Focal nodular hyperplasia(FNH) is a benign hepatic tumor characterized by hepatocyte hyperplasia and a central stellate scar.The association of FNH with other hepatic lesions,such as adenomas,hemangiomas and hepatocel...Focal nodular hyperplasia(FNH) is a benign hepatic tumor characterized by hepatocyte hyperplasia and a central stellate scar.The association of FNH with other hepatic lesions,such as adenomas,hemangiomas and hepatocellular carcinoma,has been previously reported,but FNH associated with another hepatic tumor is rare in infants.Here we report a case of FNH coexistentwith hepatoblastoma in a 36-d-old girl.Computed tomography(CT) imaging showed an ill-delineated,inhomogeneous enhanced mass with a central star-like scar in the right lobe of the liver.The tumor showed early mild enhancement at the arterial phase(from 40 HU without contrast to 52 HU at the arterial phase),intense enhancement at the portal phase(87.7HU) and 98.1HU in the 3-min delay scan.A central scar in the tumor presented as low density on non-contrast CT and slightly enhanced at delayed contrast-enhanced scanning.This infant underwent surgical resection of the tumor.Histopathology demonstrated typical FNH coexistent with a focal hepatoblastoma,which showed epithelioid tumor cells separated by proliferated fibrous tissue.展开更多
Inositol requiring mutant 80(INO80)is a chromatin remodeler that regulates pluripotency maintenance of embryonic stem cells and reprogramming of somatic cells into pluripotent stem cells.However,the roles and mechanis...Inositol requiring mutant 80(INO80)is a chromatin remodeler that regulates pluripotency maintenance of embryonic stem cells and reprogramming of somatic cells into pluripotent stem cells.However,the roles and mechanisms of INO80 in porcine preimplantation embryonic development remain largely unknown.Here,we show that INO80 modulates trophectoderm epithelium permeability to promote porcine blastocyst development.The INO80 protein is highly expressed in the nuclei during morula-toblastocyst transition.Functional studies revealed that RNA interference(RNAi)-mediated knockdown of INO80 severely blocks blastocyst formation and disrupts lineage allocation between the inner cell mass and trophectoderm.Mechanistically,singleembryo RNA sequencing revealed that INO80 regulates multiple genes,which are important for lineage specification,tight junction assembly,and fluid accumulation.Consistent with the altered expression of key genes required for tight junction assembly,a permeability assay showed that paracellular sealing is defective in the trophectoderm epithelium of INO80 knockdown blastocysts.Importantly,aggregation of 8-cell embryos from the control and INO80 knockdown groups restores blastocyst development and lineage allocation via direct complementation of the defective trophectoderm epithelium.Taken together,these results demonstrate that INO80 promotes blastocyst development by regulating the expression of key genes required for lineage specification,tight junction assembly,and fluid accumulation.展开更多
BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of...BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.展开更多
BACKGROUND Preoperative diagnosis of appendiceal mucinous neoplasms is challenging,and there are few reports regarding the endosonographic characteristics of these neoplasms.AIM To provide a retrospective assessment o...BACKGROUND Preoperative diagnosis of appendiceal mucinous neoplasms is challenging,and there are few reports regarding the endosonographic characteristics of these neoplasms.AIM To provide a retrospective assessment of the imaging features of appendiceal mucinous neoplasms using endoscopic ultrasound(EUS)by curved linear-array echoendoscope.METHODS A database of all patients with appendiceal mucinous neoplasms who had received EUS examination at our hospital between January 2018 and July 2023 was retrospectively analyzed.The EUS characteristics and patients’clinical data were reviewed.RESULTS Twenty-two patients were included in the study.The linear-array echoendoscope successfully reached the ileocecal region in every patient.In the endoscopic view,we could observe the protrusion in the appendiceal orifice in all patients.A volcano sign was observed in two patients,and an atypical volcano sign was seen in two patients.EUS showed that all 22 lesions were submucosal cystic hypoechoic lesions with clear boundaries.No wall nodules were observed,but an onion-peeling sign was observed in 17 cases.CONCLUSION Linear-array echoendoscope is safe to reach the ileocecal region under the guidance of EUS.Image features on endoscopic and echoendosonograhic views could be used to diagnose appendiceal mucinous neoplasms.展开更多
BACKGROUND Locally advanced pancreatic cancer(LAPC)is a common malignant digestive system tumor that ranks as the fourth leading cause of cancer-related death in the world.The prognosis of LAPC is poor even after stan...BACKGROUND Locally advanced pancreatic cancer(LAPC)is a common malignant digestive system tumor that ranks as the fourth leading cause of cancer-related death in the world.The prognosis of LAPC is poor even after standard treatment.Irreversible electroporation(IRE)is a novel ablative strategy for LAPC.Several studies have confirmed the safety of IRE.To date,no prospective studies have been performed to investigate the therapeutic efficacy of conventional gemcitabine(GEM)plus concurrent IRE.AIM To compare the therapeutic efficacy between conventional GEM plus concurrent IRE and GEM alone for LAPC.METHODS From February 2016 to September 2017,a total of 68 LAPC patients were treated with GEM plus concurrent IRE(n=33)or GEM alone(n=35).Overall survival(OS),progression free survival(PFS),and procedure-related complications were compared between the two groups.Multivariate analyses were performed to identify any prognostic factors.RESULTS There were no treatment-related deaths.The technical success rate of IRE ablation was 100%.The GEM+IRE group had a significantly longer OS from the time of diagnosis of LAPC(19.8 mo vs 9.3 mo,P<0.0001)than the GEM alone group.The GEM+IRE group had a significantly longer PFS(8.3 mo vs 4.7 mo,P<0.0001)than the GEM alone group.Tumor volume less than 37 cm3 and GEM plus concurrent IRE were identified as significant favorable factors for both the OS and PFS.CONCLUSION Gemcitabine plus concurrent IRE is an effective treatment for patients with LAPC.展开更多
BACKGROUND We present the case of a 72-year-old female patient with gallbladder cancer(GBC)who developed in situ recurrence and liver metastases 9 mo after irreversible electroporation ablation and oral tegafur(a fluo...BACKGROUND We present the case of a 72-year-old female patient with gallbladder cancer(GBC)who developed in situ recurrence and liver metastases 9 mo after irreversible electroporation ablation and oral tegafur(a fluoropyrimidine derivative)chemotherapy,which failed to control the progression of the disease.The patient further developed metastases in the lymph nodes around the head of the pancreas.The patient had severe anemia,requiring weekly blood transfusions.The gallbladder tumor invaded the descending part of the duodenum,causing intestinal leakage and hepatic colonic adhesion.CASE SUMMARY The patient refused other treatments and began daily hydrogen inhalation therapy.After 1 mo of treatment,the gallbladder and liver tumors continued to progress,and intestinal obstruction occurred.After continuous hydrogen therapy and symptomatic treatments including gastrointestinal decompression and intravenous nutrition support,the intestinal obstruction was gradually relieved.Three months after hydrogen therapy,the metastases in the abdominal cavity gradually reduced in size,her anemia and hypoalbuminemia were corrected,lymphocyte and tumor marker levels returned to normal,and the patient was able to resume normal life.CONCLUSION This is the first report of an efficacy and safety study about hydrogen therapy in patient with metastatic GBC and a critical general condition,who has remained stable for more than 4 months.展开更多
BACKGROUND Solid pseudopapillary tumor(SPT) of the pancreas is a rare pancreatic tumor and 10% to 15% of cases are associated with metastasis. Cryoablation is a new method that can induce tumor necrosis, and treatment...BACKGROUND Solid pseudopapillary tumor(SPT) of the pancreas is a rare pancreatic tumor and 10% to 15% of cases are associated with metastasis. Cryoablation is a new method that can induce tumor necrosis, and treatment of tumors by cryoablation can cause anti-tumor immune responses.CASE SUMMARY A 16-year-old woman with SPT of the pancreas developed liver metastases 5.3 years after complete resection of the primary pancreatic tumor. She was admitted with chief complaints of abdominal pain in the upper abdomen and a weight loss of approximately 5 kg over 4 mo. Carbohydrate antigen(CA) 125,carcinoembryonic antigen, and CA 199 were normal. An abdominal computed tomography scan found multiple nodules in the right lobe of the liver that measured approximately 13.5 cm × 10.8 cm × 21.4 cm. Immunohistochemical staining results showed that CD10 and CD56 were positive, and the patient was diagnosed with SPT of the pancreas with liver metastasis. The patient underwent percutaneous cryoablation and interventional embolization. During the 5-year follow-up, the patient remained disease-free after cryoablation, with relatively normal immune function.CONCLUSION Herein, we for the first time report the treatment of liver metastasis from SPT of the pancreas using cryoablation plus interventional embolization, which could be a promising alternative therapy for pancreatic SPT liver metastasis.展开更多
BACKGROUND Pancreatic cancer has a poor prognosis;40%–50% of patients have liver metastases at the time of initial diagnosis and only 15%–20% undergo surgical resection. Irreversible electroporation(IRE) is a new, n...BACKGROUND Pancreatic cancer has a poor prognosis;40%–50% of patients have liver metastases at the time of initial diagnosis and only 15%–20% undergo surgical resection. Irreversible electroporation(IRE) is a new, non-thermal local ablation method for solid tumors, which can induce cell membrane permeabilization,resulting in unrecoverable nanoscale perforation and apoptotic cell death without damaging the structural components of tissues.CASE SUMMARY We report the case of a 66-year-old female patient with liver metastasis from pancreatic cancer with a pathological diagnosis of poorly differentiated adenocarcinoma. Carbohydrate antigen 19-9 was elevated to 420.3 U/m L.Computed tomography showed a pancreas mass of 2.7 cm × 2.5 cm and single liver metastasis of 1.4 cm × 1.1 cm in the S6 area. The patient underwent IRE and arterial infusion chemotherapy and received tegafur. The therapeutic effect of the combination treatment has been evaluated as complete response. To date, the patient has survived for > 12 mo and is receiving tegafur as maintenance therapy(at the time this case report was written).CONCLUSION IRE plus arterial infusion chemotherapy and tegafur may be synergistic,providing a reference for treating liver metastasis from pancreatic cancer.展开更多
Introduction Imiquimod is an immune response modifier,currently the 5% imiquimod cream is approved for treatment of extemal genital,perianal warts,superficial basal cell carcinoma,and actinic keratoses.Its anti-viral ...Introduction Imiquimod is an immune response modifier,currently the 5% imiquimod cream is approved for treatment of extemal genital,perianal warts,superficial basal cell carcinoma,and actinic keratoses.Its anti-viral activity and anti-tumoral activity seem to be dependent on focal activation of the immune system with induction,synthesis,and release of cytokines,such as interferonalpha,interleukin-12 and tumor necrosis factor alpha[1-2].展开更多
基金Supported by National Key Clinical Specialty Construction Programs of China(2014-2016)Medical Guide Project of Shanghai Municipal Science and Technology Commission,No.134119a4100(to Qiao ZW)
文摘Focal nodular hyperplasia(FNH) is a benign hepatic tumor characterized by hepatocyte hyperplasia and a central stellate scar.The association of FNH with other hepatic lesions,such as adenomas,hemangiomas and hepatocellular carcinoma,has been previously reported,but FNH associated with another hepatic tumor is rare in infants.Here we report a case of FNH coexistentwith hepatoblastoma in a 36-d-old girl.Computed tomography(CT) imaging showed an ill-delineated,inhomogeneous enhanced mass with a central star-like scar in the right lobe of the liver.The tumor showed early mild enhancement at the arterial phase(from 40 HU without contrast to 52 HU at the arterial phase),intense enhancement at the portal phase(87.7HU) and 98.1HU in the 3-min delay scan.A central scar in the tumor presented as low density on non-contrast CT and slightly enhanced at delayed contrast-enhanced scanning.This infant underwent surgical resection of the tumor.Histopathology demonstrated typical FNH coexistent with a focal hepatoblastoma,which showed epithelioid tumor cells separated by proliferated fibrous tissue.
基金supported by the Anhui Provincial Natural Science Foundation(1908085MC97,2008085MC85)National Natural Science Foundation of China(31802059,31902226)+1 种基金Hefei Innovation and Entrepreneurship Support Plan for Returnee Scholar(03082009)Anhui Provincial Innovation and Entrepreneurship Support Plan for Returnee Scholar(2020LCX015)。
文摘Inositol requiring mutant 80(INO80)is a chromatin remodeler that regulates pluripotency maintenance of embryonic stem cells and reprogramming of somatic cells into pluripotent stem cells.However,the roles and mechanisms of INO80 in porcine preimplantation embryonic development remain largely unknown.Here,we show that INO80 modulates trophectoderm epithelium permeability to promote porcine blastocyst development.The INO80 protein is highly expressed in the nuclei during morula-toblastocyst transition.Functional studies revealed that RNA interference(RNAi)-mediated knockdown of INO80 severely blocks blastocyst formation and disrupts lineage allocation between the inner cell mass and trophectoderm.Mechanistically,singleembryo RNA sequencing revealed that INO80 regulates multiple genes,which are important for lineage specification,tight junction assembly,and fluid accumulation.Consistent with the altered expression of key genes required for tight junction assembly,a permeability assay showed that paracellular sealing is defective in the trophectoderm epithelium of INO80 knockdown blastocysts.Importantly,aggregation of 8-cell embryos from the control and INO80 knockdown groups restores blastocyst development and lineage allocation via direct complementation of the defective trophectoderm epithelium.Taken together,these results demonstrate that INO80 promotes blastocyst development by regulating the expression of key genes required for lineage specification,tight junction assembly,and fluid accumulation.
基金supported by the National Clinical Research Center for Geriatric Diseases(No.NCRCGPLAGH-20190003)the Chinese Cardiovascular Health Alliance-Advanced Fund(No.2019-CCAACCESS-054).
文摘BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.
基金Hebei Medical Science Research Project,No.20191279.
文摘BACKGROUND Preoperative diagnosis of appendiceal mucinous neoplasms is challenging,and there are few reports regarding the endosonographic characteristics of these neoplasms.AIM To provide a retrospective assessment of the imaging features of appendiceal mucinous neoplasms using endoscopic ultrasound(EUS)by curved linear-array echoendoscope.METHODS A database of all patients with appendiceal mucinous neoplasms who had received EUS examination at our hospital between January 2018 and July 2023 was retrospectively analyzed.The EUS characteristics and patients’clinical data were reviewed.RESULTS Twenty-two patients were included in the study.The linear-array echoendoscope successfully reached the ileocecal region in every patient.In the endoscopic view,we could observe the protrusion in the appendiceal orifice in all patients.A volcano sign was observed in two patients,and an atypical volcano sign was seen in two patients.EUS showed that all 22 lesions were submucosal cystic hypoechoic lesions with clear boundaries.No wall nodules were observed,but an onion-peeling sign was observed in 17 cases.CONCLUSION Linear-array echoendoscope is safe to reach the ileocecal region under the guidance of EUS.Image features on endoscopic and echoendosonograhic views could be used to diagnose appendiceal mucinous neoplasms.
基金Supported by International Science Foundation of Affiliated Fuda Cancer Hospital,Jinan University,No.Y2018-ZD-01.
文摘BACKGROUND Locally advanced pancreatic cancer(LAPC)is a common malignant digestive system tumor that ranks as the fourth leading cause of cancer-related death in the world.The prognosis of LAPC is poor even after standard treatment.Irreversible electroporation(IRE)is a novel ablative strategy for LAPC.Several studies have confirmed the safety of IRE.To date,no prospective studies have been performed to investigate the therapeutic efficacy of conventional gemcitabine(GEM)plus concurrent IRE.AIM To compare the therapeutic efficacy between conventional GEM plus concurrent IRE and GEM alone for LAPC.METHODS From February 2016 to September 2017,a total of 68 LAPC patients were treated with GEM plus concurrent IRE(n=33)or GEM alone(n=35).Overall survival(OS),progression free survival(PFS),and procedure-related complications were compared between the two groups.Multivariate analyses were performed to identify any prognostic factors.RESULTS There were no treatment-related deaths.The technical success rate of IRE ablation was 100%.The GEM+IRE group had a significantly longer OS from the time of diagnosis of LAPC(19.8 mo vs 9.3 mo,P<0.0001)than the GEM alone group.The GEM+IRE group had a significantly longer PFS(8.3 mo vs 4.7 mo,P<0.0001)than the GEM alone group.Tumor volume less than 37 cm3 and GEM plus concurrent IRE were identified as significant favorable factors for both the OS and PFS.CONCLUSION Gemcitabine plus concurrent IRE is an effective treatment for patients with LAPC.
文摘BACKGROUND We present the case of a 72-year-old female patient with gallbladder cancer(GBC)who developed in situ recurrence and liver metastases 9 mo after irreversible electroporation ablation and oral tegafur(a fluoropyrimidine derivative)chemotherapy,which failed to control the progression of the disease.The patient further developed metastases in the lymph nodes around the head of the pancreas.The patient had severe anemia,requiring weekly blood transfusions.The gallbladder tumor invaded the descending part of the duodenum,causing intestinal leakage and hepatic colonic adhesion.CASE SUMMARY The patient refused other treatments and began daily hydrogen inhalation therapy.After 1 mo of treatment,the gallbladder and liver tumors continued to progress,and intestinal obstruction occurred.After continuous hydrogen therapy and symptomatic treatments including gastrointestinal decompression and intravenous nutrition support,the intestinal obstruction was gradually relieved.Three months after hydrogen therapy,the metastases in the abdominal cavity gradually reduced in size,her anemia and hypoalbuminemia were corrected,lymphocyte and tumor marker levels returned to normal,and the patient was able to resume normal life.CONCLUSION This is the first report of an efficacy and safety study about hydrogen therapy in patient with metastatic GBC and a critical general condition,who has remained stable for more than 4 months.
文摘BACKGROUND Solid pseudopapillary tumor(SPT) of the pancreas is a rare pancreatic tumor and 10% to 15% of cases are associated with metastasis. Cryoablation is a new method that can induce tumor necrosis, and treatment of tumors by cryoablation can cause anti-tumor immune responses.CASE SUMMARY A 16-year-old woman with SPT of the pancreas developed liver metastases 5.3 years after complete resection of the primary pancreatic tumor. She was admitted with chief complaints of abdominal pain in the upper abdomen and a weight loss of approximately 5 kg over 4 mo. Carbohydrate antigen(CA) 125,carcinoembryonic antigen, and CA 199 were normal. An abdominal computed tomography scan found multiple nodules in the right lobe of the liver that measured approximately 13.5 cm × 10.8 cm × 21.4 cm. Immunohistochemical staining results showed that CD10 and CD56 were positive, and the patient was diagnosed with SPT of the pancreas with liver metastasis. The patient underwent percutaneous cryoablation and interventional embolization. During the 5-year follow-up, the patient remained disease-free after cryoablation, with relatively normal immune function.CONCLUSION Herein, we for the first time report the treatment of liver metastasis from SPT of the pancreas using cryoablation plus interventional embolization, which could be a promising alternative therapy for pancreatic SPT liver metastasis.
文摘BACKGROUND Pancreatic cancer has a poor prognosis;40%–50% of patients have liver metastases at the time of initial diagnosis and only 15%–20% undergo surgical resection. Irreversible electroporation(IRE) is a new, non-thermal local ablation method for solid tumors, which can induce cell membrane permeabilization,resulting in unrecoverable nanoscale perforation and apoptotic cell death without damaging the structural components of tissues.CASE SUMMARY We report the case of a 66-year-old female patient with liver metastasis from pancreatic cancer with a pathological diagnosis of poorly differentiated adenocarcinoma. Carbohydrate antigen 19-9 was elevated to 420.3 U/m L.Computed tomography showed a pancreas mass of 2.7 cm × 2.5 cm and single liver metastasis of 1.4 cm × 1.1 cm in the S6 area. The patient underwent IRE and arterial infusion chemotherapy and received tegafur. The therapeutic effect of the combination treatment has been evaluated as complete response. To date, the patient has survived for > 12 mo and is receiving tegafur as maintenance therapy(at the time this case report was written).CONCLUSION IRE plus arterial infusion chemotherapy and tegafur may be synergistic,providing a reference for treating liver metastasis from pancreatic cancer.
文摘Introduction Imiquimod is an immune response modifier,currently the 5% imiquimod cream is approved for treatment of extemal genital,perianal warts,superficial basal cell carcinoma,and actinic keratoses.Its anti-viral activity and anti-tumoral activity seem to be dependent on focal activation of the immune system with induction,synthesis,and release of cytokines,such as interferonalpha,interleukin-12 and tumor necrosis factor alpha[1-2].
