Surveillance for Hepatocellular Carcinoma Also Improves Survival of Incidentally Detected Intrahepatic Cholangiocarcinoma Arisen in Liver Cirrhosis

Background: Due to its poor survival, intrahepatic cholangiocarcinoma (ICC) is held to be a much more aggressive cancer than hepatocellular carcinoma (HCC). In most published series, patients were diagnosed when symptomatic. However, ICC is now increasingly being discovered during the surveillance for HCC in cirrhosis. Whether this earlier detection of ICC is associated with an equally dismal prognosis or not is unknown. Methods: This is amulticenter retrospective study of consecutive ICC patients. Patients were stratified into subgroups according to the absence/presence of cirrhosis. A propensity score matching was performed to reduce the potential biases. Cirrhotic patients were further stratified according to their surveillance status. The lead-time bias and its potential effects were also estimated. Results: We gathered 184 patients. Eighty-five patients (46.2%) were cirrhotic. Liver cirrhosis was not related to a worse overall survival (33.0 vs. 32.0 months, p = 0.800) even after the propensity score analysis (43.0 in vs. 44.0 months in 54 pairs of patients, p = 0.878). Among the cirrhotic population, 47 (55.3%) patients had received a diagnosis of ICC during a surveillance programme. The 2 subgroups differed in maximum tumour dimensions (30 vs. 48 mm in surveyed and non-surveyed patients, respectively). Surveyed patients were more likely to receive surgical treatments (59.8 vs. 28.9%, p = 0.003). Overall survival was higher in surveyed patients (51.0 vs. 21.0 months, p 0.001). These benefits were confirmed after correcting for the lead-time bias. Conclusions: Cirrhotic patients have different clinical presentation and outcomes of ICC according to their surveillance status. In our series, ICC in cirrhosis was not associated with worse OS. Cirrhosis itself should not discourage either surgical or non-surgical treatments

Experience with regorafenib in the treatment of hepatocellular carcinoma

Regorafenib is a diphenylurea oral multikinase inhibitor, structurally comparable to sorafenib, which targets a variety of kinases implicated in angiogenic and tumor growth-promoting pathways. Regorafenib was the first agent to positively show significant survival advantage as a second-line therapy in patients with unresectable hepatocellular carcinoma (HCC) who had previously failed first-line treatment with sorafenib. Recent evidence has shown that its antitumor efficacy is due to a comprehensive spectrum of tumor neo-angiogenesis and proliferation inhibition and immunomodulatory effects on the tumor microenvironment, which plays a crucial role in tumor development. This review addresses the rationale and supporting evidence for regorafenib’s efficacy in HCC that led to regorafenib’s approval as a second-line therapy. In addition, we review proof from clinical practice studies that validate the RESORCE trial results. We discuss regorafenib’s potential role in the newly emerging therapeutic strategy based on combination with immune checkpoint blockade and its possible extensibility to patient categories not enrolled in the registrative study

Angiosarcoma of the breast: a new therapeutic approach?

Introduction Angiosarcomas are highly malignant endothelial cell tumors with poor prognosis. These can be due to breast cancer itself or to subsequent therapeutic modalities. No evidence-based guidelines exist concerning the ideal treatment of angiosarcomas. Presentation of the case We report the case of a 76-year-old woman who developed an exuberant and aggressive post radiation angiosarcoma of the breast and discuss different aspects of therapy for this disease. A total left mastectomy was performed, followed by a right mastectomy. The lesions into the chest wall, and multiple abdominal skin nodules were treated with local Electrochemotherapy (ECT) with intravenous bleomicin. Discussion No evidence-based guidelines exist concerning the ideal treatment of angiosarcomas. Electrochemotherapy (ECT) is an efficient palliative treatment of cutaneous and subcutaneous tumor nodules. It consists of the combination of a cytotoxic drug and electroporation, using appropriate electrical parameters; destabilization of the membrane is reversible, ensuring a high survival of permeabilized cells and the delivery of non-permeant molecules inside the cell. Conclusion Due to the rarity of the disease, prospective studies concerning adjuvant or neoadjuvant therapy are limited and no evidence-based guidelines exist. The response to chemotherapy seems to be poor. Treatment with ECT in addition to systemic chemotherapy achieves a complete response in all the lesions and improving patient body image perception

Improving Healthcare Workers' Adherence to Surgical Safety Checklist: The Impact of a Short Training

Background: Although surgery is essential in healthcare, a significant number of patients suffer unfair harm while undergoing surgery. Many of these originate from failures in non-technical aspects, especially communication among operators. A surgical safety checklist is a simple tool that helps to reduce surgical adverse events, but even if it is fast to fill out, its compilation is often neglected by the healthcare workers because of unprepared cultural background. The present study aims to value the efficacy of a free intervention, such as a short training about risk management and safety checklist, to improve checklist adherence. Methods: In March 2019, the medical and nursing staff of the General Surgical Unit attended a two-lesson theoretical training concerning surgical safety and risk management tools such as the surgical safety checklist. The authors compared the completeness of the surgical checklists after and before the training, considering the same period (2 months) for both groups. Result: The surgical safety checklists were present in 198 cases (70.97%) before the intervention and 231 cases (96.25%) after that. After the training, the compilation adherence increased for every different type of healthcare worker of the unit (surgeons, nurses, anesthetists, and scrab nurses). Furthermore, a longer hospitalization was associated with a higher surgical checklist adherence by the operators. Conclusions: The results showed that a free and simple intervention, such as a two-lesson training, significantly stimulated the correct use of the surgical safety checklist. Moreover, the checklist adherence increased even for the operators who did not attend the training, maybe because of the positive influence of the colleagues' positive behaviors. As the results were promising with only two theoretical lessons, much more can be done to build a new safety culture in healthcare

Process Modeling and Conformance Checking in Healthcare: A COVID-19 Case Study

The discipline of process mining has a solid track record of successful applications to the healthcare domain. Within such research space, we conducted a case study related to the Intensive Care Unit (ICU) ward of the Uniklinik Aachen hospital in Germany. The aim of this work is twofold: developing a normative model representing the clinical guidelines for the treatment of COVID-19 patients, and analyzing the adherence of the observed behavior (recorded in the information system of the hospital) to such guidelines. We show that, through conformance checking techniques, it is possible to analyze the care process for COVID-19 patients, highlighting the main deviations from the clinical guidelines. The results provide physicians with useful indications for improving the process and ensuring service quality and patient satisfaction. We share the resulting model as an open-source BPMN file.Comment: 12 pages, 2 figures, 3 tables, 15 reference

Localization and detection of visual stimuli in monkeys with pulvinar lesions

Since the pulvinar receives a major ascending projection of the superior colliculus, pulvinar lesions might produce behavioral impairments resembling those that follow colliculus lesions. To test this possibility, we examined the effect of pulvinar lesions in monkeys on the localization and detection of brief light flashes, a task in which monkeys with colliculus lesions are severely impaired. Some of the pulvinar-lesioned monkeys showed localization impairments similar to those in monkeys with colliculus lesions. However, histological analyses of the lesions suggested that these deficits were related not to the pulvinar damage per se, but rather to interruption of corticotectal fibers that pass through the pulvinar. We conclude that the pulvinar is not critical for the ability to locate and detect brief visual stimuli.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46551/1/221_2004_Article_BF00238622.pd

迅速なヘビ検出におけるサル視床枕の役割に関する神経生理学的研究

富山大学・富生命博甲第67号・Le Van Quan・2014/09/26Pulvinar neurons reveal neurobiological evidence of past selection for rapid detection of snakes. Proceedings of the National Academy of Sciences of the United States of America,2013,110(47),19000-19005,doi:10.1073/pnas.1312648110に掲載。出版社版はhttp://www.pnas.org/content/110/47/19000（オープンアクセス）富山大

The Trigger System of the ARGO-YBJ detector

The ARGO-YBJ experiment has been designed to detect air shower events over a large size scale and with an energy threshold of a few hundreds GeV. The building blocks of the ARGO-YBJ detector are single-gap Resistive Plate Counters (RPCs). The trigger logic selects the events on the basis of their hit multiplicity. Inclusive triggers as well as dedicated triggers for specific physics channels or calibration purposes have been developed. This paper describes the architecture and the main features of the trigger system.Comment: 4 pages, to be published in the Proceedings of the 28th International Cosmic Ray Conference (Tsukuba, Japan 2003