Summary
Background
Data on HCV‐related hepatocellular carcinoma (HCC) early recurrence in patients whose HCC was previously cured, and subsequently treated by direct‐acting antivirals (DAAs), are ...equivocal.
Aim
To assess the risk of HCC early recurrence after DAAs exposure in a large prospective cohort of HCV‐cirrhotic patients with previous successfully treated HCC, also looking for risk factors for cancer early recurrence.
Methods
We enrolled 143 consecutive patients with complete response after curative treatment of HCC, subsequently treated with DAAs and monitored by the web‐based RESIST‐HCV database. Clinical, biological, and virological data were collected. The primary endpoint was the probability of HCC early recurrence from DAA starting by Kaplan‐Meier method.
Results
Eighty‐six per cent of patients were in Child‐Pugh class A and 76% of patients were BCLC A. Almost all patients (96%) achieved sustained virological response. Twenty‐four HCC recurrences were observed, with nodular or infiltrative pattern in 83% and 17% of patients, respectively. The 6‐, 12‐ and 18‐month HCC recurrence rates were 12%, 26.6% and 29.1%, respectively. Main tumour size and history of prior HCC recurrence were independent risk factors for HCC recurrence by Cox multivariate model.
Conclusions
Probability of HCC early recurrence in patients who had HCC previously cured remains high, despite HCV eradication by DAAs. Risk was comparable but not higher to that reported in literature in DAA‐untreated patients. Previous HCC recurrence and tumour size can be used to stratify the risk of HCC early recurrence. Further studies are needed to assess impact of DAAs on late recurrence and mortality.
Transient elastography (TE) is adequate for a diagnosis of cirrhosis, but its accuracy for milder stages of fibrosis is much less satisfactory. The objective of this study was to compare the ...performance and the discordance rate of acoustic radiation force impulse (ARFI) and TE with liver biopsy in a cohort of chronic hepatitis C (CHC) patients.
One hundred thirty-nine consecutive patients with CHC were enrolled in two tertiary centers, and evaluated for histological (Metavir score) and biochemical features. All patients underwent TE and ARFI.
TE was unreliable in nine patients (6.5%), while in no cases (0%) were ARFI invalid measurements recorded (P=0.029). By area under receiver operating characteristic curve (AUROC), the best cutoff values for TE and ARFI for significant fibrosis (≥F2) were ≥6.5 kPa (AUROC: 0.78) and ≥1.3 m/s (AUROC: 0.86), respectively. For severe fibrosis (F3-F4), these cutoff values were 8.8 kPa (AUROC: 0.83) for TE and 1.7 m/s (AUROC: 0.94) for ARFI. For cirrhosis, TE had its best cutoff at ≥11 kPa (AUROC: 0.80) and ARFI at ≥2.0 m/s (AUROC: 0.89). By pairwise comparison of AUROC, ARFI was significantly more accurate than TE for a diagnosis of significant and severe fibrosis (P=0.024 and P=0.002, respectively), while this difference was only marginal for cirrhosis (P=0.09). By partial AUROC analysis, ARFI performance results significantly higher for all three stages of fibrosis. The average concordance rates of TE and ARFI vs. liver biopsy were 45.4 and 54.7%, respectively. By multivariate analysis, ARFI was not associated with alanine aminotransferase (ALT), body mass index, Metavir grade, and liver steatosis, while TE was significantly correlated with the ALT value (P=0.027).
In a cohort of patients with CHC, ARFI imaging was more accurate than TE for the non-invasive staging of both significant and severe classes of liver fibrosis.
Summary
This paper deals with the performance of Licklider Transmission Protocol (LTP) in space environment, focusing on the impact of segment losses and the design of possible improvements. The ...in‐depth analysis of retransmission mechanisms carried out in the paper shows that, while LTP already achieves delivery time performance very close to the theoretical optimum in ideal conditions (no losses) and when losses affect data segments, a substantial improvement is still possible concerning signaling segments, whose loss can result in a significant increase of the LTP block delivery time. To this end, 2 simple enhancements, the Closing State and the proactive retransmission of signaling segments, are proposed and evaluated in the paper. Both enhancements have been added as optional features to the original Interplanetary Overlay Network LTP implementation (ION 3.5.0), in order to evaluate their effectiveness on a GNU/Linux testbed running the full protocol stack. Results presented in the paper confirm the validity of the proposed enhancements, as they significantly reduce the average delivery time in the presence of high losses and provide the additional advantage, even when losses are relatively low, of largely reducing the difference between average and worst cases.
While LTP already achieves delivery time performance very close to the theoretical optimum in ideal conditions, a significant margin of improvement is still possible in the presence of high segment losses. Tests show that the performance improvement that the enhancements presented in the paper becomes rapidly huge with increasing loss rate. The enhancements have been introduced by NASA in the current ION version (3.6.x).
Average delivery time vs SLR for various LTP enhancements. The enhancements significantly improve the average for SLR >5%.
Summary
Background A major problem in assessing the likelihood of survival of patients with hepatocellular carcinoma (HCC) arises from a lack of models capable of predicting outcome accurately.
Aim ...To compare the ability of the Italian score (CLIP), the French classification (GRETCH) and the Barcelona (BCLC) staging system in predicting survival in patients with HCC.
Methods We included 406 consecutive patients with cirrhosis and HCC. Seventy‐eight per cent of patients had hepatitis C. Independent predictors of survival were identified using the Cox model.
Results One‐hundred and seventy‐eight patients were treated, while 228 were untreated. The observed mortality was 60.1% in treated patients and 84.9% in untreated patients. Among treated patients, albumin, bilirubin and performance status were the only independent variables significantly associated with survival. Mortality was independently predicted by bilirubin, alpha‐fetoprotein and portal vein thrombosis in untreated patients. CLIP achieved the best discriminative capacity in the entire HCC cohort and in the advanced untreatable cases, while BCLC was the ablest in predicting survival in treated patients.
Conclusions Overall predictive ability of BCLC, CLIP and GRETCH staging systems was not satisfactory, and was not uniform for treated patients and untreated patients. None of the scoring systems provided confident prediction of survival in individual patients.
Aim: To assess the causes and the prevalence of traumatic injuries to the permanent incisors of 12‐year‐old schoolchildren in Jaragua do Sul, Brazil.
Design: Cross‐sectional survey.
Setting: Public ...and private primary schools.
Participants: 476 children of both sexes, selected by multistage sampling technique.
Methods: Clinical examination of upper and lower permanent incisors.
Main outcome measures: Incisal overjet, lip coverage, traumatised anterior teeth, cause of trauma. Parents' levels of education and employment status and family income.
Results: Boys experienced double the percentage of injuries compared to girls. Children with incisal overjet greater than 5mm (P = 0.077) and inadequate lip coverage (P = 0.667) were not more likely to have experienced dental injuries. The main causes of injuries to the permanent incisors were falls (26 per cent), traffic accidents (20.5 per cent), sports (19.2 per cent), violence (16.4 per cent) and collisions with people or inanimate objects (6.8 per cent). Socio‐economic measures had no significant effect on prevalence of trauma.
Conclusions: Policy makers must take the causes of trauma into account when developing a strategy for the prevention of dental injuries. The role of violence in causing traumatic dental injuries has been underestimated.
Eosinophilic gastroenteritis is a rare condition of unknown etiology characterized by eosinophilic infiltration of the bowel. Corticosteroids are the mainstay of EG therapy. Although rare, ...steroid-resistant EG could be a life-threatening condition with tissue destructive evolution. Associations of eosinophilic gastroenteritis with systemic lupus erythematosus have rarely been reported. In this report we describe a case of successful IVIG treatment in a patient with systemic lupus erythematosus and steroid-refractory eosinophilic gastroenteritis.
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