islet cell tumors and CT techniques. METHODS: CT manifestations in 6 patients with clinically and pathologically proved pancreatic functioning islet cell tumors were analyzed retrospectively. RESULTS: In 4 patients with insulinomas and 2 patients with glucagonomas, 5 were localized accurately by CT before surgery and 1 was detected retrospectively. The enhancement of tumors was greater than that of normal pancreas in arterial phase and pancreatic parenchymal phase. Four patients showed mild high-density and 2, iso-density in the portal venous phase. CONCLUSION: Spiral CT multi-phase enhanced scan with 1.5 ml/kg contrast agent and 2-5 mm slice width can localize functioning islet cell tumors accurately.

Spiral multi-phase CT in evaluating resectability of pancreatic carcinoma.

OBJECTIVES: To evaluate the specific manifestations of pancreatic carcinoma on spiral multi-phase CT and its resectability before operation. METHODS: Ninety-seven patients were confirmed operatively and pathologically. Enhanced CT scan was performed with intravenous injection bolus of approximately 75-120 ml (1-1.5 ml/kg body weight) contrast medium at a rate of 2.5-3 ml/s. In 68 patients receiving dual-phase scan, the delayed scan time of arterial and venous phases was 18-20 s and 60-70 s, respectively, and in 29 patients receiving three-phase scan, the delayed scan time of arterial, pancreatic and portal venous phases was 18 s, 40 s and 75 s, respectively, with a slice of 3-5 mm thickness, a pitch of 1-1.5, and a reconstruction interval of 2.5-4.8 mm. RESULTS: Positive and negative predictive values of unresectable tumors were 97.65% and 75.86%, respectively. The sensitivity and accuracy were 90.67% and 90.72%, respectively. Positive predictive values of dual-phase and three-phase were 95.83% and 100%, respectively; negative predictive values were 75% and 77.78%, respectively. CONCLUSIONS: Spiral multi-phase CT is superior in revealing the involvement of peripancreatic vessels, the invasion of the neighboring organs, the size, shape and range of carcinoma, and the metastasis of liver and lymph node. The predictability of resection is obviously increased for patients with pancreatic carcinoma.