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A prognostic nomogram for patients with resected fibrolamellar hepatocellular carcinoma

Hepatobiliary Surgery and Nutrition 2019年第4期8卷 338-344页

作者： Kelly J. Lafaro Oliver S. Eng Mustafa Raoof Philip Ituarte susanne g. Warner gagandeep Singh Yuman Fong Laleh g. Melstrom Department of Surgery City of Hope National Medical Center Duarte CA USA

Background: Fibrolamellar hepatocellular carcinoma (FLHC) is a unique entity compared to conventional hepatocellular carcinoma. The aim of this study was to examine post-resection outcomes and prognostic indicators for survival in this group of FLHC patients. Methods: A retrospective analysis of the National Cancer Database (NCDB) for patients with FLHC who underwent resection from 2004 to 2014 was performed. Univariate and multivariate Cox proportional hazard models were used to identify factors associated with overall survival, and a prognostic nomogram was generated. Results: There were 197 patients identified, 171 (86.8%) of whom had long-term follow-up data. Univariate and multivariate analyses were performed using patient and tumor demographics with the outcome variable of overall survival. On multivariate analysis, age [hazard ratio (hr) 1.03, P=0.003], vascular invasion (hr 1.75, P=0.05), tumor size >7 cm (hr 2.18, P=0.044), multifocal disease (hr 3.34, P=0.002), and node positive (pN+) disease (hr 2.75, P=0.003) were all negative predictors of overall survival. A prognostic nomogram was generated using these factors with a c-statistic superior to that of American Joint Committee on Cancer (AJCC) staging (0.710 vs. 0.654). Conclusions: Independent predictors of decreased overall survival in patients with FLHC include age, vascular invasion, tumor size >7 cm, multifocal disease, and pN+ disease. This is the first study to develop a nomogram exclusively for FLHC that may predict survival in future studies.

关键词： Fibrolamellar hepatocellular carcinoma (FLHC) liver resection overall survival

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Patient-Controlled Sedation and Analgesia with Propofol and Alfentanil:A Preliminary Safety Evaluation Prior to Use of Non-Anaesthesiology Doctors

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Open Journal of Anesthesiology 2012年第2期2卷 47-52页

作者： Andreas Nilsson Folke Sjoberg susanne Oster Hanne Bek-Jensen Claes Lennmarken Department of Anesthesiology and Intensive Care Linkoping University HospitalLinkopingSweden Department of Urology Linkoping University HospitalLinkopingSweden

Background: The aim was to evaluate safety aspects of patient-controlled sedation and analgesia (PCS) for extracorporeal shockwave lithotripsy (ESWL) and PCS to be handled by non-anaesthesiology doctors. Methods: Thirty-four ASA I-III patients used PCS with propofol and alfentanil for ESWL in this interventional study. Strict safety limits were defined regarding respiratory rate (RR), heart rate (hr), mean arterial blood pressure (MAP), oxygen saturation from pulse oximetry (SpO2), and transcutaneous partial pressures of oxygen (PtcO2) and carbon dioxide (PtcCO2). The patients' levels of consciousness was graded on a five-point scale and monitored with Bispectral Index (BIS). A nurse anaesthetist was supervising the procedure but was instructed to intervene only if safety limits were breached. No supplementary oxygen was given. Results: All patients responded to verbal stimuli during treatment. Cardiovascular stability was maintained, but respiratory variables were affected. Two patients with SpO2 2 ≥ 6.5 kPa). In 18 patients hypoxaemia was indicated as PtcO2 ≤ 8.0 kPa. All these 18 patients were given supplementary oxygen. There was no correlation between dose of drugs, age, weight or any vital variable. The 34 patients would use PCS again in the case of future treatment. Conclusions: During ESWL treatment PCS can be used with good patients’ satisfaction, and maintained cardiovascular stability, but PCS had an indisputable effect on pulmonary function with hypoxemia (resulting in need for supplementary oxygen) or hypercarbia. The person in charge of PCS must therefore be trained to perform according to the guidelines for sedation and/or analgesia by non-anaesthesiology doctors.

关键词： Anaesthesia Patient-Controlled Sedation Safety European guidelines

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东非十足类螃蟹迈纳新胀蟹对红树林海底落叶的清理

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AMBIO－人类环境杂志 2002年第7期31卷 569-573页

作者： Emil ólafsson susanne Buchmayer Martin W.Skov 王晓惠陈满春瑞典斯德哥尔摩大学动物学系 Department of Zoology Port Erin Marine Laboratory

本文通过在东非进行的一系列野外和实验室试验,研究了丰富的红树林十足类螃蟹迈纳新胀蟹(Neosarmatium meinerti)对落叶的清理。在地势高的海榄雌(Avicennia meinerti)潮间带,螃蟹掩埋了所有红树林林区海底的落叶,而且会在2小时内平均... 详细信息

本文通过在东非进行的一系列野外和实验室试验,研究了丰富的红树林十足类螃蟹迈纳新胀蟹(Neosarmatium meinerti)对落叶的清理。在地势高的海榄雌(Avicennia meinerti)潮间带,螃蟹掩埋了所有红树林林区海底的落叶,而且会在2小时内平均消耗其中的67%。在肯尼亚地势高的海岸,螃蟹可在一小时内掩埋4g/m^2的落叶,即约为日落叶量的两倍。相反,在地势低的海岸杯萼海桑(Sonneratia alba)地带,却没有典型的食叶类螃蟹,也没有树叶表明有食草类动物出现的迹象。在实验室完成的树叶选择试验表明迈纳新胀蟹更喜欢某些树种而不喜欢其它树种的树叶。每克螃蟹对树叶的消耗量,雌性螃蟹要比雄性螃蟹多。实验室研究还表明螃蟹可消耗的树叶比平均日落叶量大得多。录像记录证明为得到或保存落叶,螃蟹间会时常发生争斗,这意味着为得到落叶,螃蟹间还存在激烈的竞争。早期的研究也表明迈纳新胀蟹对红树林海底落叶的清理是确定的。在东非和南非地势高的海岸红树林地区,迈纳新胀蟹是常见的,其充沛的精力是独一无二的:事实上螃蟹保留了所有的落叶。

关键词：东非十足类螃蟹迈纳新胀蟹海底落叶红树林生态系统初级生产力清理作用

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Association of mineral and bone biomarkers with adverse cardiovascular outcomes and mortality in the german Chronic Kidney Disease(gCKD)cohort

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Bone Research 2023年第4期11卷 764-771页

作者： Katharina Charlotte Reimer Jennifer Nadal Heike Meiselbach Matthias Schmid Ulla T.Schultheiss Fruzsina Kotsis Helena Stockmann Nele Friedrich Matthias Nauck Vera Krane Kai-Uwe Eckardt Markus P.Schneider Rafael Kramann Jürgen Floege Turgay Saritas Department of Nephrology Rheumatologyand Clinical ImmunologyUniversity Hospital RWTH AachenAachenGermany Institute of Experimental Medicine and Systems Biology RWTH Aachen UniversityAachenGermany Institute for Cell and Tumor Biology RWTH Aachen UniversityAachenGermany Institute of Medical Biometry Informatics and EpidemiologyUniversity Hospital of BonnBonnGermany Department of Nephrology and Hypertension University of Erlangen-NürnbergErlangenGermany Institute of genetic Epidemiology Faculty of Medicine and Medical Center-University of FreiburgFreiburgGermany Department of Medicine IV-Nephrology and Primary Care Faculty of Medicine and Medical Center-University of FreiburgFreiburgGermany Department of Nephrology and Medical Intensive Care Charité-Universitätsmedizin BerlinBerlinGermany Department of Nephrology University Medical Center RegensburgRegensburgGermany Institute of Clinical Chemistry and Laboratory Medicine University Medicine GreifswaldGreifswaldGermany DZHK(german Centre for Cardiovascular Research) Partner Site GreifswaldUniversity MedicineGreifswaldGermany Department of Medicine I Division of NephrologyUniversity Hospital WürzburgWürzburgGermany

Mineral and bone disorder(MBD)in chronic kidney disease(CKD)is tightly linked to cardiovascular disease(CVD).In this study,we aimed to compare the prognostic value of nine MBD biomarkers to determine those associated best with adverse cardiovascular(CV)outcomes and *** 5217 participants of the german CKD(gCKD)study enrolled with an estimated glomerular filtration rate(eg FR)between 30–60 mL·min-1 per 1.73 m2 or overt proteinuria,serum osteoprotegerin(OPg),C-terminal fibroblast growth factor-23(FgF23),intact parathyroid hormone(iP TH),bone alkaline phosphatase(BAP),cross-linked C-telopeptide of type 1 collagen(CTX1),procollagen 1intact N-terminal propeptide(P1NP),phosphate,calcium,and 25-OH vitamin D were measured at *** with missing values among these parameters(n=971)were excluded,leaving a total of 4246 participants for *** a median follow-up of6.5 years,387 non-CV deaths,173 CV deaths,645 nonfatal major adverse CV events(MACEs)and 368 hospitalizations for congestive heart failure(CHF)were *** and FgF23 were associated with all outcomes,with the highest hazard ratios(hrs)for *** the final Cox regression model,adjusted for CV risk factors,including kidney function and all other investigated biomarkers,each standard deviation increase in OPg was associated with non-CV death(hr 1.76,95%CI:1.35–2.30),CV death(hr 2.18,95%CI:1.50–3.16),MACE(hr 1.38,95%CI:1.12–1.71)and hospitalization for CHF(hr 2.05,95%CI:1.56–2.69).Out of the nine biomarkers examined,stratification based on serum OPg best identified the CKD patients who were at the highest risk for any adverse CV outcome and mortality.

关键词： Kidney cardiovascular vitamin

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