Liver transplantation for non-resectable liver metastases from colorectal cancer: a systematic review and meta-analysis

Backgrounds Colorectal liver metastases were historically considered a contraindication to liver transplantation, but dismal outcomes for those with metastatic colorectal cancer and advancements in liver transplantation (LT) have led to a renewed interest in the topic. We aim to compare the current evidence for liver transplantation for non-resectable colorectal liver metastases (NRCLM) with the current standard treatment of palliative chemotherapy. Methods A systematic review and meta-analysis of proportions was conducted following screening of MEDLINE, EMBASE, SCOPUS and CENTRAL for studies reporting liver transplantation for colorectal liver metastases. Post-operative outcomes measured included one-, three- and five-year survival, overall survival, disease-free survival and complication rate. Results Three non-randomised studies met the inclusion criteria, reporting a total of 48 patients receiving LT for NRCLM. Survival at one-, three- and five-years was 83.3–100%, 58.3–80% and 50–80%, respectively, with no significant difference detected (p = 0.22, p = 0.48, p = 0.26). Disease-free survival was 35–56% with the most common site of recurrence being lung. Thirteen out of fourteen deaths were due to disease recurrence. Conclusion Although current evidence suggests a survival benefit conferred by LT in NRCLM compared to palliative chemotherapy, the ethical implications of organ availability and allocation demand rigorous justification. Concomitant improvements in the management of patients following liver resection and of palliative chemotherapy regimens is paramount

Challenges to evidence synthesis and identification of data gaps in human biomonitoring

The increasing number of human biomonitoring (HBM) studies undertaken in recent decades has brought to light the need to harmonise procedures along all phases of the study, including sampling, data collection and analytical methods to allow data comparability. The first steps towards harmonisation are the identification and collation of HBM methodological information of existing studies and data gaps. Systematic literature reviews and meta-analyses have been traditionally put at the top of the hierarchy of evidence, being increasingly applied to map available evidence on health risks linked to exposure to chemicals. However, these methods mainly capture peer-reviewed articles, failing to comprehensively identify other important, unpublished sources of information that are pivotal to gather a complete map of the produced evidence in the area of HBM. Within the framework of the European Human Biomonitoring Initiative (HBM4EU) initiative—a project that joins 30 countries, 29 from Europe plus Israel, the European Environment Agency and the European Commission—a comprehensive work of data triangulation has been made to identify existing HBM studies and data gaps across countries within the consortium. The use of documentary analysis together with an up-to-date platform to fulfil this need and its implications for research and practice are discussed

Diagnostic techniques for inflammatory eye disease: past, present and future: a review

Investigations used to aid diagnosis and prognosticate outcomes in ocular inflammatory disorders are based on techniques that have evolved over the last two centuries have dramatically evolved with the advances in molecular biological and imaging technology. Our improved understanding of basic biological processes of infective drives of innate immunity bridging the engagement of adaptive immunity have formed techniques to tailor and develop assays, and deliver targeted treatment options. Diagnostic techniques are paramount to distinguish infective from non-infective intraocular inflammatory disease, particularly in atypical cases. The advances have enabled our ability to multiplex assay small amount of specimen quantities of intraocular samples including aqueous, vitreous or small tissue samples. Nevertheless to achieve diagnosis, techniques often require a range of assays from traditional hypersensitivity reactions and microbe specific immunoglobulin analysis to modern molecular techniques and cytokine analysis. Such approaches capitalise on the advantages of each technique, thereby improving the sensitivity and specificity of diagnoses. This review article highlights the development of laboratory diagnostic techniques for intraocular inflammatory disorders now readily available to assist in accurate identification of infective agents and appropriation of appropriate therapies as well as formulating patient stratification alongside clinical diagnoses into disease groups for clinical trials

Bevacizumab (Avastin®) for the management of anterior chamber neovascularization and neovascular glaucoma

Purpose: To establish the efficacy and safety of intravitreal bevacizumab in reducing iris and anterior chamber angle neovascularization and managing neovascular glaucoma. Design: Prospective interventional case series. Patient and methods: Eleven eyes of 11 patients with iris and anterior chamber angle neovascularization with refractory intraocular pressure were treated with intravitreal injection of 1.25 mg bevacizumab (Avastin®). The study group included eight males and three females aged 23 to 77 years (average, 62 years). Out of the 11 cases, five had proliferative diabetic retinopathy, of whom two had undergone vitrectomy for tractional retinal detachment and vitreous hemorrhage, and six were secondary to ischemic central retinal vein occlusion (CRVO). All patients were followed for eight to 16 months (average, 10 months). Results: Iris and anterior chamber angle neovascularization receded in all eyes after one to three injections at monthly intervals. In five eyes, neovascularization recurred during the follow-up period. The intraocular pressure normalized in one eye. Four eyes were controlled with anti-glaucoma drops. A cyclodestructive procedure was required in two eyes. An Ahmet drainage valve was implanted in four eyes, including one controlled with additional antiglaucoma drops and one in which the intraocular pressure remained high while on maximum antiglaucoma medication and a cyclodestructive procedure was scheduled. Conclusions: Bevacizumab appears to be effective in reducing iris and anterior chamber angle neovascularization and is likely to extend our therapeutic options in the management of neovascular glaucoma. © 2009 Brouzas et al, publisher and licensee Dove Medical Press Ltd