A long‐term experience with expansion of Milan criteria for liver transplant recipients

The Milan criteria (MC) have historically determined eligibility for transplantation for hepatocellular carcinoma (HCC). The United Network for Organ Sharing (UNOS) Region 4 expanded the criteria for transplantation in HCC to include a single tumor ≤6 cm or up to 3 tumors with the largest diameter ≤5 cm and total additive diameter ≤9 cm (R4C). The aim of this study was to report the 10‐year outcomes of this expanded criteria compared to MC. Transplants performed for HCC in Region 4 between October 2007 and December 2016 were reviewed using the UNOS database. Recipients were categorized based on imaging findings at initial evaluation. A total of 2068 patients were included in the study. There was no significant difference in 10‐year patient survival between the groups (53% MC vs 48% R4C, P = .23). There was also no significant difference in recurrence‐free survival (54% MC vs 47% R4C, P = .15) or allograft survival (53% MC vs 48% R4C, P = .16). Finally, there was no significant difference in outcomes between the MC and R4C groups when stratifying patients by locoregional therapy. This study demonstrates promising data that the criteria for liver transplantation in HCC can be safely expanded to the R4C without compromising outcomes.     

Comparative Study of Staging Systems for Hepatocellular Carcinoma in 428 Patients Treated with Radioembolization

PurposeTo compare the utility of different staging systems and analyze independent predictors of survival in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 (⁹⁰Y) radioembolization.Materials and MethodsDuring the period 2004–2011, 428 patients with HCC were treated with ⁹⁰Y radioembolization. All patients were staged prospectively by the following staging systems: Child-Turcotte-Pugh (CTP), United Network for Organ Sharing, Barcelona Clinic Liver Cancer (BCLC), Okuda classification, Cancer of the Liver Italian Program (CLIP), Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire, Chinese University Prognostic Index, and Japan Integrated Staging. The ability of the staging systems to predict survival was assessed. The staging systems were compared using Cox proportional hazards regression model, linear regression, Akaike information criterion (AIC), and concordance index (C-index). Univariate and multivariate analyses were employed to assess independent predictors of survival.ResultsWhen tested independently, all staging systems exhibited significant ability to discriminate early (long survival) from advanced (worse survival) disease. CLIP provided the most accurate information in predicting survival outcomes (AIC = 2,993, C-index = 0.8503); CTP was least informative (AIC = 3,074, C-index = 0.6445). Independent predictors of survival included Eastern Cooperative Oncology Group performance status grade 0 (hazard ration [HR], 0.56; confidence interval [CI], 0.34–0.93), noninfiltrative tumors (HR, 0.62; CI, 0.44–0.89), absence of portal venous thrombosis (HR, 0.60; CI, 0.40–0.89), absence of ascites (HR, 0.56; CI, 0.40–0.76), albumin ≥ 2.8 g/dL (HR, 0.72; CI, 0.55–0.94), alkaline phosphatase ≤ 200 U/L (HR, 0.68; CI, 0.50–0.92), and α-fetoprotein ≤ 200 ng/mL (HR, 0.67; CI, 0.51–0.86).ConclusionsCLIP was most accurate in predicting survival in patients with HCC. Given that not all patients receive the recommended BCLC treatment strategy, this information is relevant for clinical trial design and predicting long-term outcomes after ⁹⁰Y radioembolization.     

护理学硕士研究生参与专业课程资源共享体系的学习体验

目的 评价护理学硕士研究生(以下简称研究生)参与专业课程资源共享体系的学习体验.方法 应用半结构式访谈法,采集研究生对参与共享课程学习后的收获.结果 获得知识和院校间研究生交流的机会是最主要收获,其次是院校特色等无形资源的共享.研究生对共享课程并未抱有高于其他课程的预期,授课教师毫无保留付出的态度让研究生感动.结论 专业课程资源共享体系可以改善区域研究生专业课程资源的供给状态,是解决资源匮乏与浪费并存问题的有效途径.     

Enhancing best practices in ophthalmology for prevention of nosocomial epidemic keratoconjunctivitis infections

Epidemic keratoconjunctivitis (EKC) outbreaks were reported as early as the 1940s in the United States. Nearly 80 years later, EKC remains a major eye health concern in the US and worldwide. Of particular concern is that a significant number of EKC cluster outbreaks in the US are healthcare acquired infections (HAIs) at ophthalmology offices. Therefore, immediate attention to enhancing best practices of standardization and universal precautions in ophthalmology is paramount.     

Durable mechanical circulatory support devices

Individuals afflicted with advanced systolic heart failure who have become unresponsive to standard medical and electrical therapies are categorized as having American Heart Association stage D heart failure. The high mortality rates for medically treated stage D heart failure have not improved in the last 10 years, and patients at this advanced stage require either palliative measures or surgical management of heart failure. In recent years, surgically implanted ventricular assist devices (VADs) have become available for long-term use and are now commonly used as a therapy for advanced heart failure. The data generated from this early experience have clearly shown that VADs improve survival and quality of life in patients with advanced heart failure when implanted as a temporary measure or as long-term support. However, with a growing heart failure population, there is much work to be done to continually improve VAD technology, patient selection criteria, and postimplantation management to define the optimal role for assist devices in the management of systolic heart failure.     

233例静脉注射海洛因滥用者HIV感染情况分析

目的：了解静脉注射海洛因滥用者HIV感染情况及高危行为与HIV感染率的关系。方法：对北京市公安局强制隔离戒毒所2006年10月-2007年10月收治的233例静脉注射海洛因滥用者进行HIV血清抗体检测,采用自行设计的“药物滥用情况调查问卷”和“高危性行为调查问卷”进行问卷调查。结果：被调查对象男性居多（124例占61．7％）,平均年龄32．9a±s8．7a（最小年龄19a,最大年龄51a）,以无业者（占50．8％）和私营／个体劳动者（占15．6％）为主,有13例（占5．6%）抗-HIV阳性。该人群平均吸毒时间5．0a±s3．4a,平均吸食剂量0．37g±s0．49g,滥用场所主要集中在自己家中（87．6％）。使用的注射器主要来自药店／百货店（占79．4％）,37．9％共用过注射器。有8-3％除配偶以外有4个以上性伴,有8．6％患有各种性病。结论：静脉注射海洛因滥用者是HIV感染的高危人群,静脉注射毒品、共用注射器、不安全性行为是感染HIV的主要途径,应对该人群实施有效的干预措施,增强自觉规避HIV感染高危行为的意识,从而有利于遏制HIV／AIDS在该群体中的蔓延。