Evidence summary on the non-pharmacological management of sleep disorders in shift workers.

PURPOSE: This study aimed to evaluate, and integrate the relevant evidence on the non-pharmacological management of sleep disorders in shift workers to provide a reference for improving sleep of shift workers. METHODS: According to the "6S" pyramid model of evidence, a comprehensive search was conducted in evidence-based databases, including BMJ-Best Practice, UpToDate, DynaMed, Cochrane Library, and Joanna Briggs Institute (JBI); clinical practice guideline websites, such as the Guidelines International Network; professional association websites, such as the World Sleep Society; and literature databases, including PubMed, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Biology Medicine disc (CBM) from inception to November 30, 2022. Two researchers independently evaluated the literature in accordance with the evaluation standards; conducted the extraction, classification, and synthesis of the evidence; and evaluated its grade and recommendation grade. RESULTS: A total of 18 studies were included, including 2 clinical decisions, 2 guidelines, 3 expert consensuses, and 11 systematic reviews. In total, 25 pieces of evidence were summarized from 6 aspects: sleep assessment, sleep scheduling, sleep hygiene, light therapy, workplace intervention, and other managements. CONCLUSION: This study summarized the best evidence for the non-pharmacological management of sleep disorders in shift workers. Shift workers should reasonably arrange their sleep time and develop good sleep hygiene. Additionally, work organizations should jointly promote sleep to improve the sleep conditions of shift workers and promote their physical and mental health.

The Perfusion Features of Recurrent Hepatocellular Carcinoma After Radiofrequency Ablation Using Contrast-Enhanced Ultrasound and Pathological Stemness Evaluation: Compared to Initial Tumors.

Objective: To investigate the perfusion features of local recurrence in hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) with contrast-enhanced ultrasound (CEUS) and pathological correlation, as well as to compare with those of initial HCC. Methods: From 2010 to 2018, 42 patients with recurrent HCC after RFA were enrolled in this study. The initial HCC patients included 32 males and 10 females with an average age of 58.2 ± 8.1 years. The CEUS images for initial HCC lesions and local recurrence after RFA were compared. The perfusion features were analyzed, including enhancement time, process, boundary, morphology, washout time, washout degree, feeding vessels, and internal necrosis. H&E staining and CD133/EpCAM staining were performed with biopsy samples for the stemness study. Results: According to CEUS, 59.5% of initial HCC lesions had centripetal enhancement, and 61.9% of recurrent HCC lesions had homogeneous enhancement in the arterial phase (p < 0.001). A total of 73.8% of initial HCC lesions had well-defined margins at the peak, and 81.0% of recurrent HCC lesions had poorly defined margins (p < 0.001). A total of 78.6% of initial HCC lesions had regular morphology at the peak, and 83.3% of recurrent HCC lesions were irregular (p < 0.001). Feeding vessels were more frequently found in initial HCC lesion (71.4%) than in recurrent HCCs (38.1%, p = 0.002). In the late phase, 60% of initial HCCs had marked washout while 83.3% of recurrent HCC lesion had marked washout (p = 0.019). A total of 31.3% of the initial HCC lesions had internal necrosis areas while only 7.1% of recurrent HCC lesions had internal necrosis areas (p = 0.035). In tumors 3-5 cm in size, the washout time of recurrent HCCs was shorter than that of initial HCCs (50.3 ± 13.5 s vs. 75.6 ± 45.8 s, p = 0.013). Pathological staining showed that the tumor stem cell markers (CD133 and EpCAM) were both highly expressed in recurrent samples compared with initial tumor samples (CD133+: 19 vs. 5%, p = 0.002; EpCAM+:15 vs. 6%, p = 0.005). Conclusions: Recurrent HCC after RFA had more homogeneous enhancement with a poorly defined border, marked washout, and fewer less feeding vessels and inner necrosis areas compared to initial HCC. The stemness study also found upregulated stemness in recurrent HCC. These specific features might be related to the aggressive biological behavior of recurrent HCC.

Fast response of complementary electrochromic device based on WO3/NiO electrodes.

Nanoporous structures have proven as an effective way for enhanced electrochromic performance by providing a large surface area can get fast ion/electron transfer path, leading to larger optical modulation and fast response time. Herein, for the first time, application of vacuum cathodic arc plasma (CAP) deposition technology to the synthesis of WO3/NiO electrode films on ITO glass for use in fabricating complementary electrochromic devices (ECDs) with a ITO/WO3/LiClO4-Perchlorate solution/NiO/ITO structure. Our objective was to optimize electrochromic performance through the creation of electrodes with a nanoporous structure. We also examined the influence of WO3 film thickness on the electrochemical and optical characteristics in terms of surface charge capacity and diffusion coefficients. The resulting 200-nm-thick WO3 films achieved ion diffusion coefficients of (7.35 × 10-10 (oxidation) and 4.92 × 10-10 cm2/s (reduction)). The complementary charge capacity ratio of WO3 (200 nm thickness)/NiO (60 nm thickness) has impressive reversibility of 98%. A demonstration ECD device (3 × 4 cm2) achieved optical modulation (ΔT) of 46% and switching times of 3.1 sec (coloration) and 4.6 sec (bleaching) at a wavelength of 633 nm. In terms of durability, the proposed ECD achieved ΔT of 43% after 2500 cycles; i.e., 93% of the initial device.

Guidelines and recommendations on the clinical use of shear wave elastography for evaluating thyroid nodule1.

Ultrasound elastography has been introduced into clinical practice for a decade and arisen continuous increasing attention worldwide. Shear wave elastography (SWE) is a further extension of ultrasound elastography on the basis of strain elastography, providing a two-dimensional distribution map of tissue stiffness and quantitative measurement of the tissue stiffness in Young's modulus (kPa) and/or shear wave speed (m/s). The Society of Ultrasound in Medicine, Chinese Medical Association (CMA) has recently released a series of guidelines for the use of SWE, including the technique and principle of SWE, and use of SWE in liver fibrosis, breast, thyroid, and musculoskeletal system. Herein, a part of SWE in thyroid nodules is presented. In this guideline, the background, classification and technology of SWE, examination methods, diagnostic performance, prognosis evaluation, reproducibility, and limitations are discussed and recommendations are given. The recommendations are based on the published literatures with regard to SWE with different levels of evidence, particularly a mid-term result of the prospective multi-center clinical trial of SWE in thyroid, as well as the Society of Ultrasound in Medicine, CMA expert's consensus. The document provides an overall analysis of SWE in thyroid from clinical perspective, which aimed to provide recommendations to the clinicians with regard to the management of thyroid nodules by the assistance of SWE.

A Multicenter Large-Sample Shear Wave Ultrasound Elastographic Study of the Achilles Tendon in Chinese Adults.

OBJECTIVES: The changes in the viscoelasticity of the Achilles tendon are related to tendinopathy. Therefore, constructing a data model in the healthy population is essential to understanding the key factors affecting the viscoelasticity of the Achilles tendon. The purpose of our research was to obtain large sample data, construct a data model, and determine parameters that affect the elastic modulus of the Achilles tendon in healthy Chinese adults. METHODS: We designed a prospective multicenter clinical trial to evaluate the viscoelasticity of the Achilles tendon by using shear wave elastography. A total of 1165 healthy adult participants from 17 Chinese hospitals were recruited for the assessment. The necessary parameters (age, height, weight, and body mass index) were recorded. The elastic modulus (Young modulus) was obtained from the middle of the Achilles tendon and calculated with feet in naturally relaxed, dorsal, and plantar positions. The thickness and perimeter of the Achilles tendon were measured via cross section on the same site. A multiple linear regression was performed to find the key factors affecting the Young modulus of the Achilles tendon. RESULTS: The Young modulus of the left Achilles tendon in the natural relaxed position followed a normal distribution (P > .05) with a mean ± SD of 374.24 ± 106.12 kPa. The regression equations showed a positive correlation between the Young modulus and weight and a negative correlation between the Young modulus and the circumference or thickness of the left Achilles tendon (P < .05). CONCLUSIONS: The Young modulus of the Achilles tendon as measured by shear wave elastography is related to body weight as well as the perimeter or thickness of the tendon.

Preliminary experience with direct percutaneous arterial embolisation combined with radiofrequency ablation for hypervascular HCC.

OBJECTIVE: The purpose of this study was to evaluate the outcomes of a novel technique consisting of ultrasound-guided percutaneous arterial embolisation (PAE) of the tumour-feeding artery before radiofrequency ablation (RFA) for hypervascular hepatocellular carcinoma (HCC). METHODS: Twenty-three HCC patients with hypervascular tumours who were non-TACE candidates were enrolled in the study. The mean size of the tumours was 4.6 ± 1.2 cm (3.2-6.0 cm). PAE was performed using 20-gauge catheter needles under greyscale and colour ultrasound guidance. Regular follow-up was performed to evaluate the outcomes and safety of this novel method. RESULTS: Post-PAE colour Doppler ultrasound revealed an immediate embolising effect in 29 feeding arteries, including 21 arteries that became invisible (72.4%) and 8 arteries that exhibited reduced flow velocity (27.6%). Based on the one-month enhanced CT/MRI, complete necrosis was achieved in 24 of 25 tumours (96.0%). The mean follow-up period was 42.7 ± 9.8 months. Local tumour recurrence was observed in 3 tumours (12.0%), and new intrahepatic tumours developed in 9 patients (39.1%). The probabilities of overall survival at 1, 3, 5 and 10 years were 77.3%, 40.0%, 25.0% and 18.8%, respectively. No major complications occurred in this group. CONCLUSIONS: The PAE method could help effectively to reduce or inhibit the blood supply of HCC. RFA followed by PAE treatment achieved 25.0% 5-year survival with no major complications. As a minimally invasive approach, PAE may provide a novel local therapy for hypervascular HCC patients who are non-TACE candidates.

Quality evaluation of the leaves of Magnolia officinalis var. biloba using high-performance liquid chromatography fingerprint analysis of phenolic compounds.

The high-performance liquid chromatography fingerprint method is a simple and reliable technique to evaluate the quality of leaves of Magnolia officinalis Rehd.et Wils. var. biloba Rehd.et Wils. We used the following bioactive phenolic constituents as reference compounds: rutin, afzelin, hyperoside, isoquercitrin, quercetin-3-O-α-l-rhamnoside, honokiol and magnolol. The conditions of an Agilent 1200 HPLC were: YMC-Pack-ODS-AQ column (250 × 4.6 mm id S-5 µm, 12 nm), mobile phase acetonitrile and 0.2% phosphoric acid in a gradient elute mode, flow rate 1.0 mL/min, detection wavelength 280 nm and column temperature 30°C. The analytical method was validated in terms of linearity, stability, repeatability, precision and recovery tests. While performing fingerprint analysis, we identified 11 peaks as characteristic peaks and assessed the similarities of 17 samples collected from different geological regions of China. The peak areas were used to evaluate the variation in the chemical composition of the tested samples. For this purpose, we performed hierarchical cluster analysis of the peak areas. Our results indicate that simultaneous determination of multiple ingredients could be done through chromatographic fingerprint analysis. Therefore, this high-performance liquid chromatography fingerprint method was readily utilized to evaluate the quality of leaves of M. officinalis var.biloba, which are used in several traditional herbal preparations.

Quantitative analysis of four types of primary glomeropathy by application of a decision forest to ultrasonic and laboratory characteristics.

The aim of this study was to apply a decision forest to analysis of the ultrasound characteristics and laboratory test indices of four types of primary glomerulopathy, and quantitative analysis of the four pathologic types using a combination of these two methods. The decision trees were derived from 41 clinical indices and 5 characteristic sonographic indices obtained for the left kidney. Fifty-six patients who had undergone ultrasound-guided renal biopsy were reviewed retrospectively, and on pathologic examination, the patients were diagnosed with primary glomerulopathy, which includes mesangial proliferative glomerulonephritis, membranous nephropathy, immunoglobulin A nephropathy and minimal change disease. In this study, eight characteristic indicators were correlated with pathologic type in the 56 cases of primary glomerulopathy. The order calculated by decision forests, from high to low, is proteinuria, length of kidney, serum creatinine, plasma albumin, area of kidney, total protein, thickness of renal parenchyma, 24-h urine protein. The glomerulopathy with the highest ++++ proteinuria is membranous nephropathy, which accounts for 39.2% (22/56) of the total sample; this was followed by minimal change disease, mesangial proliferative glomerulonephritis and immunoglobulin A nephropathy. On the basis of our analysis of 41 clinical indices, the key indices for quantitative analysis of primary glomerulonephritis are laboratory tests, and these include urine protein, serum creatinine, plasma albumin, total serum protein and 24-h urine protein. The three key sonographic features are measurement indices: renal length, renal area and renal parenchymal thickness. From the eight characteristic indicators, we observed that with respect to severity (from most severe to least severe), the four types of glomerulopathy are membranous nephropathy, minimal change disease, mesangial proliferative glomerulonephritis and immunoglobulin A nephropathy.

[Effect of fermented cordyceps powder and prednisone on the Notch2/Hes-1 signaling activation in the kidney tubules of rats with acute aristolochic acid nephropathy].

OBJECTIVE: To investigate the effect of both fermented Cordyceps powder (CS) and prednisone on the Notch2/hes-1 signaling activation in the kidney tubules of rats with acute aristolochic acid nephropathy (AAAN). METHODS: Totally 50 SD rats were randomly divided into 4 groups, i.e., the normal group, the model group, the CS group, the prednisone group, and the CS plus prednisone group, 10 in each group. The AAAN rat model was induced by intragastric administration of pure aristolochic acid A at the daily dose of 100 mg/kg for 3 days. Rats in the CS group were administered with CS at the daily dose of 5.0 g/kg by gastrogavage, while those in the prednisone group were administered with prednisone at the daily dose of 0.5 mg/kg. Rats in the CS plus prednisone group were treated by CS and prednisone. All treatment lasted for 3 successive weeks. Kidney functions [urea nitrogen (BUN) and serum creatinine (SCr)] were detected. The pathological changes of kidneys were observed by Hematoxylin-Eosin staining. The apoptosis of the renal tubular epithelial cells was detected by TUNEL. The protein expressions of Notch2 and Hes-1 in the renal tissue were detected by immunohistochemical assay and Western blot. RESULTS: Results of HE staining showed the structure in the nephridial tissue was regular in rats of the normal group. The renal tubular necrosis occurred in the rats of the model group. The pathological changes of kidneys were obviously improved in the CS group, the prednisone group, and the CS plus prednisone group. Compared with the normal group, levels of BUN and SCr, semi-quantitative score of the tubular interstitial tissue, ratio of apoptotic cells, and expressions of Notch2 and Hes-1 proteins significantly increased in the model group (P < 0.01). Compared with the model group, the aforesaid indices significantly decreased in the 3 treatment groups (P < 0.01). All indices decreased most obviously in the CS plus prednisone group (P < 0.05, P < 0. 01). CONCLUSIONS: Notch2/hes-1 signaling activation might be associated with apoptosis of renal tubular epithelial cells. Both CS and prednisone could play a nephroprotective role for AAAN. But CS plus prednisone could achieve the best effect. Inhabiting the Notch2/hes-1 signaling activation could be its nephroprotective mechanism.

Gene expression profiling of soybean leaves and roots under salt, saline-alkali and drought stress by high-throughput Illumina sequencing.

Salt, saline-alkali and drought stresses are major environmental constraints for the production and yield of soybean worldwide. To identify genes responsible for stress tolerance, the transcriptional profiles of genes in leaves and roots of seedlings (two-leaf stage) of the soybean inbred line HJ-1 were examined after 48 h under various stress conditions; salt (120 mM NaCl), saline-alkali (70 mM NaCl and 50mM NaHCO(3)) and drought (2% PEG 8000). Gene expression at the transcriptional level was investigated using high-throughput Illumina sequencing technology and bioinformatics tools. Under salt, saline-alkali and drought stress, 874, 1897, and 535 genes, respectively, were up-regulated in leaves, and 1822, 1731 and 1690 genes, respectively, were up-regulated in roots, compared with expression in the corresponding organ in control plants. Comparisons among salt, saline-alkali and drought stress yielded similar results in terms of the percentage of genes classified into each GO category. Moreover, 69 genes differentially expressed in both organs with similar expression patterns clustered together in the taxonomic tree across all conditions. Furthermore, comparison of gene expression among salt, saline-alkali and drought treated plants revealed that genes associated with calcium-signaling and nucleic acid pathways were up-regulated in the responses to all three stresses, indicating a degree of cross-talk among these pathways. These results could provide new insights into the stress tolerance mechanisms of soybean.

Role of contrast enhanced ultrasound in radiofrequency ablation of metastatic liver carcinoma.

OBJECTIVE: To investigate the application of contrast enhanced ultrasound (CEUS) in planning and guiding for radiofrequency ablation (RFA) for metastatic liver carcinoma (MLC). METHODS: One hundred and thirty-five patients with clinically and pathologically diagnosed MLC (from gastrointestinal tumors) were included in the present study, and 104 of them had received CEUS prior to RFA to assess the number, size, shape, infiltration, location and enhancing features of the lesions. Among the 104 patients, 21 (20.1%) were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS. The remaining 83 patients with 147 lesions underwent RFA (group A). During the same period, other 31 patients with 102 lesions serving as control group were treated based on findings of conventional ultrasound without contrast (group B). The patients underwent follow-up enhanced CT at the 1st month, and then every 3-6 months after RFA. The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 1st month. RESULTS: In group A, 72 of 147 MLC lesions (48.9%) showed increased sizes on CEUS. Among them, 48 lesions (66.6%) appeared enlarged in arterial phase, and 24 (33.3%) showed enlarged hypoechoic area in parenchymal phase. CEUS showed total 61 additional lesions in 35 patients (42.1%) (ranged from 8 to 15 mm) compared with conventional ultrasound (US), and 42 (68.8%) of them were visualized in parenchymal phase only. There were total 208 lesions in group A underwent RFA with CEUS planning, and the tumor necrosis rate was 94.2% (196/208). In this group, local recurrence was found in 16 lesions (7.7%) during 3-42 months' following up, and new metastases were seen in 30 cases (36.1%). For group B, the tumor necrosis rate was 86.3% (88/102), local recurrence in 17 lesions (16.7%), and new metastases in 13 cases (41.9%). Tumor early necrosis and recurrence rates were significantly different between the two groups (P=0.018, P=0.016, respectively). CONCLUSION: CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.

Intrahepatic biliary injuries associated with radiofrequency ablation of hepatic malignancies.

BACKGROUND: Biliary injury after radiofrequency ablation can cause serious consequences including death. However, there are limited data regarding bile duct changes with or without complications associated with radiofrequency ablation of hepatic malignancies. This study aimed to assess the incidence, prognosis and risk factors of intrahepatic biliary injury associated with radiofrequency ablation. METHODS: Between June 2001 and January 2009, 638 patients with hepatic malignancies (405 with hepatocellular carcinoma, and 233 with liver metastasis) who had 955 treatment sessions were enrolled in this study. Imaging and laboratory data, the course of treatment, and patient outcomes were reviewed retrospectively. The risk factors of biliary injury and the impact on overall survival of patients were analyzed. The chi-square test, Fisher's exact test, Kaplan-Meier curves and stepwise Logistic regression model were used for statistical analysis where appropriate. RESULTS: Biliary injury was observed in 17 patients after 17 ablation sessions based on imaging findings. The overall incidence of biliary injury was 1.8% (17/955) with an average onset time of 12 weeks (2-36 weeks). Mild, moderate and severe complications of biliary injury were identified in 9, 6 and 2 cases, respectively. The median survival time after detection of biliary injury was 40 months. There seemed no notable difference in overall survival between patients with and those without biliary injuries. By multivariate analysis, vessel infiltration (P = 0.034) and treatment session ≥ 4 times (P = 0.025) were independent risk factors for biliary injury of hepatocellular carcinoma; while tumor located centrally was the only independent risk factor in the metastasis group (P = 0.043). CONCLUSIONS: The incidence of biliary injury was not frequent (1.8%). Through appropriate treatment, intrahepatic bile duct injuries seemed not affect the patients' long-term survival. Additionally, risk factors may be helpful for selecting radiofrequency ablation candidates and predicting biliary complications.

[Effect of glucocorticoid treatment on the clinical outcome of patients with early-stage liver failure].

OBJECTIVE: To assess the therapeutic effect and safety of short-term low-dose glucocorticoid in the treatment of early-stage subacute liver failure. METHODS: Eight-seven patients with early-stage HBV-related subacute liver failure were randomized into glucocorticoid treatment group (n=43) and control group (n=44). The patients in the control group received lamivudine and routine integrated treatment), and those in the treatment group were given additional short-term low-dose glucocorticoid treatment. The endpoint measurements included the survival rate, mean hospital stay and adverse reactions to the treatments. RESULTS: The patients receiving glucocorticoid treatment exhibited significantly greater improvement of the liver functions than those in the control group (P<0.05). The rate of successful treatment was significantly higher in treatment group with shortened hospital stay (P<0.05), but the virological response rate and incidence of complications showed no significant differences between the two groups (P>0.05). CONCLUSION: The short-term low-dose glucocorticoid treatment can improve survival rate and shorten the mean hospital stay of patients with HBV-related early-stage subacute liver failure patients. Glucocorticoid treatment is relatively safe when administered with strictly controlled indications and time window for intervention.

Efficacy and feasibility of radiofrequency ablation for decompensated cirrhotic patients with hepatocellular carcinoma.

BACKGROUND: Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation (RFA) in treating hepatocellular carcinoma (HCC) patients with poor liver function (Child-Pugh class C), who are not suitable for surgery or hepatic artery chemo-embolization. METHODS: Thirteen HCC patients (the number of tumors was 17) with liver function of Child-Pugh C (scores: 10.2 +/- 0.4) were included in the study. Among the patients, 8 were male and 5 were female with the average age of (61.6 +/- 10.9) years old. The average size of HCC was (3.8 +/- 1.0) cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors (2 - 3 tumors). All the patients were treated with RFA. RESULTS: There were 22 RFA sessions (1 - 4 sessions per patient) in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients (69.2%), in 7 of them, the liver enzyme returned to pre-RFA level in 1 - 3 months. One month after RFA, the Child-Pugh grading was 10.3 +/- 0.8 (Child-Pugh C), while that of pre-RFA was 10.2 +/- 0.4 (Child-Pugh C), with no significant difference. Computer tomography (CT) one month after RFA showed that the tumor necrosis rate was 88.2% (15/17). Five patients had 2 - 4 repeated RFA due to HCC recurrence. During the follow-up of 2- 69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% (3/22 sessions), including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function failure. CONCLUSIONS: Minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to the required extended treatment region, special attention should be paid to the possibility of acute liver failure.

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment.

AIM: To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA. METHODS: A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 +/- 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 +/- 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo. RESULTS: In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 +/- 1.12 in group A, and 3.36 +/- 1.60 in group B (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04). CONCLUSION: PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.

Combination therapy of radiofrequency ablation and transarterial chemoembolization in recurrent hepatocellular carcinoma after hepatectomy compared with single treatment.

AIM: To assess the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (HCC) after hepatectomy and to compare its outcome with a single modality. METHOD: We retrospectively studied 103 patients with recurrent HCCs after hepatectomy who were excluded from repeat hepatectomy. Of them, 81 patients were male and 22 were female (mean age 55.8 +/- 10.7 years; range, 30-80 years). According to treatment modality, these patients were divided into three groups: RFA was used as the sole first-line anticancer treatment in 37 patients (RFA group); TACE was used as the sole first-line anticancer treatment in 35 patients (TACE group). RFA followed by TACE was performed in 31 patients (combination group). There was no significant difference in clinical material between the three groups. Indices including treatment success rate, intrahepatic recurrence rate and survival were obtained for analysis and comparison. RESULTS: The treatment success rate of the combination group was significantly higher than that of the TACE group (93.5 vs. 68.6%, P = 0.011). The intrahepatic recurrence rate of the combination group was significantly lower than that of the TACE group (20.7 vs 57.1%, P = 0.002) and the RFA group (20.7 vs 43.2%, P = 0.036). The overall 1-, 3- and 5-year survival rates were 73.9, 51.1 and 28.0% respectively in the RFA group; 65.8, 38.9 and 19.5% respectively in the TACE group; and 88.5, 64.6 and 44.3% respectively in the combination group. There was a significant difference in survival between the combination group and the TACE group (P = 0.028). CONCLUSION: RFA combined with TACE was more effective in treating recurrent HCC after hepatectomy compared to single RFA or TACE treatment. This combination therapy can thus be a valuable choice of treatment for recurrent HCC.

[Feasibility of improving radiofrequency ablation of hepatocellular carcinoma by percutaneously blocking tumor-feeding vessels].

OBJECTIVE: To explore the feasibility and outcome of radiofrequency ablation (RFA) in blocking feeding vessels of hypervascular hepatocellular carcinoma (HCC). METHODS: Totally 101 patients pathologically confirmed hypervascular HCC were included in the study. In percutaneous arterial ablation (PAA) + RFA group, 71 patients with 74 HCC underwent PAA before classical RFA of the other regions of the tumors, while in the RFA group, another 83 patients with 102 HCC were treated with RFA directly. For another 30 patients who responded poorly to transcatheter arterial chemoembolization were treated with percutaneous arterial embolization (PAE), followed by RFA; another 23 patients were treated with RFA alone were regarded as the control group. Contrast-enhanced CT and magnetic resonance imaging were used as post-RFA imaging follow-up at 1, 3, and 6 month. RESULTS: In PAA + RFA group, post-PAA imaging showed blocked blood flow in 65 (87.8%) HCC. There were average 2.76 +/- 1.12 ablated foci per HCC in PAA + RFA group and 3.36 +/- 1.60 ablated foci per HCC in control group (P = 0.01). The tumor necrosis rate at 1 month after RFA was 90. 5% (67/74) in PAA + RFA group and 90.2% (92/102) in control group. HCC recurrence rate at 6 month after RFA was 17.6% (13/74) in PAA + RFA group and 31.4% (32/102) in control group (P = 0.038). In PAE + RFA group, 88.6% of the main feeding vessels were blocked. The tumor necrosis rate at 1 and 6 month after FRA was 92.6% (25/27) and 85.2% (23/27) in PAA + RFA group and 65.2% (15/ 23) (P = 0.030) and 56.5% (13/23) (P = 0.024) in control group. CONCLUSION: PAA and PAE can block the feeding vessels of HCC, enhance the ablated necrosis in the tumor, decrease post-RFA recurrence, and therefore provides a safe and feasible method for treating hypervascular HCC.

[A tailored approach to radiofrequency ablation of hepatocellular carcinoma and its outcome].

OBJECTIVE: To evaluate the effectiveness of a tailored approach to radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). METHODS: Ultrasound-guided percutaneous RFA was performed in 274 tumors of 228 patients located at liver periphery, including 59 near the bowel, 115 near the diaphragm, 54 near the gallbladder, and 46 near the liver surface. The tumor sizes ranged 1.2-7.0 cm [mean (3.7 +/- 1.2) cm]. A tailored treatment strategy was established for tumors in different locations. Contrast-enhanced CT was performed one month later to evaluate the early necrosis rate of the treated tumors. RESULTS: Early tumor necrosis rate was 91.6% of the peripherally located HCC, including 91.5% of the tumors near the bowel, 90.4% near the diaphragm, 92.6% near the gallbladder, and 93.5% near the liver surface. Local tumor recurrence rates were 8.5%, 9.6%, 7.4%, and 6.5% for tumors near the bowel, diaphragm, gallbladder, and liver surface, respectively. The 1-, 2-, and 3-year survival rate of this group were 82.3%, 62.9%, and 53.7%, respectively. Major complications occurred in 3.3% of the treatment sessions, including haemorrhage (n = 2), nearby structure injury (n = 6), and needle tract seeding (n = 4). CONCLUSION: The tailored approach to RFA provides a promising treatment option for refractory peripherally located HCC with satisfactory tumor necrosis rate and low complication rate.

Adaptive evolution of cry genes in Bacillus thuringiensis: implications for their specificity determination.

The cry gene family, produced during the late exponential phase of growth in Bacillus thuringiensis, is a large, still-growing family of homologous genes, in which each gene encodes a protein with strong specific activity against only one or a few insect species. Extensive studies are mostly focusing on the structural and functional relationships of Cry proteins, and have revealed several residues or domains that are important for the target recognition and receptor attachment. In this study, we have employed a maximum likelihood method to detect evidence of adaptive evolution in Cry proteins, and have identified 24 positively selected residues, which are all located in Domain II or III. Combined with known data from mutagenesis studies, the majority of these residues, at the molecular level, contribute much to the insect specificity determination. We postulate that the potential pressures driving the diversification of Cry proteins may be in an attempt to adapt for the "arm race" between delta-endotoxins and the targeted insects, or to enlarge their target spectra, hence result in the functional divergence. The sites identified to be under positive selection would provide targets for further structural and functional analyses on Cry proteins.