Analysis of survival predictors in a prospective cohort of patients undergoing transarterial chemoembolization for hepatocellular carcinoma in a single Canadian centre

AbstractBackgroundDespite advances in the treatment of hepatocellular carcinoma (HCC), a great proportion of patients are eligible only for palliative therapy for reasons of advanced-stage disease or poor hepatic reserve. The use of transarterial chemoembolization (TACE) in the palliation of non-resectable HCC has shown a survival benefit in European and Asian populations. The aim of this study was to assess the efficacy of TACE by analysing overall 5-year survival, interval changes of tumour size and serum alpha-fetoprotein (AFP) levels in a prospective North American cohort.MethodsFrom September 2005 to December 2010, 46 candidates for TACE were enrolled in the study. Collectively, they underwent 102 TACE treatments. Data on tumour response, serum AFP and survival were prospectively collected.ResultsIn compensated cirrhotic patients, serial treatment with TACE had a stabilizing effect on tumour size and reduced serum AFP levels during the first 12 months. Overall survival rates at 1, 2 and 3 years were 69%, 58% and 20%, respectively. Younger individuals and patients with a lower body mass index, affected by early-stage HCC with involvement of a single lobe, had better survival in univariate analysis. After adjustment for risk factors, early tumour stage (T1 and T2 vs. T3 and T4) at diagnosis was the only statistically significant predictor for survival.ConclusionsIn compensated cirrhotic patients, TACE is an effective palliative intervention and HCC stage at diagnosis seems to be the most important predictor of longterm outcomes

The estimated prevalence of exposure to asthmagens in the Australian workforce

Background: There is very little information available on a national level as to the number of people exposed to specific asthmagens in workplaces. Methods: We conducted a national telephone survey in Australia to investigate the prevalence of current occupational exposure to 277 asthmagens, assembled into 27 groups. Demographic and current job information were obtained. A web-based tool, OccIDEAS, was used to collect job task information and assign exposure to each asthmagen group. Results: In the Australian Workplace Exposure Study – Asthma (AWES- Asthma) we interviewed 4878 participants (2441 male and 2437 female). Exposure to at least one asthmagen was more common among men (47 %) than women (40 %). Extrapolated to the Australian population, approximately 2.8 million men and 1.7 million women were estimated to be exposed. Among men, the most common exposures were bioaerosols (29 %) and metals (27 %), whilst the most common exposures among women were latex (25 %) and industrial cleaning and sterilising agents (20 %). Conclusions: This study provides information about the prevalence of exposure to asthmagens in Australian workplaces which will be useful in setting priorities for control and prevention of occupational asthma

A multi institutional comparison of imaging dose and technique protocols for neonatal chest radiography

Introduction: The focus on pediatric radiation dose reduction supports the re-evaluation of pediatric imaging protocols. This is particularly important in the neonates where chest radiographs are frequently requested to assess respiratory illness and line placement. This study aims to assess the impact of neonatal chest radiographic protocols on patient dose in four hospitals in different countries. Methods: Exposure parameters, collimation, focus to skin distance (FSD) and radiation dose from 200 neonatal chest radiographs were registered prospectively. Inclusion criteria consisted of both premature and full-term neonates weighing between 1000 and 5000 g. Only data from the examinations meeting diagnostic criteria and approved for the clinical use were included. The radiation dose was assessed using a dose area product (DAP). Results: The lowest DAP value (4.58 mGy cm2) was recorded in the Norwegian hospital, employing a high kVp, low mAs protocol using a DR system. The Canadian hospital recorded the highest DAP (9.48), using lower kVp and higher mAs with a CR system, including the addition of a lateral projection. The difference in the mean DAP, weight, the field of view (FOV) and kVp between the hospitals is statistically significant (p<0.001). Conclusion: The use of non-standardized imaging protocols in neonatal chest radiography results in differences in patient dose across hospitals included in the study. Using higher kVp, lower mAs and reducing the number of lateral projections to clinically relevant indications result in a lower DAP measured in the infant sample studied. Further studies to examine image quality based on exposure factors and added filtration are recommended. Implications for practice: Reevaluation of pediatric imaging protocols presents an opportunity to reduce patient dose in a population with increased sensitivity to ionizing radiation.info:eu-repo/semantics/publishedVersio

Effect of nibbling versus gorging on cardiovascular risk factors: Serum uric acid and blood lipids

Nibbling has been reported to decrease serum cholesterol under fasting conditions, as well as the incidence of cardiovascular disease. It has been suggested that these effects are partly attributable to reduced concentrations of serum insulin, which are also observed. However, data on the effects of nibbling on serum lipids throughout the day are not available, nor is it known how nibbling affects serum uric acid as a further insulin-related risk factor for cardiovascular disease. We have attempted to address these issues. Seven healthy men consumed identical diets in a randomized crossover design either as three meals daily (control) or as 17 meals daily (nibbling) for 2 weeks. On day 13, serum lipid levels were measured over the course of the day (12 hours) together with the 24-hour urinary excretion of mevalonic acid as an indicator of hepatic cholesterol synthesis. Concentrations of uric acid in serum and 24-hour urinary excretion of uric acid were also determined. Mean (±SE) percent treatment differences in day-long total, low-density lipoprotein (LDL), and non—high-density lipoprotein (HDL) cholesterol, and apolipoprotein (apo) B were significant, with lower values on the nibbling diet as compared with the control diet (8.1% ± 1.6%, P = .002; 12.2% ± 2.6%, P = .005; 10.1% ± 1.6%, P < .001; and 9.9% ± 2.6%, P = .008, respectively). No significant difference was seen in the total to HDL cholesterol ratio or in urinary mevalonic acid excretion. However, the percent difference between treatments in total cholesterol levels was directly related to the percent difference in urinary mevalonic acid excretion (r = .94, P = .005, n = 6). The mean fasting concentration of uric acid was significantly lower during the nibbling period as compared with the three-meal period (5.8% ± 1.8%, P = .019). Urinary uric acid excretion was also increased on nibbling (26.3% ± 7.9%, P = .021), and the treatment difference related to the reduction in serum insulin over the day (r = −.83, P = .041). We conclude that spreading the nutrient load over time reduces serum risk factors for cardiovascular disease. Our results suggest that these effects may be partly due to lower serum insulin concentrations. Lower insulin concentrations may lead to increased urinary uric acid excretion and possibly reduced hepatic cholesterol synthesis, since the treatment difference in urinary mevalonic acid excretion, although nonsignificant, related significantly to the treatment difference in serum cholestero