Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation ...vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion.
Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included. Variables encompassing clinical, tumour, treatment type and response factors were analysed against the primary outcome of overall survival. Univariate analysis and multivariate Cox regression modelling were used to identify factors pre- and post-TACE therapy significantly associated with survival.
Total of 292 consecutive patients underwent rTACE with mainly Child Pugh A cirrhosis (61%) and BCLC stage A (57%) disease. Median overall survival (OS) was 30 months (IQR 15.2-50.2) from initial TACE. On multivariate analysis greater tumour number (p = 0.02), higher serum bilirubin (p = 0.007) post initial TACE, and hepatic decompensation (p = 0.001) post second TACE were associated with reduced survival. Patients with serum AFP ≥ 200 ng/ml following initial TACE had lower survival (p = 0.001), compared to patients with serum AFP level that remained < 200 ng/ml post-initial TACE, with an overall survival of 19.4 months versus 34.7 months (p = 0.0001) respectively.
Serum AFP level following initial treatment in patients undergoing repeat TACE for HCC is a simple and useful clinical prognostic marker. Moreover, it has the potential to facilitate appropriate patient selection for rTACE particularly when used in conjunction with baseline tumour burden and severity of hepatic dysfunction post-initial TACE.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction
Primary endoscopic and percutaneous drainage for pancreatic necrotic collections is increasingly used. We aim to compare the relative effectiveness of both modalities in reducing the ...duration and severity of illness by measuring their effects on systemic inflammatory response syndrome (SIRS).
Methods
We retrospectively reviewed all cases of endoscopic and percutaneous drainage for pancreatic necrotic collections performed in 2011–2016 at two hospitals. We assessed the post‐procedure length of hospital stay, reduction in C‐reactive protein levels, resolution of SIRS, the complication rates, and the number of procedures required for resolution.
Results
Thirty‐two patients were identified and 57 cases (36 endoscopic, 21 percutaneous) were included. There was no significant difference in C‐reactive protein reduction between endoscopic and percutaneous drainage (69.5% vs 68.8%, P = 0.224). Resolution of SIRS was defined as the post‐procedure normalization of white cell count (endoscopic vs percutaneous: 70.4% vs 64.3%, P = 0.477), temperature (endoscopic vs percutaneous: 93.3% vs 60.0%, P = 0.064), heart rate (endoscopic vs percutaneous: 56.0% vs 11.1%, P = 0.0234), and respiratory rate (endoscopic vs percutaneous: 83.3% vs 0.0%, P = 0.00339). Post‐procedure length of hospital stay was 27 days with endoscopic drainage and 46 days with percutaneous drainage (P = 0.0183).
Conclusion
Endoscopic drainage was associated with a shorter post‐procedure length of hospital stay and a greater rate of normalization of SIRS parameters than percutaneous drainage, although only the effects on heart rate and respiratory rate reached statistical significance. Further studies are needed to establish which primary drainage modality is superior for pancreatic necrotic collections.
Aggravating factors in United States criminal codes, such as “heinous,” “atrocious,” “cruel,” “vile,” or “depraved,” distinguish elements of a crime that warrant more severe sentencing. These terms ...remain vaguely defined and arbitrarily applied. The Depravity Standard research was designed to develop a measure of societal standards for what elements make a crime depraved.
Thematic analysis of over 100 appellate court decisions deliberating depravity in crime was performed. Additional input drew from 91 professionals and students in forensic disciplines. 26 items reflecting depravity emerged for further study. Next, a survey of U.S. participants (n=25,096) was conducted to gauge public consensus for depravity in these items. All items received majority support for being somewhat or especially depraved (69.5%–99.1% agreement). A final set of items was then applied to 770 murder cases to refine the definitions and qualifying and disqualifying examples for each item.
Case data from 770 murder cases informed the development of a Depravity Standard of 25 items with detailed examples of the intent, actions, victim choice, and attitudes, distinct to what society endorses as the worst of crimes. The items draw content validity from validation studies using actual cases provided by U.S. jurisdictions.
•Review of over 100 higher court decisions deliberating a crime's depravity.•Public surveyed on 25 items from court decisions for a proposed Depravity Standard.•Over 25,000 participants agreed on what constitutes criminal depravity.•770 homicide case files were reviewed to develop detailed examples for items.•The Depravity Standard's guidelines facilitate applicability to felony crimes.
To the Editor:
In the August 6 issue, Kallmes et al.
1
report on the Investigational Vertebroplasty Safety and Efficacy Trial (ClinicalTrials.gov number, NCT00068822), and Buchbinder et al.
2
report ...on a randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Australian New Zealand Clinical Trials Registry number, ACTRN012605000079640). We have serious concerns about both trials, which included patients with a duration of pain of up to 12 months. Vertebroplasty provides internal fixation of nonhealed osteoporotic vertebral fractures. It is well established that fixation of acute fractures elsewhere in the skeleton reduces fracture pain. Internal fixation of healed fractures is clearly inappropriate. . . .
Global statement defining interventional radiology Kaufman, John A; Reekers, Jim A; Burnes, James P ...
Journal of vascular and interventional radiology,
08/2010, Letnik:
21, Številka:
8
Journal Article
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