Entecavir versus tenofovir for prevention of hepatitis B virus-associated hepatocellular carcinoma after curative resection: study protocol for a randomized, open-label trial.

BACKGROUND: Entecavir and tenofovir disoproxil fumarate (TDF) are standard first-line treatments to prevent viral reactivation and hepatocellular carcinoma (HCC) in individuals chronically infected with the hepatitis B virus (HBV), but the long-term efficacy of the two drugs remains controversial. Also unclear is whether the drugs are effective at preventing viral reactivation or HCC recurrence after hepatectomy to treat HBV-associated HCC. This trial will compare recurrence-free survival, overall survival, viral indicators and adverse events in the long term between patients with HBV-associated HCC who receive entecavir or TDF after curative resection. METHODS: This study is a randomized, open-label trial. A total of 240 participants will be randomized 1:1 into groups receiving TDF or entecavir monotherapy. The two groups will be compared in terms of recurrence-free and overall survival at 1, 3, and 5 years after surgery; adverse events; virological response; rate of alanine transaminase normalization; and seroreactivity at 24 and 48 weeks after surgery. DISCUSSION: This study will compare long-term survival between patients with HBV-associated HCC who receive TDF or entecavir monotherapy. Numerous outcomes related to prognosis will be analyzed and compared in this study. TRIAL REGISTRATION: ClinicalTrials.gov NCT02650271. Registered on January 7, 2016.

Treatments of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Current Status and Controversy.

The proportions of patients with hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT) varies greatly in different countries or regions, ranging from 13% to 45%. The treatment regimens for PVTT recommended by HCC guidelines in different countries or regions also vary greatly. In recent years, with the progress and development of surgical concepts, radiotherapy techniques, systematic therapies (for example, VEGF inhibitors, tyrosine kinase inhibitors and immune checkpoint inhibitors), patients with HCC involving PVTT have more treatment options and their prognoses have been significantly improved. To achieve the maximum benefit, both clinicians and patients need to think rationally about the indications of treatment modalities, the occurrence of severe adverse events, and the optimal fit for the population. In this review, we provide an update on the treatment modalities available for patients with HCC involving PVTT. Trials with large sample size for patients with advanced or unresectable HCC are also reviewed.

Immune Checkpoint Inhibitors in Hepatocellular Carcinoma: Current Progresses and Challenges.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumor in the world and its incidence is increasing in many countries. In recent years, with the deepening understanding of the immune and pathological mechanisms of HCC, immunotherapy based on the regulation of tumor immune microenvironment has become a new treatment choice for patients with HCC. Immune checkpoint inhibitors (ICIs) targeting programmed death protein-1, programmed death protein-ligand-1, or cytotoxic T-lymphocyte-associated antigen 4 are the most widely used. Instead of general immune-enhancing therapies, ICIs can reactivate anti-tumor immune responses by disrupting co-inhibitory T cell signaling. In this review, the research progress and existing problems of ICIs in the treatment of HCC in recent years are reviewed.

Cytotoxicity of chemical constituents from Torricellia tiliifolia DC. on Spodoptera litura (SL-1) cells.

In this study, we evaluated cytotoxicity of chemicals isolated from Torricellia tiliifolia DC. on Spodoptera litura (SL-1) cell line. Among the isolated compounds, 4-hydroxy-3-methoxycinnamaldehyde, 3,5-dimethoxy-4-hydroxycinnamaldehyde, and syringaresinol inhibited SL-1 cell survival in both dose- and time-dependent manners. Meanwhile, the in vivo insecticidal activity test revealed that 4-hydroxy-3-methoxycinnamaldehyde and 3,5-dimethoxy-4-hydroxycinnamaldehyde showed obvious insecticidal activities. These two compounds exhibited toxicity to SL-1 cells by inducing cellular morphological changes including shape change, cell shrinkage, vacuolation, cell membrane blebbing and chromatin condensation and apoptosis. 4-hydroxy-3-methoxycinnamaldehyde and 3,5-dimethoxy-4-hydroxycinnamaldehyde showed the most effect on mitochondrial membrane depolarization at 24h and 72h respectively and induced the apoptosis at a late time point 72h. Our results suggest that 4-hydroxy-3-methoxycinnamaldehyde and 3,5-dimethoxy-4-hydroxycinnamaldehyde inhibit SL-1 survival by inducing apoptosis.

Quantitative assessment of the effect of position changes during colonoscopy withdrawal.

OBJECTIVE: Although trials assessing the effectiveness of position changes during colonoscopy withdrawal have been reported, there has been no agreement whether such position changes actually improve the polyp detection rate (PDR) or adenoma detection rate (ADR). This article aimed to address this issue by performing a systematic review. METHODS: Relevant studies from databases including PubMed, EMBASE and the Cochrane Library and Science Citation Index were retrieved. Two reviewers independently identified potentially relevant studies. Outcome measures were PDR, ADR and bowel distention. RESULTS: Eight studies were included, of which seven were randomized controlled trials (RCTs). A non-randomized controlled trial and all four cross-over RCTs reported significant improvement in PDR, ADR and bowel distention with position change during colonoscopic withdrawal, while three parallel-group RCTs did not confirm its effectiveness. CONCLUSIONS: The conflicting results of high-quality trials indicate that the effectiveness of position change during colonoscopy withdrawal on PDR, ADR and bowel distension is uncertain. Thus, position change during colonoscopy withdrawal should not be routinely applied until future studies demonstrate its efficacy.

Efficacy of dexmedetomidine on postoperative shivering: a meta-analysis of clinical trials.

PURPOSE: Shivering is a frequent complication in the postoperative period. The aim of the current meta-analysis was to assess the efficacy of dexmedetomidine on postoperative shivering. METHODS: Two researchers independently searched PubMed, EMBASE and the Cochrane Central Register of Controlled Trials for controlled clinical trials. The meta-analysis was performed by Review Manager. RESULTS: Thirty-nine trials with 2,478 patients were included in this meta-analysis. Dexmedetomidine reduced postoperative shivering compared with placebo (risk ratio [RR] = 0.26; 95% confidence interval [CI]: 0.20 to 0.34), with a minimum effective dose of 0.5 µg·kg(-1) (RR = 0.36; 95% CI: 0.21 to 0.60). The anti-shivering effect can be achieved both intravenously and epidurally when administered within two hours prior to the end of surgery. The efficacy of dexmedetomidine was similar to widely used anti-shivering agents, such as fentanyl, meperidine, tramadol, clonidine and so on; however, dexmedetomidine may increase the incidence of sedation, hypotension, bradycardia and dry mouth. CONCLUSIONS: The present meta-analysis indicates that dexmedetomidine shows superiority over placebo, but not over other anti-shivering agents. Therefore, considering its high price and potential adverse events, dexmedetomidine may not be appropriate solely for the purpose of the prevention of postoperative shivering.

Effects of dexmedetomidine on P2X4Rs, p38-MAPK and BDNF in spinal microglia in rats with spared nerve injury.

Microglia in the spinal cord is evidenced to play a crucial role in neuropathic pain. Spinal P2X4 receptors (P2X4Rs), which are mainly expressed in microglia, have been investigated for their roles in neuropathic pain. Dexmedetomidine (DEX), a highly selective agonist of α2-adrenergic receptors, is clinically applied to sedation and analgesia. Despite the proposed mechanisms underlying DEX-induced analgesia, the possible interactions between DEX and P2X4Rs at a molecular level have not been elucidated. We designated the spared nerve injury (SNI) to establish the neuropathic pain model. Mechanical paw withdrawal threshold (MWT) was measured to evaluate the sensitivity of neuropathic pain in rats. MWT was significantly decreased in SNI rats versus control rats. Expressions of spinal P2X4Rs, phosphorylated p38-mitogen-activated protein kinase (p-p38-MAPK) and brain-derived neurotrophic factor (BDNF) were upregulated in SNI rats. Immunofluorescence assay indicated higher densities of microglia and P2X4Rs, which appeared yellow in colour, suggesting they were co-labelled. Intraperitoneal injections of DEX 40µg/kg for 14 consecutive days markedly reversed the SNI-induced decline of MWT; the activation of microglia was markedly inhibited; in addition, the protein expressions of P2X4Rs, p-p38-MAPK and BDNF were significantly downregulated. Thus, DEX could attenuate the neuropathic pain in SNI rats, of which the mechanism might be related to the down-expressed P2X4Rs, p-p38 and BDNF in microglia of spinal dorsal horn.

[Role of Ca2+/calmodulin-dependent calcineurin signaling pathway in neuropeptide Y-induced cardiac hypertrophy in rats].

OBJECTIVE: To investigate the role of Ca(2+)/calmodulin-dependent calcineurin (CaN) signaling pathway in neuropeptide Y (NPY)-induced cardiomyocyte hypertrophy in rat. METHODS: Cardiomyocytes of neonatal Wistar rats were cultured in the presence of 10 and 100 nmol/L NPY, and cyclosporine A (CsA) was applied to inhibit the activity of CaN. The protein synthesis rate, c-jun mRNA expression, CaN protein expression, CaN activity and intracellular Ca(2+) concentration in the cardiomyocytes were assessed. RESULTS: Compared with the control group, (3)H-Leu incorporation and expression of c-jun mRNA in the cardiomyocytes treated with 100 nmol/L NPY increased significantly (P<0.05, P<0.001), and the effect of NPY was blocked by CsA. The activity of CaN (P<0.05), CaN expression (P<0.05), and Ca(2+) concentration in the cytoplasm (P<0.001) and nuclei (P<0.001) of the cells with 100 nmol/L NPY treatment also significantly increased compared with those in the control cells. CONCLUSION: NPY can induce cardiomyocyte hypertrophy in rats, in which process Ca(2+)/calmodulin-dependent CaN signaling pathway plays an important role.

[Changes of endocrine hormones during -6 degrees head down bed rest in human].

OBJECTIVE: To investigate changes of endocrine hormones during 7 d head down bed rest (HDBR). METHOD: Six healthy male volunteers served as the subjects and experienced 7 d -6 degrees HDBR. Urine was collected from 6:00-22:00 and from 22:00-6:00. Serum was collected 48 h before HDBR, 48 h and 120 h during HDBR. Then the endocrine indices in urine and serum were determined. RESULT: 1) The levels of serum CORT and ALD increased at 48 h during HDBR, while serum T3, T4, TP, UN decreased but they all recovered to normal at 120 h during HDBR. 2) The level of urine CORT, ALD and NE reached its peak in 24-48 h, and then gradually decreased to normal level. CONCLUSION: The endocrine indices in serum and urine changed in the early period but returned to normal level gradually with the proceeding of HDBR.