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

Low in‑hospital mortality rate in patients with COVID‑19 receiving thromboprophylaxis: data from the multicentre observational START‑COVID Register

Abstract COVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease,and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years

Long-term Monitoring on Mrk 501 for Its VHE gamma Emission and a Flare in October 2011

As one of the brightest active blazars in both X-ray and very high energy $\gamma$-ray bands, Mrk 501 is very useful for physics associated with jets from AGNs. The ARGO-YBJ experiment is monitoring it for $\gamma$-rays above 0.3 TeV since November 2007. Starting from October 2011 the largest flare since 2005 is observed, which lasts to about April 2012. In this paper, a detailed analysis is reported. During the brightest $\gamma$-rays flaring episodes from October 17 to November 22, 2011, an excess of the event rate over 6 $\sigma$ is detected by ARGO-YBJ in the direction of Mrk 501, corresponding to an increase of the $\gamma$-ray flux above 1 TeV by a factor of 6.6$\pm$2.2 from its steady emission. In particular, the $\gamma$-ray flux above 8 TeV is detected with a significance better than 4 $\sigma$. Based on time-dependent synchrotron self-Compton (SSC) processes, the broad-band energy spectrum is interpreted as the emission from an electron energy distribution parameterized with a single power-law function with an exponential cutoff at its high energy end. The average spectral energy distribution for the steady emission is well described by this simple one-zone SSC model. However, the detection of $\gamma$-rays above 8 TeV during the flare challenges this model due to the hardness of the spectra. Correlations between X-rays and $\gamma$-rays are also investigated.Comment: have been accepted for publication at Ap

ThRAll Challenge data set and associated coding information

As part of the European Food Safety Authority funded project (GP/EFSA/AFSCO/2017/03) entitled “Detection and Quantification of Allergens in Foods and Minimum Eliciting Doses in Food-Allergic Individuals” (ThRAll) an online database was built using REDCap (Research Electronic Data Capture). This is a web application for building and managing online surveys and databases which is free to use for REDCap consortium members an electronic clinical record system. The database comprises four instruments as follows which are designed to capture various different types of data: (1) Protocol: this collates data on the allergenic food used for a food challenge, the matrix it was delivered in, the ingredients used to make the matrix, type of challenges study (e.g. double blind placebo controlled food challenge, open challenge, single dose challenge or one using interspersed doses), the dose progression, dosing interval and stopping criteria. (2) Demographics: this captures the data source, research ethics committee number and information on how the challenges are coded regarding whether objective or subjective symptoms were recorded, the country the data originated from, gender, age and BMI of study subject. (3) Challenge day: this captures data on a challenge day and the symptoms recorded during the dose progression and their time of development. This instrument is suitable for upload of clinical data collected during a food challenge. (4) Threshold dose: this captures data that is only available in a summarised form where the lowest observed adverse effect level (LOAEL) and no observed adverse effect level (NOAEL) is provided. This is frequently the case for published data. The annoymised data collated through the project is provided as an annoymised csv file together with the associated REDCap data dictionary file and code book. A coding system was also developed utilising a combination of SNOMED and FoodEx2 codes to support harmonisation of such data