BackgroundMany liver staging systems that include the tumor stage and the extent of liver function have been developed. However, prognosis assessment for hepatocellular carcinoma (HCC) remains controversial. In this study, the performances of 7 staging systems were compared in a cohort of patients with HCC who underwent non-surgical treatment.MethodsA total of 196 consecutive patients with HCC who underwent non-surgical treatment seen between January 1, 2004, and December 31, 2007, were included. Performances of TNM sixth edition, Okuda, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Chinese University Prognostic Index (CUPI), Japan Integrated Staging (JIS), and China integrated score (CIS) have been compared and ranked using concordance index (c-index). Predictors of survival were identified using univariate and multivariate Cox model analyses.ResultsThe median survival time for the cohort was 7.6 months (95% CI 5.6–9.7). The independent predictors of survival were performance status (P<.001), serum sodium (P<.001), alkaline phosphatase (P<.001), tumor diameter greater than 5 cm (P = .001), portal vein invasion (P<.001), lymph node metastasis (P = .025), and distant metastasis (P = .004). CUPI staging system had the best independent predictive power for survival when compared with the other six prognostic systems. Performance status and serum sodium improved the discriminatory ability of CUPI.ConclusionIn our selected patient population whose main etiology is hepatitis B, CUPI was the most suitable staging system in predicting survival in patients with unresectable HCC. BCLC was the second top-ranking staging system. CLIP, JIS, CIS, and TNM sixth edition were not helpful in predicting survival outcome, and their use is not supported by our data.
Low arterial blood pH and sustained nitric oxide (NO) production are critical parameters in inflammatory events such as sepsis, and appropriate treatment is still under debate. Because the stability of nitrogen and oxygen intermediates is dependent on the surrounding pH, we investigated whether the relationship among NO, peroxynitrite (ONOO−), and reactive oxygen species production also depends on the pH value, particularly with respect to their effects on hepatocellular damage. Our studies demonstrate that the extracellular pH influences NO and hydroxyl radical (OH) production in hepatocytes. Acidification (pH 7.0) of the medium revealed a significant increase ( P < 0.05) of OH-like radicals, enhanced hepatocellular damage, and a sharp drop in cellular glutathione (GSH) content compared with levels measured at physiological or alkaline pH conditions. Furthermore, inhibition of NO synthesis at all pH conditions resulted in decreased NO production and cellular GSH levels but a simultaneous increase of OH-like radicals and hepatocellular damage with a maximum seen at pH 7.0. Our results suggest that hepatocellular damage is in part regulated by the surrounding pH and that inhibition of NO synthesis at acidic conditions (e.g., in sepsis) leads to increased reactive oxygen-mediated cell injury.
The aim of this study was to investigate the prevalence of hepatitis B surface antigen (HBsAg) and clinical characteristics of middle school students infected with hepatitis B virus (HBV) after initiation of the HBV immunization program in China. A total of 82,156 serum samples were collected from students in 33 junior schools and 25 senior schools. HBsAg was tested by ELISA. Samples from HBsAg-positive students were collected and analyzed for HBV serum markers, alanine aminotransferase (ALT), HBV DNA levels, and HBV genotypes. The overall prevalence of HBsAg was 1.11% in middle school students in Shanghai, China. The prevalence of HBsAg in students born during the immunization program to HBsAg-positive mothers was significantly higher than that in students born during the universal vaccination program (1.47% vs 0.78%, P < 0.01). Only HBV genotypes B and C were found in these infections, and genotype C was the dominant one. Twenty-one (13.0%) of 162 HBsAg-positive students had active hepatitis B, and 18 were hepatitis B e antigen (HBeAg) positive. The universal infant vaccination program has reduced the prevalence of HBsAg significantly. HBeAg-positive hepatitis B, however, needs to be monitored among the students in whom vaccination failed.
shown to function as a cell-signaling molecule in the regulaNitric oxide (NO) and norepinephrine are potent vasoactive tion of vascular tone. 3,4 agents that are involved in the control of portal blood flow. The second NOS isoform, the inducible NOS (NOS2) (for We have studied NO and norepinephrine in a non-recirculated review, see Nathan 5 , Nussler 6 ) is expressed after exposing rat liver perfusion to analyze their influence on portal flow cells or mammals to various pathogens, such as bacterial and hepatic metabolism. Animals were either pretreated with products (endotoxin), or inflammatory cytokines. 7,8 Inducendotoxin (4 hours; 10 mg/kg intraperitoneally) to activate tion of the NOS2 in response to inflammatory stimuli has the inducible NO synthase (NOS2), or used without pretreatbeen shown in the liver for all major hepatic cell types.9,10 ment for the constitutive NO synthase (NOS3). In both This isoform is Ca // -independent and synthesizes NO for groups, portal flow, bile flow, bile secretion, and the sinusoiextended periods and in high concentrations.
11-13dal bile acid uptake were reduced by norepinephrine with It has been suggested that vascular tone is actively maina simultaneous increase of glucose and lactate output. The tained by a balance of vasoconstrictive and vasodilatory stimaddition of the substrate for NO synthesis, L-arginine (0.5 uli. 13 While NO is probably the most potent vasodilator, mmol/L), to the perfusate markedly inhibited the effect of 0.1 norepinephrine is one of the strongest vasoconstrictors. In mmol/L norepinephrine on portal flow from 02.6 { 0.32 to the liver, norepinephrine is released by sympathetic nerves 0.3 { 0.1 mL/g/10 min in endotoxin-treated animals, and from and has pronounced effects on carbohydrate metabolism and 02.9 { 0.45 to 0.77 { 0.29 mL/g/10 min in the untreated bile secretion. 14-16 However, it remains uncertain how norepiones. In contrast, neither NO formation after L-arginine supnephrine interferes with the balance of sinusoidal tonus and plementation nor inhibition of NO synthesis via the structural metabolism. There is controversial evidence for the proposal analogue (N
G -monomethyl-L-arginine [L-NMMA]) changedthat norepinephrine has direct effects on the hepatic bile cholestatic and glycogenolytic effects caused by norepinephformation, and that the alterations observed are not secondrine. Only the sinusoidal bile acid uptake was reduced followary to the increase of the intrahepatic resistance.14,17,18ing increased NO formation. Thus, we conclude that endogeThe present study investigated whether NO formation or nous NO formation prevents a-catecholaminergic-increased inhibition alters norepinephrine effects in a single-pass liver intrahepatic resistance without a major influence on the metaperfusion model under constant perfusion pressure condibolic effects. (HEPATOLOGY 1997;26:147-154.) tions. We perfused livers of untreated and endotoxin-pretreated animals. Our data indicate that the norepinephrineincreased hepatic resistance was significantly a...
Baihe Recipe has inhibitory effects on tumor growth and metastasis of gastric cancer orthotopically transplanted in nude mice by down-regulating the expressions of VEGF and p53 proteins.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.