Non-invasive determination of hepatic steatosis by acoustic structure quantification from ultrasound echo amplitude

AIM:To use leptin-deficient(ob/ob) mice with demonstrated differences in steatosis levels to test a new diagnostic method using the acoustical structure quantification(ASQ) mode and the associated analytical parameter,"focal disturbance ratio"(FD-ratio).METHODS:Nine ob/ob mice,at 5,8,and 12 wk of age(n = 3 in each age group),were used as models for hepatic steatosis.Echo signals obtained from ultrasonography in the mice were analyzed by ASQ,which uses a statistical analysis of echo amplitude to estimate inhomogeneity in the diagnostic region.FD-ratio,as calculated from this analysis,was the focus of the present study.FD-ratio and fat droplet areas and sizes were compared between age groups.RESULTS:No fibrosis or inflammation was observed in any of the groups.The fat droplet area significantly(P < 0.01) increased with age from 1.25% ± 0.28% at 5 wk to 31.07% ± 0.48% at 8 wk to 51.69% ± 3.19% at 12 wk.The median fat droplet size also significantly(P < 0.01) increased with age,from 1.33(0.55-10.52) m at 5 wk,2.82(0.61-44.13) m at 8 wk and 6.34(0.66-81.83) m at 12 wk.The mean FD-ratio was 0.42 ± 0.11 at 5 wk,0.11 ± 0.05 at 8 wk,and 0.03 ± 0.02 at 12 wk.The FD-ratio was significantly lower at 12 wk than at 5 wk and 8 wk(P < 0.01).A significant negative correlation was observed between the FD-ratio and either the fat droplet area(r =-0.7211,P = 0.0017) or fat droplet size(r =-0.9811,P = 0.0052).CONCLUSION:This tool for statistical analysis of signals from ultrasonography using the FD-ratio can be used to accurately quantify fat in vivo in an animal model of hepatic steatosis,and may serve as a quantitative biomarker of hepatic steatosis.

Transcatheter arterial chemoembolization with a fine-powder formulation of cisplatin for hepatocellular carcinoma

AIM:To evaluate the efficacy of transcatheter arterial chemoembolization(TACE) using a suspension of a fine-powder formulation of cisplatin(DDPH) for hepatocellular carcinoma(HCC).METHODS:The study population was comprised of 164 patients who were treated by TACE alone.Of these patients,76 underwent TACE using a suspension of DDPH in lipiodol(LPD)(DDPH group),and the remaining 88 underwent TACE with an emulsion of doxorubicin(ADM) with LPD(ADM group).We compared the DDPH group with the ADM group in terms of the objective early response rate,progression free survival(PFS) and overall survival(OS).RESULTS:The objective early response rate in the DDPH group was significantly higher than that in the ADM group(54% vs 24%,P < 0.001).The PFS rate in the DDPH group was also significantly higher than that in the ADM group(P < 0.001).Moreover,the OS in the DDPH group was significantly longer than that in the ADM group(P = 0.002).Although the incidence rate of nausea or vomiting in the DDPH group was higher than that in the ADM group,the ADM group showed a higher incidence rate of the adverse events of hepatic arterial damage and leucopenia.No other serious complications were observed in either group.CONCLUSION:We conclude that TACE using a suspension of DDPH in LPD could be a useful treatment for HCC.

Therapeutic efficacy of transarterial chemo-embolization with a fine-powder formulation of cisplatin for hepatocellular carcinoma

AIM:To evaluate the efficacy of transarterial chemoembolization(TACE) using a suspension of a finepowder formulation of cisplatin(DDPH) in lipiodol(LPD) in the treatment of hepatocellular carcinoma(HCC).METHODS:The subjects were 262 HCC patients treated with TACE using a DDPH-LPD suspension.The DDPH-LPD suspension was prepared by mixing 50 mg of DDPH into 10 mL of LPD.TACE was repeated when treated lesions relapsed and/or new hepatic lesions were detected.These patients received additional TACE using the same agent.TACE was repeated until complete regression of the tumor was obtained.The primary efficacy endpoint of the current study was the objective early response rate.Secondary efficacy endpoints were progression-free survival(PFS) and overall survival.RESULTS:The objective early response rate was 43.6%.Cumulative PFS rates were 56.7% at 6 mo,23.1% at 12 mo,13.4% at 18 mo,and 10.5% at 24 mo.The median PFS was 6.6 mo.Cumulative survival rates were 90.6% at 6 mo,81.9% at 12 mo,70.5% at 24 mo,and 58.8% at 36 mo.Median survival time was 46.6 mo.All adverse reactions were controllable by temporary suspension of treatment.No serious complications or treatment-related deaths were observed.CONCLUSION:TACE using a suspension of DDPH in LPD may be a useful treatment for HCC.

Liver cirrhosis induced by long-term administration of a daily low dose of amiodarone: A case report

The anti-arrhythmic agent amiodarone (AD) is associated with numerous adverse effects, but serious liver disease is rare. The improved safety of administration of daily low doses of AD has already been established and this regimen is used for long-term medication. Nevertheless,asymptomatic continuous liver injury by AD may increase the risk of step-wise progression of non-alcoholic fatty liver disease. We present an autopsy case of AD-induced liver cirrhosis in a patient who had been treated with a low dose of AD (200 mg/d) daily for 84 mo. The patient was a 85-year-old male with a history of ischemic heart disease.Seven years after initiation of treatment with AD, he was admitted with cardiac congestion. The total dose of AD was 528 g. Mild elevation of serum aminotransferase and hepatomegaly were present. Liver biopsy specimens revealed cirrhosis, and under electron microscopy numerous lysosomes with electron-dense, whorled, lamellar inclusions characteristic of a secondary phospholipidosis were observed. Initially, withdrawal of AD led to a slight improvement of serum aminotransferase levels, but unfortunately his general condition deteriorated and he died from complications of pneumonia and renal failure.Long-term administration of daily low doses of AD carries the risk of progression to irreversible liver injury. Therefore,periodic examination of liver function and/or liver biopsy is required for the management of patients receiving long-term treatment with AD.

Clinical Impact of Endoscopic Submucosal Dissection for Early Gastric Cancer

Aim: The aim of this study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer based on approximately 10 years’ experience. Methods: Endoscopic submucosal dissection was performed in 1272 patients with early gastric cancer (1657 lesions). We examined en bloc resection rate, curative resection rate, local recurrence rate, procedure time, and complications. Results: The overall en bloc resection rate was 98.6% for all lesions treated by ESD. The median procedure time of the operation was 54.3 minutes (range 5 - 632 min). The incidence of positive horizontal and vertical margins was 3.8% and 4.0%, respectively. The incidence was 2.5% each for perforation and postoperative bleeding. There were no deaths related to ESD. Local recurrence was observed in 10 lesions (0.06%). Conclusion: Since the procedure time and incidence of complications have been reduced, endoscopic submucosal dissection has been considered a standard treatment for early gastric cancer.

Comparison between Hypertonic Saline with Dextran and Mannitol on Vasodilatation of Encephalic Vessels Using a Magnetic Resonance Imaging in the Dogs

This study aimed to investigate whether a small volume of 7.2% hypertonic saline solution with 6% dextran 70 (HSD) is superior to mannitol in vasodilatation of encephalic vessels in the dogs using magnetic resonance imaging (MRI). Fifteen healthy 2.4 ± 0.9 year-old purpose-bred male Beagle dogs were assigned to receive 5 mL/kg of isotonic saline solution (ISS) as control, 20% mannitol or HSD infusion at a flow rate of 20 mL/kg/hours via right cephalic vein.Venous blood samples were collected immediately before fluid infusion (pre) and every 15 minutes until 120 minutes after the initiation of fluid infusion. Immediately after collection of each blood sample, T1 and T2-weighted magnetic resonance imaging recordings were undergone. Immediately after HSD infusion, the area of the cross-section of superior sagittal sinus was significantly greater than that of beagles in the other groups (p p < 0.001). Our results indicate that HSD induced a rapid and strong reduction in the area of the cross-section of CSF more than mannitol did. Therefore, it is suggested that 5 mL/kg of HSD might be superior to isovolume of mannitol in inducing vasodilatation in the dog.

Nanotwin-assisted nitridation of quenched FeNi alloy nanopowders for rare-earth-free magnets

L1_(0)-ordered FeNi alloy with a high uniaxial magnetic anisotropy and large magnetic moment is a promising candidate for rare-earth-free permanent magnets applications.However,the synthesis of this chemically ordered phase remains a longstanding challenge because of its low chemical order-disorder transition temperature(200-320℃).Although a non-equilibrium synthetic route based on a nitrogen topotactic reaction has been proposed as a valid approach,the volume fraction and degree of chemical ordering of the product phase are limited.Herein,we propose a promising approach that promotes the efficient formation of L1_(0)-ordered nitride phase in FeNi nanopowders by introducing a quenching treatment during a low-oxygen induction thermal plasma process.The quenched FeNi nanopowders possessed much smaller powder sizes(40.4 vs 74.0 nm),exhibited higher number densities of nanotwins(39.8%vs 24.1%)and formed much larger volume fraction(33.6 wt.%vs 0.6 wt.%)of ordered phase than the unquenched nanopowders.Notably,quenching-induced high-density nanotwins led to the dominant coverage of serrated{001}crystal facets over the surfaces of the FeNi nanopowders.Such unique features substantially accelerated the formation of the L1_(0)-ordered nitride phase in the FeNi nanopowders because the{001}crystallographic orientation had the highest nitrogen diffusivity.This work provides not only a valid synthetic approach for mass production of the L10-ordered nitride phase in FeNi nanopowders but also novel insights into the crystal-defect-assisted nitridation of nanomaterials.