Clinical Significance of the Initial and Best Responses after Chemoembolization in the Treatment of Intermediate-Stage Hepatocellular Carcinoma with Preserved Liver Function

PurposeTo evaluate the clinical implications of initial and best responses during repeated transarterial chemoembolization procedures for hepatocellular carcinoma (HCC).Materials and MethodsThis study included 726 patients who received a diagnosis of intermediate-stage HCC with Child-Pugh class A liver function between 2007 and 2016, and who were treated with transarterial chemoembolization as the first-line treatment. Evaluation of treatment response was based on the modified response evaluation criteria in solid tumors. Overall survival (OS) was compared between response categories after implementation of landmark analysis.ResultsOf the 726 patients, an objective response (complete response [CR] or partial response [PR]) was observed as the initial response in 78.1% of patients. Regarding the best response during the transarterial chemoembolization series, 87.2% of patients were overall responders. The median OS of initial responders (n = 483) was not significantly different from that of subsequent responders at the 1-year landmark (stable disease [SD] after first transarterial chemoembolization but CR or PR after repeated transarterial chemoembolization; n = 61; 46.2 vs 40.1 months, respectively; P = .145). Likewise, the median OS of initial CR patients (n = 326) was not significantly different from that of the subsequent CR group (n = 126) at the 1-year landmark (PR or SD after first transarterial chemoembolization but CR after repeated transarterial chemoembolization; 53.4 vs 46.3 months, respectively; P = .455). Multivariate Cox analyses showed that the objective responses, the initial responses (hazard ratio [HR], 0.638; P = .001), and the best responses (HR, 0.304; P < .001) had the significant prognostic significance for OS.ConclusionsBoth the initial and best responses during repeated transarterial chemoembolization were significantly associated with OS in patients with intermediate-stage HCC and preserved liver function.     

Geographical Origin and Level Identification of Frankincense Based on Hyperspectral Image

Background: As the demand for traditional Chinese medicinal materials increases in China and even the world, there is an urgent need for an effective and simple identification technology to identify the origin and quality of the latter and ensure the safety of clinical medication. Mineral element analysis and isotope finger-printing are the two commonly used techniques in traditional origin identification. Both of these techniques require the use of stoichiometric methods in the identification process. Although they have high accuracy and sensitivity, they are expensive and inefficient. In addition, near-infrared spectroscopy is a fast, nondestructive, and widely used identification technique developed in recent years, but its identification results are susceptible to samples’ states and environmental conditions, and its sensitivity is low. Hyperspectral imaging combines the advantages of imaging technology and optical technology, which can simultaneously access the image information and spectral information which reflect the external characteristics, internal physical structure, and chemical composition of the samples. Hyperspectral imaging is widely applied to agricultural product inspection, but research into its application in origin and quality identification of TCM materials is rare. Methods: In this study, the algorithm framework discriminative marginalized least squares regression (DMLSR) was used for feature extraction of frankincense hyperspectral data. The DMLSR with intraclass compactness graph and manifold regularization can efficiently learn the projective samples with higher separability and less redundant information than the original samples. Then, the discriminative collaborative representation with Tikhonov regularization (DCRT) was applied for classifying the geographical origin and level of frankincense. DCRT introducesthe discriminant regularization term and incorporates SID, which is more sensitive to the spectrum as the measurement method and is more suitable for the frankincense spectral data compared with SVM. Results: For the origin classification task, samples of all levels from each origin were, respectively, selected for three?way classification. We used 10-fold cross-validation to select a model parameter in the experiment. When obtaining the optimal parameters, we randomly selected the training set and testing set, where the training set accounts for 70% and the training set for 30%. After repeating this random process 10 times, we obtained the final average classification accuracy, which is higher than 90%, and the standard deviation fluctuation is usually small. For the level classification task, samples of each level from three origins were separately selected for multiclassification. We randomly selected the training set and testing set from each origin. The level classification results of the three origins are good on D4350 data, and the classification accuracy of each level is basically above 80%. Conclusion: Experiments and analysis show that our algorithm framework has excellent classification performance, which is stable in origin classification and has potential for generalization. In addition, the experiments show that in our algorithm framework, different classification tasks need to combine different data sources to achieve better classification and recognition, as the origin classification task uses frankincense’s D3000 data, and level classification task uses frankincense’s D4350 data.     

Comparative Analysis of Safety and Efficacy of Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma in Patients with and without Pre-Existing Transjugular Intrahepatic Portosystemic Shunts

PurposeTo compare the safety and efficacy of transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without transjugular intrahepatic portosystemic shunts (TIPS).Materials and MethodsThis single-institution study included a retrospective review of 50 patients who underwent transarterial chemoembolization for HCC between January 2010 and April 2017. Twenty-five patients had preexisting TIPS, and 25 patients were selected to control for age, sex, and target tumor size. Baseline median Model for End-Stage Liver Disease (MELD; 13 TIPS, 9 control; P < .001) and albumin-bilirubin (ALBI; 3 TIPS, 2 control; P < .001) differed between groups. Safety was assessed on the basis of Common Terminology Criteria for Adverse Events (CTCAE) and change in MELD and ALBI grade assessed between 3 and 6 months. Efficacy was assessed by tumor response and time to progression (TTP).ResultsThere was 1 severe adverse event (CTCAE grade >2) in the TIPS group. There was no difference in the change in MELD or ALBI grade. Although there was no difference in tumor response (P = .19), more patients achieved a complete response in the control group (19/25, 76%) than in the TIPS group (13/25, 52%). There was no difference in TTP (P = .82). At 1 year, 2 patients in the control group and 3 patients in the TIPS group received a liver transplant. Seven patients died in the TIPS group.ConclusionsTransarterial chemoembolization is as safe and effective in patients with TIPS as in patients without TIPS, despite worse baseline liver function. Severe adverse events are rare and may be transient.     

香连胃漂浮片的制备及体外释放研究

目的制备香连胃漂浮片并考察其体外释放性能。方法以羟丙基甲基纤维素K4M(hydroxypropyl methylcellulose K4M,HPMC-K4M)、十六醇、碳酸氢钠(NaHCO3)、乳糖、聚维酮K30(povidone K30,PVP-K30)、硬脂酸镁为辅料,采用粉末压片法制备香连胃漂浮片;以盐酸小檗碱的累积释放度为指标考察制剂的体外释药性能;采用正交试验对HPMC-K4M、十六醇、NaHCO3用量进行优选。通过数据拟合方程探讨制剂中盐酸小檗碱、木香烃内酯的释药机制。结果最优处方为香连复方提取物60.0 g、HPMC-K4M30.0 g、十六醇8.0 g、NaHCO38.0 g、乳糖8.0 g、PVP-K304.8 g、硬脂酸镁1.2 g(200片量)。指标成分盐酸小檗碱和木香烃内酯的体外释药特性均符合Riger Peppas模型,为扩散与骨架溶蚀协同作用。结论成功制得香连胃漂浮片,漂浮滞后时间短,持续漂浮时间长,且具有缓释特性。     

厚朴超临界CO_2提取工艺优化及提取物抗氧化活性研究

目的优选超临界CO_2提取厚朴有效成分的工艺并探讨厚朴超临界CO_2提取物的抗氧化活性。方法采用HPLC法测定厚朴超临界CO_2提取物中厚朴酚与和厚朴酚的含量,正交试验优选厚朴超临界CO_2提取工艺,MTT法检测提取物抗氧化活性。结果厚朴酚优化工艺为萃取压力25 MPa,萃取温度55℃,CO_2用量30 kg;和厚朴酚最佳提取工艺压力15 MPa、萃取温度50℃、CO_2用量25 kg。厚朴超临界CO_2提取物具有抗氧化活性,且分离参数不同,抗氧化活性有显著差异。结论在所优选的提取工艺条件下,厚朴酚、和厚朴酚的提取效率较高,重复性较好,工艺稳定可行,提取物具有良好的抗氧化活性。     

真菌性、细菌性和病毒性肺炎的若干凝血指标变化分析

探讨真菌性、细菌性和病毒性肺炎的若干凝血指标差异性研究。方法 回顾性分析2017 年7 月～2019 年11 月本院肺炎患者128 例与同期门诊健康体检者50 例，分析患者血浆纤维蛋白原（FIB）、凝血酶原时间（PT）和活化部分凝血酶时间（APTT）的水平。结果 三类肺炎组与对照组在FIB、PT 和APTT 水平比较，差异均有统计学意义（P＜0.01）；FIB、PT 水平与病原感染呈正相关，APTT 与病原感染呈负相关。结论FIB、PT、APTT 可以间接提示肺炎感染病原体类型，具有临床意义。     

正交试验优选猫爪草纳米乳喷雾剂的提取工艺

目的:正交试验优选猫爪草纳米乳喷雾剂的最佳提取工艺。方法:以总黄酮提取量和浸膏得率的综合评分为评价指标,在单因素试验基础上,采用L9(34)正交试验考察猫爪草醇提工艺的溶剂体积、乙醇浓度、提取时间及提取温度对提取工艺的影响。结果:最佳提取工艺为以75%乙醇为提取溶剂,提取温度60℃,第1次8倍量1.5 h,第2次7倍量1 h,共提取2次。结论:在单因素试验基础上,通过正交试验优选的提取工艺经验证稳定、简便易行、预测性好,为猫爪草纳米乳喷雾剂的进一步研发奠定了基础。     

正交试验优选益母阿胶膏的最佳工艺研究

目的优选益母阿胶膏生产的最佳提取工艺。方法以出膏率为指标,采用正交试验考察A加水量(倍)、B提取时间(h)、C提取次数(次)三个因素的影响,确定益母阿胶膏的最佳提取工艺。结果提取因素按影响大小依次是C提取次数>B提取时间>A加水量,最佳提取条件为:加12倍量水,提取1.5 h,提取2次。结论该制备工艺合理可行,可作为益母阿胶膏的最佳提取工艺。     

Fetal and Neonatal Imaging and Strategy of Primary Neonatal Heart Transplantation in Hypoplastic Left Heart with Ebstein's Anomaly

We present the anatomic constellation of mitral stenosis/aortic atresia variant of hypoplastic left heart syndrome, Ebstein's anomaly, and partial anomalous pulmonary venous return, an exceeding rare congenital heart defect. Prenatal echocardiography led to concern about the capacity of the right ventricle to increase cardiac output with lung expansion and pulmonary arterial runoff at birth, prompting the precaution of extracorporeal membrane oxygenator standby at delivery. Stage I palliation was not attempted, and control of pulmonary arterial blood flow was achieved with pulmonary artery banding, allowing sufficient ongoing hemodynamic stability. Orthotopic cardiac transplantation, repair of hypoplastic aortic arch, and primary sutureless repair of left pulmonary veins was performed, using dual‐site arterial cannulation and continuous mild hypothermic cardiopulmonary bypass. We discuss how this unique echocardiographic anatomy influenced the surgical decision and point out how it guided therapy toward a strategy of primary transplantation rather than standard staged surgical palliation.