BACKGROUND Despite the use of current standard therapy,the prognosis of patients with unresectable hepatocellular carcinoma(HCC)is poor,with median survival times of 40 mo for intermediate HCC(Barcelona Clinic Liver C...BACKGROUND Despite the use of current standard therapy,the prognosis of patients with unresectable hepatocellular carcinoma(HCC)is poor,with median survival times of 40 mo for intermediate HCC(Barcelona Clinic Liver Cancer[BCLC]stage B)and 6-8 mo for advanced HCC(BCLC stage C).Although patients with earlystage HCC are usually suitable for therapies with curative intention,up to 70% of patients experience relapse within 5 years.In the past decade,the United States Food and Drug Administration has approved different immunogenic treatment options for advanced HCC,the most common type of liver cancer among adults.Nevertheless,no treatment is useful in the adjuvant setting.Since 2007,the multikinase inhibitor sorafenib has been used as a first-line targeted drug to address the increased mortality and incidence rates of HCC.However,in 2020,the IMbrave150 trial demonstrated that combination therapy of atezolizumab(antiprogrammed death-ligand 1[PD-L1])and bevacizumab(anti-vascular endothelial growth factor[VEGF])is superior to sorafenib,a single anti-programmed death 1/PD-L1 antibody inhibitor used as an anti-cancer monotherapy for HCC treatment.AIM To conduct a systematic literature review to evaluate the evidence supporting the efficacy and safety of atezolizumab/bevacizumab as preferred first-line drug therapy over the conventional sorafenib or atezolizumab monotherapies,which are used to improve survival outcomes and reduce disease progression in patients with unresectable HCC and non-decompensated liver disease.METHODS A comprehensive literature review was conducted using the PubMed,Scopus,ScienceDirect,clinicaltrials.gov,PubMed Central,Embase,EuropePMC,and CINAHL databases to identify studies that met the inclusion criteria using relevant MeSH terms.This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and risk of bias(RoB)were assessed using the Cochrane RoB 2 tool and Sevis.RESULTS In the atezolizumab/bevacizumab group,an improvement in overall tumor response,reduction of disease progression,and longer progression-free survival were observed compared to monotherapy with either sorafenib or atezolizumab.Hypertension and proteinuria were the most common adverse events,and the rates of adverse events were comparable to those with the monotherapy.Of the studies,there were two completed trials and two ongoing trials analyzed using high quality and low bias.A more thorough analysis was only performed on the completed trials.CONCLUSION Treatment of HCC with atezolizumab/bevacizumab combination therapy was confirmed to be an effective first-line treatment to improve survival in patients with unresectable HCC and non-decompensated liver disease compared to monotherapy with either sorafenib or atezolizumab.展开更多
Although increased risk for adverse birth outcomes has been associated with neighborhood socioeconomic disadvantage, most studies have used cross-sectional measures to account for neighborhood context. Consequently, d...Although increased risk for adverse birth outcomes has been associated with neighborhood socioeconomic disadvantage, most studies have used cross-sectional measures to account for neighborhood context. Consequently, dynamic neighborhood processes that may influence adverse birth outcomes are not fully understood. In this study, a longitudinal measure of socioeconomic change was used to explore variation in low birth weight (LBW) rates between 1990 and 2006 in Chicago neighborhoods. A crosss-ectional measure of neighborhood socioeconomic characteristics was then used to compare the LBW rates across Chicago neighborhoods during the same time frame to determine whether the cross-sectional measure would capture the same nuances in LBW variation as the longitudinal measure. Consistent with previous studies, both measures identified higher low birth weight rates in neighborhoods entrenched in poverty during the study period. However, the longitudinal measure showed that mothers residing in low income neighborhoods with high concentrations of immigrants had LBW rates that were lower than mothers residing in high income neighborhoods. Our results suggest that while cross-sectional measures of neighborhood socioeconomic context may capture global variations in low birth weight rates, longitudinal measures may illuminate subtleties between neighborhoods that might provide an opportunity for targeted policies to reduce adverse maternal and child health outcomes.展开更多
Racial residential segregation in the United States is generally associated differences in health outcomes among Blacks and Whites due to differential exposures to physical, social and economic resources. While severa...Racial residential segregation in the United States is generally associated differences in health outcomes among Blacks and Whites due to differential exposures to physical, social and economic resources. While several studies have explored the association between segregation and several chronic conditions in the US, few have specifically examined diabetes using a nationally representative population-based sample. The current study relies on 2005 data from both the Behavioral Risk Factor Surveillance Survey (BRFSS) and the American Community Survey (ACS) to explore the association between segregation, socioeconomic status and diabetes. Using multilevel mixed-effects logistic regression, we present models that account for clustering of individuals within metropolitan areas and are adjusted for objective environmental measures (including segregation) and potential individual-level confounders (including education, employment, and income) among a sample of 121,321 adults who were at least 18 years old. After controlling for individual-level factors, Blacks residing in highly segregated areas have the same odds of being diagnosed with diabetes as Whites. Whites are more likely to be diagnosed with diabetes in areas where there are higher percentages of Blacks than in areas with low Black representation. Moreover, in this national sample, there is no statistical association between Blacks residing in highly segregated neighborhoods and diabetes risk. However, the increased prevalence of diabetes among Whites living in Black metropolitan areas suggests that future studies are needed to explore the linkages between levels of segregation and diabetes risk.展开更多
文摘BACKGROUND Despite the use of current standard therapy,the prognosis of patients with unresectable hepatocellular carcinoma(HCC)is poor,with median survival times of 40 mo for intermediate HCC(Barcelona Clinic Liver Cancer[BCLC]stage B)and 6-8 mo for advanced HCC(BCLC stage C).Although patients with earlystage HCC are usually suitable for therapies with curative intention,up to 70% of patients experience relapse within 5 years.In the past decade,the United States Food and Drug Administration has approved different immunogenic treatment options for advanced HCC,the most common type of liver cancer among adults.Nevertheless,no treatment is useful in the adjuvant setting.Since 2007,the multikinase inhibitor sorafenib has been used as a first-line targeted drug to address the increased mortality and incidence rates of HCC.However,in 2020,the IMbrave150 trial demonstrated that combination therapy of atezolizumab(antiprogrammed death-ligand 1[PD-L1])and bevacizumab(anti-vascular endothelial growth factor[VEGF])is superior to sorafenib,a single anti-programmed death 1/PD-L1 antibody inhibitor used as an anti-cancer monotherapy for HCC treatment.AIM To conduct a systematic literature review to evaluate the evidence supporting the efficacy and safety of atezolizumab/bevacizumab as preferred first-line drug therapy over the conventional sorafenib or atezolizumab monotherapies,which are used to improve survival outcomes and reduce disease progression in patients with unresectable HCC and non-decompensated liver disease.METHODS A comprehensive literature review was conducted using the PubMed,Scopus,ScienceDirect,clinicaltrials.gov,PubMed Central,Embase,EuropePMC,and CINAHL databases to identify studies that met the inclusion criteria using relevant MeSH terms.This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and risk of bias(RoB)were assessed using the Cochrane RoB 2 tool and Sevis.RESULTS In the atezolizumab/bevacizumab group,an improvement in overall tumor response,reduction of disease progression,and longer progression-free survival were observed compared to monotherapy with either sorafenib or atezolizumab.Hypertension and proteinuria were the most common adverse events,and the rates of adverse events were comparable to those with the monotherapy.Of the studies,there were two completed trials and two ongoing trials analyzed using high quality and low bias.A more thorough analysis was only performed on the completed trials.CONCLUSION Treatment of HCC with atezolizumab/bevacizumab combination therapy was confirmed to be an effective first-line treatment to improve survival in patients with unresectable HCC and non-decompensated liver disease compared to monotherapy with either sorafenib or atezolizumab.
文摘Although increased risk for adverse birth outcomes has been associated with neighborhood socioeconomic disadvantage, most studies have used cross-sectional measures to account for neighborhood context. Consequently, dynamic neighborhood processes that may influence adverse birth outcomes are not fully understood. In this study, a longitudinal measure of socioeconomic change was used to explore variation in low birth weight (LBW) rates between 1990 and 2006 in Chicago neighborhoods. A crosss-ectional measure of neighborhood socioeconomic characteristics was then used to compare the LBW rates across Chicago neighborhoods during the same time frame to determine whether the cross-sectional measure would capture the same nuances in LBW variation as the longitudinal measure. Consistent with previous studies, both measures identified higher low birth weight rates in neighborhoods entrenched in poverty during the study period. However, the longitudinal measure showed that mothers residing in low income neighborhoods with high concentrations of immigrants had LBW rates that were lower than mothers residing in high income neighborhoods. Our results suggest that while cross-sectional measures of neighborhood socioeconomic context may capture global variations in low birth weight rates, longitudinal measures may illuminate subtleties between neighborhoods that might provide an opportunity for targeted policies to reduce adverse maternal and child health outcomes.
文摘Racial residential segregation in the United States is generally associated differences in health outcomes among Blacks and Whites due to differential exposures to physical, social and economic resources. While several studies have explored the association between segregation and several chronic conditions in the US, few have specifically examined diabetes using a nationally representative population-based sample. The current study relies on 2005 data from both the Behavioral Risk Factor Surveillance Survey (BRFSS) and the American Community Survey (ACS) to explore the association between segregation, socioeconomic status and diabetes. Using multilevel mixed-effects logistic regression, we present models that account for clustering of individuals within metropolitan areas and are adjusted for objective environmental measures (including segregation) and potential individual-level confounders (including education, employment, and income) among a sample of 121,321 adults who were at least 18 years old. After controlling for individual-level factors, Blacks residing in highly segregated areas have the same odds of being diagnosed with diabetes as Whites. Whites are more likely to be diagnosed with diabetes in areas where there are higher percentages of Blacks than in areas with low Black representation. Moreover, in this national sample, there is no statistical association between Blacks residing in highly segregated neighborhoods and diabetes risk. However, the increased prevalence of diabetes among Whites living in Black metropolitan areas suggests that future studies are needed to explore the linkages between levels of segregation and diabetes risk.
