Parametric response mapping cut-off values that predict survival of hepatocellular carcinoma patients after TACE

Purpose

Parametric response mapping (PRM) is a novel image-analysis technique applicable to assess tumor viability and predict intrahepatic recurrence of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). However, to date, the prognostic value of PRM for prediction of overall survival in HCC patients undergoing TACE is unclear. The objective of this explorative, single-center study was to identify cut-off values for voxel-specific PRM parameters that predict the post TACE overall survival in HCC patients.

Methods

PRM was applied to biphasic CT data obtained at baseline and following 3 TACE treatments of 20 patients with HCC tumors ≥ 2 cm. The individual portal venous phases were registered to the arterial phases followed by segmentation of the largest lesion, i.e., the region of interest (ROI). Segmented voxels with their respective arterial and portal venous phase density values were displayed as a scatter plot. Voxel-specific PRM parameters were calculated and compared to patients’ survival at 1, 2, and 3 years post treatment to identify the maximal predictive parameters.

Results

The hypervascularized tissue portion of the ROI was found to represent an independent predictor of the post TACE overall survival. For this parameter, cut-off values of 3650, 2057, and 2057 voxels, respectively, were determined to be optimal to predict overall survival at 1, 2, and 3 years after TACE. Using these cut points, patients were correctly classified as having died with a sensitivity of 80, 92, and 86% and as still being alive with a specificity of 60, 75, and 83%, respectively. The prognostic accuracy measured by area under the curve (AUC) values ranged from 0.73 to 0.87.

Conclusion

PRM may have prognostic value to predict post TACE overall survival in HCC patients.

     

Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for hepatocellular carcinoma with macrovascular invasion or extrahepatic metastases

ObjectiveTo evaluate the safety and efficacy of percutaneous microwave ablation (MWA) combined with simultaneous transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) or extrahepatic metastases (EHM).MethodsBetween August 2012 and April 2017, 101 patients with MVI/EHM of HCC underwent percutaneous MWA combined with simultaneous TACE at our center. The clinical data were collected and analyzed for survival and prognostic factors.ResultsThe mean follow-up time was 23.6 ± 14.7 months. One patient had grade 3 complications, and the median overall survival was 12.0 months (95% confidence interval 9.7–14.3). Multivariate analysis showed that Child-Pugh class, serum alpha-fetoprotein level, and Eastern Cooperative Oncology Group performance status were independent factors of survival.ConclusionOur results suggest that percutaneous MWA combined with simultaneous TACE is a safe and effective treatment for HCC with MVI/EHM.     

Analysis of factors affecting the prognosis of transcatheter arterial chemoembolization for hepatitis B-related hepatocellular carcinoma

ObjectivesThe purpose of this study was to investigate the prognostic factors for transcatheter arterial chemoembolization (TACE) for hepatitis B-related hepatocellular carcinoma (HCC).Materials and methodsThe variables that may affect overall survival (OS), such as age, gender, AFP, Child Pugh classification, body mass index, HBV-DNA, HbeAg, tumor number, tumor diameter, BCLC stage, embolization method, ablation therapy, and targeted therapy, were analyzed by single factor and many factor COX regression. In addition, predictive factors of OS were stratified and a Kaplan-Meier survival curve was drawn.ResultsAmong the 136 patients, the median follow-up time was 14.5 months (range: 2–72 months). HCC patients with the tumor diameter <3 ​cm had the highest survival rate, followed by patients with a tumor diameter of 3–5 ​cm; the survival rate of patients with the tumor diameter (greater than 5 ​cm) was the lowest. Among the BCLC stages, stage A patients had the highest survival rate, followed by stage B and stage C patients, which had the lowest survival rate.The survival rate of Child Pugh grade A patients was higher than those with Child Pugh grade B. Compared with patients who did not undergo ablation treatment, the survival rate of patients with combined ablation treatment was relatively high. The survival rate of patients receiving drug-eluting beads transarterial chemoembolization (DEB-TACE) treatment was higher than those receiving conventional transarterial chemoembolization (cTACE) treatment. Additionally, repeated TACE treatment improved the OS rate of patients. These six factors were related to patient prognosis and the differences were statistically significant (P ​< ​0.05).ConclusionsTumor diameter, BCLC stage, TACE repetition, and TACE combined with ablation were independent prognostic factors of OS.     

Changes in peripheral blood T-cell balance after percutaneous tumor ablation

Purpose: To evaluate the changes in T-cell balance in peripheral blood following percutaneous tumor ablation.

Material and methods: Patients underwent thermal ablation including radiofrequency (n?=?9) and microwave ablation (n?=?5), or cryoablation (n?=?5). Target tumors were located in the lung (n?=?7), soft tissue (n?=?5), liver (n?=?4), and bone (n?=?3). Patient peripheral blood samples were collected before and within 14?days after ablation. Peripheral blood populations of cytotoxic T-cells (CTL), type-1 (T_h1) and type-2 helper T-cells (T_h2), and regulatory T-cells (T_reg) were measured using flow cytometry. Changes in CTL/T_reg and T_h1/T_h2 ratios before and after ablation therapy were compared using paired t-tests.

Results: Peripheral blood CTL population (27.5?±?2.1% to 30.2?±?2.5%, p?reg ratios (18.8?±?3.7% to 21.6?±?3.6%, p?reg ratios was found after heat-based ablation (18.0?±?4.4% to 21.6?±?4.7%, p?p?=?.92). T_h1/T_h2 ratio (13.7?±?3.0% to 17.2?±?3.5%, p?=?.12) remained unchanged after ablation.

Conclusion: Ablation therapy alters the T-cell balance by increasing the systemic CTL/T_reg, ratio. Heat-based ablation might be a more effective approach than cryoablation to enhance systemic anti-tumor immunity.     

Evaluation of posttreatment response of hepatocellular carcinoma: comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT

We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A better rate of complete response was found in group 1 compared to group 2 (92.7% vs. 78.3%). In RFA treatment, CEUS showed a sensitivity of 83.3% and a specificity of 100% (diagnostic accuracy of 97%) using MDCT as reference standard with no statistical difference (p > 0.05). CEUS detected all cases of incomplete response in HCC treated with TACE using angiography as reference standard (diagnostic accuracy 100%). We recommend assessing residual intratumoral flow on CEUS during RFA procedure to determine the necessity of immediate additional treatment. In case of positive CEUS results, HCC treated with TACE should be considered still viable.     

Assessment potential of a new suture simulator in laparoscopic surgical skills training

Background: The skills necessary for performing effective laparoscopic suturing are difficult to acquire; as a result, simulators for learning these skills are rapidly becoming integrated into surgical training. The aim of the study was to verify whether a new hybrid simulator has the potential to measure skill improvement in young, less experienced gastroenterological surgeons.

Material and methods: The study included 12 surgeons (median age, 29 (27–38)] years; 11 men (91.7%), one woman (8.3%)) who participated in a two-day laparoscopic training seminar. We used the new simulator before and after the program to evaluate individual performance. Skills were evaluated using five criteria: volume of air pressure leakage, number of full-thickness sutures, suture tension, wound area, and performance time.

Results: Air pressure leakage was significantly higher after than before the training (p?=?.027). The number of full-thickness sutures was significantly higher post-training (p?p?=?.011). Wound opening areas were significantly smaller post-training (p?=?.018). Performance time was significantly shorter post-training (p?=?.032).

Conclusions: Our study demonstrated the assessment quality of this new laparoscopic suture simulator.     

Five-year observation of the relationship between body mass index and glycated hemoglobin in children with Type 1 diabetes mellitus

Abstract

Background: Poor metabolic control is a well-recognized risk factor for cardiovascular disease. However, the relationship between such factor as body weight and metabolic control in children with diabetes mellitus type 1 (DM1) is unclear. The aim of this study was to examine the relationships between body weight, age, metabolic control, sex, and form of insulin therapy in children with DM1.

Methods: This was a retrospective study of children with DM1 treated at one diabetes center for a minimum of 5?years since diagnosis.

Results: Median body mass index standard deviation score (BMI-SDS) increased annually (p?=?.0042) on average 0.08?±?0.27 per year throughout the observation. As well HbA1c and daily dose insulin increased annually (p?p?p?=?.01895). No correlation between BMI-SDS and metabolic control (HbA1c) was found (R?=?0.09, p?=?.60).

Conclusions: Body weight appears to be more affected by non-diabetic factors (e.g. irregular eating and sedentary lifestyle) than by the clinical course of diabetes. Metabolic control and body weight must be maintained in all children with DM1 (males and females) to reduce their future risk of cardiovascular disease.     

Effect of early and focused benzodiazepine therapy on length of stay in severe alcohol withdrawal syndrome

Objective: Current evidence supports symptom-triggered therapy for alcohol withdrawal syndrome (AWS). Early, escalating therapy with benzodiazepines (BZD) appears to decrease ICU length of stay (LOS); however, the effect on hospital LOS remains unknown. The hypothesis of this study is that focused BZD treatment in the first 24?h will decrease hospital LOS.

Design: Pre–post cohort study.

Setting: Academic medical center.

Patients: This study included patients with severe AWS. The pre-intervention cohort (PRE) was admitted between January and November 2015. The post-intervention cohort (POST) was admitted between April 2016 and March 2017. Severe AWS was defined as patients requiring diazepam doses of >30?mg. Focused treatment was defined as >50% of total diazepam usage within the first 24?h of recognition of AWS.

Intervention: In the PRE group, patients received symptom-triggered, escalating doses of diazepam and phenobarbital based on their Richmond Agitation-Sedation Scale (RASS). In the POST group, patients received a revised, time-limited course of therapy: escalating doses of BZD and phenobarbital were given during a 24-h loading phase, and all therapy was discontinued after a 72-h tapering phase. The SHOT scale was used as an adjunct to RASS to assess non-agitation symptoms of AWS and guide additional diazepam doses.

Measurements and main results: The primary outcome was hospital LOS; secondary outcomes included ICU LOS, BZD use, and ventilator-free days. Five hundred thirty-two patients were treated using the AWS protocol; 113 experienced severe AWS. The PRE (n?=?75) and POST (n?=?38) groups were evenly matched in age, sex, history of AWS, and severity of illness. There was a substantial difference in POST patients who received focused treatment (51.3% vs. 73.7%, p?=?.03). The POST group had a significant decrease in hospital LOS (14.0 vs. 9.8 days, p?=?.03) and ICU LOS (7.4 vs. 4.4 days, p?=?.03).

Conclusion: Early, focused management of severe AWS was associated with a decrease in ICU and hospital LOS.     

Circulating miR-26a,miR-106b,miR-107 and miR-133b stratify hepatocellular carcinoma patients according to their response to transarterial chemoembolization

BackgroundA number of hepatocellular carcinoma (HCC) patients have developed resistance against transcatheter arterial chemoembolization (TACE) treatment. In this study, we aimed to develop a panel of microRNAs (miRs) biomarkers to predict clinical outcomes in HCC patients after TACE treatment.MethodsThe expression level of twenty miRs was evaluated in FFPE tissues collected from 33 HCC patients. We selected four differentially expressed miRs in TACE-responders versus non-responders and re-assessed their expression in 51 serum samples. The expressions of miRs associated with overall survival (OS), progression-free survival (PFS), and treatment outcomes were investigated. The diagnostic accuracy of these miRs in predicting patients' response to TACE was also evaluated.ResultsThe baseline of miR-106b, miR-107 and miR-133b was significantly elevated (p < .001) in sera of TACE-responders while miR-26a was elevated (p < .001) in non-responders. miR-26a and miR-133b recorded the highest diagnostic performance as individual classifiers in response to TACE (AUC = 1.0 and 100% sensitivity and specificity). Intriguingly, miR-133b distinguished complete responders from partial responders and non-responders (AUC ≥ 0.90). The PFS was improved (p < .05) in the high expression group of miR-31, miR-200b, miR-133b and miR-181a over their low expression group.ConclusionCirculating miR-133b, miR-26a, miR-107 and miR-106 in serum are potential candidates to be utilized as prognostic biomarkers for predication of TACE treatment outcomes in HCC patients.     

Apatinib Combined With Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma and Portal Vein Tumor Thrombus: A Multicenter Retrospective Study

PurposeStudies focusing on the effects of combined transcatheter arterial chemoembolization (TACE) + the tyrosine kinase inhibitor apatinib in the treatment of patients with hepatocellular carcinoma (HCC), with the location and extent of portal vein tumor thrombus (PVTT) assessed as the main variable, are rare. This multicenter, retrospective, controlled study was performed to compare the efficacy and tolerability of TACE + apatinib and TACE alone in patients with HCC and PVTT.MethodsWe retrospectively analyzed data from patients with nonresectable HCC and PVTT who underwent treatment with TACE + apatinib or TACE alone between January 2015 and January 2016. Outcomes in patients who underwent TACE + apatinib were compared with the outcomes of patients who underwent TACE alone, by using the Kaplan–Meier method, according to PVTT type: PVTT in the main portal vein (type A), PVTT in the first-order portal vein branch (type B), and PVTT in second- or lower-order portal vein branches (type C).FindingsOne hundred eighty-eight patients were included in the analysis; 85 underwent treatment with TACE + apatinib and 103 underwent treatment with TACE. TACE + apatinib was associated with a significantly greater median survival compared with TACE alone in patients with PVTT type B (12.2 vs 7.5 months; P < 0.001) or type C (13.7 vs 7.2 months; P = 0.006). Along with treatment strategies and α-fetoprotein, the absence of main PVTT was an independent factor predictive of survival on uni- and multivariate analysis. Apatinib-related grade 3 adverse events occurred in 27 patients (31.8%).ImplicationsTACE + apatinib can be of potential benefit to patients with advanced HCC with tumor thrombus in the first- and lower-order portal vein branches. Adverse events with apatinib need to be monitored during application, despite the manageable appearance.     

Evaluation of the Efficacy of Sorafenib on Overall Survival in Patients with Hepatocellular Carcinoma using FT Rate: A Devised Index

Introduction

Transcatheter arterial chemoembolization (TACE) is the first-line treatment for intermediate stage hepatocellular carcinoma (HCC) and prolongs survival in HCC patients. However, repeated TACE results in diminished therapeutic response. In addition, the superiority of sorafenib to TACE monotherapy or combined therapy in patients with HCC is still controversial. The prognosis of HCC has many variables and, thus, the effect of a specific treatment is difficult to evaluate. The frequency of treatments per year (FT rate) used in this study was obtained by dividing the total number of radiofrequency ablations and TACE or transcatheter arterial infusion treatments by the years of survival. The aim of this study was to evaluate the overall survival (OS) of TACE versus sorafenib using the FT rate.

Methods

We compared the OS of patients with recurrence of HCC receiving repeated TACE monotherapy (CON) with those receiving therapy switched from TACE to sorafenib (SOR). In addition, a one-to-one FT rate matching cohort consisting of matched SOR (mSOR) and matched CON (mCON) was determined using the propensity score matching method, and OS in the cohort was evaluated. Factors influencing survival were evaluated using Cox proportional hazard regression analysis in all patients and the FT rate matched cohort.

Results

In the FT rate matched cohort, the cumulative survival rate was significantly higher in the mSOR group compared with the mCON group. Multivariate regression analysis of the FT rate matched cohort showed the FT rate and sorafenib to be significant variables for survival with a hazard ratio (HR) of 2.86 (p < 0.001) and 0.42 (p = 0.008), respectively.

Conclusion

Early switching from TACE to sorafenib therapy may prolong OS in HCC patients unresponsive to TACE. The present study indicates that the FT rate is potentially a useful index in evaluating the outcome for patients at various stages and treatment regimens.

Funding

Bayer Yakuhin, Ltd.

     

Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD

Abstract

Background: Duodenal ESD is considered especially difficult with perforation and bleeding. This study assessed safer duodenal ESD procedures, especially with regard to obtaining a good operation view using a ring-thread method and closure of a post-ESD artificial ulcer.

Methods: From 2013 to 2015, 17 patients who were diagnosed with duodenal adenoma or early duodenal cancer >20?mm in diameter underwent conventional ESD (C group). From 2016 to 2017, 12 patients underwent ring-shaped thread counter traction ESD with hemoclips and/or Over-The-Scope Clip (OTSC) (Ovesco Endoscopy GmbH, Tuebingen, Germany) closure of post ESD artificial ulcer (ring group). An observational study between the C group and Ring group was conducted. The primary outcome was perforation events during ESD (UMIN000026184).

Results: There was a significant difference in perforation during ESD with five cases vs. 0 case in C and ring groups (p?=?.038). For bleeding that needed to be coagulated by forceps during ESD, there was a significant difference with four cases in the C group (p?=?.07). The total procedure time was 96.6?±?28.2 and 72.8?±?24.2 (min) with a significant difference (p?=?.027).

Conclusions: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.     

Clinical outcomes from early use of digoxin-specific antibodies versus observation in chronic digoxin poisoning (ATOM-4)

Introduction: In our previous study on chronic digoxin poisoning, there was a minor improvement after treatment with digoxin-specific antibody (digoxin-Fab). We hypothesised patients with elevated digoxin concentrations may derive little benefit from digoxin-Fab because their presenting complaint was more closely related to their multiple co-morbidities. We aimed to compare the outcome of patients who were initially treated with digoxin-Fab with those that received supportive care.

Method: Patients were prospectively recruited to the study if they had an elevated digoxin concentration, signs or symptoms of toxicity thought to be from digoxin. Patients who were initially managed with digoxin-Fab were compared with those not initially receiving digoxin-Fab (observation group). Patients presented with ventricular arrhythmias before initial assessment were excluded from the analysis. Primary outcome was mortality. Secondary outcomes were length of stay (LOS), change in heart rate (HR) and potassium concentration.

Results: From September 2013 to January 2018, 128 patients were recruited of which 78 (61%) received initial digoxin-Fab. Digoxin-Fab and supportive care groups had an initial median heart rate of 46 (range: 20–120) vs 52 bpm (range: 29–91) (p?=?.06), systolic blood pressure of 110?mmHg (range: 65–180) vs 125?mmHg (range: 90–184) (p?=?.009), respectively. Digoxin concentrations 4.4?nmol/L (range: 3.3–9) vs 4.2 (range: 2–11.2) (p?=?.42) and potassium concentrations 5.4?mmol/L (range: 3–11) vs 5.1?mmol/L (range: 3.5–8.2) (p?=?.33) were similar. Median dose of digoxin-Fab used was 1.5 vials (IQR: 1–2). There were 9 (12%) deaths in the Fab group compared to 7 (14%) in those treated with supportive care (risk difference ?2.5%; 95% CI: ?14 to 9%; p?=?.68). The median LOS was six days in both groups. Mean changes in potassium concentration [?0.5?±?0.1 vs. ?0.4?±?0.1?mmol/L; difference ?0.1 (95% CI: ?.02, 0.4), p?=?.70] and HR within 4?h [8?±?1 vs. 7?±?3 bpm; difference ?1.0 (95% CI: ?6.7, 4.8), p?=?0.74] were similar in the two groups.

Conclusions: This study did not appear to show any benefit from the routine use of digoxin-Fab in patients thought to have chronic digoxin poisoning. These patients have multiple co-morbidities that may be contributing to their clinical features, other treatments are often equally effective.     

Transcatheter arterial chemoembolization combined with simultaneous cone beam computed tomography-guided multipolar microwave ablation for massive hepatocellular carcinoma (≥10 cm): Safety and primary clinical results

PurposeTo explore the safety and clinical efficacy of transcatheter arterial chemoembolization (TACE)combined with simultaneous cone beam computed tomography (CBCT)-guided multipolar microwave ablation (MWA)in the treatment of massive hepatocellular carcinoma (HCC).Materials and methodsRecords of nine patients who underwent TACE combined with simultaneous CBCT-guided multipolar MWA for massive HCC, between January and June 2015, were retrospectively reviewed. Technical success rate, blood levels of liver function indicators, complications, and tumor response one month after treatmentwere investigated.ResultsThe technical success rate of TACE combined with simultaneous MWA was 100%. The mean procedure time was 195.0 min (range, 125–350 min), the mean hospital stay after the treatment was 4.0 ± 1.0 days (range, 3–7 days), and no serious complications occurred. Minor complications were experienced by some patients but were relieved after conservative treatment. One month after treatment, enhanced CT revealed a complete response rate of 66.7% (6/9), a partial response rate of 22.2% (2/9), and a stable disease rate of 11.1% (1/9). Mild and reversible injury of liver function occurred in these patients.ConclusionTACE combined with simultaneous CBCT-guided MWA for massive HCC was feasible and safe, and yielded a high response rate.     

Influence of videogames and musical instruments on performances at a simulator for robotic surgery

Objective: To assess if exposure to videogames, musical instrument playing, or both influence the psychomotor skills level, assessed by a virtual reality simulator for robot-assisted surgery (RAS).

Materials and methods: A cohort of 57 medical students were recruited: playing musical instruments (group 1), videogames (group 2), both (group 3), and no activity (group 4); all students executed four exercises on a virtual simulator for RAS.

Results: Subjects from group 3 achieved the best performances on overall score: 527.09?±?130.54 vs. 493.73?±?108.88 (group 2), 472.72?±?85.31 (group 1), and 403.13?±?99.83 (group 4). Statistically significant differences (p?p?=?.009) and for time of completion (p?=?.044). As regards experience with the piano, subjects from group 3 outperformed those from group 1 on overall score (496.98?±?122.71 vs. 470.25?±?92.31), but without statistically significant difference (p?=?.646).

Conclusions: The present study suggests that the level of psychomotor skills in subjects exposed to both musical instrument playing and videogames is higher than that in those practicing either one alone. The effect of videogames appears negligible in individuals playing the piano.     

Clinical outcomes of hypogastric artery occlusion for endovascular aortic aneurysm repair

Purpose: To determine the midterm outcomes of internal iliac artery (IIA) coverage by a stent-graft in endovascular aortic aneurysm repair (EVAR) under specific anatomic and technical circumstances.

Material and methods: From January 2003 until January 2014, 57 patients with aortoiliac aneurysms, including 20 with 24 IIA aneurysms (IIAAs), underwent EVAR with IIA coverage. IIAA diameter change or IIA thrombosis, buttock claudication, type II endoleak, and secondary interventions related to the IIA were studied.

Results: Twenty-five of the 37 patients without IIAA were embolized prior to stent-graft placement, all unilateral, and in 12, the IAA orifice was only overstented. Buttock claudication occurred in only nine (20%) of the embolization patients (9/49 IIA’s) (p?=?.14), while one IIA-related type II endoleak, occurred in the nonembolization group (p?=?.16). In patients with IIAA(s), the aneurysm diameter decreased in 16 cases (67%). Buttock claudication occurred in 75% of bilateral, and in 14.6% of unilateral embolizations (p?=?.046).

Conclusions: Carefully selected patients with aortoiliac aneurysm without IIAA may safely undergo hypogastric artery overstenting without preemptive embolization during EVAR. IIA embolization is associated with buttock claudication and should be avoided if possible. Otherwise, at least one IIA should be preserved.     

Screening for celiac disease,by endomysial antibodies,in patients with unexplained hypertransaminasaemia

Objective: To do a serological screening for celiac disease in patients with unexplained liver cytolysis.

Materials and methods: Fifty-six patients with liver cytolysis without known aetiology were studied. Endomysial antibodies were determined by indirect immunofluorescence on human umbilical cord. Two thousand and five hundred blood donors served as control group. For statistical analysis, we used Chi-square or Fisher’s exact test.

Results: The frequency of IgA endomysial antibodies in our patients was significantly higher than in the control group (8.92% vs. 0.28%, p?p?p?=?.006). The frequency of positive EMA in female patients was higher than in male, but the difference was not statistically significant (12.12% vs. 4.43%; p?=?.6). Two patients were non-compliant with the gluten-free diet. One patient was out of touch. For the two other patients, transaminase levels reverted to normal level within six months of strict gluten withdrawal.

Conclusions: A screening for celiac disease should be included within the diagnosis protocol of liver cytolysis.     

Triglyceride glucose and haemoglobin glycation index for predicting outcomes in diabetes patients with new-onset,stable coronary artery disease: a nested case-control study

Abstract

Aim: Previous studies have shown that both triglyceride glucose (TyG) and haemoglobin glycation indexes (HGI) are predictors of cardiovascular risk. However, the prognostic value of TyG index and HGI in patients with type 2 diabetes mellitus (T2DM) and stable coronary artery disease (CAD) is not determined.

Methods: We conducted a nested case-control study among 1282 T2DM patients with stable CAD. Patients were followed up for 3846 person-years. A total of 160 patients with events (12.5%) were identified and matched individually on age, gender, previous use of lipid lowering agents and duration of follow-up with 640 controls.

Results: In Kaplan–Meier analysis, the upper tertiles of TyG index and HGI had a significant lower event-free survival (p?=?.002; p?=?.036, respectively). Of the note, both TyG index and HGI were associated with increased risk of MACCEs after adjusting for confounding risk factors [adjusted HR (95% CI): 1.693 (1.238–2.316); 1.215 (1.046–1.411), respectively]. Moreover, adding TyG index to the Cox model increased the C-statistic to 0.638 (95%CI: 0.595–0.683, p?=?.002) while the C-statistic was not statistically improved when HGI was included (p?=?.240).

Conclusions: Both TyG index and HGI could predict cardiovascular outcomes in T2DM patients with new-onset, stable CAD while TyG index might be better.

• Key messages

• Both TyG and HGI are predictors of cardiovascular risk.

• The prognostic value of TyG index and HGI in T2DM patients with stable coronary artery disease is not determined.

• Our study firstly indicates that TyG index might have better prognostic value than HGI in T2DM patients with new-onset, stable CAD.

     

TACE＋PEI治疗原发性肝癌的临床研究

目的探讨肝动脉化疗栓塞术（TACE）结合经皮肝穿刺无水酒精注射术（PEI）治疗原发性肝癌的临床疗效。方法将82例肝癌患者分为对照组和治疗组,对照组单纯行TACE治疗,治疗组给予TACE＋PEI治疗,比较两组的治疗效果。结果治疗组与对照组相比,AFP下降率为88．2％和42．5％,肿瘤体积缩小有效率为83．5％和45％。半年、1年、2年生存率分别为100％、78．04％、53．65％和73．17％、52．22％、24．39％,差异有统计学意义（P〈0．05）。结论肝动脉化疗栓塞术（TACE）结合经皮肝穿刺无水酒精注射术（PEI）治疗原发性肝癌的临床疗效明显优于单纯肝动脉化疗栓塞组。     

Longitudinal associations of sauna bathing with inflammation and oxidative stress: the KIHD prospective cohort study

Purpose: We sought to determine cross-sectional and longitudinal associations of frequency of sauna bathing with high sensitivity C-reactive protein (hsCRP), fibrinogen, leucocyte count and gamma-glutamyltransferase (GGT).

Design: Baseline sauna bathing habits were assessed in 2269 men aged 42–61 years. Concentrations of hsCRP, fibrinogen, leucocyte count, and GGT were determined at baseline and 11 years later. The associations of sauna bathing frequency with baseline and 11-year hsCRP, fibrinogen, leucocyte count, and GGT levels were examined using robust multivariate regression analyses.

Results: In baseline analysis, 4–7 sauna sessions/week (compared with 1 sauna session/week) was associated with ?0.84?mg/l (95% CI, ?1.55, ?0.14; p?=?.019) lower hsCRP; ?0.07?g/l (95% CI, ?0.15, 0.02; p?=?.112) lower fibrinogen; and ?0.28?×?10⁹/l (95% CI, ?0.51, ?0.06; p?=?.015) lower leucocyte count, after multivariable adjustment. In longitudinal analysis, the corresponding estimates were ?1.66?mg/l (95% CI, ?3.13, ?0.19; p?=?.027); ?0.16?g/l (95% CI, ?0.31, ?0.02; p?=?.031); and ?0.49?×?10⁹/l (95% CI, ?0.85, ?0.14; p?=?.007) respectively. Sauna bathing frequency was not associated with GGT at baseline and 11 years.

Conclusion: Observational evidence supports the hypothesis that reduction in inflammation may be one of the pathways linking frequent sauna bathing with decreased risk of acute and chronic disease conditions.

• KEY MESSAGES

• Cross-sectional evidence or short-term studies suggest Finnish sauna bathing may exert its beneficial health effects via reduction in inflammation and oxidative stress; however, the long-term effects of sauna bathing on these outcomes are uncertain.

• In this population-based prospective cohort study, frequent sauna sessions significantly decreased levels of inflammatory markers at baseline and 11-year follow-up; but had no effect on oxidative stress.

• The health benefits of sauna bathing may in part be mediated via reduced systemic inflammation.