Clinical and economic impact of drug eluting beads in transarterial chemoembolization for hepatocellular carcinoma

International audienceWHAT IS KNOWN AND OBJECTIVE:Drug eluting beads (DEBs) theoretically improve the efficacy and safety of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). Nonetheless, their economic profile has not been assessed. Our retrospective before/after study aimed to compare efficacy, safety and economic profile of two strategies of TACE without (Period 1) or with the possibility of using DEBs (Period 2).METHODS:All HCC patients treated by TACE in our hospital between March 2006 and May 2013 were included. Economic analyses were performed from the French Public Health Insurance point of view according to the French Diagnosis-Related Group prospective payment system and from the analytic accountability.RESULTS AND DISCUSSION:One hundred and sixty-one patients were included. Median time to treatment failure and overall survival were 13.1 and 23.8 months in Period 1 vs. 14.1 and 30.2 months in Period 2 (P = 0.45 and P = 0.40). Mean hospital durations and tariffs were 14.9 ± 7.7 days and € 11 472 ± 5901 in Period 1 vs. 12.4 ± 8.4 days and € 7654 ± 4625 in Period 2 (P = 0.03 and P < 10(-4) ).WHAT IS NEW AND CONCLUSION:The possibility of using DEBs did not improve the prognosis in HCC patients treated by TACE. Nonetheless, it had a better medico-economic profile

Reliability and reproducibility of the American Association for the Surgery of Trauma scaling for renal injury and impact on radiologic follow-up

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High riverine CO₂ emissions at the permafrost boundary of Western Siberia

Abstract The fate of the vast stocks of organic carbon stored in permafrost of the Western Siberian Lowland, the world’s largest peatland, is uncertain. Specifically, the amount of greenhouse gas emissions from rivers in the region is unknown. Here we present estimates of annual CO₂ emissions from 58 rivers across all permafrost zones of the Western Siberian Lowland, between 56 and 67° N. We find that emissions peak at the permafrost boundary, and decrease where permafrost is more prevalent and in colder climatic conditions. River CO₂ emissions were high, and on average two times greater than downstream carbon export. We suggest that high emissions and emission/export ratios are a result of warm temperatures and the long transit times of river water. We show that rivers in the Western Siberian Lowland play an important role in the carbon cycle by degassing terrestrial carbon before its transport to the Arctic Ocean, and suggest that changes in both temperature and precipitation are important for understanding and predicting high-latitude river CO₂ emissions in a changing climate