Effect of neoadjuvant transarterial chemoembolization followed by resection versus upfront liver resection on the survival of single large hepatocellular carcinoma patients: A systematic review and meta-analysis.

Backgrounds/Aims: The efficacy of neoadjuvant transarterial chemoembolization (N-TACE) in resectable hepatocellular carcinoma (HCC) remains open to debate. While N-TACE may reduce tumor size, its impact on long-term outcomes is inconclusive. Methods: This meta-analysis reviewed studies on N-TACE before surgical resection vs. liver resection (LR) single large hepatocellular carcinoma (SLHCC) up to March 2023 from four online databases. Results: Five studies with 1,556 patients were analyzed. No significant differences between N-TACE and LR groups were observed in 1-, 3-, or 5-year overall survival (OS) and disease-free survival (DFS). No significant differences were noted in intraoperative blood loss between groups. Subgroup analysis showed favorable 1-, 3-, and 5-year OS with combination chemotherapy N-TACE (combination group), and better 1-year OS in the LR group with single-agent chemotherapy N-TACE (single-agent group). Five-year DFS favored LR in the single-agent group, and N-TACE in the combination group. Conclusions: Managing SLHCC requires intricate considerations, and the treatment strategies for this challenging subgroup of HCC need to be improved. The influence of N-TACE on long-term survival depends on the specific chemotherapy regimen employed, and its impact on intraoperative blood loss in SLHCC appears limited.

Effect of Intermittent Hypobaric Hypoxia Exposure on HIF-1α, VEGF, and Angiogenesis in the Healing Process of Post-Tooth Extraction Sockets in Rats.

OBJECTIVE: The aim of this study was to investigate the effect of intermittent hypobaric hypoxia (IHH) exposure on the expression of hypoxia-induced factor-1α (HIF-1α) messenger RNA (mRNA), vascular endothelial growth factor-a (VEGF-a) mRNA, and angiogenesis after tooth extraction in rats. MATERIALS AND METHODS: On 45 male Sprague-Dawley rats were performed the removal of the maxillary left first molar, and then they were randomly divided into 9 groups, namely: 4 groups that were exposed to IHH for 30 minutes every day in the Hypobaric Chamber at an altitude of 18,000 feet, with 1 time hypobaric hypoxia (HH), 3 times HH, 5 times HH, and 7 times HH; 4 normoxia groups that were terminated on days 1, 3, 5, and 7 after tooth extraction; and the 1 control group. Real-time polymerase chain reaction measured the molecular changes in the socket tissue after tooth extraction in rats to evaluate the expression of HIF-1α mRNA and VEGF mRNA. Histological changes with hematoxylin and eosin staining were noted to evaluate the amount of angiogenesis in the socket after tooth extraction. Molecular and histological parameters were calculated at the end of each experiment on days 0, 1, 3, 5, and 7 after tooth extraction, which exhibited the improvement phase of the wound-healing process. RESULTS: Increases in the expression of HIF-1α mRNA, VEGF mRNA, and angiogenesis were found in the IHH group compared with the normoxia group and the control group. The expression of HIF-1α mRNA increased significantly (p < 0.05) in the group after one time HH exposure on day 1, then decreased in the IHH group (three times HH exposure, five times HH exposure, and seven times HH exposure) approaching the control group. The expression of VEGF mRNA and angiogenesis began to increase after one time HH exposure on day 1, and increased again after three times HH exposure on day 3, then increased even more after five times HH exposure on day 5, and increased very significantly (**p < 0.05) after seven times HH exposure on day 7. It showed that repeated or intermittent exposure to HH conditions induced a protective response that made cells adapt under hypoxia conditions. CONCLUSION: IHH exposure accelerates the socket healing of post-tooth extraction, which is proven by changes in HIF-1α mRNA expression and increase in VEGF mRNA expression as stimuli for angiogenesis in post-tooth extraction sockets under hypobaric hypoxic condition, which also stimulates the formation of new blood vessels, thereby increasing blood supply and accelerating wound healing.

Synthesis and Characterization of Zirconia-Silica PMMA Nanocomposite for Endodontic Implants.

This study aimed to enhance the mechanical properties of PMMA composites by introducing various types of fillers, including ZrO2, SiO2, and a mixture of ZrO2-SiO2 nanoparticles, which were prepared as prototypes for an endodontic implant. The ZrO2, SiO2, and mixed ZrO2-SiO2 nanoparticles were synthesized using the sol-gel method and the precursors Tetraethyl Orthosilicate, Zirconium Oxychloride, and a mixture of both precursors, respectively. Before polymerization, the as-synthesized powders were subjected to the bead milling process to obtain a well-dispersed suspension. Two scenarios for the fillers were implemented in the preparation of the PMMA composite: a mixture of ZrO2/SiO2 and ZrO2-SiO2 mixed with two different types of silane: (3-Mercaptopropyl) trimethoxysilane (MPTS) and 3-(Trimethoxysilyl) Propyl Methacrylate (TMSPMA). The observation of the characteristics of all of the investigated fillers included the use of a particle-size analyzer (PSA), a Zeta-potential analyzer, FTIR, XRF, XRD, and SEM. The mechanical properties of the MMA composites, as prepared under various scenarios, were observed in terms of their flexural strength, diametrical tensile strength (DTS), and modulus of elasticity (ME). These levels of performance were compared with a PMMA-only polymer. Each sample was measured five times for flexural strength, DTS, and ME. The results showed that the best PMMA composite was SiO2/ZrO2/TMSPMA, as revealed by measurements of the flexural strength, DTS, and ME corresponding to 152.7 ± 13.0 MPa, 51.2 ± 0.6 MPa, and 9272.8 ± 2481.4 MPa, which are close to the mechanical properties of dentin. The viability of these PMMA composites, as measured up to day 7, was 93.61%, indicating that they are nontoxic biomaterials. Therefore, it was concluded that the PMMA composite created with SiO2/ZrO2/TMSPMA can be considered to be an acceptable endodontic implant.

The Impact of Intermittent Hypobaric Hypoxia Exposures on Triacylglycerol Synthesis in Rat Liver.

BACKGROUND: In a hypoxic state, fatty acid breakdown reaction may be inhibited due to a lack of oxygen. It is likely that the fatty acids will be stored as triacylglycerol. The aim of this study was to analyse triacylglycerol synthesis in the liver after intermittent hypobaric hypoxia (HH) exposures. METHODS: Samples are liver tissues from 25 male Wistar rats were divided into 5 groups: control group (normoxia), group I (once HH exposure), group II (twice HH exposures), group III (three-times HH exposures) and group IV (four-times HH exposures). The triacylglycerol level, mRNA expression of HIF-1α and PPAR-γ were measured in rat liver from each group. RESULTS: We demonstrated that triacylglycerol level, mRNA expression of HIF-1α and PPAR-γ is elevated in group I significantly compared to control group. In the intermittent HH groups (group II, III and IV), mRNA expression of HIF-1α and PPAR-γ tends to downregulate near to control group. However, the triacylglycerol level is still found increased in the intermittent HH exposures groups. Significant increasing of triacylglycerol level was found especially in group IV compared to control group. CONCLUSION: We conclude that intermittent HH exposures will increase the triacylglycerol level in rat liver, supported by the increasing of HIF-1α and PPAR-γ mRNA expression that act as transcription factor to promote triacylglycerol synthesis.