Prospective validation of the CLIP score: a new prognostic system for patient with cirrhosis and hepatocellular carcinoma

Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. The CLIP score includes Child-Pugh stage, tumor morphology and extension, serum alfa-fetoprotein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power with that of the Okuda staging system in 196 patients with cirrhosis and HCC prospectively enrolled in a randomized trial. No significant associations were found between the CLIP score and the age, sex, and pattern of viral infection. There was a strong correlation between the CLIP score and the Okuda stage, As of June 1999, 150 patients (76.5%) had died. Median survival time was 11 months, overall, and it was 36, 22, 9, 7, and 3 months for CLIP categories 0, 1, 2, 3, and 4 to 6, respectively. In multivariate analysis, the CLIP score had additional explanatory power above that of the Okuda stage. This was true for both patients treated with locoregional therapy or not. A quantitative estimation of 2-year survival predictive power showed that the CLIP score explained 37% of survival variability, compared with 21% explained by Okuda stage. In conclusion, the CLIP score, compared with the Okuda staging system, gives more accurate prognostic information, is statistically more efficient, and has a greater survival predictive power. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with RCC, and could be used in prospective therapeutic trials as a stratification variable, reducing the variability of results owing to patient selection

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users

A spin polarized He metastable beam investigation of the adsorption of L-cysteine on magnetic surfaces

We report first results on the deposition of L-cysteine (Cys), a fundamental amino-acid, on a magnetic substrate. Molecules have been deposited under ultra-high vacuum conditions on Fe(100) films. Electronic and magnetic properties of adsorbed molecules have been investigated by spin polarized metastable deexcitation spectroscopy (SPMDS). The spectra show a growth dynamics apparently similar to the one already reported on coinage metal surfaces with the formation of a strongly-bound thiolate species (S-Fe bond) and weakly-bound second-layer molecules. SPMDS revealed the spin-polarized character of an Auger (Penning) deexcitation peak related to a Cys molecular orbital. Interestingly, these spin-polarization effects, ascribed to the interaction with the magnetized substrate, vanish before the first layer completion, suggesting a possible correlation with the SAM assembly properties

Ultrahigh vacuum deposition of L-Cysteine on Au(110) studied by high-resolution x-ray photoemission: from early stages of adsorption to molecular organization

10We report on a high-resolution X-ray photoemission spectroscopy study on molecular-thick layers Of (L)-cysteine deposited under ultrahigh vacuum conditions on Au(110). The analysis of core level shifts allowed us to distinguish unambiguously the states of the first-layer molecules from those of molecules belonging to the second layer. The first-layer molecules strongly interact with the metal through their sulfur headgroup. The multipeaked structure of the N 1s, O 1s, and C 1s core levels is interpreted in terms of different molecular moieties. The neutral acidic fraction (HSCH2CH(NH2)COOH) is abundant at low coverage likely associated with isolated molecules or dimers. The zwitterionic phase (HSCH2CH(NH3+)COO-) is largely dominant as the coverage approaches the monolayer limit and is related to the formation of ordered self-assembled molecular structures indicated by electron diffraction patterns. The occurrence of a small amount of cationic molecules (HSCH2CH(NH3+)COOH) is also discussed. The second-layer molecules mainly display zwitterionic character and are weakly adsorbed. Mild annealing up to 100 degrees C leads to the desorption of the second-layer molecules leaving electronic states of the first layer unaltered.nonenoneG. GONELLA; S. TERRENI; D. CVETKO; A. COSSARO; L. MATTERA; O. CAVALLERI; R. ROLANDI; A. MORGANTE; L. FLOREANO; M. CANEPAGonella, G.; Terreni, S.; Cvetko, D.; Cossaro, A.; Mattera, L.; Cavalleri, O.; Rolandi, R.; Morgante, Alberto; Floreano, L.; Canepa, M