Restenosis after recanalization for Budd-Chiari syndrome: Management and long-term results of 60 patients.

BACKGROUND: Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction. For Asian Budd-Chiari syndrome patients, the major treatment modality is recanalization (percutaneous transluminal angioplasty with or without stent implantation). The cumulative 1-, 5-, and 10-year primary patency rates and survival rates are reported to be excellent or satisfactory, but the long-term outcome of patients with restenosis (the most common complication after recanalization) is unknown. AIM: To explore the treatment strategy for restenosis in patients with Budd-Chiari syndrome after interventional therapy and to evaluate the long-term follow-up results. METHODS: The clinical data and follow-up results of 60 patients with restenosis after interventional therapy from November 1983 to December 2013 were retrospectively analyzed. RESULTS: Sixty patients with restenosis were retrospectively divided into a percutaneous transluminal angioplasty (PTA) group (40 patients) and a PTA + stent group (20 patients) according to the primary recanalization method. For the patients with restenosis in the PTA group, 13 refused treatment, and 27 received further treatment; among these patients, five had a second restenosis, two had a third restenosis, and one had a fourth restenosis. For the patients with restenosis in the PTA + stent group, nine refused treatment, ten received PTA alone, and the other received PTA + stent implantation. Among the patients who received further treatment, five had a second restenosis, three had a third restenosis, and one had a fourth restenosis. The 1-, 5-, 10-, 20-, and 25-year cumulative survival rates of the 38 patients who received further treatment after restenosis were 100%, 78.3%, 78.3%, 70.5%, and 70.5%, respectively; however, for the 22 patients who refused treatment, the survival rates were 72.7%, 45.9%, 30.6%, 10.2%, and unavailable, respectively (P < 0.001). CONCLUSION: Long-term follow-up after interventional therapy is very important. Active treatment for patients with restenosis can improve prognosis, and minimally invasive treatment strategies for restenosis allows to obtain satisfactory results.

Influence of the substituents on phenyl groups on enantioseparation property of amylose phenylcarbamates.

A series of amylose phenylcarbamate derivatives bearing different chloro- or/and methyl- substituents on the phenyl groups were synthesized and their enantioseparation properties were examined by high-performance liquid chromatography. The enantioseparation power considerably altered due to the substituents on the phenyl units. The amylose derivative bearing 3-chloro-5-methyl disubstituents seemed to possess much higher chiral resolution power. The introduction of both an electron-withdrawing chloro and an electron-donating methyl groups enabled the NH groups to contain a moderate acidity, which may be important to construct a regular secondary structure for the amylose phenylcarbamates. Some interesting observations in 1H NMR and circular dichroism spectroscopy demonstrated the correlations between the structure and enantioseparation ability. The electronegativity, location and amount of the substituents at the phenyl residues have great influence on the enantioseparation power of the amylose derivatives. The mechanism involved in enantioselective discrimination of the amylose phenylcarbamates was further investigated by the molecular docking simulation.

Short-term and long-term efficacy of 7 targeted therapies for the treatment of advanced hepatocellular carcinoma: a network meta-analysis: Efficacy of 7 targeted therapies for AHCC.

BACKGROUND: A variety of targeted drug therapies in clinical trials have been proven to be effective for the treatment of hepatocellular carcinoma (HCC). Our study aims to compare the short-term and long-term efficacies of different targeted drugs in advanced hepatocellular carcinoma (AHCC) treatment using a network meta-analysis approach. METHODS: PubMed, Embase, Ovid, EBSCO, and Cochrane central register of controlled trials were searched for randomized controlled trials (RCTs) of different targeted therapies implemented to patients with AHCC. And the retrieval resulted in 7 targeted drugs, namely, sorafenib, ramucirumab, everolimus, brivanib, tivantinib, sunitinib, and sorafenib+erlotinib. Direct and indirect evidence were combined to evaluate stable disease (SD), progressive disease (PD), complete response (CR), partial response (PR), disease control rate (DCR), overall response ratio (ORR), overall survival (OS), and surface under the cumulative ranking curve (SUCRA) of patients with AHCC. RESULTS: A total of 11 RCTs were incorporated into our analysis, including 6594 patients with AHCC, among which 1619 patients received placebo treatment and 4975 cases had targeted therapies. The results revealed that in comparison with placebo, sorafenib, and ramucirumab displayed better short-term efficacy in terms of PR and ORR, and brivanib was better in ORR. Regarding long-term efficacy, sorafenib and sorafenib+erlotinib treatments exhibited longer OS. The data of cluster analysis showed that ramucirumab or sorafenib+erlotinib presented relatively better short-term efficacy for the treatment of AHCC. CONCLUSION: This network meta-analysis shows that ramucirumab and sorafenib+erlotinib may be the better targeted drugs for AHCC patients, and sorafenib+erlotinib achieved a better long-term efficacy.

Shape-Dependent Genotoxicity of Mesoporous Silica Nanoparticles and Cellular Mechanisms.

Although mesoporous silica nanoparticles (MSNs) are widely used in food products, cosmetics and nanomedicines as vector for drug delivery, data on their potential genotoxocity are limited. The aim of this study was to investigate the cytotoxic and genotoxic potentials of MSNs of different shapes, and to establish a high-throughput screening method for nanoparticles. We used functional macrophage receptor with collagenous structure (MARCO)-expressing DNA repair deficient chicken DT40 cells, which are designed to internalize nanoparticles and to be deficient in several specific DNA repair pathways. In addition, we verified the validity of this assay by analyzing and characterizing the genotoxicity of sphere- or rod-shaped MSNs. We demonstrated that both sphere- and rod-shaped MSNs were cytotoxic, and that this effect was greater in FEN1(-/-) and REV3(-/-) cells compared with wild-type cells. Effects of rod-shaped MSNs were more severe compared with sphere-shaped MSNs. Furthermore, MSNs induced oxidative damage and a larger number of mitotic chromosomal aberrations in repair-deficient cells compared with repair-proficient cells. Taken together, this assay system using the chimeric receptor-expressing DNA repair-deficient DT40 cells provides a sensitive method to screen for genotoxicity of MSNs.