Transcatheter arterial chemoembolization (TACE) offers a survival benefit to patients with intermediate hepatocellular carcinoma (HCC). A widely accepted TACE regimen includes administration of doxorubicin-oil emulsion followed by gelatine sponge—conventional TACE. Recently, a drug-eluting bead (DC Bead®) has been developed to enhance tumor drug delivery and reduce systemic availability. This randomized trial compares conventional TACE (cTACE) with TACE with DC Bead for the treatment of cirrhotic patients with HCC. Two hundred twelve patients with Child-Pugh A/B cirrhosis and large and/or multinodular, unresectable, N0, M0 HCCs were randomized to receive TACE with DC Bead loaded with doxorubicin or cTACE with doxorubicin. Randomization was stratified according to Child-Pugh status (A/B), performance status (ECOG 0/1), bilobar disease (yes/no), and prior curative treatment (yes/no). The primary endpoint was tumor response (EASL) at 6 months following independent, blinded review of MRI studies. The drug-eluting bead group showed higher rates of complete response, objective response, and disease control compared with the cTACE group (27% vs. 22%, 52% vs. 44%, and 63% vs. 52%, respectively). The hypothesis of superiority was not met (one-sided P = 0.11). However, patients with Child-Pugh B, ECOG 1, bilobar disease, and recurrent disease showed a significant increase in objective response (P = 0.038) compared to cTACE. DC Bead was associated with improved tolerability, with a significant reduction in serious liver toxicity (P < 0.001) and a significantly lower rate of doxorubicin-related side effects (P = 0.0001). TACE with DC Bead and doxorubicin is safe and effective in the treatment of HCC and offers a benefit to patients with more advanced disease.
is the official Journal of the European and International Rhinologic Societies and appears quarterly in March, June, September and December. Cited in Pubmed, Current Contents, Index Medicus, Exerpta Medica and Embase Founded in 1963 by H.A.E. van Dishoeck, Rhinology is a worldwide non-profit making journal. The journal publishes original papers on basic research as well as clinical studies in the major field of rhinology, including physiology, diagnostics, pathology, immunology, medical therapy and surgery of both the nose and paranasal sinuses. Review articles and short communications are also pulished. All papers are peer-reviewed. Letters-to-the-editor provide a forum for comments on published papers, and are not subject to editorial revision except for correction of English language.In-depth studies that are too long to be included into a regular issue can be published as a supplement. Supple ments are not subject to peer-review.
To investigate the outcome of olfactory function in patients with olfactory loss following infections of the upper respiratory tract (post-URTI) or head trauma.
Chronic alcohol causes hepatic steatosis and liver hypoxia. Hypoxia-regulated Hypoxia-inducible factor 1-α, (HIF1α) may regulate liporegulatory genes but the relationship of HIF1 to steatosis remains unknown. We investigated HIF1α in alcohol-induced hepatic lipid accumulation. Alcohol administration resulted in steatosis, increased liver triglyceride levels and serum ALT suggesting liver injury in WT mice. There was increased hepatic HIF1α mRNA, protein and DNA-binding activity in alcohol-fed mice compared to controls. Mice engineered with hepatocyte-specific HIF1 activation (HIF1dPA) had increased HIF1α mRNA, protein, and DNA-binding activity, and alcohol feeding in HIF1dPA mice increased hepatomegaly and hepatic triglyceride compared to WT. In contrast, hepatocyte-specific deletion of HIF1α (HIF-1α(Hep-/-), protected mice from alcohol- and LPS-induced liver damage, serum ALT elevation, hepatomegaly and lipid accumulation. HIF-1α(Hep-/-), WT, and HIF1dPA mice had equally suppressed levels of PPARα mRNA after chronic ethanol, while the HIF target, ADRP, was upregulated in WT, but not in HIF-1α(Hep-/-) ethanol fed/LPS challenged mice. The chemokine, MCP-1, was cooperatively induced by alcohol feeding and LPS in WT but not in HIF-1α(Hep-/-) mice. Using Huh7 hepatoma cells in vitro, we found that MCP-1 treatment induced lipid accumulation and increased HIF1α protein expression as well as DNA-binding activity. SiRNA inhibition of HIF1α prevented MCP-1-induced lipid accumulation suggesting a mechanistic role for HIF1α in hepatocyte lipid accumulation.
Conclusions
Alcohol feeding results in lipid accumulation in hepatocytes involving HIF1α activation. The alcohol-induced chemokine, MCP-1, triggers lipid accumulation in hepatocytes via HIF1α activation, suggesting a mechanistic link between inflammation and hepatic steatosis in alcoholic liver disease.
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