Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes

liver transplantation for hepatocellular carcinoma (HCC) may be performed ab initio, primary liver transplantation (PLT), or for HCC recurrence after previous treatments such as liver resection (LR) or radiofrequency ablation (RFA), salvage liver transplantation (SLT). the aim of this study was to evaluate the oncological outcomes of SLT vs. PLT. For this, a retrospective study was carried out on patients undergoing liver transplantation for HCC. the outcomes of PLT were compared with those of SLT. the primary outcome was disease-free survival (DFS). the secondary outcomes included overall survival (OS), cancer-specific survival (CSS), and major postoperative complications. a sub-analysis of SLT-LR and SLT-RFA was also performed. In total, 141 patients were included: 96 underwent PLT and 45 SLT. among the SLT group, 25 patients had undergone previous LR while 20 had had RFA. there were no differences in the major postoperative complications. unadjusted DFS was significantly longer in the PLT group (p = 0.02), as were OS (p = 0.025) and CSS (p = 0.001). there was no difference in DFS between PLT and SLT-LR groups, while a significant difference was found between the PLT and SLT-RFA groups (p = 0.035). nonetheless, DFS was no different between the SLT-LR and SLT-RFA groups. PLT appears to offer superior long-term oncological outcomes to SLT. both SLT-LR and SLT-RFA offer acceptable OS and CSS. further prospective studies are needed to confirm these results, but the re-direction of grafts and transplant philosophy towards PLT rather than SLT may need to be considered

A note on comonotonicity and positivity of the control components of decoupled quadratic FBSDE

In this small note we are concerned with the solution of Forward-Backward Stochastic Differential Equations (FBSDE) with drivers that grow quadratically in the control component (quadratic growth FBSDE or qgFBSDE). The main theorem is a comparison result that allows comparing componentwise the signs of the control processes of two different qgFBSDE. As a byproduct one obtains conditions that allow establishing the positivity of the control process.Comment: accepted for publicatio

EDUCAÇÃO PÚBLICA: A RESISTÊNCIA DA COMUNIDADE ACADÊMICA NO ATUAL CENÁRIO POLÍTICO BRASILEIRO

Nos últimos anos, as Universidades públicas brasileiras têm sido acometidas por sucessivas medidas de austeridade impostas pelo atual Governo as quais favorecem o desmonte de políticas educacionais, de pesquisa e de práticas extensionistas. Dentre as medidas mais recentes, a realização de cortes e contingenciamentos orçamentários, bem como as tentativas de incutir projetos de recolhimento de mensalidade vêm comprometendo os ideais e o funcionamento dessas organizações. Nesse sentido, a comunidade acadêmica tem reagido às ameaças contra as Universidades públicas por meio de movimentos sociais, reiteradamente noticiados pelos veículos de imprensa. Sob esse panorama, o presente artigo propôs analisar como têm sido divulgadas as manifestações de comunidades acadêmicas frente aos ataques à educação pública no atual contexto político nacional. Para viabilização da pesquisa, recorremos a uma análise documental cuja sistematização de dados seguiu pressupostos de Bardin (1977, 2006), o que possibilitou evidenciar a relevância da mídia e dos meios digitais como artefatos para oferecer elucidação à sociedade brasileira, bem como a legitimidade dos movimentos de resistência frente ao atual contexto em que se encontra o ensino superior público no Brasil

Trends in Precision Medicine and Pharmacogenetics as an Adjuvant in Establishing a Correct Immunosuppressive Therapy for Kidney Transplant: An Up-to-Date Historical Overview

Kidney transplantation is currently the treatment of choice for patients with end-stage kidney diseases. Although significant advancements in kidney transplantation have been achieved over the past decades, the host’s immune response remains the primary challenge, often leading to potential graft rejection. Effective management of the immune response is essential to ensure the long-term success of kidney transplantation. To address this issue, immunosuppressives have been developed and are now fully integrated into the clinical management of transplant recipients. However, the considerable inter- and intra-patient variability in pharmacokinetics (PK) and pharmacodynamics (PD) of these drugs represents the primary cause of graft rejection. This variability is primarily attributed to the polymorphic nature (genetic heterogeneity) of genes encoding xenobiotic-metabolizing enzymes, transport proteins, and, in some cases, drug targets. These genetic differences can influence drug metabolism and distribution, leading to either toxicity or reduced efficacy. The main objective of the present review is to report an historical overview of the pharmacogenetics of immunosuppressants, shedding light on the most recent findings and also suggesting how relevant is the research and investment in developing validated NGS-based commercial panels for pharmacogenetic profiling in kidney transplant recipients. These advancements will enable the implementation of precision medicine, optimizing immunosuppressive therapies to improve graft survival and kidney transplanted patient outcomes

Case Report Hepatitis B Reactivation in a HBsAg-Negative, HBcAb-Positive Patient Receiving Fludarabine for the Treatment of Chronic Lymphocytic Leukaemia

Hepatitis B virus (HBV) reactivation is an increasingly recognized cause of morbidity and mortality in patients undergoing chemotherapy. In haematology, the risk of reactivation of B hepatitis among HBsAg-positive patients has been documented; therefore, use of lamivudine prophylaxis is recommended before starting chemotherapy. Differently, for HBsAg-negative patients with markers of previous HBV infection (i.e., presence of isolated anti-HBc positivity) (anticore patients) management strategies are not univocal. We describe a rare case of HBV reactivation in an anticore patient after fludarabine therapy for chronic lymphocytic leukaemia. The patient fully recovered after a 6-month course of lamivudine with persistent HBV-DNA clearance and loss of HBsAg. The most important feature of this case is that fludarabine alone infrequently determines HBV reactivation, especially in anticore patients. Therefore, we suggest that patients candidates to receive fludarabine therapy should be considered for lamivudine prophylaxis, not only if HBsAg-positive, but even if anticore-positive only

A New Web Score to Predict Health Status in Paediatric Patients with Chronic Diseases: Design and Development of the PENSAMI Study

Paediatric chronic diseases (CD) are characterised by their ongoing duration and the fact that they are often managed throughout the lifespan, with the need to adjust lifestyle and expectations with the limitations coming from the CD. The aim of the PENSAMI study is to not only cure the disease, but to also care for the person from a clinical and psychosocial perspective. Data will be collected from 150 paediatric patients affected by heart disease, diabetes, and asthma admitted during in-hospital stay or outpatient visits, and from 200 healthy control subjects. The protocol will consist of two phases. The first one will aim at elaborating the predictive model by detecting (clinical, anthropometric at birth, environmental, lifestyle, social context, emotional state, and mental abilities) in order to develop a model predictive of the events considered: (1) re-hospitalisation; (2) severity and progression of the disease; (3) adherence to therapy; (4) HRQoL; (5) obesity and metabolic syndrome; (6) illness-stress related; (7) school drop-out; (8) school performance. The second one will address validating the previous predictive model. This model will aim to: (1) understand, prevent, and halt the progression of childhood CD; (2) develop new and improved diagnostic tools; (3) pave the way for innovative treatments and additional therapies to traditional clinical practice; and (4) create truly personalised therapeutic and preventive strategies in various sectors, such as cardiology, diabetes, and respiratory diseases

ANÁLISE ECONÔMICA DA PRODUÇÃO DE CANA-DE-AÇÚCAR CONSIDERANDO-SE A TERCEIRIZAÇÃO DAS OPERAÇÕES AGRÍCOLAS: O CASO DE UM PRODUTOR

Farmers are switching to sugar cane production, increasing the importance of the economical analysis of the activity. The objective of the study was to examine the economic feasibility of sugar cane production for ethanol and sugar industry by growers that outsource mechanized operations in western São Paulo State, Brazil, Rural Development Office of General Salgado. The data were obtained from a farmer, in an area of 24 hectares cultivated with sugar cane, in the municipality of Sud Mennucci, São Paulo State, Brazil. It was calculated the setting up total operational cost (TOC) of the crop and 5 cuts. It was also proceeded a cash flow analysis to analyse the investment in the activity. The economic data were not favorable. The payback (return) of the investment occurred after the 5th cut. The Net Present Value (NPV) was negative (R$ -278.48). The Internal Rate of Return (IRR) was 2.54%. This condition is not feasible in sugar cane production for industry by farmers who outsourced agricultural operations. KEY-WORDS: Costs; analysis investment; Sacharum spp; outsourcing operations.Produtores rurais estão, agora, migrando para a produção de cana-de-açúcar. Desta forma, é muito importante fazer uma análise econômica sobre esta atividade. O objetivo deste trabalho foi analisar, economicamente, a viabilidade da produção de cana-de-açúcar para a indústria sucroalcooleira, por um produtor rural que terceiriza as operações mecanizadas, na região oeste paulista, pertencente ao Escritório de Desenvolvimento Rural de General Salgado. Os dados foram obtidos junto a um produtor rural, área de 24 ha, cultivados com a cultura, no município de Sud Mennucci, Estado de São Paulo. Foram estimados o custo operacional total (COT) da implantação da lavoura e dos 5 cortes e elaborado o fluxo de caixa, para analisar o investimento na atividade. O resultado da análise dos dados não foi favorável. O payback (retorno) do investimento se deu após o 5o corte e a TIR é de apenas 2,54%. Neste caso, é inviável a produção de cana-de-açúcar para a indústria sucroalcooleira, pelo produtor que terceirizou as operações agrícolas. PALAVRAS-CHAVE: Custos; análise de investimento; Sacharum spp; operações terceirizadas