25-OH-vitamin D deficiency identifies poor tumor response in hepatocellular carcinoma treated with transarterial chemoembolization.

PURPOSE: Vitamin D is implicated linked to liver cancer and chronic liver diseases, but its association with tumor response in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE) remains unclear. This study aimed to determine whether vitamin D levels influence tumor response in HCC patients treated with TACE. METHODS: A total of 58 HCC patients undergoing TACE were enrolled in the study. Serum 25-hydroxyvitamin D (25-OHD) levels were determined at baseline and 1 day after TACE using electrochemiluminescence immunoassay. Response to TACE was evaluated after a 4-6 week interval. Univariate and multivariate analyses with Cox regression model were performed to determine the risk factors associated with tumor response. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of baseline 25-OHD levels on tumor response in HCC patients undergoing TACE. RESULTS: 43.1% of HCC patients showed 25-OHD deficiency. Baseline 25-OHD level was associated with liver cirrhosis (P = 0.025), vascular invasion (P = 0.031), Barcelona Clinic Liver Cancer stage (P = 0.002) and an alanine aminotransferase increase after TACE (P = 0.021). Serum 25-OHD level was significantly decreased 1 day after TACE (P = 0.045). Multiple tumor numbers (P = 0.034) and low baseline 25-OHD levels (P = 0.040) were independently correlated with poor tumor response after TACE. ROC curve analysis showed that baseline 25-OHD levels present better predictive performance for OR in those patients, compared with other current clinical test pointers. CONCLUSION: Our study suggested that 25-OHD deficiency at baseline is a prognostic indicator for a poor tumor response in hepatocellular carcinoma treated with TACE.

[Safety and efficacy of transarterial embolization combined with octreotide LAR on reducing tumor burden for neuroendocrine tumor liver metastasis].

Objective: To evaluate the tumor burden reducing efficacy and safety of transcatheter arterial embolization (TAE) combined with octreotide LAR on neuroendocrine tumor liver metastasis (NETLM). Methods: Twenty-nine NETLM patients treated in the First Affiliated Hospital of Sun Yat-sen University from October 2014 to August 2018 were retrospectively recruited, including 12 males and 17 females. The mean age was 25-69(50±11) years. All patients were histologically proved as well-differentiated NET liver metastasis. Seventeen patients underwent combined treatment of TAE plus octreotide LAR (combined group) and 12 patients treated with only octreotide LAR (control group). Response of hepatic lesions were assessed according to RECIST 1.1. Objective response rates (ORR) of two groups were compared and analyzed. Safety and tolerance to TAE were also evaluated. Results: There were 13 PR and 4 SD in combined group, but only 1 PR and 9 PD in the control group. The ORR between the two groups were significantly different (13/17 vs 1/12, P<0.01).The main complication post TAE was post embolization syndrome, including abdominal pain (12/17), vomiting (6/17), fever (4/17), elevated transaminase (8/17) and bilirubinemia (3/17). Tumor lysis syndrome was observed in one patient. Conclusion: Compared to administration of octreotide LAR, TAE combined with octreotide LAR can effectively reduce tumor burden in patients with NETLM. TAE is safe and well-tolerated.

[Relationship between coronary tortuosity and coronary microvascular disease].

Objective: To explore the relationship between coronary tortuosity and coronary microvascular disease (CMVD). Methods: Patients with typical angina symptoms and without serious coronary artery stenosis by coronary angiography were enrolled from June 2014 to December 2016, and CMVD was diagnosed by single photon emission tomography (SPECT). According to the SPECT results, patients were divided to the CMVD group and non-CMVD group. The baseline clinical characteristics, results of coronary angiography were compared between the two groups. The logistic analysis was used to analyze the relationship between coronary tortuosity and CMVD. Result: A total of 117 cases were enrolled, with 69 cases in the CMVD group and 48 cases in the non-CMVD group. No differences were found in gender distribution, age, hypertension, lipid abnormality, hyperuricemia and uses of statins between the two groups (all P>0.05). Incidence of diabetes (78.26%(54/69) vs. 35.42% (17/48) , P<0.05), hs-CRP ((4.29±2.15)mmol/L vs. (2.63±1.20)mmol/L, P<0.001), LDL-C ((2.98±0.96)mmol/L vs. (2.52±0.83)mmol/L, P=0.008) and homocysteine ((13.7±5.61)mmol/L vs. (11.5±4.38)mmol/L, P=0.025) levels were higher in the CMVD group than in the non-CMVD group. The data derived from echocardiographic examination were similar between the two groups. The Corrected TIMI frame counts were higher in the CMVD group than in non-CMVD group (LAD: 31.56±4.92 vs. 27.31±3.75, LCX: 29.47±4.18 vs. 26.62±3.19, RCA: 29.09±5.05 vs. 26.24±3.28, all P<0.001). The incidences of coronary atherosclerosis (76.81% (53/69) vs. 27.08% (13/48) , P<0.001) and coronary tortuosity ( (60.87% (42/69) vs. 33.33% (16/48) , P=0.035) were also higher in the CMVD group than in non-CMVD group. Logistic analysis found that coronary tortuosity (OR=6.111, 95%CI 2.707-13.794, P<0.001), diabetes (OR=6.565, 95%CI 2.883-14.948, P<0.001) and coronary atherosclerosis (OR=8.918, 95%CI 3.822-20.808, P<0.001) were independent risk factors of CMVD. Conclusion: Coronary tortuosity, diabetes and coronary atherosclerosis are related to CMVD in this patient cohort.

[Transarterial chemoembolization combined with cryoablation for unresectable large hepatocellular carcinoma: a controlled study].

Objective: To evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with cryoablation in patients with unresectable large hepatocellular carcinoma (HCC). Methods: A total of 122 patients with unresectable large HCC admitted to the First Affiliated Hospital of Sun Yat-sen University between November 2011 and July 2015 were retrospectively involved.The patients were divided into study group (58 patients who underwent TACE combined with cryoablation) and control group (64 patients who underwent TACE alone). Short-term effect of the initial treatment, long-term effect, prognostic factors for survival and adverse reactions were statistically analyzed. Result: There was no statistical difference in general information between two groups. The effective rates of the study and control group were 29.3% and 10.9% (P=0.011), and the control rates were 79.3% and 62.5% (P=0.042). The median survival time was 11.0 months (95% CI 7.4-14.6) for the study group and 5.0 months (95% CI 4.0-6.0) for the control group, the 6-, 12-, and 18-month overall survival rates for the study and control group were 84.5%, 49.5%, 26.8% and 48.1%, 17.8%, 11.1%, respectively (all P<0.01). On multivariate analysis, negative distant metastasis, Barcelona Clinic Liver Cancer B-stage, neutrophil-to-lymphocyte ratio ≤5, alpha fetoprotein<400 µg/L, combined treatment and effective initial treatment were independent protective factors for survival of patients with large HCC. Conclusions: The prognosis of patients with unresectable large HCC is affected by multiple factors. In comparison with TACE alone, TACE combined with cryoablation has advantage in both short-term and long-term effect with low incidence of serious adverse reactions, it is an effective and safe treatment option for patients with unresectable large HCC.

[Kindling of rat epilepsy by intracerebroventricular injection of norfloxacin and ultrastructural changes of brain].

AIM: To study the toxic effects of norfloxacin (Nor) on EEG and ultrastructure of the brain. METHODS: EEG was recorded in the sensorimotor area of rat cortex after Nor 150 and 300 micrograms.kg-1 were injected into the right ventricle of the brain. RESULTS: Spike waves occurred, first at the ipsilateral side and then bilaterally. The seizure spike appeared at 168 +/- 129, 51 +/- 35 s, and 276 +/- 138, 118 +/- 65 s in the right and left cerebral cortices in 150 and 300 micrograms.kg-1 groups, respectively. The wave forms were variable, the wave amplitude and frequency increased gradually, accompanied with limb twitching. Neuron degeneration was seen in both cerebral hemispheres, hippocampus, and cerebellum 120 min after the i.c.v. of Nor 300 micrograms.kg-1: myeloid degeneration of Golgi complex, rough endoplasmic reticulum, and neuropils; swelling of cytoplasm; dissolution of nuclears and chromatin; necrosis of gliocytes and the appearance of changes in both the light and dark neurons, especially the dark ones. CONCLUSION: Rat brain was widely damaged after the kindling by Nor.