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[en] Fibrosis is a common side effect after treatment with ionizing radiation. Several methods to ameliorate debilitating fibrosis have been employed but without consistent results. The goal of this pilot study is to determine if Pirfenidone, a novel regulator of cytokine gene expression, has the potential to ameliorate established radiation-induced fibrosis. Open label, prospective pilot study of 800 mg three times/day, orally administered Pirfenidone was administered to enrolled patients who were had completed radiation therapy and who had established radiation-induced fibrosis. Range of motion (ROM) was assessed using standard measures, and subjective measures of pain, fatigue, disability and global health were measured every three months. Seven patients were enrolled of whom 3 had ROM assessments of 1 site and 2 had ROM assessments of 2 sites. Of these assessments, 6 revealed increased ROM during drug intervention while 1 revealed a decreased ROM. There was an overall improvement in the mental composite score of the SF36 while physical composite score was decreased and the vitality score was unchanged. Two patients were removed from the study because of syncopal episodes. Several patients experienced improved function of at least 25% and reported subjective improvement. Pirfenidone may benefit patients with radiation-induced fibrosis and is worthy of a larger well controlled trial
[en] Highlights: • Three simple Doppler-US signs are associated with severe liver fibrosis. • Combined together, these simple signs are sensitive, but they lack specificity. • Doppler-US devices now include elastography modules allowing liver stiffness measurement. • Using elastography when the simple Doppler-US signs are present improves the diagnostic accuracy. • This approach represents an attractive procedure for the diagnostic of advanced liver diseases. - Abstract: ObjectivesAdvanced chronic liver disease is frequent yet largely underdiagnosed. Doppler-US is a common examination and we recently identified three simple Doppler-US signs associated with severe liver fibrosis. Recent Doppler-US devices include elastography modules, allowing for liver stiffness measurement (LSM). Our aim was to assess whether the use of elastography following positive simple Doppler-US signs improves the detection of severe liver fibrosis in a single Doppler-US examination.
[en] The role of ductular reaction (DR) in hepatocellular carcinoma (HCC) remains to be elucidated. In this study, we tried to uncover possible effect by correlating peritumoral DR in a necroinflammatory microenvironment with postoperative prognosis in HCC. The expression of peritumoral DR/CK19 by immunohistochemistry, necroinflammation and fibrosis were assessed from 106 patients receiving curative resection for HCC. Prognostic values for these and other clinicopathologic factors were evaluated. Peritumoral DR significantly correlated with necroinflammation (r = 0.563, p = 3.4E-10), fibrosis (r = 0.435, p = 3.1E-06), AFP level (p = 0.010), HBsAg (p = 4.9E-4), BCLC stage (p = 0.003), TNM stage (p = 0.002), multiple nodules (p = 0.004), absence of tumor capsule (p = 0.027), severe microscopic vascular invasion (p = 0.031) and early recurrence (p = 0.010). Increased DR was significantly associated with decreased RFS/OS (p = 4.8E-04 and p = 2.6E-05, respectively) in univariate analysis and were identified as an independent prognostic factor (HR = 2.380, 95% CI = 1.250-4.534, p = 0.008 for RFS; HR = 4.294, 95% CI = 2.255-8.177, p = 9.3E-6 for OS) in multivariate analysis. These results suggested that peritumoral DR in a necroinflammatory microenvironment was a poor prognostic factor for HCC after resection
[en] This report describes a technique of inserting an implantable venous access port (portacath) through a thrombosed and occluded vein employing a pre-existing peripherally inserted central catheter (PICC) as the route of access. The PICC was used as a conduit for venous access in a way that has not been described previously in the literature. This procedure was performed in a young patient with cystic fibrosis in an effort to prevent the use of his virgin contralateral veins, which might be used in the future.
[en] Highlights: • Hepatic CT extracellular volume fraction correlates with liver fibrosis grades. • New subtraction algorithm provides best extracellular volume fraction. • Extracellular volume fraction can be obtained from routine clinical CT data. • Further investigation is needed to determine optimal equilibrium phase delay time. - Abstract: ObjectivesTo assess whether extracellular volume fraction (ECV) obtained from routine liver CT equilibrium phase data utilizing new subtraction algorithm is useful in estimating the degree of liver fibrosis.
[en] Neurofibromatosis, or von Recklinghausen's disease, is a hereditary, harmartomatous disorder that primarily involves neuro ectoderm and mesoderm. The estimated incidence is 1 in 2,500 to 3,000 births. The clinical features are skin manifestations such as cafe-au-lait spots, skeletal manifestations primarily involving vertebrae, central and peripheral nervous manifestations, and other associated abnormalities with increased risk of malignancy. The authors analysed the radiologic findings of 18 cases of patients with neurofibromatosis who visited Pusan Kosin Medical Center and Taegu Dongsan Medical Center during the last five years. All were proven by surgery, biopsy and other diagnostic criteria. The results obtained were as follows: 1. The male to female ratio was 11:7 and the age ranged from 11 months to 51 years. 2. All the cases fulfilled the diagnostic criteria of Crowe and associates. 3. Bone manifestations were present in 44% of the cases. The other radiologic findings were intrathoracic meningocele, bilateral acoustic neurinomas, mediastinal or chest wall mass shadows, and peripheral soft tissue masses. 4. One of the soft tissue masses was proved to be malignant.
[en] The author has observed a case of ossifying fibroma occurred in the left mandibular body area of 19 year old woman. In the serial roentgenograms, the author has drawn following conclusions: 1. The lesion is circumscribed and demarcated from the surrounding bone tissues. 2. The cortical bone of the involved area was expanded and thinned markedly on the site. 3. The radiopacity was increased with more or less mottled appearance on the site.
[en] Highlights: • Long-term APAP treatment led to collagen deposition. • Long-term APAP treatment led to HSCs activation. • Long-term APAP treatment led to the phosphorylation of Smad2/3 and ERK1/2. • APAP toxic metabolite led to the activation of hepatic stellate LX2 cells. • Egr-1 deletion mice were more sensitive to APAP-induced liver fibrosis. - Abstract: Acetaminophen (APAP)-induced acute liver injury has already been well studied. However, whether long-term administration of APAP will cause liver fibrosis is still not very clear. This study aims to investigate the liver fibrosis in mice induced by long-term APAP treatment and the involvement of early growth response 1 (Egr-1). C57BL/6 mice were orally given with APAP (200, 300 mg/kg) for 2, 6 or 10 weeks, respectively. Liver hydroxyproline content, collagen deposition and inflammatory cells infiltration were increased in mice treated with APAP (200, 300 mg/kg) for 6 or 10 weeks. Liver mRNA expression of collagen (COL)1a1, Col3a1, transforming growth factor-β (TGF-β) and serum contents of COL1, COL3, TGF-β were all increased in APAP-treated mice. Liver expression of α-smooth muscle actin (α-SMA) and phosphorylated ERK1/2 and Smad2/3 were all increased in APAP-treated mice. Furthermore, increased liver mRNA expression of Egr-1 and its subsequent nuclear translocation were found in APAP-treated mice. Egr-1 knock-out mice were further applied. APAP-induced liver fibrosis was found to be more serious in Egr-1 knock-out mice. N-acetyl-p-benzoquinoneimine (NAPQI), the APAP hepatotoxic metabolite, increased cellular mRNA expression of α-SMA, Col1a1, Col3a1, TGF-β, induced ERK1/2 and Smad2/3 phosphorylation and Egr-1 nuclear translocation in hepatic stellate LX2 cells. In conclusion, long-term administration of APAP induced liver fibrosis in mice, and Egr-1 was critically involved in this process. This study points out a warning and reference for patients with long-term APAP ingestion in clinic.