Natural Products for Liver Cancer Treatment: From Traditional Medicine to Modern Drug Discovery

Primary liver cancer was the seventh most diagnosed cancer and the second leading cause of cancer death with about 906,000 cases and 830,000 deaths, respectively, in 2020. Conventional treatment for liver cancer, such as transarterial chemoembolization (TACE) or sorafenib, has limitations in that there is the recurrence of cancer, drug inefficacy, and adverse effects. Traditional medicine and natural products of several regions including Korea, China, Europe, North America, India, and the Middle East have attracted a lot of attention since they have been reported to have anticancer effects with low adverse effects. In this review, several in vivo studies on the effects of natural compounds on liver cancer and clinical trials approving their therapeutic benefits were selected and discussed. As a result of the analysis of these studies, the effects of natural compounds were classified into a few mechanisms: apoptosis, anti-metastasis, and antiangiogenesis. In addition, medications including natural products in clinical trials were observed to exhibit improvements in various liver cancer symptoms and patients’ survival rates. This study presents findings suggestive of the anticancer potential of natural products and their properties in relieving related symptoms.     

Infliximab decreases inflammatory activity but has no effect on small fiber neuropathy related symptoms in Dutch patients with sarcoidosis

Background and aim:Small fiber neuropathy (SFN) may present as complication in sarcoidosis. SFN can potentially result into a large range of symptoms with a high impact on quality of life. Although treatment of the underlying disease of SFN is paramount, little research has been performed to investigate SFN improvement as consequence of sarcoidosis treatment. This retrospective study investigates whether there is an association between the anti-inflammatory effects of infliximab and SFN-symptomsMethods:The Small Fiber Neuropathy Screening List (SFNSL) was used to measure changes in SFN symptoms during infliximab treatment. Maximal standardized uptake value (SUVmax) from Fluordeoxyglucose Positron Emission Tomography (FDG-PET) was used as a measure for inflammatory activityResults:36 sarcoidosis patients were eligible for analysis. SFNSL-score showed a mean decrease of -1,9 points (p = 0.446). SUVmax did improve with a mean of -3.7 (p<0.001). No correlation between a decrease of SUVmax and SFNSL screening list could be found (p=0.610)Conclusions:Our data reveal no association between anti-inflammatory effect of infliximab and SFN-related symptoms in patients with sarcoidosis, which contradicts previous case-reports and case-series. Given the major negative impact of SFN-related symptoms on the quality of life in patients with sarcoidosis, it is necessary that the possible beneficial effect of anti-inflammatory therapy will be further addressed in future prospective studies.     

Modulação Autonômica Cardíaca é Fator Chave para Pressão Alta em Adolescentes

BackgroundThe interest regarding hypertension among children and adolescents has increased since the blood pressure rating system was updated to be compared with the adult rating system, changing the terminology from “normal high” to “prehypertension”.ObjectiveThis study aimed to analyze the association between cardiac autonomic modulation and pressure levels of adolescents.Methods203 adolescents were grouped according to systolic blood pressure (SBP) and diastolic blood pressure (DBP). One group was characterized as prehypertension, and the other as normotensive. Anthropometric, cardiovascular and sleep quality characteristics were collected. Initially, the data were submitted to the Kolmogorov-Smirnov normality test. Continuous quantitative variables were analyzed using the unpaired Student t-test. For the analysis of categorical variables, a chi-square test was used. A logistic regression model was performed. The level of significance was set at p<0.05. The data were expressed as mean ± standard deviation and confidence interval. The R software was used for data analysis. The effect size was calculated using the Cohen’s formula.ResultsThe prehypertension group showed an increase in Shannon entropy and a decrease in total variance. Also, in the logistic regression model, adolescents in this group were 1.03 times more likely to have Shannon entropy’s affected when SBP was adjusted for gender, sexual maturation, school time, age, waist circumference, and sleep quality.ConclusionOur data show that autonomic modulation may play an important role in the development of elevated blood pressure in adolescents, when controlling for other factors, such as school time and sleep quality.     

Solitary pulmonary nodules: CT assessment

Computed tomography (CT) was used to examine 634 solitary pulmonary nodules (SPNs). Each lesion was assessed as benign or indeterminate on the basis of CT criteria. Benign nodules made up 44% of all SPNs and 58% of the 431 that were 2 cm or less in diameter. All malignant SPNs were assessed as indeterminate, and adenocarcinoma (42%) was the most common primary malignancy. A total of 176 (63% of benign SPNs) were correctly assessed as benign by CT. Ninety SPNs assessed as diffusely calcified were not so identified by conventional tomography at outside institutions. An SPN can be reliably assessed by CT as benign if it exhibits high attenuation values, exceeding a critical level and distributed diffusely throughout a CT section through the center of the lesion and a well-defined edge. Although 38 of 283 (13.4%) primary lung cancers contained localized calcification, there was no significant overlap with the diffuse calcification of benign lesions. Central carcinoid tumors may contain focal ossification, but such lesions may be recognized by noting the proximity of larger bronchi. Assessment of SPNs by CT is most effective for lesions 2.0 cm or less in diameter. For larger lesions, the frequency of benign disease was decreased (14.3% of 203), as was the percentage of benign SPNs correctly assessed as benign by CT (37.9%).     

Bowel migration in the normal fetus: US detection

Ten fetuses underwent ultrasound scanning at 7-10 weeks gestational (postmenstrual) age. In all cases, an echogenic mass measuring 0.5-1.0 cm was demonstrated within the base of the umbilical cord at its insertion into the fetal abdomen. No area with echogenicity characteristic of the small bowel was identified within the lower part of the fetal abdomen. All fetuses were reexamined 4-12 weeks later, at which time the mass in the umbilical cord was no longer seen, and normal fetal bowel was visualized in the lower abdominal cavity of the fetus. This sequence of findings appears to represent the sonographic demonstration of normal fetal bowel migration early in gestation and should not be confused with defects of the abdominal wall such as omphalocele or gastroschisis.     

Revitalizing the charge nurse role through a bespoke development programme

Aims This article describes the genesis, contents and outcomes of a bespoke Charge Nurse Development Programme which was designed to enhance the propensity of nurses to manage in an acute hospital setting. Background The charge nurse role is pivotal to the provision of high‐quality care and effective ward management. However, many nurses are promoted to these roles of substantial responsibility commonly with no formal management preparation, an inherent under‐confidence and in some cases a tangible reluctance to manage. Evaluation Evaluations from 95 charge nurses were obtained using an anonymous questionnaire. Key issues Qualitative analysis demonstrated the programme satisfied its original aims by having role models and experts teaching relevant subjects to a group who have consequently established their own peer network. Conclusions The pragmatic consequences of the programme were that charge nurses have perceived themselves to become empowered and more focussed on solutions. Implications for nursing management Creating a supportive but challenging programme has resulted in charge nurses behaving more reflexively by combining reflection with action. This has helped them enhance their confidence, autonomy and responsiveness to organizational, personal and professional objectives. Further work needs to be undertaken to correlate the charge nurses’ perceived outcomes against audited standards of their ward performances.     

Somatic mosaicism in the central nervous system in spinocerebellar ataxia type 1 and machado-joseph disease

Spinocerebellar ataxia type 1 and Machado-Joseph disease are two autosomal dominant cerebellar ataxias caused by expansions of unstable CAG repeats in the coding region of the causative genes. The selectivity of cell death and the resulting characteristic neuropathological features in each of these diseases are not explained by the gene expression patterns. Since the repeat size correlates with age at onset and severity of these diseases, somatic mosaicims, the result of mitotic instability of the CAG repeat, could be the basis for specificity of neurodegeneration; brain structures with larger expanded repeats would be more severely affected. To study the association between neuropathological changes and somatic mosaicism of the CAG repeat size in the central nervous system of patients with these two ataxias, we determined the size of the (CAG)n expansion in 20 different regions of the brain, brainstem, cerebellum, and spinal cord from 3 patients with spinocerebellar ataxia type 1 and 3 with Machado-Joseph disease; these regions were selected for their differential neuropathological involvement in the two disorders. We observed a considerable homogeneity of repeat size ranges in all but 1 of the 20 regions examined: The cerebellar cortex showed slightly smaller (CAG)n tracts in all specimens from both groups of patients. Our results suggest that the pattern of repeat size mosaicism, similar in spinocereballar ataxia type 1 and Machado-Joseph disease, reflects the developmental pathways and cell composition of different central nervous system regions and is not the cause of selective cell death in these disorders.     

Problem‐based learning: Concept,theories, effectiveness and application to radiology teaching

Australian and New Zealand medical schools are partly or entirely incorporating problem‐based learning (PBL) in their medical school curricula. As this change moves forwards and gathers momentum, radiologists are called upon to facilitate or to contribute to PBL tutorials. This study explains the concept and the theories of PBL and discusses its application to radiology teaching.