Prognostic Value of HLA Class I in Patients with Hepatocellular Carcinoma.

BACKGROUND: Downregulation of HLA class I molecules is a major tumor escape mechanism from immune attack. However, its prognostic impact for patients with hepatocellular carcinoma is still unclear. This study aimed to investigate whether HLA class I has prognostic significance in patients with hepatocellular carcinoma. METHODS: A cohort of 132 patients with hepatocellular carcinoma was enrolled. HLA class I expression was detected by immunohistochemistry. Levels of HLA class I expression were dichotomized as low and high according to staining intensity or staining percentage of positive tumor cells, respectively. Association of HLA class I expression with clinical characteristics and survival was analyzed. RESULTS: None of the clinical characteristics, including gender, age, virus infection, cirrhosis, AFP, vascular invasion, tumor size and number, was significantly associated with staining percentage of HLA class I or staining intensity (p > 0.05). Low staining percentage of HLA class I was significantly associated with a worse survival (p = 0.011), which was further confirmed by Cox regression hazards model in multivariate analysis (HR 0.416, 95% CI 0.204 - 0.849, p = 0.016). Staining intensity of HLA class I was not significantly associated with survival (p > 0.05). CONCLUSIONS: Expression of HLA class I might be a significant prognostic factor in hepatocellular carcinoma, and downregulation of HLA class I was significantly associated with a worse survival in terms of expression percentage of HLA class I.

The Main Pulmonary Artery to the Ascending Aorta Diameter Ratio (PA/A) as a Predictor of Worse Outcomes in Hospitalized Patients with AECOPD.

Purpose: The main pulmonary artery (PA) to ascending aorta diameter ratio (PA/A) greater than one is a promising indicator of pulmonary hypertension (PH) in acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) (AECOPD). This study aims to disclose the associations between the PA/A ratio and clinical outcomes in hospitalized patients with AECOPD. Patients and Methods: Consecutive AECOPD patients admitted to the Department of Respiratory Medicine from September 2017 to July 2021 were reviewed. The treatment success of AECOPD patients was defined as improvement in the clinical condition when discharged from the hospital. Conversely, treatment failure was considered to be an event of in-hospital death or deterioration of the clinical condition prior to discharge. Results: A total of 118 individuals were ultimately reviewed in this study: 74 individuals with a PA/A ratio <1 and 44 individuals with a PA/A ratio ≥1. The outcomes of 21 patients were treatment failure, and 97 patients were considered successes. Patients with a PA/A ratio ≥1 had significantly higher PaCO2, red cell distribution width, brain natriuretic peptide, PA diameters, RICU admission rates, and proportions of treatment failure than patients with PA/A ratios <1 (P < 0.05). The PA diameter and PA/A ratio were significantly increased in the treatment failure group compared with the success group (P < 0.05). A survival analysis indicated that patients with a PA/A ratio ≥1 had worse outcomes than patients with a PA/A ratio <1 during hospitalization (P < 0.05). A multivariate analysis showed that a PA/A ratio ≥1 was an independent risk factor for treatment failure in patients with AECOPD. Conclusions: AECOPD patients with a PA/A ratio ≥1 may have worse outcomes during hospitalization. A PA/A ratio ≥1 may be a promising predictor of treatment failure in patients with AECOPD.

Prognostic Value of PD-L1 in Patients with Hepatocellular Carcinoma.

BACKGROUND: The aim of the study is to investigate whether programmed death ligand l (PD-L1) on tumor cells has prognostic significance in patients with hepatocellular carcinoma. METHODS: A cohort of 143 patients with hepatocellular carcinoma was enrolled. PD-L1 expression was detected by immunohistochemistry. The association of PD-L1 expression with clinical characteristics and survival was analyzed. RESULTS: PD-L1 positive rate in our study was 13.3% (19/143). None of clinical characteristics, including gender, age, virus infection, AFP, vascular invasion, tumor size, and number, was significantly associated with PD-L1 expression (p > 0.05). PD-L1 expression was significantly associated with cirrhosis (p = 0.016). PD-L1 expression was not significantly associated with survival (Log-rank p = 0.076; HR: 0.363 p = 0.091). CONCLUSIONS: PD-L1 expression failed to have a markedly significant prognostic association with survival in patients with hepatocellular carcinoma.

Efficacy and safety of preoperative internal maxillary arterial embolization with gelfoam for nasopharyngeal angiofibroma.

PURPOSE: To investigate the efficacy and safety of preoperative internal maxillary arterial embolization with gelfoam particles in patients with nasopharyngeal angiofibroma. MATERIALS AND METHODS: We retrospectively reviewed a total of 27 consecutive patients with pathologically confirmed nasopharyngeal angiofibroma from August 2006 to September 2018. Of the 27 enrolled patients, 10 patients received surgical excision alone; 17 patients received preoperative internal maxillary arterial embolization followed by surgical excision. Embolic agents were gelfoam particles. RESULTS: The mean volume of intro-operative blood loss was 385.3 ml in patients with preoperative arterial embolization, which was significantly lower than 1215.0 ml in the patients without preoperative arterial embolization (P < 0.001). The mean surgical time was shorter in patients with preoperative arterial embolization than in the patient without preoperative arterial embolization, but the difference had no statistical significance (205.0 vs 264.5 min, P = 0.064). Neurological complications such as facial palsy or vision loss or hemiplegia were not observed in patients with preoperative arterial embolization. CONCLUSION: Internal maxillary artery embolization with gelfoam particles suffices to provide an effective and safe adjuvant procedure for surgical excision of nasopharyngeal angiofibroma.

Prophylactic selective arterial embolization for renal angiomyolipomas: efficacy and evaluation of predictive factors of significant shrinkage.

PURPOSE: To evaluate the efficacy of prophylactic selective arterial embolization (SAE) of angiomyolipomas (AMLs) and to find out predictive factors of significant shrinkage of AMLs after SAE. METHODS: Patients receiving prophylactic SAE for renal AMLs with complete medical records were included. The changes of the size, urine erythrocyte counts, and serum creatinine of all patients pre- and post-embolization were assessed. Demographic data, symptoms, the background of tuberous sclerosis complex (TSC), aneurysms, enhancement features, initial tumor sizes, and serum creatinine pre-embolization were estimated as predictive factors of significant shrinkage in size. RESULTS: Forty-five patients receiving prophylactic SAE for AMLs successfully in our center were included with median follow-up of 14.0 months (interquartile range 6.5-40.5). Mean size of AMLs decreased from 10.7 ± 6.2 to 8.3 ± 5.9 cm by 23.4% ± 20.6% at the latest follow-up (P < 0.001). Urine erythrocytes decreased significantly after SAE (11.1 [interquartile range 5.7-23.2] vs. 6.4 [interquartile range 2.7-13.4], P < 0.001). In addition, there was no significant change between the serum creatinine before and after embolization (81.8 ± 14.9 mmol/L vs. 83.6 ± 17.1 mmol/L, P = 0.224). Of the variables mentioned above, only the enhanced area of AMLs before SAE was statistically significant between the groups with and without significant shrinkage (P < 0.001). In multiv-ariate analysis, enhanced area < 25% (AOR = 0.015, 95% CI 0.001-0.367) and having the background of TSC (AOR = 0.056, 95% CI 0.004-0.799) were identified as predictive factors of significant shrinkage of the tumors. CONCLUSIONS: Prophylactic SAE is effective in reducing the size of renal AMLs and decreasing urine erythrocytes with preservation of renal function. Significant shrinkage of AMLs after SAE is modulated by the enhanced area and the background of TSC.

Superselective Transcatheter Artery Embolization in Patients with Non-ischemic Priapism.

PURPOSE: To investigate the efficacy and safety of superselective transcatheter artery embolization in patients with non-ischemic priapism. MATERIALS AND METHODS: We retrospectively reviewed a cohort of 17 consecutive patients with non-ischemic priapism from September 2006 to August 2017. The median follow-up time was 8 months. RESULTS: Sixteen patients underwent superselective transcatheter artery embolization, and all had complete resolution of non-ischemic priapism. Fifteen of 16 patients (93.7%) underwent a single embolization without recurrence. A secondary embolization was required in one patient (6.3%) as a result of recurrence. Two of 16 patients (12.5%) had a decrease in their erectile function; one of the two patients had premorbid erectile dysfunction. Excluding the patient with premorbid erectile dysfunction, 14 of 15 patients (93.3%) maintained premorbid normal erectile function after embolization; the incidence of decrease in quality of erection is 6.7% (1/15). One patient did not undergo artery embolization because of negative findings of cavernous fistula by angiography. No angiography-related complications were found. CONCLUSION: Superselective transcatheter artery embolization is an effective and safe procedure for non-ischemic priapism.

Prognostic value of Ki-67 expression in patients with extensive-stage small cell lung cancer.

AIM: To determine whether Ki-67 has prognostic significance in patients with extensive-stage small cell lung cancer. PATIENTS & METHODS: A retrospective review identified 159 consecutive patients with extensive-stage small cell lung cancer. Ki-67 expression level at the time of diagnosis was retrieved. Survival was assessed by Kaplan-Meier method and long-rank test. RESULTS: None of the clinical characteristics, including age, gender and lactate dehydrogenase, were significantly associated with Ki-67 expression level (p > 0.05). Patients with high Ki-67 expression had longer survival than patients with low Ki-67 expression (p = 0.078). Age, gender and lactate dehydrogenase were not significantly associated with survival (p > 0.05). CONCLUSION: Ki-67 expression level failed to have a markedly significant impact on survival in patients with extensive-stage small cell lung cancer.

Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa.

PURPOSE: To appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa. METHODS: A cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed. RESULTS: Vaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery, and volume of vaginal bleeding, was significantly associated with complete placenta previa (P > 0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P = 0.038). The rate of complications was 3.7%. No major complications were observed. CONCLUSION: Uterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.

Outcomes of bronchial artery embolization for life-threatening hemoptysis secondary to tuberculosis.

OBJECTIVE: To appraise the immediate and long-term outcomes of bronchial arterial embolization for life-threatening hemoptysis secondary to tuberculosis. METHODS: 112 patients with life-threatening hemoptysis due to tuberculosis underwent bronchial artery embolization from January 2004 to February 2014. Life-threatening hemoptysis was defined as expectoration of at least 400 ml of blood in 24 hour. The median follow-up is 20 months, ranging from 2 to 52 months. RESULTS: The hemoptysis control rate was 86.6% at 14 days, 84.8% at 30 days, 78.6% at 240 days, 75.9% at 360 days, respectively. None of these characteristics, including gender, age and tuberculosis status, was significantly associated with immediate control of bleeding. Patients with active tuberculosis had a significantly longer recurrence-free duration than did patients with inactive tuberculosis (P = 0.040), which was further confirmed by Cox regression hazards model (P = 0.046). There was no spinal cord complication or mortality related to bronchial artery embolization. The most common complication was transient chest pain. CONCLUSION: Bronchial arterial embolization is an effective and safe technique in the management of life-threatening hemoptysis secondary to tuberculosis. Active tuberculosis may be associated with a lower rate of recurrence of hemoptysis.

Association of BRCA1 K1183R polymorphism with survival in BRCA1/2-negative chinese familial breast cancer.

BACKGROUND: To determine whether a common BRCA1 K1183R polymorphism (3667A > G) affects survival in BRCA1/2-negative Chinese familial breast cancer. We investigated the associations between the BRCA1 E1183R polymorphism and disease-free survival and clinicopathological characteristics in a cohort of 325 Chinese familial breast cancer patients without BRCA1/2 germline mutations. METHODS: K1183R polymorphism was detected by polymerase chain reaction (PCR)-sequencing assay. RESULTS: Among the 325 Chinese familial breast cancer patients, the frequencies of the genotypes of E1183R polymorphism were 81.5% for wild-type (AA), 14.5% for heterozygote (AG), and 4.0% for variant (GG). No significant association between the genotypes and clinicopathological characteristics was found. There was a trend association that patients with the AA genotype had a better disease-free survival than those with the AG/GG genotype in univariate analysis (p = 0.111), but patients with AA genotype had a significantly better disease-free survival than did patients with AG or GG genotype in the HER2 positive subgroup (p = 0.012). CONCLUSIONS: The present study suggests that the AA genotype of BRCA1 K1183R polymorphism is associated with a favorable survival in HER2 positive familial breast cancer patients.

Association of transarterial chemoembolization with survival in patients with unresectable hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common types of cancer worldwide. Only a minority of HCC patients benefit from curative therapies, such as surgical resection, liver transplantation, or percutaneous treatment, since the majority of HCCs are diagnosed at intermediate or advanced stages. To determine whether transarterial chemoembolization (TACE) affects survival in patients with unresectable HCC, we conducted a case-controlled study, investigating 129 patients diagnosed with intermediate- or advanced-stage HCC, classified according to the Barcelona Clinic Liver Cancer staging system. Of these 129 patients, 102 received TACE and 27 received symptomatic treatment alone. The primary follow-up endpoint was survival. The association of TACE with survival was estimated with the Kaplan-Meier method. Survival was significantly higher in the chemoembolization group compared to that in the symptomatic treatment group. The estimated 1-, 2- and 3-year survival rates were 61.8, 34.0 and 24.3% for the chemoembolization group and 51.9, 9.9 and 0% for the symptomatic treatment group (P<0.001). TACE was shown to significantly improve survival and is an effective form of treatment for patients with unresectable HCC.

Methylation of p16 CpG islands correlated with metastasis and aggressiveness in papillary thyroid carcinoma.

BACKGROUND: Inactivation of p16 by methylation of CpG islands is a frequent early event in human cancers, including papillary thyroid carcinoma (PTC). This study was to observe the methylation status of the p16 gene in papillary thyroid carcinoma (PTC) and its correlation with clinical parameters. METHODS: Methylation-specific PCR (MSP) was used to analyze the methylation status of the p16 gene in 74 PTCs and 21 adjacent normal thyroid tissues. RESULTS: Hypermethylation of p16 gene was observed in 27.0% (20/74) of PTC. None of the normal thyroid tissues was methylated, when compared to the PTCs (p < 0.05). There was no marked relationship between the methylation of p16 gene and the patients' age, gender, size of cancer, histological subtypes and occurrence of recurrent disease (p > 0.05). The methylation of p16 gene was positively associated with metastasis, a high AMES (age, metastasis to distant sites, extrathyroidal invasion, size) risk group (p < 0.05) and advanced pathological tumor-lymph node-metastasis stages. CONCLUSION: The methylation of the p16 gene, one event of significance in molecular biology, was common and correlated with biological metastasis and histological features in PTC, and may be involved in thyroid tumorigenesis and aggressiveness.

Prevalence and characterization of BRCA1 and BRCA2 germline mutations in Chinese women with familial breast cancer.

Although there are some studies to investigate germline mutations in BRCA1/2 genes in Chinese women with familial breast cancer, many of them suffer relatively small sample size. In this study, we screened germline mutations in BRCA1/2 genes in a cohort of 409 Chinese women with familial breast cancer from north China by using a PCR-sequencing assay. A total of 43 deleterious mutations in BRCA1/2 genes were identified in this cohort, including 17 novel mutations and 6 recurrent mutations. The frequencies of BRCA1 and BRCA2 mutations were 3.9% (16/409) and 6.6% (27/409), respectively; the mutation rate of BRCA2 was 1.7-fold higher than that of BRCA1. The entire mutation rate of BRCA1/2 was 10.5% in this cohort; however, the mutation rate of BRCA1/2 genes was 23.0% in 78 familial breast cancer patients whose tumors were diagnosed at or before the age of 40. The mean age at diagnosis of breast cancer in BRCA1 carriers (42.8 years) and BRCA2 carriers (45.1 years) was younger than non-carriers (51.0 years) in this cohort (P = 0.005; P = 0.01, respectively). In addition, both BRCA1 carriers and BRCA2 carriers were more likely to exhibit triple-negative breast cancer (ER-, PgR-, and HER2-) than non-carriers (BRCA1 carriers vs. non-carriers, 69.2 vs. 23.0%, P = 0.001; BRCA2 carriers vs. non-carriers, 45.8 vs. 23.0%, P = 0.01). Our study suggested that the spectrum and characteristics of BRCA1/2 mutations in Chinese familial breast cancer exhibit some unique features, and Chinese women with familial breast cancer whose tumors are diagnosed at or before the age of 40 are good candidates for BRCA1/2 testing.