A nationwide assessment of hepatocellular adenoma resection:Indications and pathological discordance

Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant transformation. Data on the indication for surgery are scarce. We analyzed indications and outcome of patients operated for HCAs 50 mm (52%), suspicion of (pre)malignancy (28%), and (previous) bleeding (5.1%). No difference was observed in HCA-subtype distribution between small and large tumors. Ninety-six (43%) patients had a postoperative change in diagnosis. Independent risk factors for change in diagnosis were tumor size <50 mm (adjusted odds ratio [aOR], 3.4; p < 0.01), male sex (aOR, 3.7; p = 0.03), and lack of hepatobiliary contrast-enhanced magnetic resonance imaging (CE-MRI) (aOR, 1.8; p = 0.04). Resection for small (suspected) HCAs was mainly indicated by suspicion of (pre)malignancy, whereas for large (suspected) HCAs, tumor size was the most prevalent indication. Male sex, tumor size <50 mm, and lack of hepatobiliary CE-MRI were independent risk factors for postoperative change in tumor diagnosis

Prognostic value of total tumor volume in patients with colorectal liver metastases:A secondary analysis of the randomized CAIRO5 trial with external cohort validation

Background:This study aimed to assess the prognostic value of total tumor volume (TTV) for early recurrence (within 6 months) and overall survival (OS) in patients with colorectal liver metastases (CRLM), treated with induction systemic therapy followed by complete local treatment.Methods: Patients with initially unresectable CRLM from the multicenter randomized phase 3 CAIRO5 trial (NCT02162563) who received induction systemic therapy followed by local treatment were included. Baseline TTV and change in TTV as response to systemic therapy were calculated using the CT scan before and the first after systemic treatment, and were assessed for their added prognostic value. The findings were validated in an external cohort of patients treated at a tertiary center. Results:In total, 215 CAIRO5 patients were included. Baseline TTV and absolute change in TTV were significantly associated with early recurrence (P = 0.005 and P = 0.040, respectively) and OS in multivariable analyses (P = 0.024 and P = 0.006, respectively), whereas RECIST1.1 was not prognostic for early recurrence (P = 0.88) and OS (P = 0.35). In the validation cohort (n = 85), baseline TTV and absolute change in TTV remained prognostic for early recurrence (P = 0.041 and P = 0.021, respectively) and OS in multivariable analyses (P &lt; 0.0001 and P = 0.012, respectively), and showed added prognostic value over conventional clinicopathological variables (increase C-statistic, 0.06; 95 % CI, 0.02 to 0.14; P = 0.008). Conclusion: Total tumor volume is strongly prognostic for early recurrence and OS in patients who underwent complete local treatment of initially unresectable CRLM, both in the CAIRO5 trial and the validation cohort. In contrast, RECIST1.1 did not show prognostic value for neither early recurrence nor OS.</p

Recovery of dialysis patients with COVID-19 : health outcomes 3 months after diagnosis in ERACODA

Background. Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods. We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results. In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8-6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions. Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis

Anticoagulant rodenticides in predatory birds 2009: a Predatory Bird Monitoring Scheme (PBMS) report.

The Predatory Bird Monitoring Scheme (PBMS; http://pbms.ceh.ac.uk/) is the umbrella project that encompasses the Centre for Ecology & Hydrology’s National Capability contaminant monitoring and surveillance work on avian predators. By monitoring sentinel vertebrate species, the PBMS aims to detect and quantify current and emerging chemical threats to the environment and in particular to vertebrate wildlife. Anticoagulant rodenticides, and in particular second generation anticoagulant rodenticides (SGARs), can be toxic to all mammals and birds. Predators that feed upon rodents are particularly likely to be exposed to these compounds. The PBMS, together with other studies, have shown that there is widespread exposure to SGARs of a diverse range of predators in Britain and that some mortalities occur as a result. This report summarises the PBMS monitoring for anticoagulant rodenticides in barn owls (Tyto alba), and red kites (Milvus milvus) that were found dead in 2009 and presents long term trend analysis for barn owls. Since 2006, anticoagulant rodenticide concentrations have been quantified using the more sensitive Liquid Chromatography – Mass Spectrometry (LC-MS) method. This has resulted in lower concentrations of these compounds being detected than was previously possible. Consequently, for samples from 2006 onwards, the proportion of birds in which anticoagulant rodenticides have been detected has increased compared to previous years. SGARs were detected in 89% of barn owls and the most prevalent compounds were difenacoum and bromadiolone. The majority of the residues were low and not diagnosed as directly causing mortality. Only five red kites were received by the scheme in 2009. Most of the red kites (4 o/5 birds) had detectable liver SGAR concentrations, again mainly difenacoum and bromadiolone although brodifacoum was also detected in over half the birds. Two of the five red kites analysed showed signs of haemorrhaging thought possibly to be associated with rodenticide poisoning. SGARs have been monitored in barn owls since 1983. Data on long-term trends have been adjusted to account for changes over time in sensitivity of analytical methods. This has meant that very low residues (<0.025µg/g wet weight), which are now easily detectable, are not included in the time trend analysis. The proportion of owls with detectable SGAR residues was found to be two-fold higher in England than in either Scotland or Wales. Overall, the proportion of barn owls with detectable liver concentrations of one or more SGAR has increased significantly over the course of monitoring. The highest value was recorded in 2008 but this was approximately twice that for the previous three years. The value for 2009 was lower than 2008 but remains one of the highest recorded since monitoring began. Continued monitoring is required to determine whether the high detection rate for SGARs in barn owls in 2008 and 2009 will change. Although our data for red kites in 2009 is limited, it is consistent with a high proportion of red kites being exposed to SGARs and some dying as a result. This species remains at particular risk from anticoagulant rodenticides

Peri- and Postoperative Treatment with the Interleukin-1 Receptor Antagonist Anakinra Is Safe in Patients Undergoing Renal Transplantation: Case Series and Review of the Literature

Contains fulltext : 174156.pdf (publisher's version ) (Open Access)In patients undergoing solid organ transplantation, the presence of an interleukin-1 (IL-1) driven disease may require the addition of IL-1 inhibiting drugs to the standard immunosuppressive regimen to protect against inflammation and negative graft outcome. Three patients undergoing renal transplantation were treated perioperatively with the interleukin-1 receptor antagonist anakinra. Kidney function increased rapidly in all three and the only complications seen were minor infections. In vitro studies report associations between serum and urinary levels of IL-1beta and IL-1 receptor antagonist and negative graft outcome, and studies in animals and two small human trials illustrate a possible protective effect of anti-IL-1 therapy after solid organ transplantation. Peri- and postoperative use of anakinra is safe and effective in patients undergoing renal transplantation