Transcatheter arterial chemoembolization combined with low-dose apatinib in the treatment of unresectable hepatocellular carcinoma in elderly patients: Efficacy and safety

Context: Owing to the increasing age of the population, the incidence of hepatocellular carcinoma (HCC) in the elderly is increasing annually. Aims: This study aims to investigate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with low-dose apatinib for unresectable HCC treatment in elderly patients (≥65 years). Settings and Design: The clinical data from 61 elderly patients with unresectable HCC who were retrospectively analyzed. Subjects and Methods: Of these 61 patients, 27 received TACE combined with low-dose (250 mg/qd) apatinib (experimental group), and 34 patients received the standard TACE treatment (control group). The short-term efficacy was evaluated according to the mRECIST1.1 standards, and the mid- and long-term efficacy and safety in the two groups of patients were evaluated. Statistical Analysis Used: Statistical analyses were performed using the Statistical Package for the Social Sciences software (version 20.0; SPSS). Results: Both the objective response rate and disease control rate of the experimental group were significantly higher than those of control group (P < 0.05). The 6-month and 12-month survival rates of the experimental group were significantly higher than those of control group too (P < 0.05). The median survival in the experimental group was longer than in the control group (26.0 months vs. 20.0 months). The adverse reactions related to the intake of apatinib were higher in the experimental than the control group, but were generally alleviated after symptomatic treatment. Conclusions: TACE combined with low-dose apatinib provides an alternative treatment option for elderly patients with unresectable HCC. Our clinical study has proven its safety and efficacy.

Nutritional support with nasogastric feeding tube after transcatheter arterial chemoembolization in hepatic carcinomas / 实用放射学杂志

Objective To discuss interventional procedures before feeding tube placed in the DSA guidance,influence postoperative enteral nutrition support for the presence of nutritional risk of clinical outcomes in elderly patients with hepatocellular carcinoma. Methods 33 patients acquired with interventional therapy of hepatic carcinoma were selected as the study group.All of patients un-derwent preoperatively the nutritional risk screening and insertion of nasogastric feeding tube under DSA.Enteral nutritional support by the nasogastric feeding tube was used after interventional therapy.33 similar patients underwent parenteral nutritional support af-ter international therapy were selected as the control group.The change of the nutritional indexes,the incidence of the systemic in-flammatory response syndrome,the incidence of infection,and the length of hospital stay after operation were compared between the two groups.Results There were no significant differences in the plasma albumin levels and body weight changes compared between the two groups (P >0.05).However,the incidence of infection and the length of hospital stay were lower significantly in the study group than in the control group (P >0.05).Conclusion The nutritional risk screening before interventional treatment is necessary for the elder patients with hepatic carcinoma.The patients with nutritional risk can be placed the nasogastric feeding tube preopera-tively under DSA,and perform combined nutritional support to promote the recovery of nutritional state after operation.

Huaier granules combined with intraarterial chemoembolization for the treatment of hepatocellular carcinoma / 中华普通外科杂志

Objective To evaluate the safety and efficacy of combined transcatheter intraarterial chemoembolization with 350-560 μm gelatin sponge particles and lobaplatin (GSPs-TACE) and oral Chinese herb medication Huaier granules in patients with hepatocellular carcinoma (HCC).Methods This is a case-control,single-institution clinical trial.31 HCC patients receiving GSPs-TACE (group A) were matched with 31 patients receiving GSPs-TACE and Huaier granules (group B).Tumor response was evaluated by CECT using response evaluation criteria in solid tumors at 1 month after initial GSPs-TACE.The overall survival was calculated from the data of initial GSPs-TACE using the Kaplan-Meier method.Results The overall mean follow-up period was 28.7 (range 12-42) months.The overall 6-and 12-month survival rates in group A and group B were 90.3％ and 80.6％ vs 100％ and 93.5％,respectively.There was statistically significant difference in 12-month survival rates (x2 =5.213,P ＜0.05).Median survival time respectively was 17.1 and 20.6 months(x2 =0.745,P ＞0.05).The average TACE times were (4.1 ±7.3) and (2.9 ±8.7) respectively in group A and group B (P =0.01).Tumor objective response rate was statistically different in 6-and 12-month in two arms(x2 =5.945,6.384,P ＜0.05).There was no statistically significant difference in complications (respectively x2 =0.435,0.485,2.037,0.137,0.325,all P ＞ 0.05).Conclusions Huaier granules combined with transcatheter intraarterial chemoembolization with 350-560 μm gelatin sponge particles and carboplatin for HCC is safe and effectively prolongs patients' survival.

Regulation on function and maturation of dendritic cells from systemic lupus erythematosus patients by triptolide / 中华微生物学和免疫学杂志

Objective To explore the mechanism of immunomodulatory activity of triptolide on systemic lupus erythematosus(SLE) patients peripheral blood mononuclear cells( PBMC)-derived dendritic cells (DCs).Methods SLE -derived DCs were sorted by flow cytometry from peripheral blood mononuclear cells,then incubated with triptolide (0,5,10,30 μg/L ).After 24 h,we collected the supernatants and then detected the concentration of IFN-α,IL-6,TNF-α using ELISA.After 5 d,the cultrural cells were collected and CD11c,CD80,CD86 expression of DCs were analyzed by flow cytometry,we observed the morphology of DC by light microscope and electron microscope scanning.Results Triptolide -treated DCs from SLE patients with active and stable disease secreted lower level of IFN-α,IL-6,TNF-α,triptolide could inhibit DCs differentiation,which displayed more immature morphology and immunophenotypes than untreatedDCs.Conclusion Triptolide could decrease the immune function of DCs from SLE,inhibit differentiation and maturation of DCs.

Regulation on function and maturation of plasmacytoid dendritic cells by triptolide / 中华微生物学和免疫学杂志

Objective To explore the mechanism of immunomodulatory activity of triptolide on healthy volunteers peripheral blood mononuclear cells (PBMC)-derived plasmacytoid dendritic cells (pDCs). Methods Healthy volunteers-derived pDCs were sorted by flow cytometry, then incubated with triptolide (0, 5, 10, 30 μg/L). After 24 hours, we detected the concentration of IFN-α, IL-6, TNF-α using ELISA. After 5 days, the cultrural cells were collected and analyzed by flow cytometry, light microscope and electron microscope scanning. Results Triptolide-treated pDCs secreted lower level of IFN-α,IL-6 ,TNF-α, triptolide could inhibit pDCs differentiation to DCs which displayed more immature morphology and immunophenotypes than untreated-pDCs. Conclusion Triptolide could decrease the immune function of pDCs, inhibit differentiation and maturation of pDCs.

Clinical study about the efficacy of gelatin sponge particles chemoembolization for treating liver metastasis from gastric cancer / 中国医师进修杂志

ObjectiveTo evaluate the clinical efficacy of gelatin sponge particles chemoembolization for liver metastasis of gastric cancer patients. MethodsThe clinical data of 5 cases from December 2009 to July 2010 with gelatin sponge particles chemoembolization for liver metastasis after radical gastrectomy patients was analyzed retrospectively. ResultsVarious degrees of necrotic lesions were observed in all cases, 6 months after operation, 1 case received complete remission (CR),3 cases with partial remission (PR), 1 case with stable condition (SD), the total effective (CR + PR) rate was 80％(4/5). Conclusion Gelatin sponge particles chemoembelization for liver metastasis of gastric cancer has achieved a good shortterm effect,while the long-term efficacy remains to be identified.

Linkage analysis of a region on chromosome 2 with essential hypertension in Chinese families / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To verify the linkage of the candidate regions identified in a previous study (markers D2S168, D2S151, D2S142 on chromosome 2) with hypertension in Chinese families.</p><p><b>METHODS</b>A genetic linkage study focused on chromosome 2 was performed on 240 Chinese families containing 856 patients with essential hypertension. A total of 1080 individuals were genotyped using 9 highly polymorphic microsatellite markers around the candidate regions on chromosome 2 with an average spacing of 5 cM. Non-parametric linkage (NPL), parametric linkage analysis and transmission-disequilibrium test (TDT) with the GENEHUNTER software were used to assess evidence for linkage.</p><p><b>RESULTS</b>Linkage of a region on chromosome 2 around D2S151 and D2S142 with hypertension was confirmed by different statistical methods (NPL, LOD score and TDT). However, the linkage of D2S168 could not be replicated in this extension study.</p><p><b>CONCLUSIONS</b>The data suggest that a region on chromosome 2 at or near the loci of D2S142 and D2S151 may harbor genes responsible for the development of essential hypertension in Chinese.</p>

Heritability of serum leptin levels: a twin study / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To study the contribution of genetic factors to the variance of serum leptin concentration in healthy, normotensive twins.</p><p><b>METHODS</b>A total of 57 pairs of twins were investigated: 28 female and 19 male pairs of monozygotic(MZ) twins, and 6 female and 4 male pairs of dizygotic(DZ) twins. The zygosity of twins was determined by comparing the concordance of the genotype of nine fluorescence-labeled microsatellite markers. The genetic analysis was performed using the variance-based method. Serum leptin levels were determined in duplicate by a radioimmunoassay Kit (Linco Research, Inc., St. Charles, Missouri) as previously described.</p><p><b>RESULTS</b>The test of genetic variance revealed a significantly larger within-pair variance of serum leptin in the DZ twins, in comparison with the MZ twins. The corresponding heritability for serum leptin was 8%. Adjusted for BMI, gender, and uric acid (UA), the heritability for serum leptin was 0.18%. Log leptin correlated significantly with blood pressure (SBp r=0.355 P<0.001; DBp r=0.339 P<0.001). Stepwise multiple linear regression analysis revealed that only BMI, gender and UA were linked independently to serum leptin levels(R(2)=0.788, P<0.001).</p><p><b>CONCLUSION</b>The above data indicate that environmental factors other than genetic factors are important determinants of leptinemia in normal subjects.</p>

L-phenylalanine ameliorates the vascular remodeling in hypertensive rats / 中国病理生理杂志

AIM: To investigate the effect of L-phenyla lanine on vascular remodeling in hypertensive rats. METHODS: Vascular remodeling was measured by laser scanning conf ocal microscopy (LSCM) in mesenteric resistance arteries isolated from spontaneo usly hypertensive rat (SHR) and normotensive Wistar-Kyoto (WKY) rat. The effect of L-phenylalanine on the hypertensive vascular remodeling was observed. The thi rd most distal first-order branches of mesenteric resistance arteries from SHR a nd WKY were studied. The arteries were fixed under pressure. The segments were s tained with the nuclear dye propidium iodide. The diameter, wall thickness and o rientation angle of smooth muscle cells were measured with LSCM. RESULTS: Compared with WKY, SHR arteries showed: (1) smaller lum en, (2) increased wall thickness, (3) disorganized orientation angle of smooth m uscle cells. L-phenylalanine treatment induced specific changes in the lumen, wa ll thickness and the orientation angle of smooth muscle cells. CONCLUSIONS: Hypertension induces vascular remodeling of the bra nches of mesenteric arteries from SHR. L-phenylalanine inhibits the vascular rem odeling process of hypertension.

CORRELATION ANALYSIS OF SERUM AMINO ACID AND BLOOD-PRESSURE AMONG 8 CHINESE POPULATIONS / 营养学报

Eight populations including 4 Chinese districts and 4 nationalities 484 subjects (male, 40~59 years) were conducted for exploring amino acid (22 sorts)-BP relationship by multi-variate regression and discrimination analyses. Results showed:(1)The different amino acid levels found among "Ka-zak", "Han" and "Uygur" nationalities living in one of the same Xinjiang region might be a reflection of their diverse dietary patterns; while the difference seen between "Han" and "Yi" nationalities living in one of the same Quizhou area, taking similar diet, might be due to the inherited metabolic influence. (2) The levels of aspartic and (or) glutamic acids were the the highest in the Quizhou "Han" and "Yi" groups living in cold hilly area, while other amino acids were comparatively lower, in keeping with their BP, Quetelet's indices and serum urea levels to be the lowest, tentatively denoting that the tissue metabolic turnover rate might be also lower as well in these groups. (3) The serum levels of sulfur containing amino acids in those populations taking much animal foods, were all higher, therefor ethe lower incidences of cardio-cerebro-vascular diseases seen in fishmen can not be thus wholly ascribed to the high intake of fish meat rich in sulfur containing amino acids. (4) From BP regression equations, valine, cysteine, alanine, threonine were found to be the prohypertensives while glycine, leucine, methionine and phenylalanine,the antihypertensives.

RELATIONSHIP BETWEEN BLOOD AND URINE NUTRITIONAL PARAMETERS AND BLOOD PRESSURE AMONG FIVE POPULATION GROUPS IN CHINA / 营养学报

Five population groups, including farmers living in Veining (a cold hilly southern county), farmers and labourers in Shijiazhuang (a northern district), coastal fishermen in Zhoushan and "Yi" nationality farmers in Veining (where the incidence of hypertension is very low in China) were selected randomly (467 male subjects, 40-59 years old) to explore nutritional parameters-BP relationships. The results showed; (1) Pulse rate, QI and BP were lowest in Veining "Han" and "Yi" nationality groups. (2) Values of blood and urine nutritional parameters were in close accord with the diet customs of the different population groups. (3) Urine Na, Ca, Ca/Mg, urea nitrogen and serum cholesterol, total protein, albumin, uric acid were higher, while urine K was lower in hypertensives. (4) Urine Na, Na/K, Ca/ Mg and serum albumin, total protein, cholesterol, triglyceride, uric acid levels correlated positively, while K inversely with BP on multivariate stepwise regression and/or discrimination analyses. These results suggested high Na (Ca)-intake might be hypertensive, while high K(Mg)-intake an-tihypertensive, the serum protein - BP relationship could not be ascribed as a secondary effect of hemoconcentration in hypertension; a high protein intake, regardless of nature, could be hypertensionogenic; hyperlipidemia seemed to be a risk factor of hypertension, not being the secondary consequence to high BP. In designing a strategic protocol for primary prevention of hypertension, the above should be given due consideration.

TRACE, ORDINARY ELEMENTS AND HYPERTENSION——Comparative analysis of 4 districts, 6 populations, 3 nationalities / 营养学报

Men aged 40-59 years (325 subjects) from 4 districts, 6 populations, 3 nationalities were investigated to explore the relationship between element and blood pressure (BP) . Fe, Mo, Ni, Pb, Si, Sn, Sr, V, Cd, Co, Cr, Cu, Mn, Zn, Ca, and Mg -were measured by ion coupled plasma spectroscopy, Se by catalytic pulse polarography. Results showed; (1) The element levels were different among districts and nationalities. (2) The correlation coefficients among serum Pb, Ni, Si, Sn, V, Cd, Cr were rather high, while Sr behaved relatively independently. (3)Using multivariant stepwise regression and discrimination analysis, serum Sr was found to associate positively with BP in normotensive and hypertensive and total pooled groups without exce-piton. (4) Serum Ca (Ca/Mg), Fe, Co were positively associated, while Cr, Sn inversely associated with BP. (5) The harmful element Cd was unexpectedly found to be inversely associated with BP and it was lower in those populations with high BP levels, which might be ascribed to the non-parallel distribution of certain elements in body tissues and blood. Results also indicated; (1) The levels of essential element Ni, V, Co, Cr were lower in hypertensive group. (2) Serum Ca and urinary Ca were non-parallel, and the former could not accurately reflect Ca-intake. In short, the relationship between element and BP still remains to be elucidated.