1.The Application of Dynamic Double Contrast Radiography in Early Esophageal Carcinoma
Zhidan LEI ; Wulin JIA ; Zejun WEN
Journal of Practical Radiology 2000;0(12):-
Objective To study the role of esophageal dynamic double contrast radiography(DDCR) in diagnosing early esophageal carcinoma(EEC).Methods The patients with clinical suspected EEC underwent conventional double contrast radiography(CDCR) and DDCR using digital fluoroscopic imaging unit.The radiographic materials including CDCR and DDCR in 40 cases of EEC proved by endoscopy or pathologic histology were analyzed by a blind study,and the reliability of CDCR and DDCR was evaluated.Results The major findings of EEC included the mucosal irregularity and tortuous,small niches and filling defect,the soft and expansive extent of esophageal wall reduced or disappeared.In showing the esophageal function,DDCR was significantly superior to CDCR(?~2=4.50,?
2.Diagnosis of testicular germ cell tumors with magnetic resonance imaging
Zejun WEN ; Dapeng SHI ; Shaocheng ZHU ; Yi WEI
Journal of Practical Radiology 2016;32(7):1066-1069,1084
Objective To explore the imaging characteristics of testicular germ cell tumors and to improve the MRI diagnostic level. Methods MRI and clinical data of 25 cases confirmed testicular germ cell tumor by pathological examination were retrospectively analyzed. All the 25 cases were performed plain scan of MRI,and 16 patients underwent MRI enhanced scan.The size,morphology,signal intensity, adjacent structures,enhancement figure and tumor supplying artery were assessed and the histopathological findings were servered as the standard of reference.Results In the all 25 testicular germ cell tumors,10 cases were seminoma,8 cases showed homogeneous low signal intensity,2 cases of seminoma were low signal intensity on T2 WI,furthermore 5 cases performed poor nodular enhance-ment,2 cases performed homogeneous enhancement,4 cases performed fibrous septa enhancement.4 cases were yolk sac tumor ap-peared equal-low signal on T1 WI,slightly high signal intensity on T2 WI and progressive enhancement.Mature teratoma,pidermoid cyst and mixed germ cell tumor were 3 cases respectively,the MRI demonstrated mixed low signal intensity on T1 WI and mixed high signal on T2 WI.2 cases were embryonal carcinoma demonstrated middle-low signal intensity on T1 WI,and mixed low signal intensity on T2 WI.The two cases revealed bleeding signal intensity and septa enhancement.Conclusion MRI can be used to diagnose germ cell tumors with high accuracy,and provides essential information for pathological type,stage and differential diagnosis.
3.A Label-free Immunosensor for Microcystins-LR Based on Graphene and Gold Nanocage
Huali DU ; Xuewen FU ; Yongping WEN ; Zejun QIU ; Limei XIONG ; Nianzhang HONG ; Yunhui YANG
Chinese Journal of Analytical Chemistry 2014;(5):660-665
A label-free electrochemical immunosensor using hollow structure nanomaterials based on its ordered porous and big surface area was designed. Au nanocage, with good conductivity, catalysis, and biocompatibility, was prepared and modified on the surface of glassy carbon electrode with graphene to immobilize antibody of microcystin directly. In the absence of microcystin, biosensor can obtain high current response signal of electrochemical probe ( [ Fe( CN) 6 ] 3-/4-. When microcystin was combined with its antibody specifically, the charge density and mass transfer resistance on the surface of electrode increased, resulting in a decrease of the corresponding peak current of [ Fe ( CN ) 6 ] 3-/4-. This change was in proportion to the concentration of microcystin indirectly. Experiment conditions such as cultivation time of antigen and concentration of antibody were optimized. The results showed wide linear range of 0. 05 μg/L-1. 0 mg/L and the detection limit of 0. 017 ng/mL. This sensor has good stability and simple production procedure. This sensor provides a new and simple means for the ultrasensitive determination of microcystins in real water samples.
4.Quality Evaluation of Isatidis Radix from Different Ecotypes by Projection Pursuit Model
Zejun ZHAO ; Ximei WANG ; Xiyan WEN ; Mei GUO ; Xia SHI ; Tao DU
Chinese Journal of Information on Traditional Chinese Medicine 2017;24(5):91-94
Objective To evaluate the quality of Isatidis Radix from different ecotypes by using projection pursuit model. Methods Totally 11 batches of Isatidis Radix from different ecotypes in Gansu Province were used as evaluation samples. With the contents of epigoitrin, uridine, guanosine, adenosine, benzoic acid, salicylic acid, indigo, indirubin, and alcohol extract as evaluating indexes, combined with projection pursuit model established by DPS V 9.50 statistics software, the quality of Isatidis Radix was evaluated. Results Based on the evalution of nine main indexes, quality order of the 11 batches of Isatidis Radix was acquired: S2>S1>S9>S7>S8>S3>S5>S10>S11>S4>S6. Conclusion The projection pursuit model was available for the quality evaluation of different ecotype Isatidis Radix. The quality of Isatidis Radix from different ecotypes is different significantly, and the quality of tetraploid Isatidis Radix of Shijiazhuang is the best.
5.High-resolution 3.0 T MR imaging of esophageal carcinoma with histopathological findings
Yi WEI ; Feifei GAO ; Sen WU ; Dapeng SHI ; Zejun WEN ; Jiliang ZHANG ; Tingyi SUN ; Shewei DOU ; Dandan ZHENG ; Peigang NING ; Shaocheng ZHU
Chinese Journal of Radiology 2017;51(7):505-510
Objective To prospectively determine the feasibility of high-resolution in vivo MR imaging in the evaluation of esophageal carcinoma invasion at 3.0 T.Methods One hundred and eighteen patients with esophageal carcinoma,proven by the gastroscopic biopsy,were prospectively studied using 3.0 T MR.The esophageal specimens were sectioned transversely to keep consistent in the orientation with the MR images,the histopathological stage was made and the thickness of the tumor on the largest diameter of the slice were measured.The MR images were reviewed in the transverse plane.According to the seventh American joint committee on cancer,the MR stage was made and the tumor's thickness was measured.The MR images and the histopathological slices were matched.The staging diagnostic efficacy of the MR imaging was evaluated with the histopathological results as the standard reference,Kappa test was used to compare the stage of MR imaging with that at the histopathological analysis.Bland-Altman scatterplots were used to compare the thickness of tumor measured on the MR images with that at the histopathological measurement.Results Ninety seven cases(82.2%,97/118) of MR stage were accurately made,including 7 T1a,15 T1b,18 T2,25 T3 and 32 T4a cases,furthermore,14 cases were over staged and 7 cased were underestimated.The MR stage was highly consistent with the histopathological stage (Kappa=0.772).The sensitivity for the staging of high-resolution MR imaging at 3.0 T was 58.3%(7/12) to 100.0%(32/32),the specificity was 95.3% (82/86) to 98.1% (104/106),and the accuracy was 91.5% (108/118) to 96.6% (114/118),respectively.Bland-Altman scatterplots demonstrated that the discrepancy of the mean thickness between the value obtained by three radiologists respectively and the histopathological analysis were 2.0,2.6 and 2.1 mm,which demonstrated a good consistency.Conclusion High-resolution MR images obtained at 3.0 T can be used to evaluate the depth of carcinoma invasion and provide excellent diagnostic accuracy for preoperative staging.
6.Effects of silencing circRNA ABCB10 expression on biological properties of colorectal cancer cells
Yi XIE ; Jianbo LIU ; Junmeng LI ; Chao ZHANG ; Chuangxin LU ; Zejun WEN
Chinese Journal of Oncology 2021;43(4):449-456
Objective:To investigate the expression of circular ribonucleic acid ABCB10 (circABCB10) in colorectal cancer tissues and cells and its effects on cell biological behavior, radiosensitivity and growth of subcutaneous xenografts.Methods:The tumor tissue and adjacent tissue from colorectal cancer patients treated in Henan People′s Hospital were collected from January 2018 to December 2018. Quantitative polymerase chain reaction (qPCR) was used to detect the expressions of circABCB10 and miR-217, cell viability was detected by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide (MTT), cell apoptosis rate was detected by flow cytometry, cell migration and invasion were detected by Transwell method, cell radiosensitivity was detected by colony formation assay. The downstream miRNAs of circABCB10 were predicted by Circular RNA Interactome and verified by the dual luciferase reporter gene experiment. The effect of circABCB10 on the growth of transplanted tumor was examined in nude mice.Results:The expression level of circABCB10 mRNA in colorectal cancer tissues was (3.97±2.12), higher than (1.13±0.64) in adjacent tissues ( P<0.05). The expression level of circABCB10 mRNA in FHC cells was (1.00±0.09), lower than that (4.53±0.44) in SW480, (3.12±0.32) in HCT116 and (3.51±0.36) in HT29 cells, respectively (all P<0.05). The MTT results showed that the absorbance values of SW480 cells in si-circABCB10-1 group at 48 and 72 hours after transfection were (0.36±0.04) and (0.43±0.04), lower than (0.48±0.05) and (0.82±0.08) in circ-negative control (NC) group, respectively (all P<0.05). The number of migrating cells and invasive cells in si-circABCB10-1 group were (45±8) and (34±7), lower than (106±21) and (84±15) in circ-NC group, respectively (all P<0.01). The radiosensitization ratio was 1.632. The results of subcutaneous transplantation assay showed that the tumor volume and tumor weight of the si-circABCB10-1 group were significantly lower than circ-NC group after 8 days of inoculation ( all P<0.05). MiR-217 is a target gene of circABCB10. Inhibition of miR-217 reversed the inhibitory effect of circABCB10 silencing on cell proliferation, migration, invasion and subcutaneous xenograft growth in nude mice and the radiosensitization activity. Conclusion:Silence of circABCB10 can up-regulate the expression of miR-217 to inhibit the proliferation, migration, invasion and growth of subcutaneous xenografts and increase the radiosensitivity of SW480 cells, which reveals the underlying molecular mechanism of colorectal cancer progression and provides a new sensitizing target for clinical radiotherapy of colorectal cancer.
7.Silence of circBANP increases radiosensitivity of colorectal cancer cells and inhibits growth of subcutaneous xenografts by up-regulating miR-338-3p expression
Yi XIE ; Jianbo LIU ; Junmeng LI ; Chao ZHANG ; Chuangxin LU ; Zejun WEN
Chinese Journal of Oncology 2021;43(5):533-540
Objective:To investigate the effect of circBANP on radiosensitivity of colorectal cancer cells and subcutaneous transplanted tumor in nude mice and its potential molecular mechanism.Methods:The carcinoma and adjacent normal mucosal tissues of 20 patients with colorectal cancer who were surgically resected in Henan People′s Hospital from January 2018 to January 2019 were selected. The radio-resistant colorectal cancer cell LoVo/R was established. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the expressions of circBANP and miR-338-3p. The radiation sensitivity was determined by cell clone formation experiment. Cell vitality was detected by using methyl thiazolyl tetrazolium (MTT). The expressions of autophagy-related protein microtubule-associated protein light chain 3 (LC3) and p62 were detected by western blot. The fluorescence intensity of LC3 in cells was detected by immunofluorescence assay. The downstream microRNAs (miRNAs) of circBANP were predicted by Circular RNA Interactome website and further verified by dual luciferase reporter gene assay. The transplanted tumor model of LoVo/R cells in nude mice was established, and the effect of circBANP on the growth of transplanted tumor after radiation was observed.Results:The expression levels of circBANP and miR-338-3p in colorectal cancer tissues were 3.21+ 0.29 and 0.47+ 0.04, respectively, which were significantly higher than 1.00+ 0.07 and 1.00+ 0.05 in adjacent tissues ( P<0.05). The circBANP expression level of LoVo/R cells was 3.21±0.34, higher than 1.00±0.07 of LoVo cells ( P<0.05), and the expression level of miR-338-3p of LoVo/R cells was 0.33±0.04, lower than 1.00±0.08 of LoVo cells ( P<0.05). After 4 Gy irradiation, compared with the control group, the viability of LoVo/R cells in the circBANP silencing group [(34±4)% vs (62±6)%, P<0.05], the cell survival fraction (0.07±0.02 vs 0.27±0.04, P<0.05) were decreased, and the radiation sensitization ratio was 1.843, the expression of LC3Ⅱ/Ⅰin LoVo/R cells increased while p62 expression decreased, the cell autophagy was observed. Autophagy inhibitor chloroquine reversed the increased expression of LC3Ⅱ/Ⅰ and inhibited expression of p62 in LoVo/R cells induced by radiation, and promoted the suppression of cell viability and survival induced by radiation, the radiotherapy sensitization ratio was 1.780. Compared with control group after 4 Gy irradiation, the relative fluorescence intensity of LC3 in circBANP silencing LoVo/R cells decreased (0.11±0.01 vs 1.00±0.12, P<0.05), the expression of LC3-Ⅱ/Ⅰdecreased (1.25±0.13 vs 3.84±0.39, P<0.05) while p62 expression increased (2.76±0.29 vs 1.00±0.08, P<0.05). As predicted by Circular RNA Interactome website and confirmed by double luciferase reporter gene assay, miR-338-3p was the target gene of circBANP. The relative fluorescence intensity of LC3 in circBANP silencing + anti-miR-338-3p + 4 Gy group increased (7.32±0.72 vs 1.00±0.09, P<0.05), the expression level of LC3-Ⅱ/Ⅰ increased (4.13±0.43 vs 2.31±0.23, P<0.05) while p62 expression decreased (0.34±0.03 and 1.00±0.11, P<0.05), the radiotherapy sensitization ratio was 0.596. Nude mice subcutaneously transplanted tumor experiment showed that the tumor volume and weight of circBANP silencing group on 13, 16, 19, 22, 25, 28, and 31 days were lower than those of control group ( P<0.05), while the tumor volume and weight of circBANP silencing + anti-miR-338-3p group on days of 13, 16, 19, 22, 25, 28 and 31 after inoculated were higher than those of circBANP+ anti-miR-NC group ( P<0.05). Conclusions:CircBANP can regulate the radiosensitivity of colorectal cancer cells by regulating the expression of miR-338-3p, and affect the growth of transplanted tumor in nude mice. CircBANP may be a potential target for enhancing radiosensitivity of colorectal cancer cells.
8.Effects of silencing circRNA ABCB10 expression on biological properties of colorectal cancer cells
Yi XIE ; Jianbo LIU ; Junmeng LI ; Chao ZHANG ; Chuangxin LU ; Zejun WEN
Chinese Journal of Oncology 2021;43(4):449-456
Objective:To investigate the expression of circular ribonucleic acid ABCB10 (circABCB10) in colorectal cancer tissues and cells and its effects on cell biological behavior, radiosensitivity and growth of subcutaneous xenografts.Methods:The tumor tissue and adjacent tissue from colorectal cancer patients treated in Henan People′s Hospital were collected from January 2018 to December 2018. Quantitative polymerase chain reaction (qPCR) was used to detect the expressions of circABCB10 and miR-217, cell viability was detected by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide (MTT), cell apoptosis rate was detected by flow cytometry, cell migration and invasion were detected by Transwell method, cell radiosensitivity was detected by colony formation assay. The downstream miRNAs of circABCB10 were predicted by Circular RNA Interactome and verified by the dual luciferase reporter gene experiment. The effect of circABCB10 on the growth of transplanted tumor was examined in nude mice.Results:The expression level of circABCB10 mRNA in colorectal cancer tissues was (3.97±2.12), higher than (1.13±0.64) in adjacent tissues ( P<0.05). The expression level of circABCB10 mRNA in FHC cells was (1.00±0.09), lower than that (4.53±0.44) in SW480, (3.12±0.32) in HCT116 and (3.51±0.36) in HT29 cells, respectively (all P<0.05). The MTT results showed that the absorbance values of SW480 cells in si-circABCB10-1 group at 48 and 72 hours after transfection were (0.36±0.04) and (0.43±0.04), lower than (0.48±0.05) and (0.82±0.08) in circ-negative control (NC) group, respectively (all P<0.05). The number of migrating cells and invasive cells in si-circABCB10-1 group were (45±8) and (34±7), lower than (106±21) and (84±15) in circ-NC group, respectively (all P<0.01). The radiosensitization ratio was 1.632. The results of subcutaneous transplantation assay showed that the tumor volume and tumor weight of the si-circABCB10-1 group were significantly lower than circ-NC group after 8 days of inoculation ( all P<0.05). MiR-217 is a target gene of circABCB10. Inhibition of miR-217 reversed the inhibitory effect of circABCB10 silencing on cell proliferation, migration, invasion and subcutaneous xenograft growth in nude mice and the radiosensitization activity. Conclusion:Silence of circABCB10 can up-regulate the expression of miR-217 to inhibit the proliferation, migration, invasion and growth of subcutaneous xenografts and increase the radiosensitivity of SW480 cells, which reveals the underlying molecular mechanism of colorectal cancer progression and provides a new sensitizing target for clinical radiotherapy of colorectal cancer.
9.Silence of circBANP increases radiosensitivity of colorectal cancer cells and inhibits growth of subcutaneous xenografts by up-regulating miR-338-3p expression
Yi XIE ; Jianbo LIU ; Junmeng LI ; Chao ZHANG ; Chuangxin LU ; Zejun WEN
Chinese Journal of Oncology 2021;43(5):533-540
Objective:To investigate the effect of circBANP on radiosensitivity of colorectal cancer cells and subcutaneous transplanted tumor in nude mice and its potential molecular mechanism.Methods:The carcinoma and adjacent normal mucosal tissues of 20 patients with colorectal cancer who were surgically resected in Henan People′s Hospital from January 2018 to January 2019 were selected. The radio-resistant colorectal cancer cell LoVo/R was established. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the expressions of circBANP and miR-338-3p. The radiation sensitivity was determined by cell clone formation experiment. Cell vitality was detected by using methyl thiazolyl tetrazolium (MTT). The expressions of autophagy-related protein microtubule-associated protein light chain 3 (LC3) and p62 were detected by western blot. The fluorescence intensity of LC3 in cells was detected by immunofluorescence assay. The downstream microRNAs (miRNAs) of circBANP were predicted by Circular RNA Interactome website and further verified by dual luciferase reporter gene assay. The transplanted tumor model of LoVo/R cells in nude mice was established, and the effect of circBANP on the growth of transplanted tumor after radiation was observed.Results:The expression levels of circBANP and miR-338-3p in colorectal cancer tissues were 3.21+ 0.29 and 0.47+ 0.04, respectively, which were significantly higher than 1.00+ 0.07 and 1.00+ 0.05 in adjacent tissues ( P<0.05). The circBANP expression level of LoVo/R cells was 3.21±0.34, higher than 1.00±0.07 of LoVo cells ( P<0.05), and the expression level of miR-338-3p of LoVo/R cells was 0.33±0.04, lower than 1.00±0.08 of LoVo cells ( P<0.05). After 4 Gy irradiation, compared with the control group, the viability of LoVo/R cells in the circBANP silencing group [(34±4)% vs (62±6)%, P<0.05], the cell survival fraction (0.07±0.02 vs 0.27±0.04, P<0.05) were decreased, and the radiation sensitization ratio was 1.843, the expression of LC3Ⅱ/Ⅰin LoVo/R cells increased while p62 expression decreased, the cell autophagy was observed. Autophagy inhibitor chloroquine reversed the increased expression of LC3Ⅱ/Ⅰ and inhibited expression of p62 in LoVo/R cells induced by radiation, and promoted the suppression of cell viability and survival induced by radiation, the radiotherapy sensitization ratio was 1.780. Compared with control group after 4 Gy irradiation, the relative fluorescence intensity of LC3 in circBANP silencing LoVo/R cells decreased (0.11±0.01 vs 1.00±0.12, P<0.05), the expression of LC3-Ⅱ/Ⅰdecreased (1.25±0.13 vs 3.84±0.39, P<0.05) while p62 expression increased (2.76±0.29 vs 1.00±0.08, P<0.05). As predicted by Circular RNA Interactome website and confirmed by double luciferase reporter gene assay, miR-338-3p was the target gene of circBANP. The relative fluorescence intensity of LC3 in circBANP silencing + anti-miR-338-3p + 4 Gy group increased (7.32±0.72 vs 1.00±0.09, P<0.05), the expression level of LC3-Ⅱ/Ⅰ increased (4.13±0.43 vs 2.31±0.23, P<0.05) while p62 expression decreased (0.34±0.03 and 1.00±0.11, P<0.05), the radiotherapy sensitization ratio was 0.596. Nude mice subcutaneously transplanted tumor experiment showed that the tumor volume and weight of circBANP silencing group on 13, 16, 19, 22, 25, 28, and 31 days were lower than those of control group ( P<0.05), while the tumor volume and weight of circBANP silencing + anti-miR-338-3p group on days of 13, 16, 19, 22, 25, 28 and 31 after inoculated were higher than those of circBANP+ anti-miR-NC group ( P<0.05). Conclusions:CircBANP can regulate the radiosensitivity of colorectal cancer cells by regulating the expression of miR-338-3p, and affect the growth of transplanted tumor in nude mice. CircBANP may be a potential target for enhancing radiosensitivity of colorectal cancer cells.
10.Influencing factors for microvascular invasion in hepatocellular carcinoma and construction of nomogram model based on three-dimensional visualization
Guanbin LUO ; Chiyu CAI ; Lianyuan TAO ; Dongxiao LI ; Zhuangzhuang YAN ; Yanbo WANG ; Liancai WANG ; Zejun WEN ; Peigang NING ; Deyu LI
Chinese Journal of Digestive Surgery 2024;23(2):280-288
Objective:To investigate the influencing factors for microvascular invasion (MVI) in hepatocellular carcinoma based on three-dimensional visualization and the construction of its nomogram model.Methods:The retrospective cohort study method was conducted. The clinico-pathological data of 190 patients with hepatocellular carcinoma who were admitted to Henan University People′s Hospital from May 2018 to May 2021 were collected. There were 148 males and 42 females, aged (58±12)years. The 190 patients were randomly divided into the training set of 133 cases and the validation set of 57 cases by the method of random number table in the ratio of 7:3. The abdominal three-dimensional visualization system was used to characterize the tumor morphology and other imaging features. Observation indicators: (1) analysis of influencing factors for MVI in hepatocellular carcinoma; (2) construction and evaluation of nomogram model of MVI in hepatocellular carcinoma. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q3), and non-parametric rank sum test was used for comparison between groups. Count data were expressed as absolute numbers, and the chi-square test was used for comparison between groups. Corresponding statistical methods were used for univariate analysis. Binary Logistic regression model was used for multivariate analysis. Receiver operator characteristic (ROC) curves were plotted, and the nomogram model was assessed by area under the curve (AUC), calibration curve, and decision curve. Results:(1) Analysis of influencing factors for MVI in hepatocellular carcinoma. Among 190 patients with hepatocellular carcinoma, there were 97 cases of positive MVI (including 63 cases in the training set and 34 cases in the validation set) and 93 cases of negative MVI (including 70 cases in the training set and 23 cases in the validation set). Results of multivariate analysis showed that alpha-fetoprotein, vascular endothelial growth factor, tumor volume, the number of tumors, and tumor morphology were independent factors affecting the MVI of patients with hepatocellular carcinoma ( odds ratio=5.06, 3.62, 1.00, 2.02, 2.59, 95% confidence interval as 1.61-15.90, 1.28-10.20, 1.00-1.01, 1.02-3.98, 1.03-6.52, P<0.05). (2) Construction and evaluation of nomogram model of MVI in hepatocellular carcinoma. The results of multivariate analysis were incorporated to construct a nomogram prediction model for MVI of hepatocellular carcinoma. ROC curves showed that the AUC of the training set of nomogram model was 0.85 (95% confidence interval as 0.79-0.92), the optimal fractional cutoff based on the Jordon′s index was 0.51, the sensitivity was 0.71, and the specificity was 0.84. The above indicators of validation set were 0.92 (95% confidence interval as 0.85-0.99), 0.50, 0.90, and 0.82, respectively. The higher total score of the training set suggested a higher risk of MVI in hepatocellular carcinoma. The calibration curves of both training and validation sets of nomogram model fitted well with the standard curves and have a high degree of calibration. The decision curve showed a high net gain of nomogram model. Conclusions:Alpha-fetoprotein, vascular endothelial growth factor, tumor volume, the number of tumors, and tumor morphology are independent influencing factors for MVI in patients with hepatocellular carcinoma. A nomogram model constructed based on three-dimensional visualized imaging features can predict MVI in hepatocellular carcinoma.