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Risk factors and outcome of bacterial infections in cirrhosis

world Journal of Gastroenterology 2014年第10期20卷 2542-2554页

作者： Tony Bruns henning w zimmermann Andreas Stallmach Department of Internal Medicine IV Jena University Hospital Friedrich Schiller University Jena 07740 Jena Germany Integrated Research and Treatment Center - Center for Sepsis Control and Care Jena University Hospital Friedrich Schiller University Jena 07740 JenaGermany Department of Medicine III University Hospital Aachen 52074 Aachen Germany

Viable and non-viable pathological bacterial translocation promote a self-perpetuating circle of dysfunctional immune activation and systemic inflammation facilitating infections and organ failure in advanced *** infections and sepsis are now recognized as a distinct stage in the natural progression of chronic liver disease as they accelerate organ failure and contribute to the high mortality observed in decompensated *** increasing knowledge of structural,immunological and hemodynamic pathophysiology in advanced cirrhosis has not yet translated into significantly improved outcomes of bacterial infections over the last ***,early identification of patients at the highest risk for developing infections and infectionrelated complications is required to tailor the currently available measures of surveillance,prophylaxis and therapy to the patients in need in order to improve the detrimental outcome of bacterial infections in cirrhosis.

关键词： Immunity Infection Cirrhosis Chronic liver disease Bacterial translocation Risk factors Mortality

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Outcome Results of Treatment with Selective Internal Radiation Therapy (SIRT) in Patients with Hepatocellular Carcinoma: A Single Center Experience

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Journal of Cancer Therapy 2017年第4期8卷 349-359页

作者： Jan Pfeiffenberger Tatjana zimmermann Daniel N. Gotthardt Christoph Springfeld wolfgang Stremmel Peter Schirmacher henning Schulze-Bergkamen Arianeb Mehrabi Christoph w. Michalski Katrin Hoffmann Nikolas Kortes Boris Radeleff Uwe Haberkorn Clemens Kratochwil Karl Heinz weiss Carsten Grüllich Department of Gastroenterology and Hepatology University Hospital Heidelberg Heidelberg Germany Department of Medical Oncology National Center for Tumor Diseases Heidelberg University Hospital Heidelberg Heidelberg Germany Institute of Pathology University Hospital Heidelberg Heidelberg Germany Department of Gastroenterology and Oncology Marien-Hospital Wesel Germany Department of General and Transplant Surgery University Hospital Heidelberg Heidelberg Germany Department of Diagnostic and Interventional Radiology University Hospital Heidelberg Heidelberg Germany Department of Nuclear Medicine University Hospital Heidelberg Heidelberg Germany Liver Cancer Center Heidelberg University Hospital Heidelberg Heidelberg Germany

Background: Hepatocellular carcinoma (HCC) has a poor prognosis. Selective internal radiation therapy (SIRT) with microspheres is a treatment option for HCC. This study aimed to assess safety and survival (OS) in patients with HCC treated with SIRT, to stratify patients with tumor vascularization and analyze the impact of sequential sorafenib treatment. Methods: Thirty-nine patients who received SIRT for HCC between 2010 and 2013 at our center were included in this retrospective analysis. Tumor vascularization was assessed using a combination of MRI, MAA-scintigraphy and angiography. Tumor vascularization was correlated with survival. Subgroups are treated with two commercially available 90Y-labeled products SIR-Spheres (n = 16) and TheraSpheres (n = 23) and sequential therapy with sorafenib compared to SIRT only was analyzed. Results: Adverse events occurred in 49% of patients with only four grade 3 and no grade 4 event. Median survival for all patients was 12.5 months (95% CI: 8.7 - 16.3). No significant differences were detectable between Thera Spheres or SIR Spheres. Survival was shorter in patients with low tumor vascularization score (OS: 3.8 months (95% CI 0 - 15.0), p = 0.043). Survival was longer with sorafenib upon progression after SIRT (n=16) with an OS of 17.4 months (95% CI: 12.1 – 22.7) compared to no sorafenib (n = 13;9.1 months;95% CI: 3.0 - 15.1) or progression upon sorafenib before SIRT (n = 10;8.6 months;95% CI: 5.5 - 11.7). Conclusions: SIRT is safe in HCC patients. Tumor vascularization by radiography and scintigraphy may predict survival benefit. Sorafenib is active after SIRT and significantly prolongs survival.

关键词： SIRT Sorafenib Liver Cancer Y90

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