Prospective Phase II trial of drug-eluting bead chemoembolization for liver transplant candidates with hepatocellular carcinoma and marginal hepatic reserve.

Purpose: To determine whether chemoembolization using drug-eluting beads (DEB-TACE) is safe and effective for liver transplantation candidates with liver-limited hepatocellular carcinoma (HCC) without vascular invasion and baseline hepatic dysfunction. Materials and methods: Seventeen adult liver transplantation candidates (median age 66 years, range 58-73 years; 13 men) with HCC were treated with DEB-TACE as a part of Stage 1 of a prospective single-institution Phase II trial. All patients had marginal hepatic reserve based on at least one of the following criteria: ascites (n=14), bilirubin between 3 and 6 mg/dL (n=5), AST 5-10 times upper normal limit (n=1), INR between 1.6 and 2.5 (n=4), portal vein thrombosis (n=2), and/or portosystemic shunt (n=2). Primary study objectives were safety and best observed radiographic response. Results: Thirty-seven DEB-TACE procedures were performed. Objective response rate and disease control rate were 63% and 88%, respectively. HCC progression was observed in 12 patients. Median time to progression was 5.6 months (range 0.9-13.6 months). Within 1 month following DEB-TACE, 13 patients (76%) developed grade 3 or 4 AE attributable to the procedure. Four patients (all within Milan Criteria) were transplanted (2.7-6.9 months after DEB-TACE), and 12 patients died (1.8-32 months after DEB-TACE). All deaths were due to liver failure that was either unrelated to HCC (n=5), in the setting of metastatic HCC (n=5), or in the setting of locally advanced HCC (n=2). Mortality rate at 1 month was 0%. Conclusions: DEB-TACE achieves tumor responses but carries a high risk of hepatotoxicity for liver transplant candidates with HCC and marginal hepatic reserve

The principles driving gene drives for conservation

This is the final version. Available on open access from Elsevier via the DOI in this recordGene drive technology is an emerging biotechnology with the potential to address some of the most intractable global biodiversity conservation issues. Scientists are exploring potential gene drive applications for managing invasive species and building resilience in keystone species threatened by climate change. The possibility to use gene drive for these conservation purposes has triggered significant interest in how to govern its development and eventual applications. This includes a plethora of documents prescribing governance principles, which can be a sensible response to the governance gap created by emerging technologies and help shore up legitimacy. We conducted qualitative documentary analysis to examine the range and substance of principles emerging in the governance of conservation gene drive. Such analysis aimed to better understand the aspirations guiding these applications and how scientists and other experts imagine their responsibility in this field. We found a collection of recommendations and prescriptions that could be organised into a set of seven emerging principles intended to shape the governance of gene drive in conservation: broad and empowered engagement; public acceptance; decision-making informed by broad ranging considerations, state and international collaboration; ethical frameworks; diverse expertise; and responsible self-regulation by developers. We lay bare these emergent principles, analyzing the way in which they are valued, prioritized, and their strengths and weaknesses. By identifying these prescriptive principles, stakeholders can further interrogate their merits and shortcomings and identify more concrete ways that governance frameworks might embody them.University of ExeterUniversity of Queenslan

Rex Shunt Preoperative Imaging: Diagnostic Capability of Imaging Modalities

The purpose of this study was to evaluate the diagnostic capability of imaging modalities used for preoperative mesenteric-left portal bypass (“Rex shunt”) planning. Twenty patients with extrahepatic portal vein thrombosis underwent 57 preoperative planning abdominal imaging studies. Two readers retrospectively reviewed these studies for an ability to confidently determine left portal vein (PV) patency, superior mesenteric vein (SMV) patency, and intrahepatic left and right PV contiguity. In this study, computed tomographic arterial portography allowed for confident characterization of left PV patency, SMV patency and left and right PV continuity in 100% of the examinations. Single phase contrast-enhanced CT, multi-phase contrast-enhanced CT, multiphase contrast-enhanced MRI, and transarterial portography answered all key diagnostic questions in 33%, 30%, 0% and 8% of the examinations, respectively. In conclusion, of the variety of imaging modalities that have been employed for Rex shunt preoperative planning, computed tomographic arterial portography most reliably allows for assessment of left PV patency, SMV patency, and left and right PV contiguity in a single study

Mobilising adaptive capacity to multiple stressors: insights from small-scale coastal fisheries in the Western Region of Ghana

The processes by which adaptive capacity is mobilised in response to multiple stressors are yet to be fully understood. This study addresses this pressing research gap by drawing on the capitals framework and empirical data from small-scale coastal fisheries in the Western Region of Ghana. It employs an ethnographic approach, based on multiple sources of evidence including documents, interviews and participant observation to examine mechanisms of mobilising adaptive capacity in response to climate and non-climate stressors. Our findings suggest that responding to stressors involves mobilising sets of main-available capitals, such as local innovation, ability to improvise, new technologies, corrupt practices and belief systems (cultural capital); collective action, networks and social ties (social capital); and complaints to the government (political capital). These capitals were the main constituents of adaptive capacity, particularly considering non-responsive government and formal organisations. Further, other forms of capitals, i.e., local leadership, local knowledge, learning capacity, and training (human capital); networks, collective actions, associations and bonding ties (social capital); sand (natural capital); funds from fishing (financial capital), combine in complex ways to mobilise such available capitals. This understanding is critical if synergies among main-available and supporting-available capitals are to support building and mobilizing adaptive capacity. Further, it may help guide important decisions, proactive plans and strategic investment for developing key capitals to enhance adaptive capacity