Metronomic capecitabine versus doxorubicin in advanced hepatocellular carcinoma

PURPOSE: We evaluated oral metronomic capecitabine (MC) compared to intravenous doxorubicin in patients with advanced or metastatic hepatocellular carcinoma (HCC).METHODS: From January 2013 to December 2015, patients with Child-Pugh class A or early B were randomized either to MC group (500 mg twice daily continuously) or doxorubicin group (60 mg/m² every 21 days).RESULTS: Forty patients were included in each group. The baseline clinical characteristics of the enrolled patients were well balanced between the two groups. No complete response (CR) was reported in either group. In MC group, 2 patients (5%) had partial response (PR), 25 patients (62.5%) stable disease (SD) and 27 patients (67.5%) had disease control. In doxorubicin group, 4 patients (10%) achieved PR, 24 patients (60%) SD and 28 patients (70%) had disease control. The 6 months overall survival (OS) was 77.5% for MC and 75% for doxorubicin. The one year OS was 47.5% for MC and 42.5% for doxorubicin (P=0.521). The median OS survival was 10.2 months for MC and 9.6 months for doxorubicin (95% confidence interval, 3.2–6.5). The 6 month progression-free survival (PFS) was 45% for MC and 50% for doxorubicin. The one year PFS was 12.5% for MC and 7.5% for doxorubicin (P=0.289). The median time to progression was 3.4 months for MC and 3.1 months for doxorubicin. On multivariate analysis no significant impact for tumor stage, previous transhepatic arterial chemoembolization, portal vein thrombosis or median baseline alpha fetoprotein on OS.CONCLUSION: MC showed response rate and survival outcome comparable to doxorubicin in advanced HCC but with a more favorable toxicity profile.

Chromium picolinate inhibits cholesterol induced stimulation of platelet aggregation in hypercholesterolemic rats

Hypercholesterolemia indirectly increases the risk of myocardial infarction by enhancing platelet aggregation. Chromium, has been shown to lower plasma lipids. The objective of this study was to investigate whether chromium inhibits platelet aggregation under normal and hypercholesterolemic conditions. White albino rats were divided into four groups: control rats fed with a normolipemic diet [NLD group], chromium supplemented rats fed with NLD [NLD+Cr group], rats fed with a high fat diet [HF group], and chromium supplemented rats fed with HF [HF+Cr group]. After 10 weeks, blood was collected to determine ADP and collagen-induced platelet aggregation and plasma levels of total cholesterol, triglycerides [TG], HDL-C, apolipoprotein Al [Apo-A1], apolipoprotein B [Apo-B], and thromboxane B2 [TX B2]. LDL-C was calculated by Friedewald Formula. High fat diet animals [HF group] displayed significant elevation of plasma lipids and platelet aggregation which were normalized to control levels by chromium supplementation. Chromium supplementation in normolipemic [NLD+Cr] rats didn't produce significant changes in either plasma lipids or platelet activity. The results of the present study demonstrate that chromium supplementation to hypercholesterolemic rats returns cholesterol induced platelet aggregation to control levels. This normalization is mostly due to a reduction in plasma cholesterol level

Immunohistochemical study of vascular endothelial growth factor, angiogenesis and proliferation by Ki67 in Juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma [JNA] is a rare highly vascularized neoplasm of the nasopharynx that affects boys and young men. The underlying dysregulated molecular mechanisms remain unclear. The participation of angiogenic growth factors have been suggested. The aim of this study is to assess the expression of vasularization and proliferation in the pathogenesis of juvenile nasopharyngeal angiofibroma and to detect the role of antiangiogenic therapy in the treatment. Formalin fixed paraffin embedded sections of fifteen cases of juvenile nasopharyngeal angiofibroma [primary and recurrent] were studied immunohistochemically by VEGF, CD31 and Ki67 specific antibodies and visualized using light microscope. VEGF-expressing vessels, CD31 positive vessels and proliferating cells were evaluated by the same method. All the patients are adolescent males ranging in age between 12 to 26 years. Most tumors examined classified clinically as stage II or III with only one case as stage I and two cases as stage IV. No correlation between patient's age or tumor stage and VEGF expression, vascular density and Ki67 proliferating cells. The number of CD31 positive vessels varied from 15 to 100 per HPF. The microvascular density [MVD] varied from grade 1 to grade 3 in all the studied cases. The number of proliferating cells [ki67proliferating cells] ranged from 12 to 50 per HPF with median count 24, none of the fibroblastic stromal cells showed any reactivity to the CD31 antibodies contrasting the positive staining of the vascular endothelium. The stroma showed 12 cases [80%] with VEGF stromal positivity, while only the rest 3 cases [20%] with VEGF stromal negativity. Also it showed 7 cases [46.6%] with Ki67 positivity while 8 cases [45.4%] with Ki67 negativity. [40% of the studied cases] with positive VEGF stroma showed high vascular count and high MVD [grade 3] while only 4 cases showed low vascular count and low MVD [grade1] and negative stromal VEGF [5cases] showed [grade 2] MVD. [6 cases] with proliferating Ki67 stromal cells showed grade 3 MVD, while only one case with grade 2 MVD. We observed that cases with positive stromal VEGF showed high number of positive VEGF vessels. In JNA, VEGF is frequently expressed by the stromal cells and vessels and is associated with increased vessel density. VEGF is frequently expressed by stromal cells and blood vessels, associated with proliferation and increased vascular density. VEGF contributes to the strong vascularisation of this benign tumor. Therefore, antiangiogenic therapy might be considered. These findings support the theory that nasopharyngeal angiofibroma represents a vasoproliferative malformation

Preoperative evaluation of upper airway during pregnancy by clinical observation and acoustic pharyngometry

The present study from the period of January 2005 to June 2005 aimed to compare upper airway dimensions in pregnant and non-pregnant women. A total of 30 women in the third trimester of pregnancy were recruited from the antenatal service and matched with 30 non-pregnant. Upper airway dimensions were measured using acoustic reflection. Of those who reported whether or not they snored, 9% of control women, and 23% of pregnant women reported that they snored on at least one night per week. Snoring frequency increased during pregnancy [p < 0.001]. Of the thirty pregnant, 5% stated that they started to snore or markedly increased their snoring frequency during the first trimester, 6% during the second trimester, and 23% during the third trimester. When seated, pregnant had wider upper airways than non- pregnant [p < 0.02], but there was no difference when supine. Oropharyngeal junction area in the seated position was the same in non-pregnant and pregnant women. Supine oropharyngeal junction area was less in the pregnant women than in the non-pregnant women. The study showed that pregnant women have upper airway narrowing and high incidence of snoring