AIM: To determine the safety and effectiveness of transarterial embolization ablation (TEA) of hepatocellular carcinoma (HCC) with a lipiodol-ethanol mixture.

METHODS: Between January 1 and December 31, 2009, 15 patients with HCC (13 men/two women, aged 38-75 years) accepted TEA treatment and were enrolled in this study, including five newly diagnosed patients and 10 with refractory disease. Two months after TEA, angiography and contrast computed tomography (CT) were performed, and responses were assessed using a modified version of Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). The follow-up period was to June 30, 2010.

RESULTS: Every new case was treated once. Angiography was performed immediately after TEA, and showed that the tumor-feeding vessels were completely embolized and that lipiodol was densely deposited inside tumors. Two months after treatment, contrast CT showed no enhanced lesions. Alpha fetoprotein levels returned to normal in four patients and markedly decreased in another. mean ± SD survival after treatment was 10.8 ± 4.5 mo. All five patients survived during the follow-up period. Ten patients with refractory disease were treated a total of 14 times. Angiography immediately after TEA showed that blood flow to the tumors was obviously decreased in all cases, and contrast CT showed obvious depositions of lipiodol. Two months after treatment, the tumors had shrunk (6/10) or were stable (3/10). One had progressed after 2 mo and died of tumor rupture 3 mo after TEA. mean ± SD survival after treatment was 8.6 ± 4.3 mo; two patients survived during the follow-up period. Adverse effects included reversible hepatic decompensation, upper abdominal pain, and fever.

CONCLUSION: TEA is an effective therapy for patients with HCC and might be more effective than transcather arterial chemoembolization for treating refractory disease.

In the title compound, C24H16Cl2N2O3, the three benzene rings are twisted with respect to the central pyrazole ring, making dihedral angles of 71.56 (9) (4-chloro­benzo­yloxy), 57.55 (8) (4-chloro­benzo­yl) and 39.33 (1)° (phen­yl).

The title compound, C18H20O4, was synthesized by a Wittig–Horner reaction of diethyl 3,4-dimeth­oxy­benzyl­phosphate and 3,5-dimeth­oxy­benzaldehyde. In the crystal, the dihedral angle between the two aromatic rings is 2.47 (12)°. All the meth­oxy groups are almost coplanar with the aromatic ring to which they are attached [C—C—O—C torsion angles = −2.8 (3), −5.2 (4), −176.3 (2) and −178.0 (2)°].

In the title mol­ecule, C8H11NO2, the r.m.s. deviation of non-H atoms from their best plane is 0.031 Å. Mol­ecules are connected via a pair of N—H⋯O hydrogen bonds into a centrosymmetric dimer.

The title compound, C10H11N3O2, was synthesized by the reaction of 1H-benzotriazole with ethyl 2-chloro­acetate in ethanol. The non-H atoms, excluding the benzotriazol-1-yl group, are almost coplanar (r.m.s. deviation of the non-H atoms = 0.0409 Å). The dihedral angle formed between this plane and the benzotriazole ring is 79.12 (5)° In the crystal, weak inter­molecular C—H⋯N and C—H⋯O inter­actions help to consolidate the three-dimensional network.

In the title compound, C9H10ClNO, the non-H atoms, excluding the phenyl group, are almost coplanar (r.m.s. deviation of the non-H atoms = 0.1015 Å). The dihedral angle formed between this plane and the benzene ring is 87.07 (5)°. Weak inter­molecular C—H⋯O inter­actions help to stabilize the packing.

The asymmetric unit of the title compound, C38H37N7O2, contains one half-mol­ecule, situated on a twofold rotational axis, in which one amino group is involved in intra­molecular N—H⋯O hydrogen bond and the two phenyl rings are twisted from the plane of pyrazolone ring by 26.69 (10) and 79.64 (8)°. The crystal packing exhibits no classical inter­molecular contacts.

The non-H atoms of the title compound, C9H13NO2, are almost coplanar (r.m.s. deviation = 0.0358 Å). Weak inter­molecular N—H⋯O hydrogen bonds link the mol­ecules into zigzag chains along the b axis with graph-set motif C(5). The chains are further linked into a three-dimensional network by C—H⋯O hydrogen bonds and C—H⋯π inter­actions.

In the title compound, C17H13ClN2O2·H2O, the dihedral angle between the quinoline ring system and the benzene ring is 13.0 (1)°. An intra­molecular N—H⋯O hydrogen bond may influence the mol­ecular conformation. In the crystal structure, acetamide mol­ecules are linked to water mol­ecules via inter­molecular O—H⋯ N and N—H⋯O hydrogen bonds and in turn linked into chains along [010] via O—H⋯O hydrogen bonds.

In the title compound, C16H18N2O2, the mol­ecule adopts an E conformation about the C=N double bond. The dihedral angle between the pyrrole and phenyl rings is 41.55 (8)°. In the crystal structure, pairs of inter­molecular N—H⋯O hydrogen bonds link the mol­ecules into centrosymmetric dimers. In the dimer, the two pyrrole rings are almost coplanar and the two phenyl rings are parallel to each other.

Objective: To evaluate the serious response during tilt-table test (TTT) and its prophylactic management. Method: Seventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline condition through a peripheral intravenous duct. Results: Fifty-one of 76 patients were defined as positive including 23 having serious response; 6 of the 23 patients had arteriosclerosis involving internal carotid arteries and 7 cases had bradycardia, two of which were associated with II°-I A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (6 cases), or serious bradycardia for more than 1 min (7 cases) or serious hypotension for more than 1 min (10 cases). Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2 cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered gradually by 10 min after emergency management, while others recovered rapidly with no complications. Conclusion: Although non-invasive, TTT may result in serious response, especially in elderly. Therefore proper patient selection, control of isoproterenol infusion and close observation of vital signs are decisive for a safe consequence.

Background

Children with germline mutations in TLR3, UNC93B1, TRAF3 and STAT1 are prone to herpes simplex virus-1 (HSV-1) encephalitis (HSE), owing to impaired TLR3-triggered, UNC-93B-dependent, interferon (IFN)-α/β and/or -λ-mediated STAT1-dependent immunity.

Objective

We explore here the molecular basis of the pathogenesis of HSE in a child with a hypomorphic mutation in NEMO, which encodes the regulatory subunit of the IκB kinase (IKK) complex.

Methods

The TLR3 signaling pathway was investigated in the patient's fibroblasts by analyses of IFN-β, -λ, and IL-6 mRNA and protein levels, by quantitative PCR and ELISA, respectively, upon TLR3 stimulation (TLR3 agonists or TLR3-dependent viruses). NF-κB activation was assessed by EMSA and IRF-3 dimerization on native gels after stimulation with a TLR3 agonist.

Results

The patient's fibroblasts displayed impaired responses to TLR3 stimulation in terms of IFN-β, -λ, and IL-6 production, owing to impaired activation of both NF-κB and IRF-3. Moreover, vesicular stomatitis virus (VSV), a potent IFN-inducer in human fibroblasts, and HSV-1, induced only low levels of IFN-β and -λ in the patient's fibroblasts, resulting in enhanced viral replication and cell death, as reported for UNC-93B-deficient fibroblasts.

Conclusion

HSE may occur in patients carrying NEMO mutations, due to the impairment of NF-κB- and IRF-3-dependent-TLR3-mediated antiviral IFN production.

The complete mol­ecule of the title compound, C42H36N6O2, is generated by a crystallographic twofold axis with two C atoms of the central phenyl group lying on the axis. In the independent part of the mol­ecule, one amino group is involved in an intra­molecular N—H⋯O hydrogen bond, and the two adjacent phenyl rings are twisted from the plane of the pyrazolone ring with dihedral angles of 6.82 (3) and 88.32 (6)°. The crystal packing exhibits no classical inter­molecular contacts.