7 research outputs found
Serum biomarkers and risk of hepatocellular carcinoma recurrence after liver transplantation
Liver transplantation (LT) is the only potentially curative treatment for selected
patients with cirrhosis and hepatocellular carcinoma (HCC) who are not
candidates for resection. When the Milan criteria are strictly applied, 75% to
85%of 3- to 4-year actuarial survival rates are achieved, but up to 20% of the
patients experience HCC recurrence after transplantation. The Milan criteria are
based on the preoperative tumor macromorphology, tumor size and number on
computed tomography or magnetic resonance imaging that neither correlate well
with posttransplant histological study of the liver explant nor accurately predict
HCC recurrence after LT, since they do not include objective measures of tumor
biology. Preoperative biological markers, including alpha-fetoprotein, desgamma-
carboxiprothrombin or neutrophil-to-lymphocyte ratio and platelet-tolymphocyte
ratio, can predict the risk for HCC recurrence after transplantation.
These biomarkers have been proposed as surrogate markers of tumor
differentiation and vascular invasion, with varied risk magnitudes depending on
the defined cutoffs. Different studies have shown that the combination of one or
several biomarkers integrated into prognostic models predict the risk of HCC
recurrence after LT more accurately than Milan criteria alone. In this review, we
focus on the potential utility of these serum biological markers to improve the
performance of Milan criteria to identify patients at high risk of tumora
Lifestyle Patterns and Weight Status in Spanish Adults: The ANIBES Study
Limited knowledge is available on lifestyle patterns in Spanish adults. We investigated
dietary patterns and possible meaningful clustering of physical activity, sedentary behavior, sleep
time, and smoking in Spanish adults aged 18â64 years and their association with obesity. Analysis
was based on a subsample (n = 1617) of the cross-sectional ANIBES study in Spain. We performed
exploratory factor analysis and subsequent cluster analysis of dietary patterns, physical activity,
sedentary behaviors, sleep time, and smoking. Logistic regression analysis was used to explore the
association between the cluster solutions and obesity. Factor analysis identified four dietary patterns,
âTraditional DPâ, âMediterranean DPâ, âSnack DPâ and âDairy-sweet DPâ. Dietary patterns, physical
activity behaviors, sedentary behaviors, sleep time, and smoking in Spanish adults aggregated
into three different clusters of lifestyle patterns: âMixed diet-physically active-low sedentary lifestyle
patternâ, âNot poor diet-low physical activity-low sedentary lifestyle patternâ and âPoor diet-low physical
activity-sedentary lifestyle patternâ. A higher proportion of people aged 18â30 years was classified into
the âPoor diet-low physical activity-sedentary lifestyle patternâ. The prevalence odds ratio for obesity in
men in the âMixed diet-physically active-low sedentary lifestyle patternâ was significantly lower compared
to those in the âPoor diet-low physical activity-sedentary lifestyle patternâ. Those behavior patterns
are helpful to identify specific issues in population subgroups and inform intervention strategies.
The findings in this study underline the importance of designing and implementing interventions
that address multiple health risk practices, considering lifestyle patterns and associated determinants
Large-scale ocean connectivity and planktonic body size
Global patterns of planktonic diversity are mainly determined by the dispersal of propagules
with ocean currents. However, the role that abundance and body size play in determining
spatial patterns of diversity remains unclear. Here we analyse spatial community
structure - ÎČ-diversity - for several planktonic and nektonic organisms from prokaryotes to
small mesopelagic fishes collected during the Malaspina 2010 Expedition. ÎČ-diversity was
compared to surface ocean transit times derived from a global circulation model, revealing a
significant negative relationship that is stronger than environmental differences. Estimated
dispersal scales for different groups show a negative correlation with body size, where less
abundant large-bodied communities have significantly shorter dispersal scales and larger
species spatial turnover rates than more abundant small-bodied plankton. Our results confirm
that the dispersal scale of planktonic and micro-nektonic organisms is determined by local
abundance, which scales with body size, ultimately setting global spatial patterns of diversit
An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)
IntroductionTransanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally.MethodsA pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.ResultsOf 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02-2.48, P=0.04) and robotic TaTME (OR 3.05, 1.10-7.34, P=0.02) were associated with a higher risk of anastomotic leak than non-transanal laparoscopic TME. However this association was lost in the mixed-effects model controlling for patient and disease factors (OR 1.23, 0.77-1.97, P=0.39 and OR 2.11, 0.79-5.62, P=0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55-4.77, P<0.001) and male gender (OR 2.29, 1.52-3.44, P<0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%.ConclusionThis contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results
The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.
This is the peer reviewed version of the following article: The and E. S. o. C. c. groups (2018). "The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit." Colorectal Disease 20(S6): 69-89., which has been published in final form at https://doi.org/10.1111/codi.14371. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, PÂ <Â 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, PÂ <Â 0.001). CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection