Gadoxetic acid in hepatocellular carcinoma and liver metastases: pearls and pitfalls.

Gadoxetic disodium (Primovist) is a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent with increasing popularity with its unique dual dynamic and excretory properties in focal liver lesion detection and characterisation. In-depth knowledge of its diagnostic utility and pitfalls in hepatocellular carcinoma (HCC) and liver metastases is crucial in facilitating clinical management. The current article reviews the pearls and pitfalls in these aspects with highlights from the latest research evidence. Pearls for common usage of Primovist in HCC includes detection of precursor cancer lesions in cirrhotic patients. Hepatobiliary phase hypointensity precedes arterial phase hyperenhancement (APHE) in hepatocarcinogenesis. Hepatobiliary phase hypointense nodules without APHE can represent early or progressed hepatocellular carcinoma (HCC) and high-grade dysplastic nodules. In addition, Primovist is useful to differentiate HCC from pseudolesions. Pitfalls in diagnosing HCC include transient tachypnoea in the arterial phase, rare hepatobiliary phase hyperintense HCC, and decompensated liver cirrhosis compromising image quality. Primovist is currently the most sensitive technique in diagnosing liver metastases before curative hepatic resection. Other patterns of enhancement of liver metastases, "disappearing" liver metastases are important pitfalls. Radiologists should be aware of the diagnostic utility, limitations, and potential pitfalls for the common usage of hepatobiliary specific contrast agent in liver MRI.

RGD-conjugated iron oxide magnetic nanoparticles for magnetic resonance imaging contrast enhancement and hyperthermia.

The purpose of this study was to develop a specific targeting magnetic nanoparticle probe for magnetic resonance imaging and therapy in the form of local hyperthermia. Carboxymethyl dextran-coated ultrasmall superparamagnetic iron oxide nanoparticles with carboxyl groups were coupled to cyclic arginine-glycine-aspartic peptides for integrin α(v)ß3 targeting. The particle size, magnetic properties, heating effect, and stability of the arginine-glycine-aspartic-ultrasmall superparamagnetic iron oxide were measured. The arginine-glycine-aspartic-ultrasmall superparamagnetic iron oxide demonstrates excellent stability and fast magneto-temperature response. Magnetic resonance imaging signal intensity of Bcap37 cells incubated with arginine-glycine-aspartic-ultrasmall superparamagnetic iron oxide was significantly decreased compared with that incubated with plain ultrasmall superparamagnetic iron oxide. The preferential uptake of arginine-glycine-aspartic-ultrasmall superparamagnetic iron oxide by target cells was further confirmed by Prussian blue staining and confocal laser scanning microscopy.

Resolution of hyposmotic stress in isolated mouse ventricular myocytes causes sealing of t-tubules.

It has recently been shown that various stress-inducing manipulations in isolated ventricular myocytes may lead to significant remodelling of t-tubules. Osmotic stress is one of the most common complications in various experimental and clinical settings. This study was therefore designed to determine the effects of a physiologically relevant type of osmotic stress, hyposmotic challenge, to the integrity of the t-tubular system in mouse ventricular myocytes using the following two approaches: (1) electrophysiological measurements of membrane capacitance and inward rectifier (IK1) tail currents originating from K(+) accumulation in t-tubules; and (2) confocal microscopy of fluorescent dextrans trapped in sealed t-tubules. Importantly, we found that removal of '0.6 Na' (60% NaCl) hyposmotic solution, but not its application to myocytes, led to a ∼27% reduction in membrane capacitance, a ∼2.5-fold reduction in the amplitude of the IK1 tail current and a ∼2-fold reduction in the so-called IK1 'inactivation' (due to depletion of t-tubular K(+)) at negative membrane potentials; all these data were consistent with significant detubulation. Confocal imaging experiments also demonstrated that extracellularly applied dextrans become trapped in sealed t-tubules only upon removal of hyposmotic solutions, i.e. during the shrinking phase, but not during the initial swelling period. In light of these data, relevant previous studies, including those on excitation-contraction coupling phenomena during hyposmotic stress, may need to be reinterpreted, and the experimental design of future experiments should take into account the novel findings.

Genomic sequence of an avian paramyxovirus type 1 strain isolated from Muscovy duck (Cairina moschata) in China.

The complete sequence of an avian paramyxovirus type 1 (APMV-1) strain, FP1/02, isolated from Muscovy duck in China, was determined. Sequence analysis indicated that the complete genome of strain FP1/02 contained 15,192 nucleotides (nt), following the rule of six. The genome contained an extra 6-nt insertion in the non-coding region of the NP gene when compared with other APMV-1 strains, such as strains La Sota and Beaudette C. The cleavage site of the F protein was (112)R-R-Q-K-R↓F(117), indicating that the FP1/02 strain was virulent, but the morbidity and mortality varied with the species of duck. Genotypic analysis based on the F gene revealed that APMV-1 FP1/02 was a member of genotype VII. Phylogenetic analysis showed that the FP1/02 strain shared high identity with other APMV-1 strains such as ZJ1, SF02 and NA-1 isolated from geese.

Hepatocellular carcinoma with extrahepatic collateral arterial supply.

Haepatocellular carcinoma (HCC) is the most common primary liver malignancy, representing the fifth most common cancer in the world. Without treatment, the median survival of HCC patients has been reported to be 8 weeks from symptomatic presentation. Transarterial chemoembolisation is widely used to manage unresectable HCCs. However, when a tumour is large or locates near the liver capsule, it may receive supplies from vessels other than hepatic arteries. In this paper, we discuss the anatomy of possible extrahepatic collateral arterial supplies of HCCs.

An appraisal of timely magnetic resonance imaging in diagnosing spinal cord compression.

INTRODUCTION: Spinal cord compression is a very debilitating condition and could be secondary to many causes. Urgent magnetic resonance (MR) imaging of the spine is crucial in making the diagnosis and guiding further management. Our objectives were to assess the nature of MR imaging requests, the diagnostic yield, and the subsequent management according to relevant MR imaging findings. METHODS: We focused on all the urgent MR imagings of the spine conducted from July 1, 2007 to December 31, 2007. Clinical data, including the demographical information, presenting symptoms, radiological diagnosis, waiting time for MR imaging and treatment, was reviewed. RESULTS: A total of 33 cases of urgent MR imaging of the spine were performed. Patients were aged 29-85 years, with 18 males and 15 females. Most of them (84.8 percent) presented with neurological symptoms. 84 percent of the MR imaging was performed within 24 hours. 76 percent of the examinations yielded significant cord compression, of which 56 percent were due to vertebral metastasis, while others were due to epidural haematoma (12 percent), infective spondylodiscitis (8 percent), vertebral fracture (8 percent) and disc herniation (16 percent). Of the vertebral metastasis patients, 43 percent had one region imaged. 64 percent of the cord compression patients received surgical treatment or radiotherapy, with a mean waiting time of 1.7 days. CONCLUSION: The urgent MR imaging spine service was able to react promptly with a high diagnostic yield. One-third of the patients with vertebral metastasis had multiple levels involved, and imaging of the whole spine would be useful.

Attempt of photodynamic therapy on esophageal varices.

Small vessels gradually reappear within the esophageal wall after endoscopic injection sclerotherapy or endoscopic variceal ligation, which causes late recurrent bleeding. Additional ligation or a small amount of sclerotherapy of these thin and serpentine vessels is sometimes difficult to perform, and stenosis of the esophagus sometimes occurs after a small amount of sclerotherapy. In this study we attempted endoscopic photodynamic therapy on newly visible vessels and evaluated its ability to prevent recurrent bleeding. Fourteen patients with newly visible vessels within the esophageal wall were enrolled. All patients had esophageal varices secondary to hepatitis B and had their varices eliminated through endoscopic sclerotherapy before neovascularization. Seven patients received photodynamic therapy, and seven patients served as the control group. In the photodynamic therapy group, intravenous injection of 5 mg/kg of hematoporphyrin monomethyl ether was given and immediately followed by endoscopic irradiation of the newly visible vessels by copper vapor laser for 40 min with a power density of 150 mW/cm(2). Endoscopic examination was performed 3 months later to evaluate the therapeutic effect. The duration of non-bleeding was compared between the two groups. The number of newly visible vessels was found to have decreased after photodynamic therapy when compared with the control group (P < 0.001). Kaplan-Meier analyses demonstrated a longer period of non-bleeding in the photodynamic therapy group. The recurrent bleeding rate in the photodynamic therapy (PDT) group was lower than that in the control group (P = 0.027). One patient in the photodynamic therapy group suffered from facial dermatitis from shining direct light. Endoscopic photodynamic therapy seemed to be effective in the elimination of esophageal newly visible vessels and the prevention of recurrent bleeding.

Inhibitory effect of triptolide on interleukin-18 and its receptor in rheumatoid arthritis synovial fibroblasts.

OBJECTIVE: To determine the effects of triptolide (TP) on the expression of interleukin-18 (IL-18) and its receptor in phorbol 12-myristate 13-acetate (PMA)-stimulated rheumatoid arthritis synovial fibroblasts (RASF). MATERIALS AND METHODS: RASF were obtained from the synovial tissue of patients with RA. RASF were pretreated with TP (0~100 ng/ml) for 2 h before stimulation with PMA (50 ng/ml). The bioactivity of IL-18 in the supernatant was detected based on IFN-gamma secretion from IL-18-responding human myelomonocytic KG-1 cells. IL-18 level was analyzed by ELISA. In situ expression of IL-18Ralpha was determined by immunofluorescence assay. To estimate the protein and mRNA expression of IL-18 and IL-18Ralpha in RASF, western blot and quantitative RT-PCR were performed. Nuclear factor-kappaB (NF-kappaB) activity in the whole-cell extract of treated RASF was also measured using an ELISA-based method. RESULTS: TP effectively inhibited the bioactivity of IL-18 in PMA-stimulated RASF. The expression of IL-18 and IL-18R at protein and gene levels was reduced by TP. NF-kappaB activity in PMA-stimulated RASF was profoundly suppressed by TP. These effects showed a high correlation with TP concentration (0~100 ng/ml). CONCLUSION: TP effectively inhibited the expression of IL-18 and its receptor in PMA-stimulated RASF. These results suggest a mechanism of TP in RA therapy.

Oesophageal gastro-intestinal stromal tumour presenting with rupture into pleural cavity.

Gastro-intestinal stromal tumours are rarely found in the oesophagus and it is uncommon for these tumours to present with rupture. In this paper, we report a case where the tumour ruptured through the distal oesophagus. As a result, the patient underwent surgical tumour dissection. A histopathological examination of the tumour mass confirmed that it was a gastro-intestinal stromal tumour. In this report, we review the diagnosis, pathology, and treatment of a patient presenting with a ruptured oesophageal gastro-intestinal stromal tumour.

Bipaddled radial forearm flap for the reconstruction of bilateral buccal defects in oral submucous fibrosis.

Oral submucous fibrosis can result in progressive closure of the mouth. A total of 10 patients with advanced oral submucous fibrosis were surgically treated. The procedure consisted of (1) release of all the intraoral fibrotic tissue, (2) masticatory muscle myotomy and coronoidotomy, and (3) reconstruction with a bipaddled radial forearm flap. Preoperative mouth opening was 0-5mm (mean 2.3mm). The intraoperative mouth opening was 12-20mm (mean 16 mm) after submucous release, and 32-42 mm (mean 35.5mm) after further release via myotomy and coronoidotomy. The proximal flap included one perforator in four patients and two perforators in the remaining six patients. The flaps were 8-9 cm in length and 2-2.5 cm in width. Nine flaps survived uneventfully. Arterial thrombosis was noted in one flap, which was successfully salvaged. Temporomandibular joint subluxation developed in one patient. Two patients needed flap revision due to bulkiness. The postoperative mouth opening was 18-38 mm (mean 28.2mm) after a mean of 21 months' follow-up, and the mean increase was 25.9 mm. A bipaddled radial forearm flap, using a single donor site, can cover two separate buccal defects after release of oral submucosal fibrosis and obviate the need for a second free flap.

Photodynamic therapy of esophageal varices: experimental studies in animal veins, and first clinical cases.

BACKGROUND AND STUDY AIMS: Endoscopic injection sclerotherapy and endoscopic variceal ligation have been found to have shortcomings in the treatment of esophageal varices. In this study the effectiveness of photodynamic therapy (PDT) in the obliteration of veins was investigated to evaluate its potential in the treatment of esophageal varices. METHODS: Auricular margin veins of rabbits were irradiated by copper vapor laser after intravenous injection of 10 mg/kg of hematoporphyrin monomethyl ether (which is a hematoporphyrin derivative) into the rabbits. Control groups included rabbits that received irradiation only, that received injection of photosensitizer only, and that received injection sclerotherapy (using sodium morrhuate). The treated areas were observed macroscopically and also identified using with ultrasonic miniprobe. Biopsies were performed and the specimens were examined microscopically after hematoxylin-eosin staining and Victoria blue staining. In addition, two patients with newly visible veins within the esophageal wall after endoscopic injection sclerotherapy underwent PDT. Intravenous injection of 5 mg/kg of hematoporphyrin monomethyl ether was given, and the newly visible veins were endoscopically irradiated by copper vapor laser. Endoscopic re-examination was performed 1 month later to evaluate the therapeutic effect. RESULTS: Thrombi of the auricular margin vein were formed and blood flow was obstructed after PDT. Thrombus formation and diffused necrosis of adjacent tissue was found after injection of sodium morrhuate. On ultrasonic examination, the lumina of the veins showed a slightly higher echo after PDT compared with a lower echo before treatment, which was another sign of thrombus formation. The rabbit ears showed a diffused low echo after injection of sodium morrhuate, indicating diffuse necrosis. On microscopic observation, destruction of the endothelium and formation of thrombus was seen after PDT. Further observation of specimens stained with Victoria blue showed that the layer of elastic fiber was intact. After injection of sodium morrhuate, extensive necrosis of tissue was seen microscopically. No macroscopic, ultrasonic, or microscopic change was found in the rabbits that received irradiation only or injection of photosensitizer only. The rate of thrombus formation in rabbits that received PDT was significantly higher than that in the rabbits that received irradiation only or injection of photosensitizor only ( P = 0.015, P = 0.015), and comparable to that in the rabbits that received sclerotherapy ( P = 0.467). In the clinical study, at endoscopy 1 month after PDT both the number and the "red sign" of newly visible veins were found to have decreased. No adverse effect was found. CONCLUSION: PDT can destroy the endothelium of the vein, result in thrombus formation, and eventually obliterate the vein. It is potentially a new method for the treatment of esophageal varices.

Photocatalytic oxidation using a new catalyst--TiO2 microsphere--for water and wastewater treatment.

Since the suspended TiO2 powder enjoys free contact with UV irradiation in a photoreactor system, it can generally achieve better efficiency than the immobilized TiO2 catalysts. However, the separation and reuse of this catalyst powder from treated water often limit its application in practice. In this study, a new type of TiO2 catalyst called TiO2 microsphere was prepared by a sol-spraying-calcination method, which can easily settle in its aqueous suspensions under gravity. The SEM image of the TiO2 microsphere samples demonstrated that they had an almost spherical shape with a particle size of 30-160 microm, while the XRD analysis indicated that these TiO2 microspheres still had a crystal size of 8.1 nm. Since these TiO2 microspheres had a porous structure with higher specific surface area and pore volume than normal TiO2 powders, they appeared to have strong adsorption ability in its aqueous suspensions. The photocatalytic activity of the TiO2 microspheres was evaluated in the photodegradations of salicylic acid (SA) and sulfosalicylic acid (SSA). The experimental results showed that the reaction rate using the TiO2 microspheres was similar to that using the TiO2 powders in the SA suspensions and even higher than that in the SSA suspensions. Chemical and physical properties of the TiO2 microspheres and powders that are attributed to photoactivity were discussed based on the Langmuir-Hinshelwood kinetic model. The prepared TiO2 microsphere samples were reused in the photooxidation reaction more than 50 times. It was found that there was no significant weakening in their photoactivity and no change in their particle shape. This TiO2 microsphere catalyst can be simply used to conduct an effective photooxidation in its suspension for water and wastewater treatment with ease of recovery from treated water.

Expression of multidrug resistance-related markers in gastric cancer.

BACKGROUND: To detect the expression of glutathione S-transferase Pi(GST-pi), multidrug resistance-associated protein (MRP), lung-resistance protein(LRP), multidrug resistance gene1 (MDR1) and MGr1 antigen(MGr1-Ag) in the patients with primary gastric cancer and without any prior chemotherapy and to evaluate the correlations between them. PATIENTS AND METHODS: The expression of GST-pi, MRP, LRP and MDR1 in cancer tissue and the adjacent non-cancerous tissue from 50 patients was examined by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR). The expression of MGr1-Ag in these tissues was also examined by immunohistochemistry. RESULTS: The positive rate of GST-pi mRNA, MRP mRNA, LRP mRNA, MDR1mRNA and MGr1-Ag in gastric cancer tissue was 36.00%, 12.00%, 10.00%, 10.00% and 18.00% respectively. The overall positive rate of their expression was 58.00%. Clinicopathological factors were not significantly related to their expression. No significant correlation was observed between these markers. CONCLUSION: These MDR markers are differently over-expressed and no coexpression exists in gastric cancer. MGr1-Ag was a novel MDR protein.

Distraction osteogenesis in the hand.

Distraction osteogenesis was used to correct congenital hand deformities in 12 digits. The patients' ages at the time of distraction ranged between 2.5 and 7 years. A total of nine patients underwent lengthening of 12 bones. The average period of distraction was 31.1 +/- 17.6 days. The average length of distraction was 23.6 +/- 7.3 mm. Seventeen percent of the patients after lengthening had an angular deformity that required remodeling of the regenerate. No infections were noted. Distraction osteogenesis provides a useful tool for reliable and predictable correction of osseous defects with vascular bone in patients with congenital anomalies of the hand.

Central-type eight-toed polydactyly associated with ipsilateral complex renogluteal agenesis: a case report with 8 years' follow-up.

At birth, a baby girl was found to have central-type eight-toed polydactyly of the left foot associated with ipsilateral nonvisualization of the kidney and atrophy of the gluteal maximum muscle. X-ray examination showed eight completely developed metatarsal and digit bones, and a chromosome study showed a normal 46, XX karyotype. She received ray amputation of the extra toes when she was 1 year old. Follow-up examination at age 9 showed unchanged renogluteal anomalies and a slightly smaller left foot. In addition, a bony defect over the posterior iliac spine and a wide femoral neck-shaft angle were found on the radiograph. Her left leg was found to be 1 cm shorter than the right, but there was no evidence of valgus or varus. Presently she can walk and run quite well, and there is no callus formation over her sole. The timing and options for excision of the supernumerary digits are discussed and this rare disease reviewed.

Human keratinocyte culture using porcine pituitary extract in serum-free medium.

Extensive burn wound coverage remains a major problem in acute and reconstructive stages due to shortage of autologous skin donor sites. Many reports have described successful coverage of extensive burn wounds by using cultured keratinocytes sheet graft alone or overlaying a glycosaminoglycan substrate, allodermis or xenodermis. In our experience, the use of Boyce and Ham's serum-free medium made the preparation of keratinocyte cultures simple and the cell growth was prompt. In this study, one of the supplements in Boyce's culture medium, the bovine pituitary extract (BPE at concentration of 140 micrograms/ml), was replaced by different concentrations of fresh frozen porcine pituitary extract (PPE). The protein concentration of the original preparation of PPE was also 140 micrograms/ml but in which 375 +/- 21 pg/ml (1/10 dilution) of platelet-derived growth factor (PDGF) was detected by immunoassay (PDGF ELISA). Our results proved that PPE is an ideal supplement for the in vitro growth of keratinocytes, and when its protein concentration is 350 micrograms/ml will induce a significant keratinocyte growth by day 9 when compared to the regular BPE and also to the other concentrations of PPE (P < 0.05).

[Primary hepatic carcinoma treated by chemoembolization--a clinical analysis of 20 cases with survival period longer than 3 years].

Advanced primary hepatic carcinoma was treated in 110 patients by percutaneous transhepatic arterial chemoembolization (TAE) from January 1987 to October 1989 according to Seldinger's protocol with mitomycin C, Adriamycin or carboplatin and 40% iodized oil. The treatment was given once every 4-12 weeks and the number of treatment for each patient varied from 2 to 19 depending on patients' condition and response. Of the 110 patients, 20 survived > 3 years, among which 7 survived > 4 years and 4 survived > 5 years. Following treatment, a greater than 50% reduction of tumor size was observed in 13 cases and a decrease in AFP to normal level in 12 cases. Seven patients were treated with TAE followed by tumor resection and, 2 patients were treated with TAE due to recurrence after tumor resection 11 patients were treated with TAE alone. The mean survival period was 53.1 and 43.5 months, respectively. TAE is considered as the first choice of palliative treatment for patients with advanced hepatic carcinoma. Factors that might influence the result of TAE treatment are discussed.

[Sclerotherapy of gastric varices].

160 patients, 128 males, 32 females, with portal hypertension were admitted into our department for sclerotherapy from May 1987 to August 1990. Gastric fundus could be observed clearly in 145 of these patients who were examined with endoscope. Gastric varices were found in 105 of the 145 patients. Sclerotherapy of gastric varices were carried out in 47 of the 105 patients by intravenous injection with the method of lesser injection points and larger dosage. The results showed that a satisfactory effect was obtained with a rate of immediate stoppage of bleeding by 95.7%; and a rate of disappearance of gastric varices by 95.3%. The rate of recurrent bleeding was 7.9%. In addition, the occurrence rate, the severity, the manifestations under endoscopy and the classification of gastric varices as well as the indication, and complications of sclerotherapy of gastric varices were discussed in detail.