Increased Risk of Hepatocellular Carcinoma and Liver Cirrhosis in Vinyl Chloride Workers: Synergistic Effect of Occupational Exposure with Alcohol Intake

Hepatocellular carcinoma (HCC) and liver cirrhosis (LC) are not well-established vinyl chloride monomer (VCM)–induced diseases. Our aim was to appraise the role of VCM, alcohol intake, and viral hepatitis infection, and their interactions, in the etiology of HCC and LC. Thirteen cases of HCC and 40 cases of LC were separately compared with 139 referents without chronic liver diseases or cancer in a case–referent study nested in a cohort of 1,658 VCM workers. The odds ratios (ORs) and the 95% confidence intervals (CIs) were estimated by common methods and by fitting models of logistic regression. We used Rothman’s synergy index (S) to evaluate interactions. By holding the confounding factors constant at logistic regression analysis, each extra increase of 1,000 ppm × years of VCM cumulative exposure was found to increase the risk of HCC by 71% (OR = 1.71; 95% CI, 1.28–2.44) and the risk of LC by 37% (OR = 1.37; 95% CI, 1.13–1.69). The joint effect of VCM exposure above 2,500 ppm × years and alcohol intake above 60 g/day resulted in ORs of 409 (95% CI, 19.6–8,553) for HCC and 752 (95% CI, 55.3–10,248) for LC; both S indexes suggested a synergistic effect. The joint effect of VCM exposure above 2,500 ppm × years and viral hepatitis infection was 210 (95% CI, 7.13–6,203) for HCC and 80.5 (95% CI, 3.67–1,763) for LC; both S indexes suggested an additive effect. In conclusion, according to our findings, VCM exposure appears to be an independent risk factor for HCC and LC interacting synergistically with alcohol consumption and additively with viral hepatitis infection

Position Paper of the Italian Association of Medical Oncology on Early Palliative Care in Oncology Practice (Simultaneous Care)

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EOSC. Scenari evolutivi e sviluppi in ambito italiano - Speakers: Panelist Bios

Biografie dei panelist al workshop tenutosi il 3 aprile 2019 presso l'Aula Baratto dell'Università Ca' Foscari di Venezia

Tecniche della comunicazione nella relazione d'aiuto

Questo manuale teorico-pratico di tecniche della comunicazione verbale e non verbale, \ue8 un compendio di tecnica della comunicazione in medicina psicosomatica, per coloro che desiderino affrontare con maggior sicurezza le relazioni interpersonali nella malattia cronica severa e terminale. Il libro spiega i passi essenziali per poter costruire un rapporto empatico dove la qualit\ue0 della relazione si basa sull'ascolto non valutativo e si concentra sulla comprensione dei sentimenti e bisogni fondamentali dell'altro. Molti sono i fattori che influenzano e determinano la qualit\ue0 della comunicazione: l'ambiente, i valori, gli atteggiamenti, le parole, i gesti, il silenzio. non essendo possibile "non comunicare" occorre sempre porsi il problema di "come" comunicare: occorre quindi formulare strategie, definire obiettivi, programmare attivit\ue0 di comunicazione. Dalla conoscenza di questi punti deriva un elemento di grande importanza: per sviluppare una buona comunicazione occorre saper ascoltare. Soltanto se ascoltiamo attentamente i nostri interlocutori possiamo realizzare una comunicazione davvero efficace. Esiste quindi la possibilit\ue0 di un approccio cordiale alla comunicazione empatica, in cui si comincia a dare ci\uf2 che si sente di dare: questo libro, passo dopo passo, ci aiuta a capire, e a costruire, la migliore relazione con chi ci sta vicino

Bortezomib-melphalan-prednisone-thalidomide followed by maintenance with bortezomib-thalidomide compared with bortezomib-melphalan-prednisone for initial treatment of multiple myeloma: Updated follow-up and improved survival

Purpose: Bortezomib-melphalan-prednisone (VMP) has improved overall survival in multiple myeloma. This randomized trial compared VMP plus thalidomide (VMPT) induction followed by bortezomibthalidomide maintenance (VMPT-VT) with VMP in patients with newly diagnosed multiple myeloma. Patients and Methods: We randomly assigned 511 patients who were not eligible for transplantation to receive VMPT-VT (nine 5-week cycles of VMPT followed by 2 years of VT maintenance) or VMP (nine 5-week cycles without maintenance). Results: In the initial analysis with a median follow-up of 23 months, VMPT-VT improved complete response rate from 24% to 38% and 3-year progression-free- survival (PFS) from 41% to 56% compared with VMP. In this analysis, median follow-up was 54 months. The median PFS was significantly longer with VMPT-VT (35.3 months) than with VMP (24.8 months; hazard ratio [HR], 0.58; P < .001). The time to next therapy was 46.6 months in the VMPT-VT group and 27.8 months in the VMP group (HR, 0.52; P < .001). The 5-year overall survival (OS) was greater with VMPT-VT (61%) than with VMP (51%; HR, 0.70; P = .01). Survival from relapse was identical in both groups (HR, 0.92; P = .63). In the VMPT-VT group, the most frequent grade 3 to 4 adverse events included neutropenia (38%), thrombocytopenia (22%), peripheral neuropathy (11%), and cardiologic events (11%). All of these, except for thrombocytopenia, were significantly more frequent in the VMPT-VT patients. Conclusion: Bortezomib and thalidomide significantly improved OS in multiple myeloma patients not eligible for transplantation. © 2014 by American Society of Clinical Oncology