The aim of any oncological treatment is not just to eliminate the tumour, but to maximise patient survival and quality of life. Since the liver has a vital function, any radical treatment that ...severely compromises liver function will result in a shortening of life expectancy, rather than a prolongation. Furthermore, even non-severe liver damage may prevent the delivery of further effective therapies. This is particularly important in the case of hepatocellular carcinoma (HCC), as it is associated with underlying cirrhosis in most patients – cirrhosis itself is not only a potentially lethal disease and independent prognostic factor in HCC, but it also makes liver function fragile. Accordingly, some information about liver dysfunction is included in most staging systems for HCC and can be used to guide the selection of treatments that the functional liver reserve can tolerate. Unfortunately, the prediction of functional damage to the liver in the case of antitumor treatments is very challenging and still suboptimal in any given patient. Moreover, while the assessment of functional reserve can now be used to avoid postoperative liver failure in the surgical setting, its use has been less well clarified for non-surgical therapies, which is of particular relevance today, as several lines of effective non-surgical treatments, including systemic therapies, have become available. The present article will a) critically review the implications of the assessment of liver functional reserve in patients with HCC, b) illustrate the available tools to assess liver functional reserve and c) discuss the role of functional assessment for each type of non-surgical therapy for HCC.
The goal of this study was to evaluate the influence of obstructive sleep apnoea on the severity and short-term prognosis of patients admitted for acute coronary syndrome. Obstructive sleep apnoea ...was defined as an apnoea-hypopnoea index (AHI) >15 h(-1). We evaluated the acute coronary syndrome severity (ejection fraction, Killip class, number of diseased vessels, and plasma peak troponin) and short-term prognosis (length of hospitalisation, complications and mortality). We included 213 patients with obstructive sleep apnoea (mean±sd AHI 30±14 h(-1), 61±10 years, 80% males) and 218 controls (AHI 6±4 h(-1), 57±12 years, 82% males). Patients with obstructive sleep apnoea exhibited a higher prevalence of systemic hypertension (55% versus 37%, p<0.001), higher body mass index (29±4 kg·m(-2) versus 26±4 kg·m(-2), p<0.001), and lower percentage of smokers (61% versus 71%, p=0.04). After adjusting for smoking, age, body mass index and hypertension, the plasma peak troponin levels were significantly elevated in the obstructive sleep apnoea group (831±908 ng·L(-1) versus 987±884 ng·L(-1), p=0.03) and higher AHI severity was associated with an increased number of diseased vessels (p=0.04). The mean length of stay in the coronary care unit was higher in the obstructive sleep apnoea group (p=0.03). This study indicates that obstructive sleep apnoea is related to an increase in the peak plasma troponin levels, number of diseased vessels, and length of stay in the coronary care unit.
Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA), but treatment compliance is often unsatisfactory. This study investigated the efficacy and ...cost-effectiveness of telemonitoring for improving CPAP compliance.100 newly diagnosed OSA patients requiring CPAP (apnoea-hypopnoea index >15 events·h
) were randomised to standard management or a telemonitoring programme that collected daily information about compliance, air leaks and residual respiratory events, and initiated patient contact to resolve issues. Clinical/anthropometric variables, daytime sleepiness and quality of life were recorded at baseline and after 3 months. Patient satisfaction, additional visits/calls, side-effects and total costs were assessed.There were no significant differences between the standard and telemedicine groups in terms of CPAP compliance (4.9±2.2
5.1±2.1 h·night
), symptoms, clinical variables, quality of life and unwanted effects. Telemedicine was less expensive than standard management (EUR123.65
EUR170.97; p=0.022) and was cost-effective (incremental cost-effectiveness ratio EUR17 358.65 per quality-adjusted life-year gained). Overall patient satisfaction was high, but significantly more patients rated satisfaction as high/very high in the standard management
telemedicine group (96%
74%; p=0.034).Telemonitoring did not improve CPAP treatment compliance and was associated with lower patient satisfaction. However, it was more cost-effective than traditional follow-up.
The reduction in blood pressure (BP) with continuous positive airway pressure (CPAP) is modest and highly variable. In this study, we identified the variables that predict BP response to CPAP.24-h ...ambulatory BP monitoring (ABPM), C-reactive protein (CRP), leptin, adiponectin and 24-h urinary catecholamine were measured before and after 6 months of CPAP in obstructive sleep apnoea (OSA) patients.Overall, 88 middle-aged, obese male patients with severe OSA (median apnoea-hypopnoea index 42 events·h
) were included; 28.4% had hypertension. 62 patients finished the study, and 60 were analysed. The daytime diastolic BP (-2 mmHg) and norepinephrine (-109.5 nmol·day
) were reduced after CPAP, but no changes in the 24-h BP, night-time BP, dopamine, epinephrine, CRP, leptin or adiponectin were detected. The nocturnal normotension was associated with an increased night-time-BP (+4 mmHg) after CPAP, whereas nocturnal hypertension was associated with a reduction of 24-h BP (-3 mmHg). A multivariate linear regression model showed differential night-time BP changes after CPAP. Specifically, low night-time heart rate (<68 bpm) and BP dipper profile were associated with increased night-time BP and new diagnosis of nocturnal hypertension.Our results suggest that nocturnal hypertension, circadian BP pattern and night-time heart rate could be clinical predictors of BP response to CPAP and support the usefulness of 24-h ABPM for OSA patients before treatment initiation. These results need to be confirmed in further studies.
The cardiovascular consequences of obstructive sleep apnoea (OSA) differ by sex. We hypothesized that sex influences the severity of acute coronary syndrome (ACS) in patients with OSA. OSA was ...defined as an apnoea-hypopnoea index (AHI)>15 events·h-1. We evaluated the severity of ACS according to the ejection fraction, Killip class, number of diseased vessels, number of stents implanted and plasma peak troponin level.
We included 663 men (mean±SD, AHI 37±18 events·h-1) and 133 women (AHI 35±18 events·h-1) with OSA.
The men were younger than the women (59±11 versus 66±11 years, p<0.0001), exhibited a higher neck circumference (p<0.0001), and were more likely to be smokers and alcohol users than women (p<0.0001, p = 0.0005, respectively). Body mass index and percentage of hypertensive patients or diabetics were similar between sexes. We observed a slight tendency for a higher Killip classification in women, although it was not statistically significant (p = 0.055). For men, we observed that the number of diseased vessels and the number of stents implanted were higher (p = 0.02, p = 0.001, respectively), and a decrease in the ejection fraction (p = 0.002).
This study shows that sex in OSA influences the severity of ACS. Men show a lower ejection fraction and an increased number of diseased vessels and number of stents implanted.
The effect of continuous positive airway pressure (CPAP) on secondary cardiovascular disease prevention is highly debated.
To assess the effect of CPAP treatment for obstructive sleep apnea (OSA) on ...the risk of adverse cardiovascular events in randomized clinical trials.
PubMed (MEDLINE), EMBASE, Current Controlled Trials: metaRegister of Controlled Trials, ISRCTN Registry, European Union clinical trials database, CENTRAL (Cochrane Central Register of Controlled Trials), and ClinicalTrials.gov databases were systematically searched through June 22, 2023.
For qualitative and individual participant data (IPD) meta-analysis, randomized clinical trials addressing the therapeutic effect of CPAP on cardiovascular outcomes and mortality in adults with cardiovascular disease and OSA were included.
Two reviewers independently screened records, evaluated potentially eligible primary studies in full text, extracted data, and cross-checked errors. IPD were requested from authors of the selected studies (SAVE NCT00738179, ISAACC NCT01335087, and RICCADSA NCT00519597).
One-stage and 2-stage IPD meta-analyses were completed to estimate the effect of CPAP treatment on risk of recurrent major adverse cardiac and cerebrovascular events (MACCEs) using mixed-effect Cox regression models. Additionally, an on-treatment analysis with marginal structural Cox models using inverse probability of treatment weighting was fitted to assess the effect of good adherence to CPAP (≥4 hours per day).
A total of 4186 individual participants were evaluated (82.1% men; mean SD body mass index, 28.9 4.5; mean SD age, 61.2 8.7 years; mean SD apnea-hypopnea index, 31.2 17 events per hour; 71% with hypertension; 50.1% receiving CPAP mean {SD} adherence, 3.1 {2.4} hours per day; 49.9% not receiving CPAP usual care, mean SD follow-up, 3.25 1.8 years). The main outcome was defined as the first MACCE, which was similar for the CPAP and no CPAP groups (hazard ratio, 1.01 95% CI, 0.87-1.17). However, an on-treatment analysis by marginal structural model revealed a reduced risk of MACCEs associated with good adherence to CPAP (hazard ratio, 0.69 95% CI, 0.52-0.92).
Adherence to CPAP was associated with a reduced MACCE recurrence risk, suggesting that treatment adherence is a key factor in secondary cardiovascular prevention in patients with OSA.
In patients with resistant hypertension (RH) and obstructive sleep apnea (OSA), the blood pressure response to continuous positive airway pressure (CPAP) treatment is highly variable and could be ...associated with differential micro-ribonucleic acid (miRNA) profiles. Currently, no available methods exist to identify patients who will respond favorably to CPAP treatment.
The aim of this study was to identify plasma miRNA profiles that predict blood pressure responses to CPAP treatment.
Cardiovascular system-focused circulating miRNA expression was evaluated in plasma samples using an 84-miRNA array among patients with RH and OSA at baseline and after 3 months of adherent CPAP use. Pathway analysis and miRNA target gene enrichment were performed in silico. Plasma levels of peptides and hormones related to cardiovascular function were also measured.
The OSA responder group exhibited blood pressure decreases exceeding the observed median (>4.5 mm Hg) after CPAP, which were not present in the nonresponder group (≤4.5 mm Hg) (p < 0.01). Three miRNAs provided a discriminatory predictive model for such a favorable blood pressure response to CPAP (area under the curve: 0.92; p = 0.01). Additionally, CPAP treatment significantly altered a total of 47 plasma miRNAs and decreased aldosterone-to-renin ratios in the responder group (p = 0.016) but not in the nonresponder group.
A singular pre-CPAP treatment cluster of 3 plasma miRNAs predicts blood pressure responses to CPAP treatment in patients with RH and OSA. CPAP treatment is accompanied by changes in cardiovascular system-related miRNAs that may potentially influence the risk for cardiovascular disease among patients with OSA and RH. (Effect of Continuous Positive Airway Pressure CPAP Treatment in the Control of Refractory Hypertension; NCT00616265).
Mars 2020 Mission Overview Farley, Kenneth A.; Williford, Kenneth H.; Stack, Kathryn M. ...
Space science reviews,
12/2020, Letnik:
216, Številka:
8
Journal Article
Recenzirano
The Mars 2020 mission will seek the signs of ancient life on Mars and will identify, prepare, document, and cache a set of samples for possible return to Earth by a follow-on mission. Mars 2020 and ...its
Perseverance
rover thus link and further two long-held goals in planetary science: a deep search for evidence of life in a habitable extraterrestrial environment, and the return of martian samples to Earth for analysis in terrestrial laboratories.
The Mars 2020 spacecraft is based on the design of the highly successful Mars Science Laboratory and its
Curiosity
rover, but outfitted with a sophisticated suite of new science instruments. Ground-penetrating radar will illuminate geologic structures in the shallow subsurface, while a multi-faceted weather station will document martian environmental conditions. Several instruments can be used individually or in tandem to map the color, texture, chemistry, and mineralogy of rocks and regolith at the meter scale and at the submillimeter scale. The science instruments will be used to interpret the geology of the landing site, to identify habitable paleoenvironments, to seek ancient textural, elemental, mineralogical and organic biosignatures, and to locate and characterize the most promising samples for Earth return. Once selected, ∼35 samples of rock and regolith weighing about 15 grams each will be drilled directly into ultraclean and sterile sample tubes.
Perseverance
will also collect blank sample tubes to monitor the evolving rover contamination environment.
In addition to its scientific instruments,
Perseverance
hosts technology demonstrations designed to facilitate future Mars exploration. These include a device to generate oxygen gas by electrolytic decomposition of atmospheric carbon dioxide, and a small helicopter to assess performance of a rotorcraft in the thin martian atmosphere.
Mars 2020 entry, descent, and landing (EDL) will use the same approach that successfully delivered
Curiosity
to the martian surface, but with several new features that enable the spacecraft to land at previously inaccessible landing sites. A suite of cameras and a microphone will for the first time capture the sights and sounds of EDL.
Mars 2020’s landing site was chosen to maximize scientific return of the mission for astrobiology and sample return. Several billion years ago Jezero crater held a 40 km diameter, few hundred-meter-deep lake, with both an inflow and an outflow channel. A prominent delta, fine-grained lacustrine sediments, and carbonate-bearing rocks offer attractive targets for habitability and for biosignature preservation potential. In addition, a possible volcanic unit in the crater and impact megabreccia in the crater rim, along with fluvially-deposited clasts derived from the large and lithologically diverse headwaters terrain, contribute substantially to the science value of the sample cache for investigations of the history of Mars and the Solar System. Even greater diversity, including very ancient aqueously altered rocks, is accessible in a notional rover traverse that ascends out of Jezero crater and explores the surrounding Nili Planum.
Mars 2020 is conceived as the first element of a multi-mission Mars Sample Return campaign. After Mars 2020 has cached the samples, a follow-on mission consisting of a fetch rover and a rocket could retrieve and package them, and then launch the package into orbit. A third mission could capture the orbiting package and return it to Earth. To facilitate the sample handoff,
Perseverance
could deposit its collection of filled sample tubes in one or more locations, called depots, on the planet’s surface. Alternatively, if
Perseverance
remains functional, it could carry some or all the samples directly to the retrieval spacecraft.
The Mars 2020 mission and its
Perseverance
rover launched from the Eastern Range at Cape Canaveral Air Force Station, Florida, on July 30, 2020. Landing at Jezero Crater will occur on Feb 18, 2021 at about 12:30 PM Pacific Time.
Abstract
We calculate the seasonal and interannual variation in dust aerosol particle size above Gale Crater during the first 1413 Martian solar days (sols = 24.6 h) of the Mars Science Laboratory ...mission. Measurements of UV radiation made by the Rover Environmental Monitoring Station in combination with atmospheric opacities retrieved from the Mastcam instrument are used for the calculations. Our results indicate that the dust effective radius varies significantly with season, ranging from ~0.6 μm during the low opacity season (
L
s
= 60°–140°) to ~2 μm during the high opacity season (
L
s
= 180°–360°). Our results suggest that Gale Crater is affected by dust events of high aerosol content originated at various distances from it. Our results improve the accuracy of estimations of ultraviolet radiation fluxes at the Martian surface. Moreover, our results have important implications because the lifetime of suspended dust and its ability to nucleate clouds are affected by particle size.
Plain Language Summary
The Martian atmosphere transports large amounts of dust, which interacts strongly with solar and infrared radiation. The large spatial and temporal variability in atmospheric dust load creates complex feedbacks connecting dust lifting with the evolving atmospheric circulations. The size of suspended aerosols affects the surface and atmospheric heating rates, influencing the Martian climate. In this work, we have calculated the dust aerosol particle size above Gale Crater during the first 1413 sols of the Mars Science Laboratory (MSL) mission using measurements of UV radiation made for the first time from the surface of Mars. Our results indicate that the dust effective radius varies significantly with season, ranging from ~0.6 μm during the clear season to ~2 μm during the dusty season. Our results suggest that Gale Crater is affected by dust events of high aerosol content originated at various distances from it. Our results are important because the lifetime of suspended dust and its ability to nucleate clouds are affected by the particle size.
Key Points
We have developed a novel methodology to retrieve dust aerosol particle size at Gale Crater using Mars Science Laboratory data
The retrieved dust effective radii range from 0.6 μm during the clear aphelion season to 2 μm during the dusty perihelion season
Our results improve the estimation of ultraviolet radiation fluxes at the Martian surface
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