Survival benefit of second line therapies for recurrent hepatocellular carcinoma: repeated hepatectomy, thermoablation and second-line transplant referral in a real life national scenario

BACKGROUND

Despite second-line transplant(SLT) for recurrent hepatocellular carcinoma(rHCC) leads to the longest survival after recurrence(SAR), its real applicability has never been reported. The aim was to compare the SAR of SLT versus repeated hepatectomy and thermoablation(CUR group).

METHODS

Patients were enrolled from the Italian register HE.RC.O.LE.S. between 2008 and 2021. Two groups were created: CUR versus SLT. A propensity score matching (PSM) was run to balance the groups.

RESULTS

743 patients were enrolled, CUR = 611 and SLT = 132. Median age at recurrence was 71(IQR 6575) years old and 60(IQR 53-64, p < 0.001) for CUR and SLT respectively. After PSM, median SAR for CUR was 43 months(95%CI = 37 - 93) and not reached for SLT(p < 0.001). SLT patients gained a survival benefit of 9.4 months if compared with CUR. MilanCriteria(MC)-In patients were 82.7% of the CUR group. SLT(HR 0.386, 95%CI = 0.23 - 0.63, p < 0.001) and the MELD score(HR 1.169, 95%CI = 1.07 - 1.27, p < 0.001) were the only predictors of mortality. In case of MC-Out, the only predictor of mortality was the number of nodules at recurrence(HR 1.45, 95%CI= 1.09 - 1.93, p = 0.011).

CONCLUSION

It emerged an important transplant under referral in favour of repeated hepatectomy or thermoablation. In patients with MC-Out relapse, the benefit of SLT over CUR was not observed.

Network approach in liquidomics landscape

Tissue-based biopsy is the present main tool to explore the molecular landscape of cancer, but it also has many limits to be frequently executed, being too invasive with the risk of side effects. These limits and the ability of cancer to constantly evolve its genomic profile, have recently led to the need of a less invasive and more accurate alternative, such as liquid biopsy. By searching Circulating Tumor Cells and residues of their nucleic acids or other tumor products in body fluids, especially in blood, but also in urine, stools and saliva, liquid biopsy is becoming the future of clinical oncology. Despite the current lack of a standardization for its workflows, that makes it hard to be reproduced, liquid biopsy has already obtained promising results for cancer screening, diagnosis, prognosis, and risk of recurrence.Through a more accessible molecular profiling of tumors, it could become easier to identify biomarkers predictive of response to treatment, such as EGFR mutations in non-small cell lung cancer and KRAS mutations in colorectal cancer, or Microsatellite Instability and Mismatch Repair as predictive markers of pembrolizumab response.By monitoring circulating tumor DNA in longitudinal repeated sampling of blood we could also predict Minimal Residual Disease and the risk of recurrence in already radically resected patients.In this review we will discuss about the current knowledge of limitations and strengths of the different forms of liquid biopsies for its inclusion in normal cancer management, with a brief nod to their newest biomarkers and its future implications.

The Effect of a Liver Transplant Program on the Outcomes of Resectable Hepatocellular Carcinoma: A Nationwide Multicenter Analysis

OBJECTIVE

To evaluate the effect of a liver transplantation (LT) program on the outcomes of resectable hepatocellular carcinoma (HCC).

BACKGROUND

Surgical treatment of HCC includes both hepatic resection (HR) and LT. However, the presence of cirrhosis and the possibility of recurrence make the management of this disease complex and probably different according to the presence of a LT program.

METHODS

Patients undergoing HR for HCC between January 2005 and December 2019 were identified from a national database of HCC. The main study outcomes were major surgical complications according to the Comprehensive Complication Index, posthepatectomy liver failure (PHLF), 90-day mortality, overall survival, and disease-free survival. Secondary outcomes were salvage liver transplantation (SLT) and postrecurrence survival.

RESULTS

A total of 3202 patients were included from 25 hospitals over the study period. Three of 25 (12%) had an LT program. The presence of an LT program within a center was associated with a reduced probability of PHLF (odds ratio=0.38) but not with overall survival and disease-free survival. There was an increased probability of SLT when HR was performed in a transplant hospital (odds ratio=12.05). Among transplant-eligible patients, those who underwent LT had a significantly longer postrecurrence survival.

CONCLUSIONS

This study showed that the presence of a LT program was associated with decreased PHLF rates and an increased probability to receive SLT in case of recurrence.

Machine Learning Predictive Model to Guide Treatment Allocation for Recurrent Hepatocellular Carcinoma After Surgery

Importance

Clear indications on how to select retreatments for recurrent hepatocellular carcinoma (HCC) are still lacking.

Objective

To create a machine learning predictive model of survival after HCC recurrence to allocate patients to their best potential treatment.

Design, Setting, and Participants

Real-life data were obtained from an Italian registry of hepatocellular carcinoma between January 2008 and December 2019 after a median (IQR) follow-up of 27 (12-51) months. External validation was made on data derived by another Italian cohort and a Japanese cohort. Patients who experienced a recurrent HCC after a first surgical approach were included. Patients were profiled, and factors predicting survival after recurrence under different treatments that acted also as treatment effect modifiers were assessed. The model was then fitted individually to identify the best potential treatment. Analysis took place between January and April 2021.

Exposures

Patients were enrolled if treated by reoperative hepatectomy or thermoablation, chemoembolization, or sorafenib.

Main Outcomes and Measures

Survival after recurrence was the end point.

Results

A total of 701 patients with recurrent HCC were enrolled (mean [SD] age, 71 [9] years; 151 [21.5%] female). Of those, 293 patients (41.8%) received reoperative hepatectomy or thermoablation, 188 (26.8%) received sorafenib, and 220 (31.4%) received chemoembolization. Treatment, age, cirrhosis, number, size, and lobar localization of the recurrent nodules, extrahepatic spread, and time to recurrence were all treatment effect modifiers and survival after recurrence predictors. The area under the receiver operating characteristic curve of the predictive model was 78.5% (95% CI, 71.7%-85.3%) at 5 years after recurrence. According to the model, 611 patients (87.2%) would have benefited from reoperative hepatectomy or thermoablation, 37 (5.2%) from sorafenib, and 53 (7.6%) from chemoembolization in terms of potential survival after recurrence. Compared with patients for which the best potential treatment was reoperative hepatectomy or thermoablation, sorafenib and chemoembolization would be the best potential treatment for older patients (median [IQR] age, 78.5 [75.2-83.4] years, 77.02 [73.89-80.46] years, and 71.59 [64.76-76.06] years for sorafenib, chemoembolization, and reoperative hepatectomy or thermoablation, respectively), with a lower median (IQR) number of multiple recurrent nodules (1.00 [1.00-2.00] for sorafenib, 1.00 [1.00-2.00] for chemoembolization, and 2.00 [1.00-3.00] for reoperative hepatectomy or thermoablation). Extrahepatic recurrence was observed in 43.2% (n = 16) for sorafenib as the best potential treatment vs 14.6% (n = 89) for reoperative hepatectomy or thermoablation as the best potential treatment and 0% for chemoembolization as the best potential treatment. Those profiles were used to constitute a patient-tailored algorithm for the best potential treatment allocation.

Conclusions and Relevance

The herein presented algorithm should help in allocating patients with recurrent HCC to the best potential treatment according to their specific characteristics in a treatment hierarchy fashion.

Ultrasound liver map technique for laparoscopic liver resections: perioperative outcomes are not impaired by technical complexity

Intraoperative liver ultrasound has a crucial role to guide open liver surgery. A 4-step ultrasound liver map technique for laparoscopic liver resection (LLR) has been standardized in our center. The aim of this study was to evaluate outcomes of our technique according to the hepatectomy technical complexity. A difficulty scale (DS) ranging from 1 to 10 was applied to each LLR. A cumulative sum control-chart analysis identified 3 periods of gradually increasing DS. Perioperative outcomes of the 3 periods were compared. 300 LLRs performed between 2006 and 2018 were analyzed. Median DS was 3 for first 100 cases (P1), 5 for cases 101-200 (P2) and 6 for cases 201-300 (P3). A significantly greater percentage of postero-superior segments resections (P1 11%, P2 36%, P3 46%, p < 0.001) were performed in P3. P3 LLRs had a significantly longer transection time (p < 0.001) and wider cut surface area (p < 0.001), but median blood losses were similar among the 3 periods (P1 100 cc, P2 100 cc, P3 140 cc). There were no differences among periods in overall morbidity (P1 12%, P2 17%, P3 17%), major morbidity (P1 1%, P2 2%, P3 3%) and length of hospital stay (5 days in all the three groups). Despite the increasing surgical complexity of LLR, ultrasound liver map technique allows good perioperative outcomes.

Pretargeting of Carcinomas with the Avidin-Biotin System

Diagnosis and experimental therapy of cancer have been performed with encouraging results using radiolabelled monoclonal antibodies. However, the high background due to non-specific uptake by normal tissue and blood is a major drawback in antibody-guided tumor detection. Various strategies have been proposed to overcome this problem, such as computed background subtraction, use of a second antibody, and local delivery. An antibody is a slow “bullet” for tumor targeting, since in many lesions it requires two or three days to accumulate. The use of fragments such as F(ab’)2 or Fab, which display a faster blood clearance than whole antibody, improves tumor localization to a sufficient extent (hours) to allow the use of the most suitable radionuclides, e.g. 99m-Tc. In therapeutic applications we are still far away from the optimal condition in terms of the absolute amount of radioactivity delivered to the tumor. The high specificity of antibodies could be exploited at its best by delaying the delivery of the label to a time when the ratio tumor-bound to non-tumor-bound antibody has reached its maximum value. To obtain this goal, the label should display a fast clearance and should be captured by the antibody already targeted onto tumor cells. These considerations have led to strategies of tumor pretargeting where antibody and label are administered separately. One of these strategies, based on the avidin-biotin system, has already been used extensively for several years in immunohistochemistry and in ELISA. Due to the flexibility of this system, several alternative protocols are possible.

We describe a three-step and a two-step pretargeting protocol based on the avidin-biotin system.

Using Deconvolution to Improve PET Spatial Resolution in OSEM Iterative Reconstruction

Objectives : A novel approach to the PET image reconstruction is presented, based on the inclusion of image deconvolution during conventional OSEM reconstruction. Deconvolution is here used to provide a recovered PET image to be included as “a priori" information to guide OSEM toward an improved solution.

Methods : Deconvolution was implemented using the Lucy-Richardson (LR) algorithm: Two different deconvolution schemes were tested, modifying the conventional OSEM iterative formulation: 1) We built a regularizing penalty function on the recovered PET image obtained by deconvolution and included i in the OSEM iteration. 2) After each conventional global OSEM iteration, we deconvolved the resulting PET image and used this “recovered" version as the initialization image for the next OSEM iteration. Tests were performed on both simulated and acquired data.

Results : Compared to the conventional OSEM, both these strategies, applied to simulated and acquired data, showed an improvement in image spatial resolution with better behavior in the second case. In this way, small lesions, present on data, could be better discriminated in terms of contrast.

Conclusions : Application of this approach to both simulated and acquired data suggests its efficacy in obtaining PET images of enhanced quality.

Different training schedules influence platelet aggregation in show jumping horses

Depending on the intensity, duration and type of physical exercise, equine metabolism has to adapt to nervous, cardiovascular, endocrine and respiratory system requirements. In horses, exercise and training are known to have considerable effects on the mechanisms of hemostatic system involving platelet activity. The aim of the present study was to evaluate the effect of different training schedules on platelet aggregation in 15 Italian Saddle jumping horses. Animals were divided into three equal groups: Group A was subjected to a high intensity-training program; group B to a light training program, group C included sedentary horses. From each animal, blood samples were collected by jugular venipuncture at rest on the 1st, 3rd and 5th days, and afterwards, once a week, for a total of 5 weeks data recording, in order to assess the maximum degree of platelet aggregation and the initial velocity of aggregation (slope) platelet aggregation. Two-way analysis of variance (ANOVA) showed a significant effect of the different training schedules on studied parameters. The results revealed a different degree of platelet aggregation and a different initial velocity of platelet aggregation that changes during the different training schedules in horses that could represent a different protective endothelial mechanism. These findings could have an important role for a clearer knowledge of the physiological reference values of platelet aggregation and for a better interpretation of these variations during the training.

Pharmacological interventions for acute pancreatitis

BACKGROUND

In people with acute pancreatitis, it is unclear what the role should be for medical treatment as an addition to supportive care such as fluid and electrolyte balance and organ support in people with organ failure.

OBJECTIVES

To assess the effects of different pharmacological interventions in people with acute pancreatitis.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 9), MEDLINE, Embase, Science Citation Index Expanded, and trial registers to October 2016 to identify randomised controlled trials (RCTs). We also searched the references of included trials to identify further trials.

SELECTION CRITERIA

We considered only RCTs performed in people with acute pancreatitis, irrespective of aetiology, severity, presence of infection, language, blinding, or publication status for inclusion in the review.

DATA COLLECTION AND ANALYSIS

Two review authors independently identified trials and extracted data. We did not perform a network meta-analysis as planned because of the lack of information on potential effect modifiers and differences of type of participants included in the different comparisons, when information was available. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) for the binary outcomes and rate ratios with 95% CIs for count outcomes using a fixed-effect model and random-effects model.

MAIN RESULTS

We included 84 RCTs with 8234 participants in this review. Six trials (N = 658) did not report any of the outcomes of interest for this review. The remaining 78 trials excluded 210 participants after randomisation. Thus, a total of 7366 participants in 78 trials contributed to one or more outcomes for this review. The treatments assessed in these 78 trials included antibiotics, antioxidants, aprotinin, atropine, calcitonin, cimetidine, EDTA (ethylenediaminetetraacetic acid), gabexate, glucagon, iniprol, lexipafant, NSAIDs (non-steroidal anti-inflammatory drugs), octreotide, oxyphenonium, probiotics, activated protein C, somatostatin, somatostatin plus omeprazole, somatostatin plus ulinastatin, thymosin, ulinastatin, and inactive control. Apart from the comparison of antibiotics versus control, which included a large proportion of participants with necrotising pancreatitis, the remaining comparisons had only a small proportion of patients with this condition. Most trials included either only participants with severe acute pancreatitis or included a mixture of participants with mild acute pancreatitis and severe acute pancreatitis (75 trials). Overall, the risk of bias in trials was unclear or high for all but one of the trials.

SOURCE OF FUNDING

seven trials were not funded or funded by agencies without vested interest in results. Pharmaceutical companies partially or fully funded 21 trials. The source of funding was not available from the remaining trials.Since we considered short-term mortality as the most important outcome, we presented only these results in detail in the abstract. Sixty-seven studies including 6638 participants reported short-term mortality. There was no evidence of any differences in short-term mortality in any of the comparisons (very low-quality evidence). With regards to other primary outcomes, serious adverse events (number) were lower than control in participants taking lexipafant (rate ratio 0.67, 95% CI 0.46 to 0.96; N = 290; 1 study; very low-quality evidence), octreotide (rate ratio 0.74, 95% CI 0.60 to 0.89; N = 770; 5 studies; very low-quality evidence), somatostatin plus omeprazole (rate ratio 0.36, 95% CI 0.19 to 0.70; N = 140; 1 study; low-quality evidence), and somatostatin plus ulinastatin (rate ratio 0.30, 95% CI 0.15 to 0.60; N = 122; 1 study; low-quality evidence). The proportion of people with organ failure was lower in octreotide than control (OR 0.51, 95% CI 0.27 to 0.97; N = 430; 3 studies; very low-quality evidence). The proportion of people with sepsis was lower in lexipafant than control (OR 0.26, 95% CI 0.08 to 0.83; N = 290; 1 study; very low-quality evidence). There was no evidence of differences in any of the remaining comparisons in these outcomes or for any of the remaining primary outcomes (the proportion of participants experiencing at least one serious adverse event and the occurrence of infected pancreatic necrosis). None of the trials reported heath-related quality of life.

AUTHORS' CONCLUSIONS

Very low-quality evidence suggests that none of the pharmacological treatments studied decrease short-term mortality in people with acute pancreatitis. However, the confidence intervals were wide and consistent with an increase or decrease in short-term mortality due to the interventions. We did not find consistent clinical benefits with any intervention. Because of the limitations in the prognostic scoring systems and because damage to organs may occur in acute pancreatitis before they are clinically manifest, future trials should consider including pancreatitis of all severity but power the study to measure the differences in the subgroup of people with severe acute pancreatitis. It may be difficult to power the studies based on mortality. Future trials in participants with acute pancreatitis should consider other outcomes such as complications or health-related quality of life as primary outcomes. Such trials should include health-related quality of life, costs, and return to work as outcomes and should follow patients for at least three months (preferably for at least one year).

Iron profile in Thoroughbreds during a standard training program

OBJECTIVES

The aim of this study was to evaluate the modifications of some haematological parameters and iron profile during an 80-day training program and their relationship with athletic performance of performance horses.

METHODS

During the training period, 20 Thoroughbreds were subjected to a standardised exercise test, previously standardised for gallopers to evaluate athletic performance. The test was performed immediately before the beginning of the training program (T0) and after 30 days (T30), 60 days (T60) and 90 days (T90). For each horse, their velocities at blood lactate concentrations of 2 and 4 mmol/L (V2 and V4) and a heart rate of 200 beats/min (V200) were calculated to assess the effect of the training program on athletic performance. Blood samples were collected at 20-day intervals over a period of 80 days from the beginning of the training program.

RESULTS

One-way repeated measures analysis of variance (ANOVA) showed a statistically significant effect of days of training (time) on iron, ferritin, transferrin, total iron-binding capacity, transferrin saturation and unsaturated iron-binding capacity (P < 0.001 for all).

CONCLUSIONS

The results showed the influence of the intensity and duration of exercise on iron metabolism. These findings may be useful for evaluating the athletic status of horses during training and to assess the degree of training adaptability, providing an opportunity to modify the training schedule to achieve the desired performance.

Risonanza magnetica funzionale: Localizzazione dell'area motoria primaria in pazienti portatori di lesioni espansive cerebrali Risultati preliminari

La Risonanza Magnetica Funzionale (RMF) ha dimostrato di poter localizzare la sede di aree corticali funzionali in numerosi protocolli su volontari sani. La identificazione prechirurgica di aree corticali eloquenti è molto importante al fine della realizzazione di un intervento il meno lesivo possibile per la funzione. Il sowertimento più o meno grossolano della regione anatomica da parte di un processo espansivo rende spesso difficile la identificazione di determinati reperi anatomici.

Ci siamo proposti di studiare con RMF, su tomografo convenzionale, pazienti affetti da neoplasie intra ed extrassiali che interessavano il lobo frontale posteriore o quello parietale. Sono stati studiati quindici pazienti, tutti destrimani, di età compresa tra i 15 ed i 64 anni. Sono state ottenute mappe di attivazione, che hanno evidenziato aree di significativo aumento del segnale in regione parieto-frontale posteriore.

La morfologia delle aree di significativo aumento di segnale era il più delle volte di tipo serpiginoso. Quando l'effetto massa era netto, l'area attivata nell'emisfero patologico appariva dislocata rispetto a quella nell'emisfero controlaterale. Sino ad ora sono stati ripetuti gli esami di RMF dopo l'intervento chirurgico in tre pazienti che non presentavano deficit motori significativi all'arto superiore.

Neoplasms compressing or infiltrating cerebral cortex often alter the normal anatomy in such a way that the neurosurgeon can not easily localize and spare functional areas. Moreover, the results of mass effect on brain functional anatomy have not been extensively investigated in vivo yet.

Water temperature influences growth and gonad differentiation in European sea bass (Dicentrarchus labrax, L. 1758)

The effect of rearing temperature on gonad differentiation and growth was evaluated in sea bass (Dicentrarchus labrax). One control group (CG, n = 60) and two experimental groups (EG1, n = 30; EG2, n = 30) were selected. CG was reared at 15.0 °C during 10 days post-hatch (dph) and at 19.0 °C throughout the remaining larval and post-larval development. EG1 was exposed to 14.5 °C from 1 to 50 dph, followed by an increase to 20 °C until sampling (176 dph). EG2 was exposed to 14.5 °C from 1 to 37 dph, followed by an increase to 20 °C until sampling (226 dph); 30 fish from CG were randomly sampled at 176 dph (CG1, control for EG1) and 30 fish were sampled at 226 dph (CG2, control for EG2). Weight, total and fork length measurement, and gonad collection were performed. All biometric indices were higher in EG1 and EG2 than in CG1 and CG2, respectively. Histologic analysis reported 100% of undifferentiated gonads in CG1 and; EG1 reported 80% of undifferentiated gonads and 20% of gonads at early differentiation toward the male line. CG2 reported 34% of undifferentiated gonads, 10% of gonads at early differentiation toward the female line, 23% of gonads at early differentiation toward the male line, and 33% of gonads with intratesticular oocytes. EG2 reported 47% of gonads differentiated in testis, 33% gonads differentiated in ovary, and 20% of gonads with intratesticular oocytes. These results suggest that water temperature plays an important role in the process of gonad differentiation and growth of sea bass.

The peripartum period influenced the serum macromineral profile in mares

Abstract. Changes in metabolic requirements during pregnancy may produce nutritional imbalances predisposing mares to pathological conditions. Therefore, we aimed to examine changes in serum macrominerals during the peripartum period in mares. Fifteen pregnant mares (Group A) were monitored starting at the 263rd day of pregnancy until the 21st day after foaling. Seven non-pregnant and non-lactating mares were used as a control group (Group B). Group A was subjected to blood sampling within 24 ± 12 h after parturition (P) and then 7, 14 and 21 days after foaling (+1, +2, +3 weeks, respectively). Group B was subjected to regular sampling throughout the study to ensure that seasonal changes had no significant effect on studied parameters. Serum samples were analysed for serum electrolytes including sodium (Na+), potassium (K+), calcium (Ca+ + ), phosphorus (P+), chloride (Cl−) and magnesium (Mg+ + ). Two-way repeated measures of analysis of variance (ANOVA) was applied to evaluate significant effects of peripartum on electrolyte concentrations. Group A showed a decrease in Cl− concentrations (P = 0.011) after foaling and lower P+ concentrations (P = 0.015) compared to Group B throughout the study. The linear regression model showed an increase in Na+ concentrations (P = 0.002) and a gradual decrease in serum Ca+ +  (P = 0.001) during pregnancy. Because the most significant changes in serum electrolytes occurred within 2 weeks before and 2 weeks after foaling, monitoring serum electrolyte concentrations would indicate whether the mare needs further mineral supplementation at this stage. The significant changes in a mare's macromineral profile that we observed over the peripartum provide enhanced knowledge about mineral interrelations and their modifications during specific physiological conditions such as late pregnancy and early postpartum.

Laparoscopic left lateral hepatectomy for colorectal metastasis is the standard of care

PURPOSE

Over the last decade, laparoscopic liver surgery has significantly evolved. The aim of this study was to analyse the outcomes of Laparoscopic Left Lateral Hepatectomy (LLLH) for colorectal cancer (CRC) metastases in a tertiary referral hepato-pancreato-biliary centre.

METHODS

A consecutive series of patients undergoing LLLH between January 2009 and April 2013 were analysed using prospectively collected data in a tertiary referral HPB centre. In particular, the study focused on patients who had LLLH for colorectal liver metastasis (CRLM). The following features were analysed: operative time, intraoperative blood loss, number and size of tumours, resection margins, complication rates, follow up period and recurrence rates.

RESULTS

A total of 17 patients were finally included. There were no bile leaks or collections and no postoperative bleeding. The median hospital stay was 4 days (range 2-10). The median size of the metastatic lesions was 28.1 mm (range 8-56). The resection was R0 in all except 2 patients (11%) where the margin was less than 1 mm. The mean resection margin was 14.6 mm (range 1-50). Eight patients (47%) did not develop any recurrence till latest follow up. Seven patients (41%) developed recurrence in the liver or lungs. The median time to recurrence was 11 months (range 2-12). There was only one death in the follow up period (22-77 months). Sixteen patients (94%) were alive at the latest follow up.

CONCLUSION

LLLH for CRLM is safe and can be performed with low complication rates, adequate resection margins, short hospital stay, and oncologic outcomes similar to those of open surgery.

Metabolic profile of broodmares during late pregnancy and early post-partum

Pregnancy represents a specific physiological status characterized by continuous adjustments that affect maternal metabolism of all nutrients. In the last trimester of pregnancy, mare's nutrient requirements greatly increase and most pregnancy-associated diseases are likely to occur. Therefore, we aimed to assess the metabolic profile of broodmares focusing on the last 3 months of pregnancy and the early post-partum. Fifteen pregnant mares (Group A) were monitored from 263 ± 3 days of pregnancy until 21 days after foaling. Seven non-pregnant mares (Group B) were used as the control group. Blood samples were collected weekly by jugular venipuncture throughout the experimental period, and additional blood samples were collected within 24 ± 12 h of foaling. Obtained sera were analyzed for urea (Ur), creatinine (Cre), total protein (TP), total, direct and indirect bilirubin (tB, dB, iB), triglycerides (TG), total cholesterol (tChol) and β-hydroxybutyrate (BHB). During pregnancy, Ur (p = 0.015) and dB (p = 0.028) were higher in Group A than Group B. Serum Cre, tB, iB and TG (p < 0.001) decreased after foaling; furthermore, Group A exhibited lower tChol (p < 0.001) and higher BHB (p < 0.001) than Group B during the study. There were significant interactions of time × peripartum on Ur (p = 0.007), Cre (p < 0.001), tB (p = 0.018), TG (p < 0.001) and tChol (p < 0.001). These results can be used in the interpretation of biochemical studies in late gestation mares which develop systemic disease. The improved understanding of the metabolic profile during the peripartum might assist in monitoring the health status of the broodmares to promote foetal growth and well-being.

Hemostatic profile during late pregnancy and early postpartum period in mares

Hemostasis is a physiological process that prevents excessive blood loss and represents a protective mechanism at the time of delivery. Peripartum hemorrhage is a recurring hazardous condition to mare's health; therefore, we aimed to study mares' hemostatic profile to investigate whether physiological adjustments occur during late pregnancy and early postpartum. Fifteen pregnant mares have been monitored from the 34th week of pregnancy until the third week after foaling. Fifteen nonpregnant mares were used as control group. Jugular blood samples were analyzed for platelet count (Plt), prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen (Fb). Platelet count showed significant changes at foaling (P < 0.05) and a negative correlation (r = -0.968; P = 0.032) with postpartum. Prothrombin time changed (P < 0.05) showing a significant correlation (r = 0.675; P = 0.016) with late pregnancy. Fibrinogen concentrations changed throughout the experimental period (P < 0.0001). The linear regression model revealed a positive correlation (r = 0.9210; P < 0.0001) between Fb and late pregnancy and a negative correlation (r = -0.9583; P = 0.042) between Fb and early postpartum. The shortening in PT recorded in the imminence of parturition along with the increase in Plt and Fb at foaling might reflect a physiological hypercoagulable state that constrains excessive bleeding, enhancing mares' odds of surviving. Our research improves the knowledge about blood coagulation in periparturient mares providing specific information on routine coagulation tests that may support in monitoring mare's hemostatic profile during late pregnancy and early postpartum.

Changes in blood coagulation induced by exercise training in young athletic horses

Prothrombin Time (PT), Activated Partial Prothrombin Time (APTT), Fibrinogen concentration (Fbg) and Platelet number (Plt) were evaluated in 20 young athletic horses during a training program. A standardized exercise test (SET) was performed every month for three months. The V4 variations (the speed, in m/min, reached at the blood lactate concentration of 4 mmol/l) obtained for each test were calculated to assess the effect of training program on athletic performance. Blood samples were collected at 20-day intervals over a period of 80 days from the beginning of the training program. The V4 (P < 0.001), PT (P < 0.001), APTT (P < 0.01), Fbg (P < 0.01) and Plt (P < 0.001) varied throughout the training period showing that the modifications of clotting mechanism in response to training period may be considered as a normal physiological response of the hemostatic system to training exercise.

Laparoscopic right posterior sectionectomy for hepatocellular carcinoma using a modified liver-hanging maneuver

BACKGROUND

Posterosuperior liver segments are the most difficult locations for laparoscopy to access. This location is considered by most surgeons to be a poor indication for a laparoscopic liver resection due to the limited visualization and the difficulty of controlling bleeding. The liver-hanging maneuver (LHM) is a technique taking aim at reducing intraoperative blood loss through an open approach.

METHODS

We report our early experience on adopting a modified liver-hanging technique to perform a totally laparoscopic right posterior sectionectomy to remove a 5-cm hepatocellular carcinoma located in Couinaud's segments 6 and 7.

RESULTS

The procedure was completed laparoscopically with acceptable time of surgery and blood loss. A 3.5-cm tumor-free resection margin was achieved. The patient was discharged on postoperative Day 10 without complications. No evidence of recurrence was seen at the 12-month follow-up.

CONCLUSIONS

Total laparoscopic posterior sectionectomy using a modified LHM is a possible operative procedure greatly facilitating surgical manipulation. This maneuver was successfully used to mobilize the liver, to guide the hepatic transection, and to prevent bleeding. The potential advantages of this procedure should be evaluated in a comparative study on a large number of patients.

Cinnabarinic acid, an endogenous metabolite of the kynurenine pathway, activates type 4 metabotropic glutamate receptors

Cinnabarinic acid is an endogenous metabolite of the kynurenine pathway that meets the structural requirements to interact with glutamate receptors. We found that cinnabarinic acid acts as a partial agonist of type 4 metabotropic glutamate (mGlu4) receptors, with no activity at other mGlu receptor subtypes. We also tested the activity of cinnabarinic acid on native mGlu4 receptors by examining 1) the inhibition of cAMP formation in cultured cerebellar granule cells; 2) protection against excitotoxic neuronal death in mixed cultures of cortical cells; and 3) protection against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine toxicity in mice after local infusion into the external globus pallidus. In all these models, cinnabarinic acid behaved similarly to conventional mGlu4 receptor agonists, and, at least in cultured neurons, the action of low concentrations of cinnabarinic acid was largely attenuated by genetic deletion of mGlu4 receptors. However, high concentrations of cinnabarinic acid were still active in the absence of mGlu4 receptors, suggesting that the compound may have off-target effects. Mutagenesis and molecular modeling experiments showed that cinnabarinic acid acts as an orthosteric agonist interacting with residues of the glutamate binding pocket of mGlu4. Accordingly, cinnabarinic acid did not activate truncated mGlu4 receptors lacking the N-terminal Venus-flytrap domain, as opposed to the mGlu4 receptor enhancer, N-phenyl-7-(hydroxyimino)cyclopropa[b]chromen-1a-carboxamide (PHCCC). Finally, we could detect endogenous cinnabarinic acid in brain tissue and peripheral organs by high-performance liquid chromatography-tandem mass spectrometry analysis. Levels increased substantially during inflammation induced by lipopolysaccharide. We conclude that cinnabarinic acid is a novel endogenous orthosteric agonist of mGlu4 receptors endowed with neuroprotective activity.

Influence of transportation on serum concentrations of acute phase proteins in horse

The modifications of Haptoglobin (Hp), Serum Amyloid A (SAA), Fibrinogen (Fbg) and White Blood Cells (WBCs) were evaluated in 15 Saddle Italian horses. Ten horses were transported covering a distance of about 320 km within 4 h with an average speed of 80 km/h (experimental group) and five horses were not subject to transportation (control group). Blood was collected via jugular venipuncture before the transportation (T0), immediately after the transportation (T1), 12 (T12), 24 (T24) and 48 (T48)hours after the transportation in experimental group and at the same time point in control group. For each parameter statistical analysis of different groups and sampling time was performed using a two-way analysis of covariance, with the data before the transportation (T0) as the covariate, by the GLM procedure of SAS. For all parameters the interaction (Group × Time) was tested and it was resulted no significant. The application of statistical analysis showed significant differences between the control group and horses subjected to transportation (P<0.01), and the influence of sampling time (P<0.05) on Hp, SAA and WBCs. These modifications appeared to be innovative showing that equine Hp, generally considered as moderate acute phase protein, increases more rapidly than the SAA after transportation-induced stress.

Electrophoretic serum protein fraction profile during the different physiological phases in Comisana ewes

The aim of this study was to evaluate the influence of different physiological phases on serum total proteins and their fractions of ten Comisana ewes housed in Mediterranean area. From each animal, blood samples were collected at different physiological phases: late pregnancy, post-partum, early, mid-, end lactation and dry period. On all samples serum total proteins were determined by the biuret method, and albumin, α-globulins, β(1) -globulins, β(2) -globulins and γ-globulins concentrations were assessed using an automated system. One-way repeated measures analysis of variance was applied to determine the significant effect of different physiological phases on the parameters studied. During the late pregnancy and post-partum, total proteins, β1- and β2-globulins and γ-globulins showed the highest values. Starting from post-partum, α-globulins increased to reach their peaks in mid-lactation. Early lactation was characterized by low γ-globulins values. The increase in serum albumin concentration and the drop in some globulin fractions determined the significant increase in albumin/globulin ratio. The obtained results contributed to improve the knowledge on electrophoretic profile during the different physiological phases in ewes, confirming that pregnancy and lactation periods affect the protein metabolism. Particularly, serum protein fractions pattern could give information about dehydration, plasma volume expansion and hepatic function, which occur during the different physiological phases. Dynamics of the protein profile - from pregnancy to dry period - which are provided by our results, could be considered as guidelines for the management strategies to guarantee the nutritional needs of these animals during the different physiological phases and to avoid a decline of productive performance and consequently an economic loss.

Seasonal variations of the serum proteins in sheep and goats (Short Communication)

Abstract. The aim of this study was to assess the seasonal trend of the serum protein content of sheep and goats. The tested animals were six female goats (Maltese breed) and six female sheep (Valle del Belice breed). All animals were clinically healthy and not pregnant or lactating before or during the study. On blood samples, collected through an external jugular venipuncture every 30 days for 12 months, electrophoresis was performed using a semiautomated AGE system and then electrophoretic curves with the relative protein concentrations were analyzed. One way for repeated measure analysis of variance (ANOVA) was applied to determine the effect of time and by means of cosinor rythmometry, mesor (mean level), amplitude (half the range of oscillation) and acrophase (Φ, time of peak) were determined. The results showed a seasonal rhythm on Albumin and Alumin/Globulin ratio for sheep and goats, with different acrophases, winter for goats and spring for sheep. A seasonal rhythm was shown also in Alpha 2 globulins by sheep and in Beta globulins by goats. The difference in the acrophase can be attributed to a different production pattern of melatonin in goat, so the liver production of albumin is major during the winter that has a longer scotophase.

Training-induced modifications of circadian rhythmicity of peroxidative parameters in horses

The aim of this study was to evaluate the daily rhythms of peroxidative parameters in untrained and trained horses. Blood samples were collected every 4 h for a 48-h period for the determination of reactive oxygen metabolites test (d-ROMs), antioxidant barrier (Oxy-ads), thiol antioxidant barrier (SHp) and lipid peroxidation (LPO). Two-way anova showed a significant effect of time of day on all parameters studied, except on LPO. Higher values of Oxy-ads and SHp were observed in trained horses during both days of monitoring (p < 0.01). All studied parameters, except for LPO, showed robust daily rhythms. Their acrophases occurred during the day in untrained horses and in the evening in trained horses. Our results showed that training increases antioxidative capacity and demonstrated that the daily rhythms of antioxidative parameters can be modified by training.

Daily variations of serum lipids in Ovis aries under different lighting and feeding conditions

The aim of this study was to discriminate the impact of lighting and feeding conditions on the regulation of lipid metabolism in Ovis aries. Six clinically healthy female Comisana ewes, not pregnant and not lactating were kept under different environmental conditions: 12:12 light-dark (LD) cycle, constant darkness and fasting. Blood samples were collected at the end of each period of treatment every 4 h for a 24-h period. Blood concentration of triglycerides, total cholesterol and non-esterified fatty acid showed robust daily rhythmicity in ewes maintained under 12:12 LD cycle and fed ad libitum. Conversely, either constant darkness or fasting had a deep impact on all lipid parameters investigated. Our results suggest that lighting and feeding conditions have an impact on daily variations in lipid metabolism in ewes.

Levels of serum osteocalcin and some electrolytes in foal during the first six months of life (Brief Report)

Abstract. Bone is a dynamic tissue characterized by continuous bone formation and bone resorption. The transformation of the primordial part of the long bones (the cartilaginous matrix during the embryonal period) into the definitive bone (lamellar bone tissue) is completed after puberty. Osteocalcin, also called the vitamin k-dependent protein of bone and synthesized predominantly by osteoblasts and in lower way by odontoblasts, is incorporated into the extracellular matrix of bone (LEPAGE et al. 2001) and it may function as a useful indicator of the equine bone growth rate which decreases considerably with age. In particular, osteocalcin or bone Gla-protein is a small abundant non-collagenous calcium binding protein, indigenous to the organic matrix of bone dentin and possibly other mineralized tissue, which circulates in the blood (LEPAGE et al. 1991). It is accepted as a marker of osteoblast activity (RISTELI and RISTELI 1993) and plays a not yet defined role in the regulation of bone turnover (BOSKEY et al. 1998).

Modifications of some acute phase proteins and the white blood cell count in thoroughbreds during training

The concentrations of plasma fibrinogen and serum haptoglobin and the white blood cell count (WBC) were assessed in 17 thoroughbreds. All horses were trained for 80 days, six days a week, with one day of rest per week. Blood samples were collected from each animal by jugular venepuncture, at 06.00, every 20 days for a period of 80 days, and the fibrinogen and haptoglobin concentrations and WBC were determined. One-way repeated measures analysis of variance, followed by the Bonferroni test, was used to determine significant differences. Training was associated with a significant increase in the concentrations of plasma fibrinogen (P<0.01) and serum haptoglobin (P<0.0005), but had no significant effect on the WBC count.

Daily rhythms of serum and salivary parameters in goats

OBJECTIVE

Determine the daily rhythms of urea, bicarbonate, sodium, potassium, chloride, calcium, magnesium and inorganic phosphorus secretion in the serum and saliva of goats and whether there is a relationship between them.

DESIGN

Ten non-gravid, non-lactating does underwent a 30-day preconditioning period (natural 24-h photoperiod, environmental temperature 19-21 degrees C, relative humidity 40-50%, the same feeding regimen, offered as a single meal at 07:00 hours, and water ad libitum), following which saliva and blood samples were collected from each subject every 4 h for 2 days (starting at 08:00 hours) for measurement of urea and electrolytes.

RESULTS

Data analysis was conducted by one-way repeated measures analysis of variance (ANOVA) and by the single cosinor method. ANOVA showed a significant effect of time (0.001 < P < 0.01) on all the studied parameters in saliva and serum on both days. Cosinor analysis identified the periodic parameters and their acrophases (expressed in hours) during the 2 days of monitoring. Serum and salivary acrophases were all diurnal and were observed between 11:40 and 16:24 hours. No circadian rhythmicity was found for bicarbonate, magnesium or potassium in either saliva or serum.

CONCLUSION

There was a daily rhythm of secretion for the majority of the measured parameters, suggesting the potential role of saliva as an additional, reliable index for physiological, clinical, nutritional and chronophysiological studies.

Incidental detection by [11C]choline PET/CT of meningiomas in prostate cancer patients

AIM

Anti-androgenic hormonal therapy in prostate cancer patients with concomitant meningioma may result in tumor growth and development of neurological symptoms. Positron emission tomography/computed tomography (PET/CT) with [11C]choline is used for restaging prostate cancer patients with biochemical failure. In vitro and in vivo data support altered choline metabolism in meningiomas.

METHODS

During a retrospective study in prostate cancer patients with biochemical failure referred to our institution between November 2004 and January 2007, encephalic focal uptake of [11C]choline was incidentally noted in 4 patients, 2 of which had been taking luteinizing hormone-releasing hormone analogs.

RESULTS

Subsequent to the incidental finding, one patient underwent surgical removal of the meningioma; strict neuroradiological follow-up was planned for the 3 other patients.

CONCLUSION

We suggest that in prostate cancer patients candidate for anti-androgenic therapy the whole body [11C]choline PET/CT scan should include the whole skull to check for the possible presence of meningiomas. This could help to identify patients at risk for the development of neurological symptoms during anti-androgenic therapy and help the referring urologist in the clinical management of these patients.