AFP In Group Research Articles

Evaluation of Bond Strength and Fracture Load of Teeth With Flared Root Canals Restored With Prefabricated, Anatomical, and Computer-aided Design and Computer-aided Manufacturing Fiber Posts.

This study compared the use of anatomical glass fiber posts using bulk-fill composite resin with computer-aided design and computer-aided manufacturing (CAD/CAM) milled glass fiber post in oversized root canals, through bond strength (BS) and fracture resistance (FR) tests (fracture load). A total of 48 mandibular premolars were selected, half of them had their crowns removed at the cemento-enamel junction (CEJ) and the other half were sectioned 2 mm above the CEJ. Subsequently, teeth were endodontically treated. After 1 week, the standard preparation of the canals was carried out, and the roots were divided into three groups (n=16), according to the use of different restorative techniques (control: prefabricated glass fiber post [PFP], direct anatomical glass fiber post [AFP], and CAD/CAM milled glass fiber post [MFP]). After luting procedures using Single Bond Universal and RelyX Ultimate (3M ESPE), for eight teeth in each group, six specimens were obtained (two slices from each root third: cervical, middle, and apical). For the remaining eight roots of each group, standardized preparations for metal-free crowns, milling of 5 mol% yttria-stabilized tetragonal zirconia polycrystalline, cementation of the crowns, and periodontal ligament simulation were performed. Then, for each group, the BS was evaluated through the push-out test, and the FR was evaluated in compression. The data obtained from BS were submitted to two-way analysis of variance (ANOVA; group vs root region) and Tukey (α=0.05) and from FR to one-way ANOVA (group) and Tukey (α=0.05). For the BS test, the MFP group was statistically superior to the PFP group in all root regions and was statistically superior to the AFP group only in the cervical region, being statistically similar in the middle and apical root regions. For the FR test, the MFP group was statistically superior to the PFP and AFP groups. The milled fiber post technique can be a legitimate alternative in the restoration of weakened roots with flared root canals.

Clinical efficacy of CT-guided 125I brachytherapy in patients with local residual or recurrent hepatocellular carcinoma after thermal ablation

ObjectivesTreatment methods of local residual or recurrent hepatocellular carcinoma (HCC) after thermal ablation are limited. Therefore, our study aimed to explore the efficacy and prognostic factors of 125I brachytherapy for local residual or recurrent lesion after thermal ablation.MethodsA total of 114 patients with 212 local residual or recurrent HCC tumors after thermal ablation underwent 125I brachytherapy. Local progression-free survival (LPFS) and prognostic factors were analyzed by Kaplan–Meier curves and the Cox model.ResultsAfter a 6-month follow-up, the percentage of patients who achieved complete response (CR), partial response (PR), and stable disease (SD) was 57%, 13.2%, and 5.2%, respectively. The 1-, 2-, and 3-year LPFS rates were 58.7%, 50.0%, and 41.2%, respectively. Portal vein tumor thrombus (PVTT) (p = 0.03), the number of intrahepatic tumors (p = 0.01), and AFP level (p = 0.02) were independent risk factors for local tumor progression (LTP). The median LPFS in patients without PVTT (22 months) was much longer compared to those with PVTT (10 months). The median LPFS in patients with less than three intrahepatic lesions improved from 17 to 24 months. The median LPFS was only 5 months in the high AFP group, but was prolonged with a decrease in AFP level (24 months). No severe complications were recorded. All complications were controllable and treatable.ConclusionsCT-guided 125I brachytherapy was a safe and effective treatment for patients with local residual or recurrent HCC after thermal ablation to improve local control rate.

Real-World Treatment Patterns and Health-Resource Utilization in Patients with Hepatocellular Carcinoma (HCC) Following Failure of Sorafenib: A Retrospective Chart Review of 127 Patients in South Korea.

BackgroundEuropean, US, Asian and Korean treatment guidelines all recommend sorafenib as first-line systemic therapy in patients with hepatocellular carcinoma (HCC). However, due to the emergence of several new treatments, post-sorafenib treatment patterns in real-world clinical practice are less well understood.ObjectiveThis study aimed to characterize current treatment patterns and healthcare resource utilization (HRU) in patients with HCC following the failure of first-line sorafenib in a real-world setting in Korea.Patients and methodsA chart review was conducted in 127 HCC patients who received systemic therapy or best supportive care following failure of first-line systemic treatment with sorafenib (2016–2018). Anonymized data on patient characteristics, treatment patterns, and survival were abstracted by 37 physicians in Korea.ResultsThe mean (range) age of patients was 60 (37–79) years; 63 patients had low alpha-fetoprotein (AFP < 400 ng/mL), 64 patients had high alpha-fetoprotein (AFP ≥ 400 ng/mL). Post-sorafenib, 64 (50%) patients had systemic therapy. Regorafenib, used by 54 (84%) patients in second-line, and nivolumab monotherapy, by ten (56%) patients in third-line, were the most common therapies. Hepatologist visits and hospitalizations, at an average rate of 6.89 (95% CI 6.37–7.45) and 2.24 (95% CI 1.95–2.57) per patient-year, respectively, were the key contributors of HRU. The median overall survival (95% CI) from discontinuation of sorafenib was 13.0 (9.8–20.7), 6.5 (5.0–9.5) and 9.5 (6.7–12.3) months in the low AFP, high AFP and overall group, respectively.ConclusionThis real-world evidence research on treatment patterns reflected current clinical guidelines and highlighted fast progressing nature and continuing high mortality in HCC, especially among the high AFP group, underlying a need for new treatments that can lengthen survival. Results from this real-world chart review, together with existing clinical trial data, can inform future evaluations of new HCC treatments that estimate their health economic impact in Korea.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-021-00286-z.

Vitronectin (VTN): A Novel Diagnostic and Prognostic Marker for Hepatocellular Carcinoma (HCC) On Top Of Chronic Hepatitis C Virus Related Diseases

Abstract Background Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the most common form of primary liver cancer. Aim of the study to study the level of serum vitronectin (VTN) compared to AFP in diagnosis and prognosis of hepatocellular carcinoma on top of HCV-related liver diseases. Patients and Methods This prospective observational study included a total number of 60 subjects who were divided into 4 groups: Group 1: include 10 normal persons. Group 2: included 10 patients who have Hepatitis C Virus infection. Group 3: included 20 cirrhotic patients. Group 4: included 20 patients with HCC (on top of hepatitis C virus related cirrhosis), in which we tested them for vitronectin before first intervention and after intervention within 3 months. Results The mean age of the cases showed high statistically significant difference between the study groups (P &amp;lt; 0.001).There were a total number of 29 males and 31 females with significant difference in the sex distribution between the study groups. 80% of the cases in HCC group were males. This sex distribution can be attributed to high prevalence of risk factors like smoking, DM and HCV in males in addition to possible role of sex hormones. On analyzing laboratory characters of the studied groups, we found statistically significant difference between cirrhosis group and non-cirrhotic groups with low platelets count, high serum creatinine, high INR, lower serum albumin, high bilirubin and higher AST. The median level of AFP in group 4 (HCC patients) was 110 IU/ml which was higher than its median value in the other study groups with high level of significance between the study groups. The median level of vitronectin levels in the different study groups didn’t reveal a statistically significant difference between the different study groups. Serum level of vitronectin in group 3 (cirrhotic patients) has no statistically significant difference between the three subgroups according to child's classification. By the analysis of serum level of AFP and vitronectin level in group IV (HCC patients) before and after treatment, the median level of AFP was significantly lower than its level before intervention, while the decrease in vitronectin level was statistically insignificant after intervention. Conclusions Chronic HCV infection and its serious complicatons specially HCC are still representing a health challenge in Egypt, reflecting wide HCV prevalence and late diagnosis. Serum AFP alone has an unreliable role in HCC surveillance as it has low sensitivity because it may be normal in up to 40% of HCC cases especially early stages of the tumor, and low specificity as its levels may be elevated in conditions other than HCC as cirrhosis or exacerbation of chronic hepatitis or even in some cases of cholangiocarcinoma. AFP is useful in clinical practice in screening and diagnosis of HCC in association with US and CT. According to our study, we can't use Vitronectin alone in diagnosis and prognosis of HCC on top of cirrhosis related to HCV +ve infection. It didn’t reveal a statistically significant difference between the different study groups ,so it may require further study and research.

Perioperative circulating tumor DNA analysis to predict patient prognosis in liver cancer.

4593 Background: Resection is a major method for early-stage liver cancer patients. Unfortunately, there still a few patients with post-operation recurrences. Circulating tumor DNA (ctDNA) had been reported as a biomarker in reflecting tumor load and treatment efficacy in some cancer species. Here, we report an application of ctDNA in the perioperative period of liver cancer using targeted sequencing with a 1021-gene panel. Methods: 97 patients diagnosed with liver cancer were enrolled in this study. Postoperative peripheral blood samples were collected within 7 days after surgery and analyzed using hybridization capture based NGS ERSeq method from all patients. Whether a mutant gene was detected in the peripheral blood was defined as ctDNA(+) and ctDNA(-), respectively. Results: Multivariate Cox analysis showed that the post-operation ctDNA was an independent poor prognostic predictor (AFP, RR: 1.0002, 95% Cl: 1.0001-1.0002; ctDNA, RR: 3.738, Cl: 1.872-7.691). 21 patients were ctDNA(+), and all of them had recurrenced (21/21, 100%), while 76 patients were ctDNA(-), and only 12 (12/76, 15.8%) patients had recurrenced. The median disease-free survival time was 5.0 months in ctDNA(+) group and the ctDNA(-) group had not reach the median time (Log-rank test, P &lt; 0.0001). ctDNA combined with AFP would effectively predict the prognosis of patients after surgery. AFP(H) ( &gt; = 400 ng/mL) and ctDNA(+) patients have the worst prognosis and all of the patients had relapsed, while AFP(L) ( &lt; 400 ng/mL) and ctDNA(-) patients had the best prognosis, with less than 20% of patients had relapsed (Log-rank test, P &lt; 0.0001). The median disease-free survival time was 2.0, 6.0 and 7.0 months in ctDNA(+)-AFP(H) (n = 8), ctDNA(-)-AFP(H) (n = 30) and ctDNA(+)-AFP(L) (n = 13) groups, respectively, while ctDNA(-)-AFP(L) group (n = 46) had not reach the median time statistically (Log-rank test, P = 0.0364). Conclusions: In summary, Perioperative ctDNA detection has great potential value clinically, and it also suggests that patients with positive ctDNA after surgery should receive some adjuvant treatments as soon as possible to improve the survival time.

Study of Oncoprotein 24p3 as Diagnostic Marker for Hepatocellular Carcinoma on Top of Hepatitis C Virus

Background: Hepatitis C virus is one of the main causes of chronic liver disease worldwide. Egypt has the highest prevalence of HCV in the world, estimated nationally at 14.7% and is therefore confronted with a disease burden of historical proportions that distinguishes this nation from others. In HCC, 24P3 is overexpressed in tissues and closely associated with the proliferation and invasion of HCC cells.24P3 is mainly expressed in myeloid cells and later assigned to a cluster of at least three lipocalins on the long arm of human chromosome 9. Aim of the Work: was to shed the light on the role of oncoprotein 24p3 as a diagnostic marker in patients with hepatocellular carcinoma complicating hepatitis C virus. Subjects and Methods: This case control clinical study was carried out on 60 subjects who were divided into three groups: Group I: Twenty Patients diagnosed with HCC on top of HCV. Group II: Twenty Patients diagnosed with HCV without HCC. Group III: Twenty normal subjects with matched age and sex as a control group. Studied groups were subjected to abdominal ultrasonography, triphasic CT for patients with focal lesions, laboratory investigations including; liver function tests included hepatitis markers and serum 24P3, detected by enzyme linked immunosorbent assay (ELISA). Results: The study revealed a significant increase in AFP in Group I compared to Group II and in Group II compared to Group III. A significant difference P=0.001 was found among the three different groups. The cutoff for AFP was >20ng/mL, sensitivity was 70%, specificity was 85%, PPV 90%, NPV 65% and accuracy 78%. There was a significant increase of 24P3 in Group I compared to Group II and in Group II compared to Group III. A statistical significance p=0.001 was found among the three different groups. The cutoff for 24P3 was >250ng/mL and its sensitivity, specificity, PPV, NPV, and accuracy were all 100%. Based on the present study, 24P3 has a higher sensitivity, specificity and accuracy as compared to AFP, a famously used biomarker in HCC. Conclusion: Serum 24P3 levels in patients with HCV may be used as a guide for progression and prognosis of HCC. In these patients, if 24P3 levels were found to be high, serum alpha‑ feto protein and ultrasonographic examination could be repeated at more frequent intervals. This may also be used as a guide in terms of the treatment plan. Measurement of 24P3 in sera of large number of patients and follow up may pave the way to pick up early stage of HCC and showed its prognostic effect.

Non-secretion of AFP and neutrophil lymphocyte ratio as predictors for survival in hepatocellular carcinoma patients treated with sorafenib: a large UK cohort.

BackgroundSorafenib is the current standard of care for patients with advanced or metastatic hepatocellular carcinoma. Currently no universally agreed model exists correlating the Neutrophil Lymphocyte ratio (NLR) and non-secretion of AFP with the survival of HCC patients treated with sorafenib.Patients and MethodsWe retrospectively analysed patient records with a confirmed diagnosis of HCC treated with sorafenib between April 2009 and March 2014. Survival analysis was performed using the Kaplan–Meier method and Cox regression.ResultsPatients separated into groups based on NLR (≤3 or >3), or AFP secretion profile (<7 ng/ml or ≥7 ng/ml) derived diverging Kaplan–Meier curves for overall survival (OS). The median OS in those with NLR ≤3.0 was 9.0 months (95% CI: 7.7–11.1 months) and in those with NLR >3.0 it was 6.0 months (95% CI: 4.9–8.2 months) [HR 1.32 (95% CI: 0.96–1.80)]. The median overall survival post sorafenib was higher in the “non-secretor” AFP group. OS for AFP <7 ng/ml was 10.0 months (95% CI: 7.7–19.3 months) compared to AFP ≥7ng/ml: 6.6 months (95% CI: 5.3–8.4 months) [HR 1.64 (95% CI: 1.15–2.33)].ConclusionNLR and AFP non - secretion at diagnosis are potential significant prognosticators for overall survival from initiation of sorafenib.

ALBI Grade Determines Post-progression Survivals after Sorafenib Treatment Failure in Advanced HCC Patients: A Model for Second-Line Trial Selection

Introduction: Sorafenib can improve the overall survival (OS) and progression-free survival (PFS) of advanced hepatocellular carcinoma (HCC). Appropriate criteria for selection patients who can be enrolled in second-line trials are in unmet need. In this study, we aimed to evaluate the post-progression survival (PPS) in patients undergoing sorafenib for advanced HCC based on Albumin-Bilirubin (ALBI) grade, a new model with good performance in predicting OS of HCC. Methods: Consecutive 276 advanced HCC patients receiving sorafenib were retrospectively enrolled. All patients were in Child-Pugh A status and BCLC stage C with either portal vein invasion or extrahepatic metastasis. Radiologic evaluation was based on mRECIST criteria, clinical and compliance assessments were performed every two months, and two to four weeks, respectively. Results: During the median follow-up period of 5.6 months (interquartile range [IQR], 3.0-13.5), 220 (79.7%) patients developed progressive disease (PD) and 245 (88.8%) deaths occurred. The mean sorafenib dosage was 613.3mg (standard deviation, 189.7mg) per day; and the medium treatment duration was 64 days (IQR, 50-125). The median PFS, OS, and PPS were 2.1 (IQR, 1.4-5.9), 5.7 (IQR, 3.1-13.6), and 4.0 (IQR, 1.9-9.1) months, respectively. The ALBI grade could independently predict the OS (hazard ratio [HR], 1.505 for grade 2 vs 1; and 4.354 for grade 3 vs 1) but did not have a role in predicting PFS. Independent predictors of PPS included ALBI grade at progression (HR, 1.654 for grade 2 vs 1; and 2.655 for grade 3 vs 1), new extrahepatic lesions (NEH) (HR, 2.026), high alpha-fetoprotein level (HR, 1.801), and early progression within 4 months (HR, 1.591). In the subgroup analysis according to the alpha-fetoprotein level at PD and time to progression interval, better PPS was only presented while NEH(-), ALBI grade 1 in early PD, high AFP group as well as NEH(-), ALBI grade 1-2 in late PD, low AFP group. Conclusion: Liver function and progression pattern are important determinants of survival after sorafenib failure. The presence of NEH is contraindicated for second-line trials as a poor PPS can be expected. Patients with early PD and high AFP level, ALBI grade 1; or patients without early PD or high AFP level, ALBI grade 1 & 2 can be a new inclusion criteria of second-line trials for advanced HCC.

Fistula Plug in Fistulising Ano-Perineal Crohn's Disease: a Randomised Controlled Trial.

Anal fistula plug [AFP] is a bioabsorbable bioprosthesis used in ano-perineal fistula treatment. We aimed to assess efficacy and safety of AFP in fistulising ano-perineal Crohn's disease [FAP-CD]. In a multicentre, open-label, randomised controlled trial we compared seton removal alone [control group] with AFP insertion [AFP group] in 106 Crohn's disease patients with non- or mildly active disease having at least one ano-perineal fistula tract drained for more than 1 month. Patients with abscess [collection ≥ 3mm on magnetic resonance imaging or recto-vaginal fistulas were excluded. Randomisation was stratified in simple or complex fistulas according to AGA classification. Primary end point was fistula closure at Week 12. In all, 54 patients were randomised to AFP group [control group 52]. Median fistula duration was 23 [10-53] months. Median Crohn's Disease Activity Index at baseline was 81 [45-135]. Fistula closure at Week 12 was achieved in 31.5% patients in the AFP group and in 23.1 % in the control group (relative risk [RR] stratified on AGA classification: 1.31; 95% confidence interval: 0.59-4.02; p = 0.19). No interaction in treatment effect with complexity stratum was found; 33.3% of patients with complex fistula and 30.8% of patients with simple fistula closed the tracts after AFP, as compared with 15.4% and 25.6% in controls, respectively [RR of success = 2.17 in complex fistula vs RR = 1.20 in simple fistula; p = 0.45]. Concerning safety, at Week 12, 17 patients developed at least one adverse event in the AFP group vs 8 in the controls [p = 0.07]. AFP is not more effective than seton removal alone to achieve FAP-CD closure.

Radiotherapy as Down Staging Treatment to Living Donor Liver Transplantation for Hepatocellular Carcinoma.

Introductions Curative surgical resection cannot be an option for most patients with hepatocellular carcinoma (HCC) because of underlying liver disease or extent of tumor. Radiotherpay (RT) for HCC is not generally considered a treatment of choice but RT has been used in advanced HCC patients such as portal venous tumor thrombosis (PVTT) and multiple large tumors. Recently, some studies showed that RT may be bridge to living donor liver transplant (LDLT). We report our experience with RT as pretransplant therapy. Methods Between May 1996 and March 2013, total 1360 patients treated by LT in our institution. Thirteen patients had history of RT and we analyze these patients retrospectively. Objective tumor response is evaluated with CT and/or MRI according to modified RECIST criteria and outcomes is estimated by disease free survival (DFS) and overall survival (OS). Results Before RT, seven patients exceed Milan criteria, and four patients have PVTT. Three patients are multiple HCC and all patients are LDLT and interval between RT and LDLT is 719.7 days. There was no significant difference between RT with LDLT and LDLT alone in operation times and amount of intraoperative transfusion. 3, 6 months and 1 year DFS is 82.5%, 73.3%, 55.0%, respectively. As shown in [table 1] and [table 2], low AFP group (<20ng/mL) and good objective tumor response after RT group have good prognosis compare with the other group. Conclusions LDLT is feasible in advanced HCC patients who have low AFP levels and good tumor response after RT.Table: No Caption available.Table: No Caption available.

Diagnostic value of AFP-L3 and PIVKA-II in hepatocellular carcinoma according to total-AFP

To evaluate diagnostic value of α-fetoprotein (AFP)-L3 and prothrombin induced by vitamin K absence-II (PIVKA-II) in hepatocellular carcinoma (HCC). One hundred and sixty-eight patients during routine HCC surveillance were included in this study. Of the 168 patients, 90 (53.6%) had HCC including newly developed HCC (n = 82) or recurrent HCC after treatment (n = 8). Sera were obtained during their first evaluation for HCC development and at the time of HCC diagnosis before commencing HCC treatment. HCC was diagnosed by histological examination, appropriate imaging characteristics-computed tomography or magnetic resonance imaging. Control sera were collected from 78 patients with benign liver disease (BLD), which were obtained during routine surveillance with a suspicion of HCC. AFP, AFP-L3 and PIVKA-II were measured in the same serum by microchip capillary electrophoresis and liquid-phase binding assay on a micro-total analysis system Wako i30 auto analyzer. The performance characteristics of three tests and combined tests for the diagnosis of HCC were obtained using receiver operating characteristic curves in all populations and subgroups with AFP < 20 ng/mL. Of 90 HCC patients, 38 (42.2%) patients had AFP < 20 ng/mL, 20 (22.2%) patients had AFP 20-200 ng/mL and 32 (35.6%) patients had AFP > 200 ng/mL. Of the 78 BLD patients, 74 (94.9%) patients had AFP < 20 ng/mL. After adjustment for age and HBV infection status, AFP-L3 levels were higher in HCC than in BLD among patients with low AFP levels (< 20 ng/mL) (P < 0.001). In a total of 168 patients, areas under the curve (AUC) for HCC were 0.879, 0.887, 0.801 and 0.939 for AFP, AFP-L3, PIVKA-II and the combined markers, respectively. The combined AUC for three markers showed higher value than the AUCs of individual marker (P < 0.05). AFP-L3 had higher AUC value than PIVKA-II for HCC detection in entire patients (P = 0.043). With combination of AFP-L3 (cut-off > 5%) and PIVKA-II (cut-off > 40 AU/L), the sensitivity were 94.4% and specificity were 75.6% in all patients. In 112 patients with low AFP levels (< 20 ng/mL), AUCs of AFP-L3, PIVKA-II and combine AFP-L3 and PIVKA-II tests were 0.824, 0.774 and 0.939, respectively. AFP-L3 with a cut-off value of 5% showed sensitivity of 71.1% and specificity of 83.8%, and PIVKA-II with a cut-off value of 40 AU/L had sensitivity of 57.9% and specificity of 95.9% in patients with low AFP levels. The combination of AFP-L3 and PIVKA-II increased the sensitivity and specificity up to 92.1% and 79.7%, respectively, in low AFP group. Combined markers detected 81.8% of early stage HCC (Union for International Cancer Control stage I), 86.7% of small sized tumor (< 2 cm) and 91.7% of single tumor of HCC in the low AFP group. In multivariate analysis, AFP-L3 was correlated with AFP and tumor size, and PIVKA-II was correlated with laboratory tests including serum aspartate aminotransferase, total bilirubin, platelets and albumin levels. PIVKA-II had no correlation with AFP, AFP-L3 or tumor characteristics. Combined determination of AFP-L3 and PIVKA-II could improve the diagnostic value for HCC detection in patients with or without increased AFP levels.

Elevated midtrimester α-fetoprotein and delivery markers of inflammation in a preterm population

Objective: Determine whether elevated second trimester maternal serum α-fetoprotein (AFP) is associated with clinical and histopathologic markers of inflammation at preterm delivery. Methods: 105 women <32 weeks’ gestation were included. AFP levels were dichotomized at 2.0 multiples of the median (MoM). Rates of neonatal morbidities, clinical chorioamnionitis, cord blood IL-6 level, and placental inflammatory findings were compared. Results: Thirteen (12.4%) had elevated AFP. Fewer women with AFP ≥2 MoM had histologic placental or membrane rupture site inflammation, funisitis, or placental culture positive for Mycoplasma and Ureaplasma species, compared to those with normal AFP. Neonatal death was increased in the elevated AFP group (23.1% vs. 2.27%, RR 10.6). Elevated AFP was associated with a nonsignificant increase in indicated birth (54% vs. 35%; p = 0.225). Virtually all inflammatory findings were confined to the spontaneous delivery group. Conclusion: Elevated midtrimester AFP conveyed significant risk of neonatal death, but was negatively associated with clinical or histopathologic inflammation in preterm infants.

Impact of Preoperative α‐Fetoprotein Level on Disease‐Free Survival After Liver Transplantation for Hepatocellular Carcinoma

Preoperative α-fetoprotein (AFP) levels may have an influence on disease-free survival (DFS) of patients after liver transplantation for hepatocellular carcinoma (HCC) located on a cirrhotic liver. Between 2000 and 2009, two groups were distinguished according to preoperative AFP level: normal-level group (<10 ng/ml) and increased-level group (>10 ng/ml). The increased-level group was further divided into three levels of preoperative AFP: 10-150, 150-500, and ≥ 500 ng/ml. DFS and recurrence rates were compared. All patients underwent transplantation using the preoperative 5/5 criteria. Of the 122 patients in this study, 63 had normal and 59 had increased preoperative AFP. There were no differences between the two groups concerning perioperative or pathologic data. Those with an increased preoperative AFP level had a significantly shorter 5-year DFS, and their recurrence rate was higher than that of the normal AFP group. The 5-year DFS and recurrence rates were 71 and 4 %, respectively, for those with normal AFP; 57 and 10 %, respectively, for those with AFP 10-150 ng/ml; 46 and 24 %, respectively, for those with AFP 150-500 ng/ml; and 28 and 62 %, respectively, for those with AFP ≥ 500 ng/ml. This study shows the prognostic value of preoperative AFP levels on DFS after a liver transplant for HCC in a population of patients undergoing transplantation with the same preoperative criteria.

Mesenchymal stem cells differentiate into hepatocyte-like cells under different induction systems in hepatitis B patients with liver failure

This study aimed to investigate and compare induced differentiation of mesenchymal stem cells from hepatitis B (HB) patients with liver failure into hepatocytes-like cells with different induction systems in vitro . The differentiation of MSCs from HB patients with liver failure was induced in vitro into hepatocytes-like cells by three cell culture media (serum-free medium (group 1), auto serum-containing medium (group 2) and medium supplemented with fetal bovine serum (FBS) (group 3)). Cell morphology, cell growth curve, amount of urea and glycogen and mRNA expressions of ALB, CK18 and AFP were detected and compared. Morphological changes in group 1 and 2 were more evident than that in group 3 and cell growth in group 3 was faster than the other two groups. The amount of urea and glycogen in group 1 and 2 was significantly elevated when compared with that in group 3 after 6 days of culture. RT-PCR analysis indicated the mRNA expressions of ALB, CK18 and AFP in group 1 and 2 were markedly increased as compared to that in group 3. The differentiation of MSCs from HB patients with liver failure into hepatocytes-like cells can be induced by three different cell culture media and the inductive effects were more profound in cells grown in the serum-free medium and auto serum-containing medium. Key words : Liver failure, mesenchymal stem cells, hepatogenic differentiation, in vitro .

Preliminary study of the transcatheter arterial chemoembolization in combination of percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis in treatment of primary hepatic carcinoma accompanied by portal vein tumor thrombosis

Objective To assess the therapeutic outcomes of transcatheter arterial chemoembolization combined with percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis for primary hepatic carcinoma accompanied by portal vein tumor thrombus. Methods Thirty patients with primary hepatic carcinoma accompanied by portal vein tumor thrombosis of type Ⅱ and type Ⅲ were randomly divided into two groups. The Child-Pugh ratings (class A and B) of group A and B were 9 vs 9 (class A) and 5 vs 7 (class B) respectively (χ2 = 0.201, P > 0.05). The constitution of Type Ⅱ and type Ⅲ portal vein tumor thrombus in group A and B were 8 vs 9 and 6 vs 7 respectively (χ2 =0.002, P>0.05). The median values of ALT, TBIL, ALB and AFP in group A and B were 58.7U/L vs 70.5 U/L (W=191.5, P>0.05), 21.4 μmol/L vs 21.7μmol/L (W=203, P>0.05), 35.3 g/L vs 37.5 g/L (W = 214, P > 0.05) and 680 μg/L vs 873 μg/L (W = 179. 00, P > 0.05) respectively. Group A was treated with transcatheter arterial chemoembolization (TACE) using emulsion made up of adriamycin, cisplatin, mitomycin and ultraliquidlipiodol plus percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis using emulsion consisted of cisplatin and ultraliquidlipiadol, while group B was treated with TACE only as a control group. Survival analyses were performed via the Kaplan-Meier test in SPSS11.5 with the log-rank tests with an threshold of 0.05. Results The 3, 6 and 12 months survival cases of group A and B were 11 vs 10, 10 vs 3, and 7 vs 0 respectively. The median survival time of group A and group B were 14.0 months and 4.0 months respectively. The difference of the two groups was significantly (χ2 =11.728, P<0.01). There was no severe side-effect related to therapy in both groups. Conclusion Comparing with the control group, TACE combined with percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis could significantly prolong the median survival time of patient with primary hepatic carcinoma accompanied by type Ⅱ and type Ⅲ portal vein tumor thrombosis. Key words: Liver neoplasms; Neoplasm metastasis; Portal vein; Tumor thrombus; Embolization, therapeutic

OC28.01: The role of contrast media in the diagnosis and management of ovarian masses

There were 12 intrauterine fetal death (IUFD) and 1 neonatal death (15.7%) in AFP against 3 (4.4%) in hCG Group, despite tertiary perinatal care. Mean gestational age at delivery was 34.5 weeks (range 21–41) for AFP and 37.7 weeks (range 22–42) for hCG Group. 6 (7.2%) in AFP and 3 (4.4%) in hCG Group developed severe preeclampsia. Multimodal screening predicted preterm delivery < 32 weeks with a likelihood ratio (LR+) of 6.932 in AFP against 0 in hCG group and IUFD with LR+ of 4.438 in AFP against 0 in hCG group. Conclusion: Predictive value of placental morphology and uterine artery Doppler was higher in the AFP group. Pregnancies with an elevated maternal serum AFP are more commonly associated with adverse perinatal outcomes than those with elevated hCG warranting increased maternal and fetal surveillance.

Successful Nonfreezing, Subzero Preservation of Rat Liver with 2,3-Butanediol and Type I Antifreeze Protein

Background. Organ cryopreservation is hindered by ice inflicted damage. Nonfreezing preservation of livers at subzero temperatures might offer advantages over current preservation.Methods. Sprague–Dawley rats were divided into three groups. UW livers (n = 6) were stored in University of Wisconsin (UW) solution at +4°C. UWB livers (n = 6) were perfused ex vivo with UW + 10% 2,3-butanediol at ≤7°C and stored at −4°C. AFP livers (n = 4) were preserved identical to UWB livers, except for addition of 1 mg/ml of type I antifreeze protein. After 24 h livers were perfused with Krebs–Henseleit buffer (37°C) for 60 min. Bile production, O2 consumption (O2C), taurocholate extraction, and lactate dehydrogenase (LDH) release during perfusion and liver adenine nucleotide content and energy charge at the end of perfusion were measured. Cell membrane integrity was determined by trypan blue infusion.Results. Ice formation was prevented in all livers stored at −4°C. Bile production, O2C, and taurocholate extraction were similar among three groups. Livers stored at −4°C contained significantly more adenine nucleotides than livers stored at +4°C but the energy charge was similar. LDH release was significantly greater (P < 0.05) in the AFP group vs UWB and UW (63 vs 28 and 21 mU/min/g liver, respectively). Hepatocyte and sinusoidal cell trypan blue uptake was similar in all three groups.Conclusions. Butanediol with or without AFP was effective in preventing ice formation up to 24 h in rat livers stored at −4°C. Although as effective as current +4°C protocols, subzero preservation for longer periods needs to be achieved prior to clinical application.

Evaluation of gonadotrophin insufficiency in thalassemic boys with pubertal failure: spontaneous versus provocative test.

The objective of this study was to determine whether iron toxicity in blood transfusion dependent beta-thalassemic patients with pubertal failure was associated with gonadotrophin (GTH) insufficiency as assessed by spontaneous and dynamic tests. Gonadotrophin-releasing-hormone (GnRH)-GTH secretory dynamics were studied by serial ultradian GTH profiles and a 100 microg i.v. GnRH bolus test (GBT) in 28 male beta-thalassemia major patients with failed puberty (FP group). Five healthy, non thalassemic prepubertal males were studied for comparative purposes. According to the pulse profile, patients in the FP group were subdivided into apulsatile (no FSH and LH pulses, n = 16; AFP group) and pulsatile (defective pulse profile, n = 12; PFP group) subsets. The FP group had lower basal FSH (p < 0.01), LH (p < 0.01) and GnRH stimulated FSH (p < 0.001) and LH levels (p < 0.001) than the controls. However, basal and GnRH-stimulated FSH (p < 0.01 for basal and p < 0.001 for peak) and LH (p < 0.01 for both basal and peak) levels were lower in the AFP than the PFP group. Serum ferritin levels in GnRH-non-responders were higher than those in the responders (9,052.63 +/- 579.14 mg/l vs 5,933.33 +/- 1,819.65 mg/l; p < 0.05). Similarly, symptomatic organ damage was higher in the AFP than the PFP patients (81% vs 42%; p < 0.001). In conclusion, this study suggests that iron overloaded thalassemic patients with failed puberty had abnormal GnRH-GTH secretory dynamics. The severity of the defect was heterogeneous, ranging from very severe (apulsatile) to less severe (pulsatile) subsets. Comparison between spontaneous and dynamic test levels showed that there was concordance between the degree of pulse defect and magnitude of LH response to GBT. However, ultradian GTH profile was a more reliable method for identifying the degree of GTH insufficiency than GBT. Our data also showed that iron toxicity was the major cause of GnRH-GTH deficiency in thalassemic patients. Such information may be useful for better understanding of the pathophysiology of hypogonadotrophic hypogonadism (HH), thereby promoting therapeutic options for induction of puberty and spermatogenesis.

High Frequency of c-Met Expression in Gastric Cancers Producing Alpha- Fetoprotein

Gastric cancers producing α-fetoprotein (AFP) have a poor prognosis and a high incidence of liver metastasis. Hepatocyte growth factor (HGF) and its receptor, c-Met, are known to induce mitosis and cell movement and to promote tumor progression. In the present study, c-Met and HGF expression in AFP-producing gastric cancer was compared with those gastric cancers that do not produce AFP. Twenty-six patients with AFP-producing gastric cancers [AFP(+)] and 26 patients stage-matched gastric cancers without AFP production [AFP(–)] were evaluated for c-Met and HGF expression and proliferating cell nuclear antigen-labelling index using immunohistochemical analysis. A higher frequency of c-Met expression was observed in the AFP(+) group than in the AFP(–) group (p < 0.01). A higher expression of c-Met might be one explanation for the poorer prognosis of AFP-producing gastric cancers.