To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantat...To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT).METHODSWe retrospectively evaluated the preoperative predictors of HCC recurrence in 70 patients treated with conventional (n = 16) or doxorubicin-eluting bead TACE (n = 54) before LT. The patient and tumour characteristics, including the static and dynamic alpha-fetoprotein, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR) measurements, were recorded. Treatment response was classified according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and the European Association for the Study of the Liver (EASL) criteria as complete response (CR), partial response (PR), stable disease or progressive disease. After examination of the explanted livers, histological necrosis was classified as complete (100% of the cumulative tumour area), partial (50%-99%) or minimal (< 50%) and was correlated with the preoperative radiological findings.RESULTSAccording to the pre-TACE radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. After TACE procedures, the objective response (CR + PR) rates were 71.4% and 70.0% according to mRECIST and EASL criteria, respectively. The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). Complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Using histopathology as the reference standard, mRECIST criteria correctly classified necrosis in 72.9% (51/70) of patients and EASL criteria in 68.6% (48/70) of cases. The mRECIST non-response to TACE [Exp(b) = 9.2, p = 0.012], exceeding UCSF criteria before TACE [Exp(b) = 4.7, p = 0.033] and a preoperative PLR > 150 [Exp(b) = 5.9, p = 0.046] were independent predictors of tumour recurrence.CONCLUSIONThe radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of TACE-treated candidates for LT.展开更多
目的探讨帕金森病(PD)患者皮肤小神经纤维的病理特点。方法收集16例临床确诊并符合纳入和排除标准的PD患者和性别年龄匹配的16例健康对照者的临床资料和神经电生理结果,对PD症状及周围神经病变进行评估。所有受试者行小腿皮肤活组织检查...目的探讨帕金森病(PD)患者皮肤小神经纤维的病理特点。方法收集16例临床确诊并符合纳入和排除标准的PD患者和性别年龄匹配的16例健康对照者的临床资料和神经电生理结果,对PD症状及周围神经病变进行评估。所有受试者行小腿皮肤活组织检查,通过标准化泛轴突标记蛋白基因产物9.5(PGP9.5)和生长相关蛋白43(GAP-43)两种免疫组织化学染色定量表皮内神经纤维密度(Intraepidermal nerve fiber density,IENFD),并进行统计学分析。结果16例PD患者,男7例,女9例,年龄(66.000±9.675)岁,Hoehn and Yahr(H-Y)分期(1.906±0.612)。PD组尺神经、正中神经、腓肠神经远端感觉潜伏期较对照组延长(P<0.05),余2组间神经电生理结果未见统计学差异(P>0.05)。PD组PGP9.5和GAP-43染色下IENFD值均低于健康对照组(8.618±3.984根/mm vs18.198±5.387根/mm,4.543±3.363根/mm vs 14.174±5.485根/mm;P<0.05)。两种染色下IENFD值与PD的临床症状有相关性。GAP-43/PGP9.5染色下IENFD比值在2组之间无统计学差异(0.575±0.380 vs 0.787±0.218;P>0.05)。结论PD患者存在周围神经损害,以小神经纤维受累为主,大直径神经纤维受累不明显,皮肤活检是诊断PD小纤维神经病较为可靠的方法。展开更多
文摘To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT).METHODSWe retrospectively evaluated the preoperative predictors of HCC recurrence in 70 patients treated with conventional (n = 16) or doxorubicin-eluting bead TACE (n = 54) before LT. The patient and tumour characteristics, including the static and dynamic alpha-fetoprotein, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR) measurements, were recorded. Treatment response was classified according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and the European Association for the Study of the Liver (EASL) criteria as complete response (CR), partial response (PR), stable disease or progressive disease. After examination of the explanted livers, histological necrosis was classified as complete (100% of the cumulative tumour area), partial (50%-99%) or minimal (< 50%) and was correlated with the preoperative radiological findings.RESULTSAccording to the pre-TACE radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. After TACE procedures, the objective response (CR + PR) rates were 71.4% and 70.0% according to mRECIST and EASL criteria, respectively. The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). Complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Using histopathology as the reference standard, mRECIST criteria correctly classified necrosis in 72.9% (51/70) of patients and EASL criteria in 68.6% (48/70) of cases. The mRECIST non-response to TACE [Exp(b) = 9.2, p = 0.012], exceeding UCSF criteria before TACE [Exp(b) = 4.7, p = 0.033] and a preoperative PLR > 150 [Exp(b) = 5.9, p = 0.046] were independent predictors of tumour recurrence.CONCLUSIONThe radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of TACE-treated candidates for LT.
文摘目的探讨帕金森病(PD)患者皮肤小神经纤维的病理特点。方法收集16例临床确诊并符合纳入和排除标准的PD患者和性别年龄匹配的16例健康对照者的临床资料和神经电生理结果,对PD症状及周围神经病变进行评估。所有受试者行小腿皮肤活组织检查,通过标准化泛轴突标记蛋白基因产物9.5(PGP9.5)和生长相关蛋白43(GAP-43)两种免疫组织化学染色定量表皮内神经纤维密度(Intraepidermal nerve fiber density,IENFD),并进行统计学分析。结果16例PD患者,男7例,女9例,年龄(66.000±9.675)岁,Hoehn and Yahr(H-Y)分期(1.906±0.612)。PD组尺神经、正中神经、腓肠神经远端感觉潜伏期较对照组延长(P<0.05),余2组间神经电生理结果未见统计学差异(P>0.05)。PD组PGP9.5和GAP-43染色下IENFD值均低于健康对照组(8.618±3.984根/mm vs18.198±5.387根/mm,4.543±3.363根/mm vs 14.174±5.485根/mm;P<0.05)。两种染色下IENFD值与PD的临床症状有相关性。GAP-43/PGP9.5染色下IENFD比值在2组之间无统计学差异(0.575±0.380 vs 0.787±0.218;P>0.05)。结论PD患者存在周围神经损害,以小神经纤维受累为主,大直径神经纤维受累不明显,皮肤活检是诊断PD小纤维神经病较为可靠的方法。
