Validation of the SNACOR clinical scoring system after transarterial chemoembolisation in patients with hepatocellular carcinoma

Background Transarterial chemoembolisation is the standard of care for intermediate stage (BCLC B) hepatocellular carcinoma, but it is challenging to decide when to repeat or stop treatment. Here we performed the first external validation of the SNACOR (tumour Size and Number, baseline Alpha-fetoprotein, Child-Pugh and Objective radiological Response) risk prediction model. Methods A total of 1030 patients with hepatocellular carcinoma underwent transarterial chemoembolisation at our tertiary referral centre from January 2000 to December 2016. We determined the following variables that were needed to calculate the SNACOR at baseline: tumour size and number, alpha-fetoprotein level, Child-Pugh class, and objective radiological response after the first transarterial chemoembolisation. Overall survival, time-dependent area under receiver-operating characteristic curves, Harrell’s C-index, and the integrated Brier score were calculated to assess predictive ability. Finally, multivariate analysis was performed to identify independent predictors of survival. Results The study included 268 patients. Low, intermediate, and high SNACOR scores predicted a median survival of 31.5, 19.9, and 9.2 months, respectively. The areas under the receiver-operating characteristic curve for overall survival were 0.641, 0.633, and 0.609 at 1, 3, and 6 years, respectively. Harrell’s C-index was 0.59, and the integrated Brier Score was 0.175. Independent predictors of survival included tumour size (P < 0.001), baseline alpha-fetoprotein level (P < 0.001) and Child-Pugh class (P < 0.004). Objective radiological response (P = 0.821) and tumour number (P = 0.127) were not additional independent predictors of survival. Conclusions The SNACOR risk prediction model can be used to identify patients with a dismal prognosis after the first transarterial chemoembolisation who are unlikely to benefit from further transarterial chemoembolisation. However, Harrell’s C-index showed only moderate performance. Accordingly, this risk prediction model can only serve as one of several components used to make the decision about whether to repeat treatment

Lessons Learned from PARADeS Project for Flood Disaster Risk Planning and Management in Ghana

The PARADeS project focused on Ghana’s national flood disaster risk reduction and management strategy by investigating existing flood risk and mechanisms for disaster management, governance-policy, human-water interaction, and development of possible future scenarios and feasible and sustainable measures. Three case study areas with different types of flooding were identified and chosen in a participatory flood risk-based process. These are including the catchments Odaw in Accra (pluvial, fluvial and coastal floods), Aboabo in Kumasi (pluvial and fluvial floods), and the White Volta (fluvial floods). The project used innovative socio-technical and participatory approaches and tools that combines research, development, and institutional strengthening activities. It integrated diverse information, local knowledge and data sources and was developed collaboratively with stakeholder scenarios and socio-technical tools in order to support coherent decision-making processes. A key aspect was analysing different scenarios of flood hazards, investigating and modelling cascading risk effects regarding critical infrastructure, and an assessment tool to identify flood risk at a household level, the FLOODLABEL Ghana. All processes and working steps are realized using interdisciplinary and participatory approaches together with Ghanaian stakeholders. The end products are strengthening institutional and citizens’ capacity through a series of activities on societal awareness and training of specialists, decision, and policymakers. Technologically, the project has produced a set of decision support tools (Flood Information Systems, FLOODLABEL Ghana, etc.) to effectively disseminate vital information to citizens, researchers, and decision makers to respond and mitigate the impact of flooding. In pursuit of sustainable development in FDRM measures, we disseminated the outcomes and products, including technical tools, through reports and scientific publications. Additionally, we developed training materials tailored for students, experts, and decision-makers

Compartmentalization proteomics revealed endolysosomal protein network changes in a goat model of atrial fibrillation

Endolysosomes (EL) are known for their role in regulating both intracellular trafficking and proteostasis. EL facilitate the elimination of damaged membranes, protein aggregates, membranous organelles and play an important role in calcium signaling. The specific role of EL in cardiac atrial fibrillation (AF) is not well understood. We isolated atrial EL organelles from AF goat biopsies and conducted a comprehensive integrated omics analysis to study the EL-specific proteins and pathways. We also performed electron tomography, protein and enzyme assays on these biopsies. Our results revealed the upregulation of the AMPK pathway and the expression of EL-specific proteins that were not found in whole tissue lysates, including GAA, DYNLRB1, CLTB, SIRT3, CCT2, and muscle-specific HSPB2. We also observed structural anomalies, such as autophagic-vacuole formation, irregularly shaped mitochondria, and glycogen deposition. Our results provide molecular information suggesting EL play a role in AF disease process over extended time frames

Data for critical infrastructure network modelling of natural hazard impacts: Needs and influence on model characteristics

Natural hazards impact interdependent infrastructure networks that keep modern society functional. While a variety of modelling approaches are available to represent critical infrastructure networks (CINs) on different scales and analyse the impacts of natural hazards, a recurring challenge for all modelling approaches is the availability and accessibility of sufficiently high-quality input and validation data. The resulting data gaps often require modellers to assume specific technical parameters, functional relationships, and system behaviours. In other cases, expert knowledge from one sector is extrapolated to other sectoral structures or even cross-sectorally applied to fill data gaps. The uncertainties introduced by these assumptions and extrapolations and their influence on the quality of modelling outcomes are often poorly understood and difficult to capture, thereby eroding the reliability of these models to guide resilience enhancements. Additionally, ways of overcoming the data availability challenges in CIN modelling, with respect to each modelling purpose, remain an open question. To address these challenges, a generic modelling workflow is derived from existing modelling approaches to examine model definition and validations, as well as the six CIN modelling stages, including mapping of infrastructure assets, quantification of dependencies, assessment of natural hazard impacts, response &amp; recovery, quantification of CI services, and adaptation measures. The data requirements of each stage were systematically defined, and the literature on potential sources was reviewed to enhance data collection and raise awareness of potential pitfalls. The application of the derived workflow funnels into a framework to assess data availability challenges. This is shown through three case studies, taking into account their different modelling purposes: hazard hotspot assessments, hazard risk management, and sectoral adaptation. Based on the three model purpose types provided, a framework is suggested to explore the implications of data scarcity for certain data types, as well as their reasons and consequences for CIN model reliability. Finally, a discussion on overcoming the challenges of data scarcity is presented

Electrochromic graduated filters with symmetric electrode configuration

Graduated optical filters are commonly used for spatial image control as they are capable of darkening the overexposed parts of the image specifically. However, they lack flexibility because each filter has a fixed transmission distribution. We herein present a fully controllable graduated filter based on the electrochromic device. Its graduated transmission distribution can be spatially controlled by the application of multiple electric potentials. In this way, the control of the gradient’s position and its width, transmission and angular orientation is possible. Simulation of both the spatial potential distribution and the resultant optical absorption distribution are conducted to optimize the electrode configuration and furthermore to derive a control dataset that facilitates the adjustment and thus the application of the graduated filter. Based on three objective and quantitative criteria, we identify the electrode configuration with the highest flexibility in all four controls, manufacture the device using a gravure printing process for the nanoparticle electrodes and show its successful application

Endovascular simulation training: a tool to increase enthusiasm for interventional radiology among medical students

Objectives: Interventional radiology (IR) is a growing field but is underrepresented in most medical school curricula. We tested whether endovascular simulator training improves medical students' attitudes towards IR. Materials and methods: We conducted this prospective study at two university medical centers; overall, 305 fourth-year medical students completed a 90-min IR course. The class consisted of theoretical and practical parts involving endovascular simulators. Students completed questionnaires before the course, after the theoretical and after the practical part. On a 7-point Likert scale, they rated their interest in IR, knowledge of IR, attractiveness of IR, and the likelihood to choose IR as subspecialty. We used a crossover design to prevent position-effect bias. Results: The seminar/simulator parts led to the improvement for all items compared with baseline: interest in IR (pre-course 5.2 vs. post-seminar/post-simulator 5.5/5.7), knowledge of IR (pre-course 2.7 vs. post-seminar/post-simulator 5.1/5.4), attractiveness of IR (pre-course 4.6 vs. post-seminar/post-simulator 4.8/5.0), and the likelihood of choosing IR as a subspecialty (pre-course 3.3 vs. post-seminar/post-simulator 3.8/4.1). Effect was significantly stronger for simulator training compared with that for seminar for all items (p < 0.05). For simulator training, subgroup analysis of students with pre-existing positive attitude showed considerable improvement regarding "interest in IR" (× 1.4), "knowledge of IR" (× 23), "attractiveness of IR" (× 2), and "likelihood to choose IR" (× 3.2) compared with pretest. Conclusion: Endovascular simulator training significantly improves students' attitude towards IR regarding all items. Implementing such courses at a very early stage in the curriculum should be the first step to expose medical students to IR and push for IR. Key points: • Dedicated IR-courses have a significant positive effect on students' attitudes towards IR. • Simulator training is superior to a theoretical seminar in positively influencing students' attitudes towards IR. • Implementing dedicated IR courses in medical school might ease recruitment problems in the field

Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance

BACKGROUND: There is strong evidence that portal vein tumor thrombosis (PVTT) is associated with poor survival in patients with hepatocellular carcinoma (HCC). However, data regarding the clinical significance of hepatic vein tumor thrombosis (HVTT) is rare, particularly in Western patients. OBJECTIVE: To determine the HVTT prevalence in a Western patient population and its impact on survival. METHODS: We included 1310 patients with HCC treated in our tertiary referral center between January 2005 and December 2016. HVTT and PVTT were diagnosed with contrast‐enhanced cross‐sectional imaging. Overall survival (OS) was calculated starting from the initial HCC diagnosis, and in a second step, starting from the first appearance of vascular invasion. RESULTS: We observed macrovascular invasion (MVI) in 519 patients who suffered from either isolated HVTT (n = 40), isolated PVTT (n = 352), or both combined (HVTT + PVTT) (n = 127). Calculated from the initial HCC diagnosis, the median OS for patients with isolated HVTT was significantly shorter than that of patients without MVI (13.3 vs. 32.5 months, p < 0.001). Calculated from the first appearance of MVI, the median OS was similar among patients with isolated HVTT (6.5 months), isolated PVTT (5 months), and HVTT + PVTT (5 months). Multivariate analysis confirmed HVTT as an independent risk factor for poor survival. CONCLUSIONS: HVTT may be more common than typically reported. In most patients, it was accompanied by PVTT. Isolated HVTT occurred less frequently and later than isolated PVTT; however, once developed, it had the same deleterious impact on survival. Therefore, patients with HVTT should be classified as advanced stage of HCC

Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance

Background There is strong evidence that portal vein tumor thrombosis (PVTT) is associated with poor survival in patients with hepatocellular carcinoma (HCC). However, data regarding the clinical significance of hepatic vein tumor thrombosis (HVTT) is rare, particularly in Western patients. Objective To determine the HVTT prevalence in a Western patient population and its impact on survival. Methods We included 1310 patients with HCC treated in our tertiary referral center between January 2005 and December 2016. HVTT and PVTT were diagnosed with contrast-enhanced cross-sectional imaging. Overall survival (OS) was calculated starting from the initial HCC diagnosis, and in a second step, starting from the first appearance of vascular invasion. Results We observed macrovascular invasion (MVI) in 519 patients who suffered from either isolated HVTT (n = 40), isolated PVTT (n = 352), or both combined (HVTT + PVTT) (n = 127). Calculated from the initial HCC diagnosis, the median OS for patients with isolated HVTT was significantly shorter than that of patients without MVI (13.3 vs. 32.5 months, p < 0.001). Calculated from the first appearance of MVI, the median OS was similar among patients with isolated HVTT (6.5 months), isolated PVTT (5 months), and HVTT + PVTT (5 months). Multivariate analysis confirmed HVTT as an independent risk factor for poor survival. Conclusions HVTT may be more common than typically reported. In most patients, it was accompanied by PVTT. Isolated HVTT occurred less frequently and later than isolated PVTT; however, once developed, it had the same deleterious impact on survival. Therefore, patients with HVTT should be classified as advanced stage of HCC