共查询到20条相似文献，搜索用时 31 毫秒
1.
Martinus J. van Amerongen Sjoerd F.M. Jenniskens Peter B. van den Boezem Jurgen J. Fütterer Johannes H.W. de Wilt 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):749-756
Background
Hepatic resection and ablative treatments, such as RFA are available treatment options for liver tumors. Advantages and disadvantages of these treatment options in patients with colorectal liver metastases need further evaluation. The purpose of this study was to systematically evaluate the role of radiofrequency ablation (RFA) compared to surgery in the curative treatment of patients with colorectal liver metastases (CRLM).Methods
A systematic search was performed from MEDLINE, EMBASE and the Cochrane Library for studies directly comparing RFA with resection for CRLM, after which variables were evaluated.Results
RFA had significantly lower complication rates (OR = 0.44, 95% CI = 0.26–0.75, P = 0.002) compared to resection. However, RFA showed a higher rate of any recurrence (OR = 1.66, 95% CI = 1.15–2.40, P = 0.007), local recurrence (OR = 9.56, 95% CI = 6.85–13.35, P = 0.001), intrahepatic recurrence (OR = 1.96, 95% CI = 1.34–2.87, P = 0.001) and extrahepatic recurrence (OR = 1.21, 95% CI = 0.90–1.63, P = 0.22). Also, 5-year disease-free survival (OR = 2.20, 95% CI = 1.28–3.79, P = 0.005) and overall survival (OR = 2.35, 95% CI = 1.49–3.69, P = 0.001) were significantly lower in patients treated with RFA.Conclusions
RFA showed a significantly lower rate of complications, but also a lower survival and a higher rate of recurrence as compared to surgical resection. All the included studies were subject to possible patient selection bias and therefore randomized clinical trials are needed to accurately evaluate these treatment modalities. 相似文献2.
Jenny Chan Marcos Perini Michael Fink Mehrdad Nikfarjam 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(6):487-496
Background
Central hepatectomy (CH) is a relatively uncommon liver resection technique. It is generally perceived as a more complex operation than extended hepatectomies (EH), with potentially higher associated morbidity. The outcomes of CH compared with EH is not well defined and there is a need to reassess.Methods
A systematic literature search was conducted in PubMed, MEDLINE, EMBASE and Web of Science according to PRISMA guidelines for studies on the treatment of liver tumours with CH published from 1972 until February 2017. Outcomes of patients undergoing CH were assessed and compared to those undergoing EH.Results
18 publications including 1380 CH were included for analysis. Mortality rates after CH ranged from 0 to 9%. There were 20 (1.4%) deaths after CH and the most common cause of death was post-hepatectomy liver failure (PHLF). Morbidity rates varied between 12 and 61% and 316 (23%) post-operative events were reported. Analysis of five comparative studies showed similar mortality between CH and EH groups (OR: 0.64, 95% CI = 0.24–1.70, p = 0.37). There were significantly fewer overall post-operative complications in the CH group (OR: 0.38, 95% CI = 0.28–0.51, p < 0.001) and reduced PHLF was found in the CH group compared to EH (OR: 0.53, 95% CI = 0.29–0.98, p = 0.04). The rates of post-hepatectomy biliary complications were similar between groups (OR: 0.98, 95% CI = 0.51–1.88, p = 0.96). Mean length of stay (days) was shorter in the CH group (MD: ?2.67, 95% CI = ?4.93 to ?0.41, p = 0.02).Conclusion
CH appears to have similar post-operative mortality rates compared to EH but is associated with fewer post-operative complications, including PHLF and shorter overall length of stay. 相似文献3.
W.Q. Ding J.T. Liu Y.X. Shang B. Gao X.Y. Zhao H.P. Zhao W.J. Wu 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(6):618-628
Background and aim
The exact constellation of body composition characteristics among metabolically unhealthy obese (MUO) and nonobese (MUNO) children and adolescents remains unclear. The purpose of this study was to identify the major body composition determinants of metabolically unhealthy phenotypes among Chinese children and adolescents.Methods and results
We used data from a cross-sectional survey in 2015 that included 1983 children and adolescents aged 6–18 years. Subjects were classified into two phenotypes based on a combination of body mass index (BMI) and metabolic syndrome components. Body composition was measured by dual-energy X-ray absorptiometry (DXA). Among all boys and among adolescent boys, those with MUNO phenotypes displayed significantly higher indices of body composition except for fat mass (FM) percentage and trunk-to-legs FM ratio compared with the metabolically healthy nonobese phenotype (all P < 0.05). MUO individuals had higher arm FM, lean body mass (LBM), and trunk lean mass compared to metabolically healthy obese individuals (all P < 0.05). Visceral fat mass (VFM) and BMI were the major independent determinants of MUNO (VFM, 6- to 9-year-old boys, OR = 1.02, 95% CI = 1.00–1.03, P = 0.021; BMI, 6- to 9-year-old girls, OR = 1.90, 95% CI = 1.31–2.84, P = 0.001; and adolescent boys, OR = 1.34, 95% CI = 1.23–1.44, P < 0.001). LBM was the major independent predictor of MUO among adolescent boys (OR = 1.90, 95% CI = 1.03–1.17, P = 0.003).Conclusions
Among children and adolescents, the metabolically unhealthy phenotype was associated with excess of body composition, but with significant differences observed based on age and sex. VFM and LBM derived by DXA can predict the metabolically unhealthy phenotype effectively in specific sex and age groups. 相似文献4.
Sandy Y. Kim Laurence Weinberg Christopher Christophi Mehrdad Nikfarjam 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):475-482
Background
There is an increasing needed to consider pancreaticoduodenectomy (PD) for the treatment of pancreatic and periampullary malignancy in patients aged 80 and over, given the increasing aging population.Methods
A systematic literature search was undertaken to identify selected studies that compared the outcomes of patients aged 80 years or over to those younger undergoing PD.Results
In total 18 studies were included for evaluation. Octogenarian or older populations had significantly higher 30-day post-operative mortality rate (OR: 2.22, 95% CI = 1.48–3.31, p < 0.001) and length of hospital stay (OR: 2.23, 95% CI = 1.36–3.10, p < 0.001). The overall post-operative complication rate was higher in the older group compared to the younger population (OR: 1.51, 95% CI = 1.25–1.83, p < 0.001). Elderly patients were more likely to develop pneumonia (OR: 1.72, 95% CI = 1.39–2.13, p < 0.001) and experience delayed gastric emptying (DGE) (OR: 1.77, 95% CI = 1.35–2.31, p < 0.001). The incidence of post-operative pancreatic fistula and bile leak were not significantly different between the groups. Rehabilitation and home nursing care services was also more frequently required by the older patient group at the time of hospital discharge.Conclusion
Patients aged 80 years and older have approximately double the risk of 30-day post-operative mortality and 50% increased rate of complications following PD. Careful patient selection is required when offering surgery in this age group. 相似文献5.
Matteo De Pastena Salvatore Paiella Anna M. Azzini Giovanni Marchegiani Giuseppe Malleo Debora Ciprani Annarita Mazzariol Erica Secchettin Deborah Bonamini Clizia Gasparini Ercole Concia Claudio Bassi Roberto Salvia 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(6):555-562
Background
Despite improvements in the perioperative care, the morbidity rate after pancreaticoduodenectomy (PD) is still higher than 50%. The aim of this study was twofold: first, to assess the correlation between preoperative rectal swab (RS) and intraoperative bile cultures; to examine the impact of RS isolates on postoperative course after PD.Methods
An observational study was conducted analyzing all consecutive PD performed from January 2015 to July 2016. Based on the positivity/negativity of preoperative RS for multi-drug resistant bacteria, two groups of patients were identified (RS+ vs. RS?) and then compared.Results
Three hundred thirty-eight patients were considered for the analysis. RS culture showed a perfect correlation (species and phenotypic antibiotic susceptibility pattern) with bile culture in 157 patients (86.7%). Fifty patients (14.8%) had a RS+. Preoperative biliary drain (PBD) was the single independent preoperative risk factor associated to RS+ (p = 0.021, OR = 2.6, 95% CI = 1.5–11.7). Infective complications (IC) and mortality were independently correlated to RS+ (p = 0.013, OR = 2.9, 95% CI = 1.3–6.7; p = 0.009 OR = 3.4, 95% CI = 1.8–14.9, respectively).Conclusions
Preoperative surveillance RS-culture's positivity correlates to biliary colonization that occurs after PBD. IC and mortality after PD are associated with RS+. Preoperative RS can direct antibiotic prophylaxis to reduce morbidity and mortality after PD. 相似文献6.
Elena F. Wurster Solveig Tenckhoff Pascal Probst Katrin Jensen Eva Dölger Phillip Knebel Markus K. Diener Markus W. Büchler Alexis Ulrich 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):491-497
Background
Recurrence of colorectal liver metastases after a first hepatectomy is common (4–48% of patients). This review investigates the utility of repeated hepatic resection of colorectal liver metastases.Methods
A systematic search of the literature was performed in the Cochrane Library, MEDLINE, EMBASE, and trial registers. All studies comparing repeated hepatic resection for colorectal liver metastases with patients who underwent only one hepatectomy were eligible. Outcome criteria were safety parameters and survival rates. Data were analyzed using the random-effects model.Results
In eight observational clinical studies, 450 patients with repeated hepatic resection were compared with 2669 single hepatic resections. Morbidity such as hepatic insufficiency (OR [95% CI] 1.46 [0.69; 3.08], p = 0.32) and biliary leakage and fistula (OR [95% CI] 1.22 [0.80; 1.85], p = 0.35) was comparable between the two groups. Mortality (OR [95% CI] 1.13 [0.46; 2.74], p = 0.79) and overall survival (HR [95% CI] 1.00 [0.63; 1.60], p = 0.99) were not significantly different between the two groups.Discussion
Repeated hepatic resection for colorectal liver metastases is safe in selected patients. A prospective, multicenter high-quality trial or register study of repeated hepatic resection will be required to clarify patient-oriented outcomes such as overall survival and quality of life. 相似文献7.
R.F. Tayyem A.E. Al-Shudifat A. Johannessen H.A. Bawadi S.S. AbuMweis L.M. Agraib S.S. Allhedan I. Haj-Husein M. Azab 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(3):262-269
Background and Aims
Dietary pattern and lifestyle have been reported to be significant risk factors in the development of coronary heart diseases (CHD). The contribution degree of these dietary risk factors in CHD development in non-westernized countries is unclear. This study aimed to evaluate several dietary choices and their potential association with CHD.Methods and results
A case–control study was conducted at Prince Hamza Hospital, a referral center for coronary angiography in Amman, Jordan. Four-hundred patients referring for elective coronary angiography with clinical suspicion of coronary artery disease were enrolled. Data was collected using interview-based questionnaires. Dietary patterns were derived using Principal Component Analysis. Multivariate logistic regression was used to estimate the relationship between dietary choices and CHD. Three dietary patterns were identified. The “Healthy Dietary Pattern”, which presented a diet rich in olive oil, fruits, vegetables, legumes, whole grains, fish, and low meat intake, was associated with a significant decrease in the odds of CHD (OR = 0.53, 95% CI = 0.28–0.98). The “High-Fiber Pattern”, which is mainly composed of legumes and bulgur, significantly reduced the odd of CHD (OR = 0.55, 95% CI = 0.27–0.92) for the fourth quartile compared to the first one. No significant association was found between CHD and the “Western Dietary Pattern”, which is loaded with refined grains, sweets and deserts, sugary drinks, and deep fried foods.Conclusions
The “Healthy Dietary Pattern” and the “High-Fiber Pattern” were associated with a decrease in odds of CHD among Jordanians. 相似文献8.
P. Mirmiran M. Carlström Z. Bahadoran F. Azizi 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(12):1261-1266
Background and aim
Here, we examined the potential effect of coffee consumption and total caffeine intake on the occurrence of pre-diabetes and T2D, in a population with low coffee consumption.Methods and Results
Adults men and women, aged 20–70 years, were followed for a median of 5.8 y. Dietary intakes of coffee and caffeine were estimated using a 168-food items validate semi-quantitative food frequency questionnaire, at baseline. Cox proportional hazards regression models, adjusted for potential cofounders, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between coffee and caffeine intakes and incidence of pre-diabetes and T2D. The total population was 1878 adults (844 men, 1034 women) and 2139 adults (971 men, 1168 women) for analysis of pre-diabetes and T2D, respectively.During the follow-up period the incidence of pre-diabetes and T2D was 30.8% and 6.6%, respectively. Forty-three percent of our subjects were no coffee drinker whereas 51.4% consumed 1 cup of coffee/week and 6.0% consumed more than 1 cup of coffee/week. A lower risk of pre-diabetes (HR = 0.73, 95% CI = 0.62–0.86) and T2D (HR = 0.66, 95% CI = 0.44–1.00) was observed in coffee drinkers compared to non-drinkers, in the fully adjusted models. Higher dietary intake of caffeine (≥152 vs. <65 mg/d) was accompanied with a borderline (P = 0.053) reduced risk of pre-diabetes (HR = 0.45, 95% CI = 0.19–1.00).Conclusion
Our findings indicated that coffee drinking may have favorable effect in prevention of pre-diabetes and T2D. 相似文献9.
Hyun Yong Koh Eunhae Cho So-Yeon Lee Woo Kyung Kim Yong Mean Park Jihyun Kim Kangmo Ahn Seung Won Lee Mi Ae Kim Myung-Il Hahm Yoomi Chae Kee-Jae Lee Ho-Jang Kwon Man Yong Han 《Allergology international》2018,67(2):225-233
Background
Solar irradiation affects sensitization to aeroallergens and the prevalence of allergic diseases. Little is known, however, about how the time and amount of solar irradiation during pregnancy affects such risks in children. We aimed to find out how solar irradiation during pregnancy affects sensitization to aero-allergens and the prevalence of allergic diseases in children.Methods
This population-based cross-sectional study involved 7301 aged 6 years and aged 12 years children. Maternal exposure to solar irradiation during pregnancy was evaluated using data from weather stations closest to each child's birthplace. Monthly average solar irradiation during the second and third trimesters was calculated with rank by quartiles. Risks of allergic sensitization and allergic disease were estimated.Results
Relative to the first (lowest) quartile, the adjusted odds ratio (aOR) for allergic sensitization in the fourth (highest) quartile was lowest within solar irradiation during pregnancy months 5–6 (aOR = 0.823, 95% CI 0.720–0.942, p < 0.05). During months 9–10, the aOR for allergic sensitization for the fourth was higher than the first quartile of solar irradiation (aOR = 1.167, 95% CI 1.022–1.333, p < 0.05). Similar results were observed when solar irradiation was analyzed as a continuous variable during months 5 (aOR = 0.975, 95% CI 0.962–0.989, p < 0.001) and month 9 (aOR = 1.018, 95% CI 1.004–1.031, p = 0.003). Increased solar irradiation during months 7–8 increased the risk of asthma (aOR = 1.309, 95% CI 1.024–1.674, p = 0.032).Conclusions
Maternal exposure to solar irradiation during the second trimester of pregnancy associated with reduced aeroallergen sensitization, whereas solar irradiation during the third trimester was related to increased sensitization to aeroallergens. 相似文献10.
Lennart B. van Rijssen Maurice J. Zwart Susan van Dieren Thijs de Rooij Bert A. Bonsing Koop Bosscha Ronald M. van Dam Casper H. van Eijck Michael F. Gerhards Josephus J. Gerritsen Erwin van der Harst Ignace H. de Hingh Koert P. de Jong Geert Kazemier Joost Klaase Berendina M. van der Kolk Cornelis J. van Laarhoven Misha D. Luyer Peter P. Coene 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(8):759-767
Background
In the mandatory nationwide Dutch Pancreatic Cancer Audit, rates of major complications and Failure to Rescue (FTR) after pancreatoduodenectomy between low- and high-mortality hospitals are compared, and independent predictors for FTR investigated.Methods
Patients undergoing pancreatoduodenectomy in 2014 and 2015 in The Netherlands were included. Hospitals were divided into quartiles based on mortality rates. The rate of major complications (Clavien-Dindo ≥3) and death after a major complication (FTR) were compared between these quartiles. Independent predictors for FTR were identified by multivariable logistic regression analysis.Results
Out of 1.342 patients, 391 (29%) developed a major complication and in-hospital mortality was 4.2%. FTR occurred in 56 (14.3%) patients. Mortality was 0.9% in the first hospital quartile (4 hospitals, 327 patients) and 8.1% in the fourth quartile (5 hospitals, 310 patients). The rate of major complications increased by 40% (25.7% vs 35.2%) between the first and fourth hospital quartile, whereas the FTR rate increased by 560% (3.6% vs 22.9%). Independent predictors of FTR were male sex (OR = 2.1, 95%CI 1.2–3.9), age >75 years (OR = 4.3, 1.8–10.2), BMI ≥30 (OR = 2.9, 1.3–6.6), histopathological diagnosis of periampullary cancer (OR = 2.0, 1.1–3.7), and hospital volume <30 (OR = 3.9, 1.6–9.6).Conclusions
Variations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications. 相似文献11.
M.-H. Kim H.-N. Kim W.-S. Choi 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(11):1106-1113
Backgrounds and Aims
We aimed to reveal the association between subclinical inflammation and metabolic risk factors and to determine the difference in the association between normal-weight and obese Korean individuals.Methods and Results
Data collected from the Korean National Health and Nutrition Examination Survey (KNHANES) 2015, conducted from January to December 2015, were analyzed. Overall, 4620 subjects were examined and divided into two subgroups: 2987 and 1633 subjects in the normal-weight and obese groups, respectively. The prevalence of obesity in the study population was 34.5% (n = 1633). After multivariate adjustment, impaired fasting glucose (IFG) (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05–1.42, P = 0.010), high triglyceride (TG) levels (OR 1.29, 95% CI 1.13–1.47, P < 0.001), and low high-density lipoprotein–cholesterol (HDL-C) levels (OR 1.47, 95% CI 1.31–1.64, P < 0.001) were significantly associated with increased high-sensitivity C-reactive protein (hs-CRP) levels in the normal-weight group but not in the obesity group.Conclusion
Subclinical inflammation was associated with IFG, high TG levels, and low HDL-C levels in normal-weight Korean individuals. Prospective and biochemical research is necessary to clarify the role of subclinical systemic inflammation in individuals with normal body weight and its impact on insulin resistance and abnormal lipid metabolism, which promote the incidence of metabolic syndrome and cardiovascular disease. 相似文献12.
Joseph T. Brooks Naoru Koizumi Elizabeth Neglia Bilel Gdoura Tina W. Wong Chang Kwon Tony E. Smith Jorge Ortiz 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(7):649-657
Background
Share 35 prioritizes offers of deceased donor livers to regional candidates with Model for End-Stage Liver Disease (MELD) ≥35 over local candidates with lower MELD scores. Analysis of Share35 has shown that overall 1- or 2-year post-transplant (LTx) outcomes have been unchanged while waitlist mortality has been reduced. However, these studies exclude retransplant (reLTx) recipients. This study aims to investigate the outcomes of liver retransplants in evaluating the impact of the Share35 policy.Methods
A retrospective analysis of data from the United Network for Organ Sharing database over the period June 2011–June 2015 was performed.Results
A total of 19,748 LTx and 312 reLTx recipients were identified. Of the LTx recipients, 9626 (48.7%) underwent transplant pre-Share 35 and 10,122 (51.3%) post-Share 35. 123 (39.4%) reLTx recipients underwent retransplantation pre-Share 35 and 189 (60.6%) post-Share 35. ReLTx recipients experienced improved 2-year graft survival post-Share 35 compared to pre-Share 35 (67% vs. 21.1%). Patient survival also improved at 2-years for reLTx recipients post-Share 35 compared to pre-Share 35 (69.2% vs. 33.1%). Transplant post-Share 35 was protective for both 2-year graft (HR = 0.669, CI = 0.454–0.985, p = 0.04) and patient (HR = 0.659, CI = 0.44–0.987, p = 0.003) survival.Conclusion
Share35 is associated with improved outcomes after retransplantation. 相似文献13.
Junfang Zhao Pamir Sawo Sander S. Rensen Margriet M.J. Rouflart Alison Winstanley Celien P.H. Vreuls Joanne Verheij Kim M.C. van Mierlo Toine M. Lodewick Victor van Woerden Frank H. van Tiel Ronald M. van Dam Cornelis H.C. Dejong Steven W.M. Olde Damink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(2):147-154
Background
An inverse relation between chemotherapy-associated liver injury (CALI) and tumour response to chemotherapy has been reported. The aim was to validate these findings, and further investigate the impact of CALI on survival in patients who underwent partial hepatectomy for colorectal liver metastases (CRLM).Methods
Patients who received neoadjuvant chemotherapy and underwent partial hepatectomy for CRLM between 2008 and 2014 were included. Liver and tumour specimens were histologically examined for CALI (steatosis, steatohepatitis, sinusoidal dilatation [SD], nodular regeneration) and tumour regression grade (TRG). TRG 1–2 was defined as complete tumour response.Results
166 consecutive patients were included with a median survival of 30 and 44 months for recurrence-free and overall survival, respectively. Grade 2–3 SD was found in 44 (27%) and TRG 1–2 was observed in 33 (20%) patients. Of studied CALI, only grade 2–3 SD was associated with increased TRG 3–5 (odds ratio 3.99, 95% CI 1.17–13.65, p = 0.027). CALI was not significantly related to survival. TRG 1–2 was associated with prolonged recurrence-free (hazard ratio 0.47, 95% CI 0.25–0.89, p = 0.020) and overall survival (hazard ratio 0.35, 95% CI 0.18–0.68, p = 0.002).Conclusion
CALI was not directly related to survival. CALI was, however, associated with diminished complete tumour response, and diminished complete tumour response, in turn, was associated with decreased survival. 相似文献14.
Heather G. Lyu Gaurav Sharma Ethan Y. Brovman Julius Ejiofor Richard D. Urman Jason S. Gold Edward E. Whang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(7):591-596
Background/Purpose
Reoperation is being increasingly utilized as a metric for surgical care quality. The aim of this study was to identify the incidence of and risk factors for unplanned reoperation following index hepatectomy.Methods
Pre, intra- and post-operative information of patients who underwent partial hepatectomy in 435 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013 were analyzed.Results
343 (4%) of 9195 patients required reoperation within 30 days of index hepatectomy. The index procedures with the highest incidence of reoperation (%) were trisectionectomy (7%) and right hepatectomy (5%). Patients who underwent reoperation had increased index operative duration (323 ± 174 min versus 243 ± 125 min, p < 0.001), postoperative transfusion (57% versus 23%, p < 0.001), wound complications, cardiorespiratory, renal, thromboembolic, and infectious events. Hemorrhage was the most common indication for reoperation (10%). Male gender, ASA class 4, and right hepatectomy or trisectionectomy were independent predictors of reoperation (OR 1.4 [1.1–1.7], p = 0.007; 2.0 [1.3–3.1], p = 0.003; 1.6 [1.2–2.0], p = 0.001 and 2.5 [1.8–3.4], p < 0.001, respectively). All reoperations occurred during index hospitalization and resulted in longer mean length of stay (19 ± 17 days versus 7 ± 7 days, p < 0.001).Conclusion
Reoperation is associated with several patient characteristics and procedural factors in this national sample. Knowledge of these factors can increase awareness of patients at risk for reoperation. 相似文献15.
Purpose
To report planned final overall (OS) and progression-free survival (PFS) analyses from the phase II PEAK trial (NCT00819780).Methods
Patients with previously untreated, KRAS exon 2 wild-type (WT) metastatic colorectal cancer (mCRC) were randomised to mFOLFOX6 plus panitumumab or bevacizumab. The primary endpoint was PFS; secondary endpoints included OS, objective response rate, duration of response (DoR), time to response, resection and safety. Treatment effect by tumour RAS status was a prespecified objective. Exploratory analyses included early tumour shrinkage (ETS) and depth of response (DpR).Results
One hundred seventy patients had RAS WT and 156 had RAS WT/BRAF WT mCRC. Median PFS was longer for panitumumab versus bevacizumab in the RAS WT (12.8 vs 10.1 months; hazard ratio (HR) = 0.68 [95% confidence intervals (CI) = 0.48–0.96]; p = 0.029) and RAS WT/BRAF WT (13.1 vs 10.1 months; HR = 0.61 [95% CI = 0.42–0.88]; p = 0.0075) populations. Median OS (68% OS events) for panitumumab versus bevacizumab was 36.9 versus 28.9 months (HR = 0.76 [95% CI = 0.53–1.11]; p = 0.15) and 41.3 versus 28.9 months (HR = 0.70 [95% CI = 0.48–1.04]; p = 0.08), in the RAS WT and RAS WT/BRAF WT populations, respectively. Median DoR (11.4 vs 9.0 months; HR = 0.59 [95% CI = 0.39–0.88]; p = 0.011) and DpR (65.0 vs 46.3%; p = 0.0018) were improved in the panitumumab group. More panitumumab patients experienced ≥30% ETS at week 8 (64 vs 45%; p = 0.052); ETS was associated with improved PFS/OS. No new safety signals occurred.Conclusions
First-line panitumumab + mFOLFOX6 increases PFS versus bevacizumab + mFOLFOX6 in patients with RAS WT mCRC.16.
Monica?Verdoia Patrizia?Pergolini Roberta?Rolla Matteo?Nardin Lucia?Barbieri Veronica?Daffara Paolo?Marino Giorgio?Bellomo Harry?Suryapranata Giuseppe?De?Luca 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2016,30(2):143-150
Background
Cardiovascular risk is still underestimated in women, experiencing higher mortality and worse prognosis after acute cardiovascular events. Gender differences have been reported in thrombotic and hemorrhagic risk during dual antiplatelet therapy (DAPT), thus suggesting a potential variability in platelet reactivity according to sex. The aim of the present study was to assess the role of gender on platelet function and the prevalence of high-on treatment residual platelet reactivity (HRPR) during DAPT in patients with recent acute coronary syndrome or percutaneous coronary revascularization.Methods
Patients treated with DAPT (ASA and clopidogrel or ticagrelor) were scheduled for platelet function assessment at 30–90 days post-discharge. By whole blood impedance aggregometry, HRPR was considered for ASPI test >862 AU*min (for ASA) and ADP test values ≥417 AU*min (for ADP-antagonists).Results
We included 541 patients on DAPT, 122 (22.6 %) of whom were females. Females were older (p < 0.001), displayed more frequently hypercholesterolemia (p = 0.003), renal failure (p = 0.04), acute presentation (p < 0.001), higher cholesterol levels and platelets count (p < 0.001). Inverse association was demonstrated with smoking (p < 0.001), previous PCI (p = 0.04) and statin use (p = 0.03), creatinine and haemoglobin (p < 0.001). Female gender did not influence mean platelet reactivity or the prevalence of HRPR for ASA (1.7 % vs 1.4 %, OR[95%CI] = 1.14[0.17–4.36], p = 0.99, adjusted OR[95%CI] = 1.54[0.20–11.6], p = 0.68) or ADP-antagonists (26.3 % vs 22.8 %, OR[95%CI] = 1.17[0.52–1.34], p = 0.45, adjusted OR[95%CI] = 1.05[0.59–1.86], p = 0.87). Results did not change when considering separately the 309 patients treated with clopidogrel (34 % vs 31.3 %, OR[95%CI] = 1.13[0.62–2.07], p = 0.76, adjusted OR[95%CI] = 1.35[0.63–2.9], p = 0.44 for females vs males), or patients (n = 232) on ticagrelor (20.4 % vs 11.1 %, OR[95%CI] = 2.27[0.99–5.17], p = 0.06 for females vs males), confirmed after correction for baseline differences (adjusted OR[95%CI] = 1.21[0.28–2.29], p = 0.68).Conclusion
In patients receiving dual antiplatelet therapy, gender does not impact on the prevalence of high-on treatment residual platelet reactivity (HRPR) with the major antiplatelet agents ASA, clopidogrel or ticagrelor.17.
Laëtitia Courtin-Tanguy Olivier Turrini Damien Bergeat Stéphanie Truant Benjamin Darnis Jean R. Delpero Jean Y. Mabrut Nicolas Regenet Laurent Sulpice 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):405-410
Background
Although the peri-operative mortality following pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DCC) has decreased, the post-operative morbidity remains high. The aim of this study was to evaluate the impact of factors that may affect the long term survival for patients with DCC following PD.Methods
All patients who underwent PD for DCC between January 2000 and December 2015 in 5 tertiary referral centers underwent retrospective medical record review. Factors likely to influence overall (OS) and disease-free (DFS) survivals were assessed by univariate and multivariate analysis.Results
A total of 201 on 217 patients who underwent PD for DCC were included for further analysis. The median OS was 39 months, with actuarial survival rates at 1, 3, and 5 years of 85%, 53% and 39%. Recurrence occurred in 123 (61%) patients. The median DFS was 16 months, with actuarial survival rates at 1, 3 and 5 years of 60%, 37% and 28%. Following multivariate analysis, peri-operative blood transfusions (PBT) were associated to worse OS (HR = 2.25 [1.31–3.85], P = 0.003) and DFS (HR = 2.08 [1.24–3.5], P = 0.005).Conclusion
This study confirms the negative impact of PBT on the oncologic result following PD for DCC. 相似文献18.
Jaya Chandrasekhar Usman Baber Samantha Sartori Melissa Aquino Annapoorna S. Kini Sunil Rao William Weintraub Timothy D. Henry Serdar Farhan Birgit Vogel Sabato Sorrentino Zhen Ge Samir Kapadia Joseph B. Muhlestein Sandra Weiss Craig Strauss Catalin Toma Anthony DeFranco Roxana Mehran 《The Canadian journal of cardiology》2018,34(3):319-329
Background
Potent P2Y12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type.Methods
PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm. Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke, or unplanned revascularization. Outcomes were adjusted using multivariable Cox regression for effect of PCI complexity and propensity-stratified analysis for effect of thienopyridine type.Results
The study cohort included 48.9% (n = 9735) complex and 51.1% (n = 10,179) noncomplex patients. Second generation drug-eluting stents were used in 70.1% complex and 66.2% noncomplex PCI patients (P < 0.0001). Complex PCI was associated with greater adjusted risk of 1-year MACE (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.20-1.39; P < 0.001). Prasugrel was prescribed in 20.7% of complex and 20.1% of noncomplex PCI patients (P = 0.30). Compared with clopidogrel, prasugrel significantly decreased adjusted risk for 1-year MACE in complex PCI (HR, 0.79; 95% CI, 0.68-0.92) but not noncomplex PCI (HR, 0.91; 95% CI, 0.77-1.08), albeit there was no evidence of interaction (P interaction = 0.281).Conclusions
Despite the use of contemporary techniques, acute coronary syndrome patients who undergo complex PCI had significantly higher rates of 1-year MACE. Adjusted magnitude of treatment effects with prasugrel vs clopidogrel were consistent in complex and noncomplex PCI without evidence of interaction. 相似文献19.
G. Ndrepepa S. Holdenrieder S. Cassese M. Fusaro E. Xhepa K.-L. Laugwitz H. Schunkert A. Kastrati 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(1):64-70
Background and aims
Whether gamma-glutamyl transferase (GGT) or alkaline phosphatase (ALP) is a better prognostic marker in patients with coronary heart disease (CHD) remains unknown. The aim of this study was to compare the prognostic value of GGT and ALP in patients with CHD.Methods and results
This study included 3768 patients with CHD. The main study outcome was 3-year all-cause mortality. The median values of GGT and ALP were 36.2 U/L and 69.3 U/L. Patients were divided into subgroups according to GGT or ALP activity > or ≤median. Overall, there were 304 deaths: 195 deaths occurred in patients with GGT >median (n = 1882) and 109 deaths occurred in patients with GGT ≤median (n = 1886); Kaplan–Meier [KM] estimates of all-cause mortality were 11.9% and 6.4% (unadjusted hazard ratio [HR] = 1.85, 95% confidence interval [CI], 1.46 to 2.34]; P < 0.001). According to ALP activity, 186 deaths occurred in patients with ALP >median (n = 1883) and 118 deaths occurred in patients with ALP ≤median (n = 1885); KM estimates of all-cause mortality were 11.4% and 7.1% (unadjusted HR = 1.64 [1.30–2.06]; P < 0.001). After adjustment, GGT (adjusted HR = 1.32 [1.11–1.58]; P = 0.002) but not ALP (adjusted HR = 1.20 [1.00–1.43]; P = 0.051, with both HR calculated per 1 unit increment in logarithmic GGT or ALP scale) remained significantly associated with the risk for mortality. The C statistic of the mortality model with GGT was greater than the C statistic of the model with ALP (0.831 [0.802–0.859] vs. 0.826 [0.793–0.855]; P < 0.001).Conclusions
In patients with CHD, GGT was a stronger correlate of all-cause mortality than ALP. 相似文献20.
Islam Y. Elgendy Ahmed N. Mahmoud Hend Mansoor Anthony A. Bavry 《The American journal of medicine》2017,130(9):1059-1067