Liver resection after downstaging with systemic chemotherapy in a case of a multicentric hepatocellular carcinoma with virus B cirrhosis

Hepatocellular carcinoma is often diagnosed in an advanced stage when curative therapeutical options are limited, especially with coexisted cirrhosis. Downstaging-resection plays a role in improving prognosis of unresectable hepatocarcinoma. We report the case of a 27 years old woman with multicentric hepatocellular carcinoma and virus B cirrhosis, portal vein thrombosis with systemic chemotherapy followed be hepatic resection--left hepatectomy and lymph node dissection for the remaining tumor. Postoperative outcome was uneventful, the patient being alive at 22 month after diagnosis, without recurrence. Combined modalities with systemic chemotherapy and surgical resection can achieve complete clinical remission and long-term control of disease in patients with unresectable hepatocarcinoma.     

Association between short sleeping hours and overweight in adolescents: results from a US Suburban High School survey

Insufficient sleep may lead to adverse health effects, influencing body weight. This study quantified the prevalence of short sleep and the association between sleep duration and overweight in a sample of suburban students. Cross-sectional study was conducted in 2004, involving 529 students from Bay High School, Bay Village, OH, USA, using self-administered questionnaires assessing lifestyle and sleep behaviors. Students with a body mass index Z Score >85th percentile for sex and age were deemed overweight. Ninety percent of students reported average sleep time less than 8 h on school nights, with 19% reported less than 6 h of sleep per night. Twenty percent of the sample were overweight. Overweight was significantly associated with the male gender, increased caffeine consumption, and short sleep duration. Compared with students sleeping >8 h, the age and gender-adjusted odds ratio of overweight was 8.53 (95% CI: 2.26, 32.14) for those with <5 h sleep (P = 0.0036); 2.79 (1.03, 7.55) for those with 5–6 h sleep; 2.81 (1.14, 6.91) for those with 6–7 h sleep; and 1.29 (0.52, 3.26) for those with 7–8 h sleep. Short sleep duration was common and associated with overweight with evidence of a “dose–response” relationship. These results confirm a high prevalence of short sleep among suburban high school students and provide additional support suggesting significant association between short sleeping hours and overweight. There are no financial disclosures from any of the authors.     

Contribution of the IL-17/IL-23 axis to the pathogenesis of inflammatory bowel disease

Inflammatory bowel diseases(IBDs) are chronic disorders of modern society, requiring management strategies aimed at prolonging an active life and establishing the exact etiology and pathogenesis.These idiopathic diseases have environmental, genetic,immunologic, inflammatory, and oxidative stress components. On the one hand, recent advances have shown that abnormal immune reactions against the microorganisms of the intestinal flora are responsible for the inflammation in genetically susceptible individuals. On the other hand, in addition to T helper cell-type(Th) 1 and Th2 immune responses,other subsets of T cells, namely regulatory T cells and Th17 maintained by IL-23 are likely to develop IBD. IL-23 acts on innate immune system members and also facilitates the expansion and maintenance of Th17 cells. The IL-17/IL-23 axis is relevant in IBD pathogenesis both in human and experimental studies. Novel biomarkers of IBD could be calprotectin,microRNAs, and serum proinflammatory cytokines.An efficient strategy for IBD therapy is represented by the combination of IL-17 A and IL-17 F in acute IL-17 A knockout TNBS-induced colitis, and also definite decrease of the inflammatory process in IL-17 F knockout, DSS-induced colitis have been observed.Studying the correlation between innate and adaptive immune systems, we hope to obtain a focused reviewin order to facilitate future approaches aimed at elucidating the immunological mechanisms that control gut inflammation.     

Pancreatic cancer and predictors of survival: comparing the CA 19-9/bilirubin ratio with the McGill Brisbane Symptom Score

Introduction

Few tools predict survival from pancreatic cancer (PAC). The McGill Brisbane Symptom Score (MBSS) based on symptoms at presentation (weight loss, pain, jaundice and smoking) was recently validated. The present study compares the ability of four strategies to predict 9-month survival: MBSS, carbohydrate antigen 19-9 (CA 19-9) alone, CA19-9-to-bilirubin ratio and a combination of MBSS and the CA19-9-to-bilirubin ratio.

Methodology

A retrospective review of 133 patients diagnosed with PAC between 2005 and 2011 was performed. Survival was determined from the Quebec civil registry. Blood CA 19-9 and bilirubin values were collected (n = 52) at the time of diagnosis. Receiver-operating characteristic (ROC) curves were used to determine a cutoff for optimal test characteristics of CA 19-9 and CA19-9-to-total bilirubin ratio in predicting survival at 9 months. Predictive characteristics were then calculated for the four strategies.

Results

Of the four strategies, the one with the greatest negative predictive value was the MBSS: negative predictive value (NPV) was 90.2% (76.9–97.3%) and the positive likelihood ratio (LR) was the greatest. The ability of CA 19-9 levels alone, at baseline, to predict survival was low. For the CA19-9-to-bilirubin ratio, the test characteristics improved but remained non-significant. The best performing strategy according to likelihood ratios was the combined MBSS and CA19-9 to the bilirubin ratio.

Conclusion

CA19-9 levels and the CA19-9-to-bilirubin ratio are poor predictors of survival for PAC, whereas the MBSS is a far better predictor, confirming its clinical value. By adding the CA19-9-to-bilirubin ratio to the MBSS the predictive characteristics improved.     

Identification of cervicothoracic intervertebral spaces by surface landmarks and ultrasound

Purpose

Precise localization of the cervicothoracic vertebral levels is essential for accurate placement of epidural catheters. Previous studies have demonstrated that anesthesiologists are inaccurate when using surface anatomy to locate lumbar vertebral levels. Our study was designed to determine the agreement between anatomical landmarks and the ultrasound technique in identifying the T7-8 and C7-T1 intervertebral spaces.

Methods

Adult healthy volunteers were assessed for the identification of cervicothoracic intervertebral spaces, initially in the anatomic position (AP)—upright, back straight, arms at the sides, and palms forward and then in the epidural position (EP) routinely used for epidural placement—seated, back arched, neck flexed, and arms across the chest. The T7 and C7 spinous processes were identified by one investigator using the inferior tip of the scapula and the vertebra prominens, respectively, as landmarks. Ultrasound was then used by a second investigator to identify the intervertebral spaces corresponding to the previously marked levels.

Results

Fifty-five volunteers (23 males, 32 females) were recruited. The T7-8 intervertebral space determined by ultrasound coincided with the landmark findings in the AP and in the EP in 18% and 36% of the cases, respectively. The C7-T1 interspace identified by ultrasound corresponded with the surface landmarks in the AP and in the EP in 53% and 58% of the cases, respectively. In most cases, when the surface landmark and ultrasound findings of T7-8 did not agree, the surface landmark identified a lower interspace than ultrasound.

Conclusion

Identification of cervicothoracic intervertebral spaces by surface landmarks corresponded poorly with their identification using ultrasound. However, compared with the upright position, agreement in identifying the T7-8 interspace improved in the epidural position.