135 research outputs found
Pattern, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma: how do they matter?
No full textSearching for Pigeons in the Belfry: The Inquest, the Abolition of the Deodand and the Rise of the Family
No full textThis article explores the abolition in 1846 of the deodand – the object or animal declared responsible for death by an inquest jury – and its relationship with the family of the deceased. Drawing on the work of Jacques Donzelot, it argues that the deodand brought contingency into the heart of law, and that its replacement with a legal right to compensation for dependents was a move to rationalize the investigation of death. This rationalization had consequences; limiting the place of the unruly community, centering and regulated the family, and disconnecting the inquest from the material of death
Radiology of pyloric reflux
No full textPaper read at a special meeting at the New Charing Cross Hospital, London, on the 29th September 1971, to discuss the subject of Pyloric Regurgitation. Up to a few years ago the only radiological examination for the pylorus was the standard Regurgitation barium meal, which cannot show whether or not such regurgitation occurs. Bile regurgitation can be deduced by two methods, namely Isotopes Studies and radiology. From the author`s perspective, the antegrade intubation is the preferred method, whereby the findings can be recorded by one of the following methods: a) Cineradiography b) Conventional radiography c) 70 m.m. Fluorography d) Video-tape. Of these four methods, the author maintains that video-tape recording is the most informative. The full significance of pyloric regurgitation is not known yet and in this regard further studies are required.peer-reviewe
Diversifying police recruitment? the deployment of Police Community Support Officers in London
No full textDevelopment of pre and post-operative models to predict early recurrence of hepatocellular carcinoma after surgical resection
No full textBACKGROUND & AIMS:Resection is the most widely used potentially curative treatment for patients with early hepatocellular carcinoma (HCC). However, recurrence within 2 years occurs in 30-50% of patients, being the major cause of mortality. Herein, we describe 2 models, both based on widely available clinical data, which permit risk of early recurrence to be assessed before and after resection. METHODS:A total of 3,903 patients undergoing surgical resection with curative intent were recruited from 6 different centres. We built 2 models for early recurrence, 1 using preoperative and 1 using pre and post-operative data, which were internally validated in the Hong Kong cohort. The models were then externally validated in European, Chinese and US cohorts. We developed 2 online calculators to permit easy clinical application. RESULTS:Multivariable analysis identified male gender, large tumour size, multinodular tumour, high albumin-bilirubin (ALBI) grade and high serum alpha-fetoprotein as the key parameters related to early recurrence. Using these variables, a preoperative model (ERASL-pre) gave 3 risk strata for recurrence-free survival (RFS) in the entire cohort - low risk: 2-year RFS 64.8%, intermediate risk: 2-year RFS 42.5% and high risk: 2-year RFS 20.7%. Median survival in each stratum was similar between centres and the discrimination between the 3 strata was enhanced in the post-operative model (ERASL-post) which included 'microvascular invasion'. CONCLUSIONS:Statistical models that can predict the risk of early HCC recurrence after resection have been developed, extensively validated and shown to be applicable in the international setting. Such models will be valuable in guiding surveillance follow-up and in the design of post-resection adjuvant therapy trials. LAY SUMMARY:The most effective treatment of hepatocellular carcinoma is surgical removal of the tumour but there is often recurrence. In this large international study, we develop a statistical method that allows clinicians to estimate the risk of recurrence in an individual patient. This facility enhances communication with the patient about the likely success of the treatment and will help in designing clinical trials that aim to find drugs that decrease the risk of recurrence
Clinical characteristics of patients with hepatocellular cell carcinoma.
No full text<p>AJCC: American Joint Committee on Cancer; NA: Not Available; Risk factors: Alcohol consumption, Hepatitis B/C, Hemochromatosis, Nonalcoholic Fatty Liver Disease, Alpha-1 Antitrypsin Deficiency</p><p><sup>a</sup> Statistical significant results (in bold)</p><p>Clinical characteristics of patients with hepatocellular cell carcinoma.</p
Kaplan–Meier survival curves for hepatocellular cell carcinoma patients.
No full text<p>The 327 hepatocellular cell carcinoma patients are compared in two groups according to: a 7-miRNA signature (1 high risk vs. 2 low risk); b Tumor status (1 Tumor free vs. 2 With tumor); c AJCC pathological (1 I + II vs. 2 stage III + IV); and d AJCC T stage (1 T1+T2 vs. 2 T3+T4). Log Rank (Mantel-Cox) P value are 0.000, 0.001, 0.042 and 0.002, respectively. (Blue line: group 1, Green line: group 2, Horizontal axis: overall survival time, Vertical axis: survival function).</p
Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses.
No full textBackground
The application and feasibility of minimally invasive liver resection (MILR) for huge liver tumours (≥10 cm) has not been well documented.
Methods
Retrospective analysis of data on 6,617 patients who had MILR for liver tumours were gathered from 21 international centers between 2009-2019. Huge tumors and large tumors were defined as tumors with a size ≥10.0 cm and 3.0-9.9 cm based on histology, respectively. 1:1 coarsened exact-matching (CEM) and 1:2 Mahalanobis distance-matching (MDM) was performed according to clinically-selected variables. Regression discontinuity analyses were performed as an additional line of sensitivity analysis to estimate local treatment effects at the 10-cm tumor size cutoff.
Results
Of 2,890 patients with tumours ≥3 cm, there were 205 huge tumors. After 1:1 CEM, 174 huge tumors were matched to 174 large tumors; and after 1:2 MDM, 190 huge tumours were matched to 380 large tumours. There was significantly and consistently increased intraoperative blood loss, frequency in the application of Pringle maneuver, major morbidity and postoperative stay in the huge tumour group compared to the large tumour group after both 1:1 CEM and 1:2 MDM. These findings were reinforced in RD analyses. Intraoperative blood transfusion rate and open conversion rate were significantly higher in the huge tumor group after only 1:2 MDM but not 1:1 CEM.
Conclusions
MILR for huge tumours can be safely performed in expert centers It is an operation with substantial complexity and high technical requirement, with worse perioperative outcomes compared to MILR for large tumors, therefore judicious patient selection is pivotal
A Seven-microRNA Expression Signature Predicts Survival in Hepatocellular Carcinoma.
No full textHepatocellular carcinoma (HCC) is the fifth common cancer. The differential expression of microRNAs (miRNAs) has been associated with the prognosis of various cancers. However, limited information is available regarding genome-wide miRNA expression profiles in HCC to generate a tumor-specific miRNA signature of prognostic values. In this study, the miRNA profiles in 327 HCC patients, including 327 tumor and 43 adjacent non-tumor tissues, from The Cancer Genome Atlas (TCGA) Liver hepatocellular carcinoma (LIHC) were analyzed. The associations of the differentially expressed miRNAs with patient survival and other clinical characteristics were examined with t-test and Cox proportional regression model. Finally, a tumor-specific miRNA signature was generated and examined with Kaplan-Meier survival, univariate\multivariate Cox regression analyses and KEGG pathway analysis. Results showed that a total of 207 miRNAs were found differentially expressed between tumor and adjacent non-tumor HCC tissues. 78 of them were also discriminatively expressed with gender, race, tumor grade and AJCC tumor stage. Seven miRNAs were significantly associated with survival (P value <0.001). Among the seven significant miRNAs, six (hsa-mir-326, hsa-mir-3677, hsa-mir-511-1, hsa-mir-511-2, hsa-mir-9-1, and hsa-mir-9-2) were negatively associated with overall survival (OS), while the remaining one (hsa-mir-30d) was positively correlated. A tumor-specific 7-miRNAs signature was generated and validated as an independent prognostic predictor. Collectively, we have identified and validated an independent prognostic model based on the expression of seven miRNAs, which can be used to assess patients' survival. Additional work is needed to translate our model into clinical practice
History of Dialysis in the UK: c. 1950–1980
No full textDialysis, the first technological substitution for organ function, is significant not only for the numbers of patients who have benefited. It contributed to the emergence of the field of medical ethics and the development of the nurse specialist, and transformed the relationship between physicians and patients by allowing patients to control their treatment.
This seminar drew on participants’ recollections of dialysis from the early, practically experimental days after the Second World War, when resources for research were scant, until the 1980s when it had become an established treatment. Pioneers from the first UK dialysis units recalled the creation of the specialty of nephrology amid discouragement from renal physicians and the MRC, which felt that the artificial kidney was a gadget that would not last.
International and interdisciplinary collaborations, and interactions between with industry and clinics in developing and utilising the specialist technology were emphasized. Patients, carers, nurses, technicians and doctors reminisced about their experiences of home dialysis, its complications and impact on family life, as well as the physical effects of surviving on long-term dialysis before transplantation became routine.
The meeting was suggested and chaired by Dr John Turney and witnesses include Dr Rosemarie Baillod, Professor Christopher Blagg, Professor Stewart Cameron, Mr Eric Collins, Professor Robin Eady, Mrs Diana Garratt, Professor David Kerr, Professor Sir Netar Mallick, Dr Frank Marsh, Dr Jean Northover, Dr Chisholm Ogg, Dr Margaret Platts, Dr Stanley Rosen and Professor Stanley Shaldon. Two appendices contain reminiscences from Professor Kenneth Lowe and Sir Graham Bull
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