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OBJECTIVE To mine and analyze adverse drug event （ADE） signals after the marketing of pazopanib and provide references for clinically safe medication. METHODS OpenVigil 2.1 data platform was used to mine ADE signals from the US FDA adverse event reporting system （FAERS） database. ADE reports of pazopanib from October 2009 to June 2022 were collected， and ADE signals were analyzed using proportional reporting ratio （PRR） method and reporting odds ratio （ROR） method in the proportional imbalance method. RESULTS A total of 16 655 ADE reports were identified with pazopanib as the primary suspect drug. Through ROR and PRR analysis， 220 ADE signals involving 19 system organ classes were identified. The top 10 ADE signals by frequency were recorded in the drug instruction. Additionally， 88 new ADE signals were discovered， mainly related to the gastrointestinal system， various investigations， and the renal and urinary system. Decreased basophil count， nail bed hemorrhage， tumor rupture， and vaginal fistula were both new ADE signals and the top 10 ADE signals by strength. CONCLUSIONS The occurrence of common ADEs （diarrhea， hair color changes， hypertension， etc.） during the use of pazopanib after marketing is generally consistent with its drug instruction； the number of reported cases for new suspected risk signals （decreased basophil count， nail bed hemorrhage， tumor rupture， and vaginal fistula， etc.） is limited， and continuous monitoring is required.
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Objective To investigate the quality and safety of liquid bandage and establish a reliable quality control method. Methods The quality of liquid bandage was evaluated by appearance, film forming time, viscosity, comfort, waterproof and air permeability. The content was determined by HPLC. The safety of liquid bandage was investigated with skin irritation test and allergy test. Results The self-made liquid bandage was uniform and delicate, with good ductility, fast film formation, good mechanical strength, waterproof and air permeability. The content of active pharmaceutical ingredients in the film met the requirements. It had no obvious irritation to the skin and no allergic reaction. Conclusion The established quality control method was reliable. The liquid bandage had good safety profile.
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Objective@#To explore the effect of puberty on refractive development of children and adolescents and its interaction with outdoor activities, near work and the use of electronic products, so as to provide a reference for strategies for intervening myopia.@*Methods@#Cluster sampling method was used to select 776 students aged 7-13 from a nine year consistent school in Shanghai to participate and were followed up for 2 years. All participants underwent cycloplegic refraction and ocular axial length measurement once a year, as well as pubertal development, average daily outdoor time, near work time and time of electronic products usage. The influencing factors and interaction effects of refractive parameters in different puberty stages were analyzed by generalized estimation equation.@*Results@#At baseline, 634 children participated in cycloplegic refraction, of which 350 were myopic (55.2%). There were significant differences in axial length, average daily outdoor time, near work time and time of using electronic products at different stages of puberty ( F = 4.10 ，4.24，5.54，9.20， P <0.05). There was interaction between puberty and outdoor time on axial length development ( β =0.133, P < 0.05), and the interaction between puberty and the time of near work or using electronic products was not statistically significant ( P >0.05).@*Conclusion@#Puberty may play a regulatory role in the relationship between outdoor time and refractive development among Chinese children and adolescents.
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Objective:To evaluate the effect of miR-133b on the apoptosis and radiosensitivity of colon cancer cell line (SW620 cells), and to explore its mechanism.Methods:SW620 cells were transfected with miR-con (miR-con group), miR-133b mimics (miR-133b group), si-con (si-con group) and si-HER-2(si-HER-2 group) by the liposome method, and then irradiated with 0, 2, 4, 6, 8 Gy. The miR-133b protein expression, HER-2 protein expression, apoptosis, cell survival fraction and cytofluoroactivity in each group were evaluated by qRT-PCR, Western blot, flow cytometry, colony formation assay and dual luciferase reporter gene assay, respectively.Results:Compared with the pre-irradiation group, the expression level of miR-133b was significantly down-regulated ( P<0.05), whereas that of HER-2 was significantly up-regulated in SW620 cells after irradiation ( P<0.05). Overexpression of miR-133b and knockdown of HER-2 remarkably reduced the survival fraction (both P<0.05), and significantly promoted the apoptosis of SW620 cells ( P<0.05). miR-133b could considerably inhibit the fluorescent activity of wild-type HER-2 cells ( P<0.05) and negatively regulate the expression of HER-2 protein. Conclusion:miR-133b can inhibit the survival of colon cancer cells, promote the apoptosis and enhance the sensitivity of radiotherapy probably via the mechanism of targeting HER-2.
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The aim of this study was to develop a blocking enzyme-linked immunosorbent assay (bELISA) based on a biotinylated nanobody target the S1 protein of porcine epidemic diarrhea virus (PEDV) for detecting the anti-PEDV antibodies and evaluating the immune effect of the vaccine. The gene encoding the single-domain antibody sdAb3 target the PEDV S1 protein was amplified and the Avitag sequence was fused at its 3'-end. The PCR product was cloned into the expression vector pET-21b for expression and purification of the sdAb3-Avitag protein. The purified sdAb3-Avitag fusion protein was biotinylated and its activity was determined. Using the recombinant S1 protein as a coating antigen, a bELISA was established and optimized. Serum samples were tested in parallel by the bELISA and a commercial kit. The recombinant vector pET21b-sdAb3-Avitag was constructed to express the tagged sdAb3. After induction for expression, the biotin-labeled sdAb3 (sdAb3-Biotin) with high purity and good activity was obtained. For the optimized bELISA, the coating concentration of the S1 protein was 200 ng/well, the serum dilution was 1:2 and incubated for 2 h, the dilution ratio of the biotinylated sdAb3 was 1:8 000 and incubated for 30 min, the dilution of the enzyme-labeled antibody was 1:5 000 and incubated for 30 min. The bELISA had no cross reaction with the sera of major porcine viruses including transmissible gastroenteritis virus, porcine reproductive and respiratory syndrome virus and showed good specificity and reproducibility. For a total of 54 porcine serum samples tested, the overall compliance rate of the bELISA with a commercial kit was 92.56%. This study developed a rapid and reliable bELISA method, which can be used for serosurveillance and vaccine evaluation for PEDV.
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Animals , Antibodies, Viral , Coronavirus Infections/veterinary , Enzyme-Linked Immunosorbent Assay , Porcine epidemic diarrhea virus/genetics , Reproducibility of Results , Sensitivity and Specificity , Single-Domain Antibodies , Swine , Swine DiseasesABSTRACT
OBJECTIVE: To explore the influence of work pressure and psychological capital on job burnout of college teachers. METHODS: A total of 287 teachers from 7 universities in Nanjing City were selected as the research subjects using the convenient sampling method. The Maslach Burnout Inventory, Job Stress Scale for University Teachers and Psychological Capital Questionnaire were used to investigate their job burnout, job stress and psychological capital. RESULTS: The total scores of job burnout and job stress were(42.9±12.5) and(48.5±12.4) respectively, and the occurrence of job burnout was 64.1%. The total scores of psychological capital was(106.7±14.7), and the scores of the four dimensions including self-efficacy, hope, resilience and optimism were(27.6±4.6),(26.7±4.8),(27.0±4.2) and(25.4±3.8) respectively. The total score of job stress was positively correlated with the total score of job burnout [correlation coefficient(r)=0.41, P<0.01]. The total score of psychological capital, self-efficacy, hope, resilience and optimism were negatively correlated with the total score of job burnout(r values were-0.42,-0.28,-0.36,-0.36 and-0.42, respectively, P<0.01). The results of multiple linear regression analysis showed that after adjusting the influence of confounding factors and excluding other confounding factors, the higher the job stress, the higher the job burnout level(P<0.01), the higher the psychological capital optimism dimension score, the lower the job burnout level(P<0.01). CONCLUSION: The job stress and psychological capital of college teachers can independently affect their job burnout level, with a dose-effect relationship.
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Objective To prepare a wound dressing using nitrocellulose as a membrane and optimize its formulation. Methods Partial analysis was performed on commercial available products. The wound dressings were prepared by using nitrocellulose as a film-forming material, benzyl alcohol as a bacteriostatic agent, castor oil as a plasticizer, isopropyl palmitate as a skin emollient, camphor as a fragrance, and isopropyl alcohol, ethyl acetate and butyl acetate as volatile solvent. The tensile strength, breakpoint elongation percentage, breathability and waterproof performance were tested and evaluated. Results The film-forming performance of the prepared liquid wound dressing was good. The final use amount of nitrocellulose was determined to be 6%. The use amount of plasticizer castor oil was determined to be 4%. Conclusion The prepared liquid wound dressing has good film-forming property, good mechanical property, good waterproof and certain breathability.
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Objective@#To investigate the changes of internal fixation stress under different angles of interior fracture line and different screw placement modes in the case of A-type distal femoral fracture.@*Methods@#A 24-year-old healthy male volunteer was recruited to collect the right femur data. CATIA V5R21 software produced a 10 mm fracture gap at the external side of the femur 6.5 cm proximal to the joint line and different angle fracture lines were generated on the internal of the femur at the same height. Based on the actual measured dimensions, the three-dimensional (3D) model of the locking plate and screw was reconstructed using CATIA V5R21 software, ignoring the screw surface threads and then the assembly of the internal fixation of the titanium plate, screws and femur was done. All models were meshed using Hypermesh 13.0 software. The assembled 3D model was input into ABAQUS 6.14 to generate a finite element model. Preliminary finite element biomechanical analysis was performed using the four medial fracture line angles and the stress distribution of the internal fixation under the three screw placement modes, and then the analysis was continued after the optimal screw placement method was re-determined.@*Results@#Under an axial loading of 700 N, with the increase of the angle of the fracture line, the stress of the lateral internal fixation gradually increased, and the displacement of the proximal end of the fracture gradually increased. The sequential screw placement method was superior to the leaping screw placement method. The placement of the first screw at the proximal end of the fracture was critical to the distribution of the internal fixation stress.@*Conclusions@#The operation plan of the type A of distal femoral fracture needs to be confirmed according to the internal and external fracture′s condition. When the fracture line is at a excessive positive angle or a negative angle, a simple lateral fixation may not provide a stable fracture fixation so that other fixation methods are needed.
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Zika virus ( ZIKV) infection may lead to some serious potential complications, such as neonatal microcephaly and Guillain-Barre syndrome. ZIKV epidemics have caused public panic and aroused global concern. World Health Organization ( WHO) has listed ZIKV infection as one of the public health emergencies of international concern. This paper focused on the progress in ZIKV detection methods, espe-cially in serological tests, and summarized the advantages and disadvantages of each method in practical ap-plication, aiming to provide technical reference for the prevention and control of Zika virus infection.
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Abstract Purpose: To investigate the long non-coding RNAs (lncRNAs) profile on renal ischemia reperfusion in a mouse model. Methods: Microarray analysis was used to study the expression of misregulated lncRNA in a mouse model of renal ischemia reperfusion(I/R) with long ischemia time. Quantitative real-time PCR (qPCR) was used to verify the expression of selected lncRNAs and mRNAs.The potential functions of the lncRNA was analyzed by bioinformatics tools and databases. Results: Kidney function was impaired in I/R group compared to the normal group. Analysis showed that a total of 2267 lncRNAs and 2341 messenger RNAs (mRNAs) were significantly expressed in I/R group (≥2.0-fold, p < 0.05).The qPCR result showed that lncRNAs and mRNAs expression were consistent with the microarray analysis. The co-expression network profile analysis based on five validated lncRNAs and 203 interacted mRNAs showed it existed a total of 208 nodes and 333 connections. The GO and KEEG pathway analysis results showed that multiple lncRNAs are involved the mechanism of I/R. Conclusion: Multiple lncRNAs are involved in the mechanism of I/R.These analysis results will help us to further understand the mechanism of I/R and promote the new methods targeted at lncRNA to improve I/R injury.
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Animals , Rats , RNA, Messenger/analysis , Reperfusion Injury/genetics , RNA, Long Noncoding/analysis , Kidney/blood supply , Reference Values , Down-Regulation , Gene Expression , Up-Regulation , Gene Expression Profiling , Tissue Array Analysis/methods , Gene Regulatory Networks , Real-Time Polymerase Chain Reaction , Mice, Inbred C57BLABSTRACT
CCCTC-binding factor (CTCF) is a zinc-finger protein, serving an important part in the genome architecture as well as some biochemical processes. Over 70,000 CTCF binding DNA sites have been detected genome-wide, and most anchors of chromatin loops are demarcated with the CTCF binding. Various protein or RNA molecules interact with DNA-bound CTCF to conduct different biological functions, and potentially the interfaces between CTCF and its cofactors can be targets for drug development. Here we identify the effective region of CTCF in DNA recognition, which defines the exposed CTCF surface feature for the interaction of cofactors. While the zinc-finger region contributes the most in DNA association, its binding affinity varies based on different DNA sequences. To investigate the effectiveness of individual zinc-fingers, the key residues are mutated to inactivate the DNA binding ability, while the finger configuration and the spacing between fingers are preserved. The strategy is proved to be successful, while clear differences are observed in the DNA binding affinities among the 11 finger mutants and the result is consistent to previous studies in general. With the help of inactivated finger mutants, we identify the ineffective fingers and the dominant effective fingers, which form distinctive patterns on different DNA targets.
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Objective To prepare compound ketoconazole ointment and perform the stability study .Methods Ketocon-azole ,mupirocin and mometasone furoate were used as active pharmaceutical ingredients (API) .PEG mixture was used as ma-trix to prepare the ointment .Stability of the API in the ointment was evaluated by the stress tests .Results The optimal ratio of PEG400 to PEG3350 for the ointment matrix was 2:1 .Mometasone furoate and mupirocin in the ointment were stable to the high temperature(40 ℃)while ketoconazole had some degradation .The stability of the API was improved by addition of 0 .5％ of L-A .During the accelerate test ,the ointment had no color change and the API percentages were above 98％ .Conclu-sion The novel compound ketoconazole ointment was successfully prepared and the formulation stability was excellent .
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Objective To investigate the effect of mentalization based treatment on the negative emotion such as anxiety,depression and chronic drug craving among methamphetamine addicts.Methods Totally 612 methamphetamine addicts in 6 compulsory isolated detoxification center of Liaoning served as the study subjects and randomly divided into the experimental group (mentalization based treatment group) and control group,306 cases in each group.The Beck Anxiety Inventory (BAD,Beck Depression Inventory (BDI) and the Drug Craving Inventory were used to evaluate the anxiety,depression and chronic craving in the two groups.Results The scores of BAI,BDI and Drug Craving Inventory after mentalization base treatment in the experimental group were decreased compared with those of before intervention (P＜0.05).The declining trend of the scores of BAI,BDI and Drug Craving Inventory after intervention in the experimental group were more significant than that in the control group (P＜0.05).Conclusion The mentalization based treatment can improve the negative emotions such as anxiety and depression to some extent,and reduces the chronic drug craving among methamphetamine drug addicts.
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Objective To investigate the effect of mentalization based treatment on the negative emotion such as anxiety,depression and chronic drug craving among methamphetamine addicts.Methods Totally 612 methamphetamine addicts in 6 compulsory isolated detoxification center of Liaoning served as the study subjects and randomly divided into the experimental group (mentalization based treatment group) and control group,306 cases in each group.The Beck Anxiety Inventory (BAD,Beck Depression Inventory (BDI) and the Drug Craving Inventory were used to evaluate the anxiety,depression and chronic craving in the two groups.Results The scores of BAI,BDI and Drug Craving Inventory after mentalization base treatment in the experimental group were decreased compared with those of before intervention (P＜0.05).The declining trend of the scores of BAI,BDI and Drug Craving Inventory after intervention in the experimental group were more significant than that in the control group (P＜0.05).Conclusion The mentalization based treatment can improve the negative emotions such as anxiety and depression to some extent,and reduces the chronic drug craving among methamphetamine drug addicts.
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Objective:To investigate the clinical characteristics,treatment and prognosis of primary pe-noscrotal extra-mammary Paget’s disease (PSPD).Methods:The clinical and pathological data of 22 cases of primary PSPD were retrospectively reviewed.Survival rate of the overall patients,the invasive patients,and the patients with positive surgical margin or negative surgical margin were analyzed with Ka-plan-Meier survival curve method.Results:Among all the patients with primary PSPD,the median age of onset was 64.5 (39 -84)years,the median time of disease duration was 40 (2 -300)months,and the median long diameter of lesion was 4.75 (1 -10)cm.In the study,12 patients (54.5%)were in pathological stage A1,6 patients (27.3%)were in pathological stage A2,and 4 patients (18.2%) were in pathological stage B.Scrotum and penile of most patients (n =12,54.5%)were involved,5 patients (22.7%)were scrotum only,and 5 patients (22.7%)were penile only.Erythema (n =18, 81.8%),itchiness (n =16,72.7%),ulcerate (n =12,54.5%),exudation (n =11,50.0%),and pain (n =4,18.2%)were the major manifestations.All the patients with primary PSPD were treated with wide surgical excision.The rate of invasive patients was 77.3% (n =17).Of them,6 patients had positive surgical margin.The surgical margins of non-invasive patients were all negative.Twelve patients exhibited local recurrence or/and metastases,and the status of surgical margins (P =0.015)and the depth of invasion (P =0.010)were important risk factors.Inguinal lymph nodes were generally in-volved.The difference of the delay of diagnosis between metastasis and non-metastasis was significant (P =0.040).The 5-year survival rates of the overall and invasive patients were 33.7% and 27.9%, respectively.The patients with positive surgical margin had poor prognosis.Conclusion:Primary PSPD, with the characteristics of long duration,high invasive tendency and high incidence of local recurrence or metastases,generally occurs in the elderly.Surgery should be performed at first.The delay of diagnosis, positive surgical margins and the involvement of inguinal lymph node are important risk factors.Biopsy, frozen section and inguinal lymph node biopsy (ILNB)can standardize diagnosis and treatment.
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Objective To determine how genetic polymorphisms in norepinephrine transporter (NET) gene influence the response of antidepressant treatment and how they interact with childhood trauma and recent life stress in a Chinese depressive patients.Methods 281 Chinese Han depressive patients received single antidepressant drugs for 6 weeks.Hamilton Depression Scale-17 (HAMD-17),the Childhood Trauma Questionnaire short term (CTQ-SF) and the Life Events Scale (LES) were used to evaluate severity of depressive symptoms and the occurrence of stressful life events respectively.Three single nucleotide polymorphisms (SNPs) in norepinephrine transporter were genotyped.Associations of single locus and haplotypes with antidepressant treatment response were analyzed using UNPHASED 3.0.13.The interaction of gene and life stress was analyzed by SPSS13.0 software.Results One NET SNP rs2242446 was significantly associated with antidepressant response in this Chinese male sample(0.4118vs0.2375,x2=7.046,P=0.0079,OR=0.445,95％ CI (0.243-0.815)),as was the haplotype CG(rs2242446 and rs5569;x2 =5.886,P=0.0153,OR=0.457,95％ CI (0.198-1.054)) and another haplotype CG-G(rs2242446,rs1532701 and rs5569;x2=5.360,P=0.0206,OR=0.530,95％ CI (0.202-1.386)) of NET in male samples.The NET SNPs rs5569 demonstrated interaction with childhood trauma to influence antidepressant response(β=-2.727,SE =1.195,P=0.023,OR=0.065,95％ CI (0.006-0.681)).Conclusion Antidepressant drug response was influenced by not only NET genetic polymorphisms in norepinephrine transporter gene but also interaction between the NET genetic polymorphisms and early life stress.
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<p><b>OBJECTIVE</b>To investigate the efficacy of brachytherapy for patients with localized prostate cancer and the influence factors.</p><p><b>METHODS</b>There were 61 patients with localized prostate cancer were treated with brachytherapy between April 2001 and March 2011 in Department of Urology, Peking University First Hospital, including 11 patients who received combined external beam radiotherapy. The mean age was 75.2 years (range 57-84 years). Clinical stage was T1c in 12 patients, T2a in 18 patients, T2b in 17 patients, and T2c in 14 patients. Long-term follow-up was carried on all patients for prostate specific antigen (PSA) and adverse effects. Kaplan-Meier survival curves, Log-rank test and univariate Cox proportional hazard regression analysis was used to examine the factors associated with the treatment efficacy.</p><p><b>RESULTS</b>The median follow-up was 49 months (range 9-126 months). The mean PSA before treatment and the mean nadir PSA after operation were (17.80 ± 14.44) µg/L and (1.16 ± 1.15) µg/L, respectively. The PSA of 58 patients (95.1%) reached a nadir < 4.0 µg/L, which was even < 1.0 µg/L in 37 patients (60.7%). The mean time to reach the nadir PSA was 11.6 months after operation. The short-term adverse events after operation included fever in 4 patients, hematuria in 7 patients, and hematochezia in 4 patients. The most common long-term adverse event was urinary irritation (31.1%); other long-term adverse events were rare, including hematochezia, hematuria, urinary incontinence, urinary retention, mild diarrhea and radiation enteritis. The estimated mean biochemical recurrence-free survival after brachytherapy was 41.0 months (95% CI: 31.05-50.94 months). The mean nadir PSA after operation were 1.32 µg/L in the 11 patients who received combined external beam radiotherapy, and their estimated mean biochemical recurrence-free survival was 38 months. Patients with nadir PSA < 1.0 µg/L had a significant longer biochemical recurrence-free survival than those with nadir PSA between 1.0 µg/L and 4.0 µg/L (42.9 vs. 32.0 months, χ² = 4.445, P = 0.035).</p><p><b>CONCLUSIONS</b>Brachytherapy is an effective treatment strategy for localized prostate cancer, with relatively low rate of severe adverse events. After brachytherapy, a nadir PSA < 1.0 µg/L might indicate a better prognosis.</p>
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Aged , Aged, 80 and over , Humans , Male , Middle Aged , Brachytherapy , Kaplan-Meier Estimate , Prognosis , Prostate-Specific Antigen , Blood , Prostatic Neoplasms , Radiotherapy , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To study the residue of in roots of Atractylodes macrocephalal and in soil.</p><p><b>METHOD</b>Samples were extracted with methanol. The extracts were cleaned up by liquid-liquid extraction and detected by HPLC.</p><p><b>RESULT</b>Repeatability and accuracy of the method was verified by fortified recovery at 0.01, 0.05, 0.1, 0.2 mg x kg(-1) levels. Average recovery were 86.1%-98.3% and RSD were 1.0%-6.5% in root and soil. A. macrocephala was treated with two dosage of carbendazim during growing. Results of field test showed that the half lives of carbendazim were 6.51-7.98 d in cultivated soil, 4.51-6.50 d in roots, separately. After sample was preliminarily processed, the residue of dried samples was 0.042-0.433 mg x kg(-1), higher than the fresh samples.</p><p><b>CONCLUSION</b>If 0.2 mg x kg(-1) is recommended as the MRL (maximum residues limited) of carbendazim in the roots of A. macrocephala, it is suggested that the dose of 0.675 kg a.i. x hm(-1) carbendazim is sprayed twice a year, and carbendazim should not be used within 21 days before the harvest.</p>
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Agriculture , Methods , Atractylodes , Chemistry , Benzimidazoles , Pharmacology , Carbamates , Pharmacology , Drug Residues , Pharmacology , Fungicides, Industrial , Pharmacology , Plant Roots , Chemistry , Quality Control , SoilABSTRACT
<p><b>BACKGROUND</b>To study the effect of DTB against HIV-1, for developing anti-HIV drugs.</p><p><b>METHODS</b>Different concentration of DTB was added to cell culture system after viral inoculation, MTT staining method for viable cells (MTT assay) and p24 (ELISA) were used as markers to monitor the viral replication.</p><p><b>RESULTS</b>The inhibition rates of DTB at concentrations 160, 80, and 40mg/ml were 93.0%, 56.2% and 18.1%, respectively.</p><p><b>CONCLUSIONS</b>DTB could effectively inhibit HIV-1 in vitro.</p>
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Humans , Anti-HIV Agents , Pharmacology , Bilirubin , Pharmacology , Dose-Response Relationship, Drug , HIV-1 , In Vitro TechniquesABSTRACT
Objective To investigate the practical value of transcatheter hepatic arterial chemoembolization (TACE) in the treatment of spontaneously ruptured hepatocellular carcinoma. Methods Using Seldinger technique,we treated 14 patients with ruptured hepatocellular carcinoma by TACE, in which a suspension of gelatin sponge, iodide oil and chemotherapeutic agents was used as embolus. Results Of 12 patients with active bleeding, successful hemostasis was achieved in 10 patients, with an effective rate of 83 3% (10/12), and 2 patients died from hemorrhagic shock within 48 hours, with an in-hospital mortality of 14 3% (2/14). One patient succumbed to hepatic failure two months after the TACE, and 1 patient received a radical operation two months after the TACE. Follow-up in 10 patients revealed that 8 patients underwent TACE for 1 ～ 4 times (mean survival time, 7 8 months) and 5 patients existed for more than 1 year (35 7%, 5/14). Conclusions TACE is effective in the management of spontaneously ruptured hepatocellular carcinoma.