Radiofrequency ablation versus hepatic resection for hepatocellular carcinoma within the Milan criteria – A comparative study

AbstractBackgroundTo compare the results of radiofrequency ablation (RFA) with hepatic resection in the treatment of hepatocellular carcinoma (HCC) within the Milan criteria.MethodsA nonrandomized comparative study was performed with 111 consecutive patients who underwent laparoscopic RFA (n = 31) or curative hepatic resection (n = 80) for HCC within Milan criteria.ResultsProcedure related complications were less often and severe after RFA than resection (3.2% vs. 25%). There was no significant difference in hospital mortality (0% vs. 3.8%). Hospital stay was significantly shorter in the RFA group than in the resection group (mean, 3.8 vs. 6.8 days). The 1-, 3-, and 5-year disease-free survival rates for the RFA group and the resection group were 76%, 40%, 40% and 76%, 60%, 60%, respectively. Disease-free survival was significantly lower in the RFA group than in the resection group. The corresponding 1-, 3-, and 5-year overall survival rates for the RFA group and the resection group were 100%, 92%, 84%, and 92%, 75%, 71%, respectively. The overall survival for RFA and resection were not significantly different.ConclusionsOur result showed comparable overall survival between RFA and surgery, although RFA was associated with a significantly higher tumor recurrence rate. RFA had the advantages over surgical resection in being less invasive and having lower morbidity

Efficacy and Safety of Lenabasum, a Cannabinoid Type 2 Receptor Agonist, in a Phase 3 Randomized Trial in Diffuse Cutaneous Systemic Sclerosis

Objective This phase 3 study was undertaken to investigate the efficacy and safety of lenabasum, a cannabinoid type 2 receptor agonist, in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods A multinational double-blind study was conducted in 365 dcSSc patients who were randomized and dosed 1:1:1 with lenabasum 20 mg, lenabasum 5 mg, or placebo, each twice daily and added to background treatments, including immunosuppressive therapies (IST). Results The primary end point, the American College of Rheumatology combined response index in dcSSc (CRISS) at week 52 for lenabasum 20 mg twice a day versus placebo, was not met, with CRISS score of 0.888 versus 0.887 (P = 0.4972, using mixed models repeated measures [MMRM]). The change in the modified Rodnan skin thickness score (MRSS) at week 52 for lenabasum 20 mg twice a day versus placebo was −6.7 versus −8.1 (P = 0.1183, using MMRM). Prespecified analyses showed higher CRISS scores, greater improvement in MRSS, and lower decline in forced vital capacity in patients on background mycophenolate and those who were taking IST for ≤1 year. No deaths or excess in serious or severe adverse events related to lenabasum were observed. Conclusion A benefit of lenabasum in dcSSc was not demonstrated. Most patients were treated with background IST, and treatment with mycophenolate mofetil in particular was associated with better outcomes. These findings support the use of IST in the treatment of dcSSc and highlight the challenge of demonstrating a treatment effect when investigational treatment is added to standard of care IST. These findings have relevance to trial design in SSc, as well as to clinical care

Effects of preweaning and post weaning implants on suckling, growing, and finishing steer performance

One hundred and ninety-five crossbred steers were used to compare lifetime implant strategies and study the effects of implanting during the suckling period on performance in the growing and finishing periods. There were no differences in growing period gains when both groups were implanted in the suckling period and the growing period. However, steers implanted in the suckling period but not implanted in the growing period had significantly lower gains than all other treatments including controls. Steers implanted only in the growing period had better feed efficiency in the growing period than both controls and steers implanted only in the suckling period. Steers reimplanted during the finishing period had similar finishing gains regardless of prior implant treatment, and all implanted cattle gained faster than controls in the finishing period. Steers not reimplanted during the finishing period had lower gains than those reimplanted. Implanting in the finishing period resulted in better feed efficiency. All implanted cattle that were reimplanted in the finishing period had higher lifetime gains than controls, but there was no difference between implant combinations. The only carcass characteristic changed by implanting was quality grade, which was reduced by all implant combinations with the exception of implanting only in the finishing period. Implanting during the suckling period did not reduce cattle performance during the growing and finishing periods when the steers were also implanted during these periods. This study emphasizes the importance of implanting twice in the finishing period to maximize finishing gain and final weight

Effects of preweaning and postweaning implants on suckling, growing, and finishing steer performance - a three trial summary

Over 500 crossbred steers were used in three trials to compare lifetime implant strategies and to study the effects of implanting during the suckling period on performance in the growing and finishing periods. Contrary to previous research, implanting in the suckling period did not increase suckling gain. Implanting in the growing period increased (P<.05) average daily gain, and the implant response in the growing period was not influenced by suckling implant treatment. Steers implanted twice during the finishing period had similar finishing gains regardless of prior implant treatment. Steers implanted only once during the finishing phase gained less (P<.05) than those implanted twice, and while their gains were higher than those of control steers, the difference was small (P>.05). Implanting steers in the finishing phase tended to improve feed conversion but again the difference was not statistically significant. All implant treatments increased (P<.05) lifetime average daily gains and total gain, and there was no difference among implant combinations. Implant treatments increased lifetime gains by 30 to 54 lbs. Because implanting in the suckling period did not reduce cattle performance during the growing and finishing periods, there appears to be no basis for discounting the price of previously implanted cattle. Additionally, this study emphasizes the importance of reimplanting cattle during long finishing period