[Efficacy of nasal cavity ventilation expansion surgery for OSAHS with multiplane obstruction].

Objective:To evaluate the improvement of nasal obstruction sympotom， AHI and LSaO²of OSAHS patients with multiplane obstruction after nasal cavity ventilation expansion techniques.Method:All the 41 OSAHS patients diagnosed by PSG were assessed with multiplane obstruction after examinations.Nasal cavity ventilation expansion techniques were performed. Each patient received the examinations of acoustic rhinometry and nasal resistance to assess the objective nasal ventilation, completed the nasal obstruction symptom evaluation(NOSE) scale to assess the subjective nasal obstructon. Postoperative datas were obtained at least 3 months later. Result:①The unilateral nasal volume 0-5 cm（UV5）were significantly changed(P<0.05), whereas the nasal resistance(NR)and NOSE were significantly decreased(P<0.05);②the AHI was significantly decreased,the LSaO2 was significantly increased(P<0.05). Conclusion:①The nasal cavity ventilation expansion techniques can improve the nasal ventilation of OSAHS patients with multiplane obstruction;②the postoperative AHI was significantly decreased whereas the chronic hypoxemia of patients was improve after surgery. Nasal cavity ventilation expansion surgery was effective and helpful for the later treatments for OSAHS patients with multiplane obstruction.

[Surgical treatment progress of OSAHS with multiplane obstruction].

For OSAHS patients with multiplane obstruction,the surgery aimed to single-plane can not receive satisfactory results,while perioperative risks increased significantly. In this paper,in order to provide safe and effective diagnosis and treatment strategies,the assessment,the surgical treatments and effects of different obstructive planes are reviewed.

Anatomical versus non-anatomical liver resection for hepatocellular carcinoma exceeding Milan criteria.

BACKGROUND: Liver resection is effective for hepatocellular carcinoma (HCC) exceeding the Milan criteria in selected patients. However, the benefit of anatomical resection (AR) versus non-anatomical resection (NAR) has not been clarified in this patient subgroup. This study aimed to compare outcomes between AR and NAR for HCC exceeding the Milan criteria. METHODS: Data on consecutive patients with HCC exceeding the Milan criteria who underwent liver resection with curative intent over a recent 6-year interval were extracted from a prospective single-centre HCC database and examined retrospectively. The postoperative outcomes of patients were compared before and after propensity score matching. RESULTS: Some 546 patients were included: 264 in the AR and 282 in the NAR group. In the original cohort, the AR group contained more patients with larger tumours, multiple tumours, macroscopic portal vein tumour thrombi, incomplete tumour capsules and microscopic vascular invasion. After propensity score matching, 177 pairs of patients were selected. The baseline data, including liver function and tumour burden, were similar in the matched groups. The 3-year recurrence-free survival rate was comparable between the matched NAR and AR groups (36·5 versus 28·5 per cent; P = 0·448). Similar results were observed for 3-year overall survival (57·5 versus 50·3 per cent; P = 0·385), recurrence patterns and early recurrence rates (57·6 per cent versus 59·9 per cent; P = 0·712). CONCLUSION: AR and NAR achieved favourable and similar outcomes for HCC exceeding the Milan criteria in selected patients.

Dendritic cells transfected with hepatocellular carcinoma (HCC) total RNA induce specific immune responses against HCC in vitro and in vivo.

BACKGROUND: Immunotherapy is an effective method for preventing metastasis and recurrence of carcinoma. Hepatocellular carcinoma (HCC) is a common malignancy with a high rate of recurrence, and has not successfully been introduced to immunotherapy. METHODS: Peripheral blood mononuclear cells were isolated from whole blood of HCC patients and stimulated to transform into dendritic cells (DCs). These DCs were then transfected with RNA extracted from HepG-2 hepatoma cells to induce expression of specific antigens. RESULTS: The transfected DCs stimulated T lymphocytes to produce cytotoxic T lymphocytes, which specifically attacked HepG-2 cells. Injection of T lymphocytes from HCC patients and transfected DCs into severe combined immunodeficiency mice limited the growth of HepG-2 tumors. CONCLUSION: A specific immune response against hepatoma can be generated in vivo by administering DCs transfected with RNA from a specific tumor. This method may have therapeutic application in humans to reduce recurrence of HCC.

Prognostic impact of pERK in advanced hepatocellular carcinoma patients treated with sorafenib.

BACKGROUND: Sorafenib represents the standard of care targeted therapy for patients with advanced hepatocellular carcinoma (HCC). However, biomolecules that predict a patient's response to sorafenib treatment for HCC remain largely unknown. Thus, this study was designed to investigate whether phosphorylated ERK (pERK) and members of the sorafenib target or PI3K/Akt/mTOR signaling pathway predict the efficacy of sorafenib in advanced HCC patients. METHODOLOGY: From December 2008 to October 2011, pathological specimens from 54 advanced HCC patients received sorafenib treatment were obtained. Clinicopathological variables, treatment response, survival and time to progression (TTP) were recorded. Immunophenotypical analysis was carried out using antibodies against pERK, phosphorylated S6K (pS6K), VEGFR2 and PTEN. RESULTS: The median overall survival (OS) and TTP were 14.2 and 3.4 months, respectively, and the disease control rate (DCR) was 59.3%. Better Eastern Cooperative Oncology Group Performance Status (ECOG PS) (95% CI: 3.27-4.93 m vs. 1.15-2.85 m, p = 0.01), Child-Pugh class A score (95% CI: 3.47-4.53 vs. 1.14-2.06 m, p < 0.01), and higher pERK (3.34-6.66 m vs. 1.33-2.67 m, p = 0.03) and VEGFR2 (3.49-6.52 m vs. 2.15-2.73 m, p = 0.04) immunohistochemical staining score were associated with increased TTP by univariate analysis. The ECOG PS (p = 0.022), Child-Pugh class (p = 0.045) and pERK staining score (p = 0.012) were found to be associated with TTP using multivariate analysis. CONCLUSION: Sorafenib treatment outcome is favorable in advanced HCC patients who received tumor resection and who have a good ECOG PS and Child-Pugh class A liver function. The pERK immunohistological staining score, ECOG PS and Child-Pugh class may be helpful in determining patients most likely to benefit from sorafenib therapy.

WITHDRAWN: Adjuvant portal vein chemotherapy improves the efficacy of hepatectomy for hepatocellular carcinoma with portal vein tumor thrombus.

This article has been withdrawn consistent with Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologizes for any inconvenience this may cause.

Induction of cytotoxic T-lymphocyte responses using dendritic cells transfected with hepatocellular carcinoma mRNA.

This study aims to induce an efficient expansion of cytotoxic T-lymphocytes (CTL) from peripheral blood mononuclear cells (PBMCs) using dendritic cells (DC) transfected with hepatocellular carcinoma (HCC) messenger RNA (mRNA) for adoptive immunotherapy of HCC. Dendritic cells are generated from PBMCs. HCC mRNA is isolated either from HepG-2 cells or from tumour tissue from three HCC patients, and then amplified using the polymerase chain reaction (PCR). Expansion of CTLs is achieved from PBMCs induced by DCs transfected with HCC mRNA and cytotoxicity is measured using a crystal violet staining assay. The proportion of CD3+, CD4+ and CD8+ cells is determined using flow cytometry. Dendritic cells transfected with the total HCC mRNA stimulated antigen-specific cytotoxic T-cell responses that are capable of recognising and killing autologous tumour cells in vitro. The cytotoxic activity was inhibited by treatment with anti-CD3, anti-CD8 and anti-MHC class I monoclonal antibodies, but not with anti-CD4 and MHC class II antibodies. In conclusion, HCC mRNA-transfected DCs may represent a broadly applicable vaccine strategy to induce potentially therapeutic CTL responses in HCC.

A tumour vaccine of fixed tumour fragments in a controlled-release vehicle with cytokines for therapy of hepatoma in mice.

BACKGROUND: Cytokines can be strong potentiators for a tumour vaccine, but they have very short life in vivo when administered as a solution. AIMS: To evaluate the slow release of interleukin 2 from a cytokine-vehicle in vitro and in vivo and to evaluate the anti-tumour activity of a new tumour vaccine in vivo. METHODS: The tumour vaccine was composed of formalin-fixed Hepa 1-6 hepatoma tissue fragments, tuberculin and a lipid based vehicle containing granulocyte-macrophage colony-stimulating factor and interleukin 2. The quantity of interleukin 2 release from the cytokine-vehicle in vitro and in vivo was determined by a proliferation assay with CTLL-2 cell line. Hepa 1-6 hepatoma model system with C57BL/6J mice was used to examine protective and therapeutic anti-tumour effect of the vaccine. RESULTS: Release of interleukin 2 from the cytokine-vehicle lasted 5 days in vitro and 3 days in vivo. The vaccine protected 67% of mice from a Hepa 1-6 cell challenge and had a therapeutic effect by prolonging the life span of mice bearing established Hepa 1-6 tumours of 5 mm in diameter. Of the treated mice, 20% became completely tumour-free. CONCLUSIONS: Formalin-fixed tumour fragments and cytokines in controlled-release vehicle are useful in the rational design of tumour vaccines.

Group I metabotropic glutamate receptors in spiral ganglion neurons contribute to excitatory neurotransmissions in the cochlea.

Evidence has accumulated over the years supporting glutamate as the primary neurotransmitter used by hair cells in afferent cochlear neurotransmission. Besides acting on ionotropic glutamate receptors, glutamate also activates second messenger systems via G-protein-coupled metabotropic glutamate receptors (mGluRs) to modulate neuronal excitability. However, it is unclear whether mGluRs participate in cochlear neurotransmission. We present evidence directly supporting a functional role for group I metabotropic glutamate receptors (mGluRIs) in spiral ganglion (SG) neurons. The presence of mGluRI and downstream G-protein subunits was demonstrated by molecular biology and immunolabeling methods. Direct activation of mGluRIs in cultured SG neurons resulted in transient increases of intracellular Ca(++) concentration and transient inward currents that gave rise to firings of multiple action potentials. These responses showed mGluRI pharmacological specificity and quickly desensitized. We next examined changes in cochlear function after noise exposure as a result of pharmacologically manipulating cochlear glutamate neurotransmission. These in vivo tests showed that blocking non-N-methyl-D-aspartic acid glutamate receptors was sufficient to eliminate compound action potentials of the auditory nerve, and pharmacologically inhibiting mGluRIs in the cochlea did not significantly affect the hearing threshold. In contrast, blocking mGluRIs lowered the amplitude of compound action potentials at louder sound levels and reduced the noise-induced temporary threshold shift. Our results suggest that although mGluRIs did not initiate fast excitatory cochlear neurotransmission, their activation contributed to the growth of excitatory responses of the cochlea. As a result, the cochlea was more resistant to noise-induced temporary hearing losses without the activation of mGluRIs in SG neurons.

Portal vein embolization with ethanol injection via a fine needle in dogs.

We devised a method for portal vein embolization with ethanol injection (PVEEI) via a fine needle. Both the efficacy and safety of this procedure were evaluated in 28 dogs. An embolization of the left central and lateral lobes was undertaken with various doses of absolute (95%) ethanol. The smallest dose, 0.25 ml/kg ethanol (n = 7), caused the least damage to the liver, but the embolization was not complete. At the highest dose at 1.0 ml/kg, four of the seven dogs died of respiratory arrest; however, embolization was complete in the remaining dogs. All animals tolerated the procedure by 0.5 ml/kg ethanol (n = 11) with a satisfactory embolic effect, slight toxicity to the hepatic parenchyma, and only transient changes in liver function. The results suggested that PVEEI is safe and effective when a suitable dose of ethanol is administered. Local overembolization occurred in one dog due to extension of the thrombus, suggesting that the point of puncture should not be near the confluence of the branches. Since a selective portal venous puncture is not difficult to perform under sonographic guidance, PVEEI is expected to be clinically applied.

[Two-stage multivariant analyses for prediction of hepatic function reserve].

Eleven liver function tests were used for preoperative estimations of the hepatic function reserve in 103 patients with primary hepatocellular carcinoma (HCC) and underlying liver cirrhosis. Postoperatively, the patients' liver function could be classified as good recovering (Grade A, n = 38), functional damage (Grade B, n = 37) and liver failure (Grade C, n = 28). Single factor analyses showed 6 of those tests were significant indicators, including the ratio of blood glucose level at 120 minutes and 60 minutes by oral glucose tolerance test, total bilirubin, the ratio of albumin and globulin, prealbumin, prothrombin time and indocyanine green retention at 15 minutes. The correlations between 11 preoperative parameters (xi) and postoperative course scored (Y) were analysed by Fisher's discriminant test. The multiple regression equation Y1 was obtained by comparing from groups of Grade A with B and formula Y2 from groups of Grade B with C. The predictive accuracy of both equations were 88.0%, 83.1%, respectively. To select adequate surgical procedures with the best therapeutic effect and minimal liver damage for the patients with HCC, we proposed a method of "two-stage predications" combining use of Y1 and Y2 for evaluation of liver function reserve.