AIM: To investigate the clinical course of untreatable hepatocellular carcinoma (HCC) identified at any stage and to identify factors associated with mortality. METHODS: From January 1999 to December 2010, 320 out of ...AIM: To investigate the clinical course of untreatable hepatocellular carcinoma (HCC) identified at any stage and to identify factors associated with mortality. METHODS: From January 1999 to December 2010, 320 out of 825 consecutive patients with a diagnosis of HCC and not appropriate for curative or palliative treatments were followed and managed with supportive therapy. Cirrhosis was diagnosed by histological or clinical features and liver function was evaluated according to Child-Pugh score. The diagnosis of HCC was performed by Ultra-Sound guided biopsy or by multiphasic contrast-enhanced computed tomography or gadolinium-enhanced magnetic resonance imaging. Data were collected for each patient including all clinical, laboratory and imaging variables necessary for the outcome prediction staging systems considered. HCC staging was performed according Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program scores. Follow-up time was defined as the number of months from the diagnosis of HCC to death. Prognostic baseline variables were analyzed by multivariate Cox analysis to identify the independent predictors of survival. RESULTS: Seventy-five per cent of patients had hepatitis C. Ascites was present in 169 patients (53%), while hepatic encephalopathy was present in 49 patients (15%). The Child-Pugh score was class A in 105 patients (33%), class B in 142 patients (44%), and class C in 73 patients (23%). One hundred patients (31%) had macroscopic vascular invasion and/or extra-hepatic spread of the tumor. A single lesion > 10 cm was observed in 34 patients (11%), while multinodular HCC was present in 189 patients (59%). Thirty nine patients (12%) were BCLC early (A) stage, 55 (17%) were BCLC intermediate (B) stage, 124 (39%) were BCLC advanced (C) stage, and 102 (32%) were end-stage BCLC (D). At the time of this analysis (July 2011), 28 (9%) patients were still alive. Six (2%) patients who were lost during follow-up were censored at the last visit. The overall median survival was 6.8 mo, and the 1-year survival was 32%. The 1-year survival according to BCLC classes was 100%, 79%, 12% and 0%, for BCLC A, B, C and D, respectively. There was a significant difference in survival between each BCLC class. The median survival of patients of BCLC stages A, B, C and D was 33, 17.4, 6.9, and 1.8 mo, respectively (P < 0.05 for comparison between stages). The median survival of Child-Pugh A, B and C classes were 9.8 mo (range 6.4-13), 6.1 (range 4.9-7.3), and 3.7 (range 1.5-6), respectively (P < 0.05 for comparison between stages). By univariate analysis, the variables significantly associated to an increased liklihood of mortality were Eastern Cooperative Oncology Group performance status (PS), presence of ascites, low level of albumin, elevated level of bilirubin, international normalized ratio (INR) and Log-[(α fetoprotein (AFP)]. At multivariate analysis, mortality was independently predicted by bad PS (P < 0.0001), high INR values (P = 0.0001) and elevated Log-(AFP) levels (P = 0.009). CONCLUSION: This study confirms the heterogeneous behavior of untreated HCC. BCLC staging remains an important prognostic guide and may be important in decision-making for palliative treatment.展开更多
As all branches of science grow and new experimental techniques become readily accessible,our knowledge of medicine is likely to increase exponentially in the coming years.Recently developed technologies have revoluti...As all branches of science grow and new experimental techniques become readily accessible,our knowledge of medicine is likely to increase exponentially in the coming years.Recently developed technologies have revolutionized our analytical capacities,leading to vast knowledge of many genes or genomic regions involved in the pathogenesis of congenital heart diseases,which are often associated with other genetic syndromes,coronary artery disease and non-ischemic cardiomyopathies and channelopathies.The knowledge-base of the genesis of cardiovascular diseases is likely going to be further revolutionized in this new era of genomic medicine.Here,we review the advances that have been made over the last several years in this field and discuss different genetic mechanisms that have been shown to underlie a variety of cardiovascular diseases.展开更多
Modern liver ultrasonography(US)has become a“one-stop shop”able to provide not only anatomic and morphologic but also functional information about vascularity,stiffness and other various liver tissue properties.Mode...Modern liver ultrasonography(US)has become a“one-stop shop”able to provide not only anatomic and morphologic but also functional information about vascularity,stiffness and other various liver tissue properties.Modern US techniques allow a quantitative assessment of various liver diseases.US scanning is no more limited to the visualized plane,but three-dimensional,volumetric acquisition and consequent post-processing are also possible.Further,US scan can be consistently merged and visualized in real time with Computed Tomography and Magnetic Resonance Imaging examinations.Effective and safe microbubble�based contrast agents allow a real time,dynamic study of contrast kinetic for the detection and characterization of focal liver lesions.Ultrasound can be used to guide loco-regional treatment of liver malignancies and to assess tumoral response either to interventional procedures or medical therapies.Microbubbles may also carry and deliver drugs under ultrasound exposure.US plays a crucial role in diagnosing,treating and monitoring focal and diffuse liver disease.On the basis of personal experience and literature data,this paper is aimed to review the main topics involving recent advances in the field of liver ultrasound.展开更多
Introduction: Granulomatous mastitis (GM) is a rare benign histopathologic lesion, associated with tissue inflammation, architectural distortions and heterogeneous parenchymal inflammation upon radiological evaluation...Introduction: Granulomatous mastitis (GM) is a rare benign histopathologic lesion, associated with tissue inflammation, architectural distortions and heterogeneous parenchymal inflammation upon radiological evaluation. The treatment of GM is controversial, and currently, there is no consensus about the most appropriate therapy. Case Presentation: We presented a unique, atypical GM case with a prolonged disease course that ultimately led to a bilateral mastectomy. A conservative therapeutic approach and limited or wide surgical excisions have failed to prevent unfavorable outcomes in both the initial presentation and recurrent disease. Conclusions: There’re no clear data in the literature delineating persistent recurrences of GM after conservative treatment and multiple surgeries. Obtaining a disease-free surgical margin might be an important prognostic factor for a lasting relapse-free clinical resolution.展开更多
To the editor Soft-tissue sarcomas(STS)represent a very heterogeneous group of rare tumors including more than 100 different subtypes[1].Surgery and neo/adjuvant radiation therapy represent the cornerstone of treatmen...To the editor Soft-tissue sarcomas(STS)represent a very heterogeneous group of rare tumors including more than 100 different subtypes[1].Surgery and neo/adjuvant radiation therapy represent the cornerstone of treatment for STS.However,despite an optimal resection of the tumor,up to 40%of patients will develop metastatic relapse and will die from the disease[1].Doxorubicin represents the first-line standard of care for patients with advanced disease since the 1970s,despite several attempts to identify better regimens.The median overall survival(OS)of patients with metastatic disease is<18 months and has only modestly improved over the past 20 years[2].展开更多
Theγδcells are a unique population of T lymphocytes that combine innate-like features and adaptive-type responses and play an important role in the early host response to infections and malignancies.Different fromα...Theγδcells are a unique population of T lymphocytes that combine innate-like features and adaptive-type responses and play an important role in the early host response to infections and malignancies.Different fromαβT cells,γδT cells recognize a limited set of antigens,which are shared by a variety of microbial pathogens and tumor cells in a non-MHC restricted manner;1 thus,these cells use the TCR in a manner similar to a pattern recognition receptor(PRR).Moreover,whereasαβT cells require antigen-and cytokine-driven clonal expansion,γδT cells are equipped with immediate effector functions.1 However,the potentialγδrepertoire with junctional diversity is estimated at∼10^(18),which is much greater than theαβrepertoire(∼10^(16)),thus raising questions concerning the forces governing the selection of such a huge TCR repertoire during ontogeny and whether and how theγδTCR repertoire is shaped under physiological and pathological conditions.展开更多
文摘AIM: To investigate the clinical course of untreatable hepatocellular carcinoma (HCC) identified at any stage and to identify factors associated with mortality. METHODS: From January 1999 to December 2010, 320 out of 825 consecutive patients with a diagnosis of HCC and not appropriate for curative or palliative treatments were followed and managed with supportive therapy. Cirrhosis was diagnosed by histological or clinical features and liver function was evaluated according to Child-Pugh score. The diagnosis of HCC was performed by Ultra-Sound guided biopsy or by multiphasic contrast-enhanced computed tomography or gadolinium-enhanced magnetic resonance imaging. Data were collected for each patient including all clinical, laboratory and imaging variables necessary for the outcome prediction staging systems considered. HCC staging was performed according Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program scores. Follow-up time was defined as the number of months from the diagnosis of HCC to death. Prognostic baseline variables were analyzed by multivariate Cox analysis to identify the independent predictors of survival. RESULTS: Seventy-five per cent of patients had hepatitis C. Ascites was present in 169 patients (53%), while hepatic encephalopathy was present in 49 patients (15%). The Child-Pugh score was class A in 105 patients (33%), class B in 142 patients (44%), and class C in 73 patients (23%). One hundred patients (31%) had macroscopic vascular invasion and/or extra-hepatic spread of the tumor. A single lesion > 10 cm was observed in 34 patients (11%), while multinodular HCC was present in 189 patients (59%). Thirty nine patients (12%) were BCLC early (A) stage, 55 (17%) were BCLC intermediate (B) stage, 124 (39%) were BCLC advanced (C) stage, and 102 (32%) were end-stage BCLC (D). At the time of this analysis (July 2011), 28 (9%) patients were still alive. Six (2%) patients who were lost during follow-up were censored at the last visit. The overall median survival was 6.8 mo, and the 1-year survival was 32%. The 1-year survival according to BCLC classes was 100%, 79%, 12% and 0%, for BCLC A, B, C and D, respectively. There was a significant difference in survival between each BCLC class. The median survival of patients of BCLC stages A, B, C and D was 33, 17.4, 6.9, and 1.8 mo, respectively (P < 0.05 for comparison between stages). The median survival of Child-Pugh A, B and C classes were 9.8 mo (range 6.4-13), 6.1 (range 4.9-7.3), and 3.7 (range 1.5-6), respectively (P < 0.05 for comparison between stages). By univariate analysis, the variables significantly associated to an increased liklihood of mortality were Eastern Cooperative Oncology Group performance status (PS), presence of ascites, low level of albumin, elevated level of bilirubin, international normalized ratio (INR) and Log-[(α fetoprotein (AFP)]. At multivariate analysis, mortality was independently predicted by bad PS (P < 0.0001), high INR values (P = 0.0001) and elevated Log-(AFP) levels (P = 0.009). CONCLUSION: This study confirms the heterogeneous behavior of untreated HCC. BCLC staging remains an important prognostic guide and may be important in decision-making for palliative treatment.
基金Supported by Italian Ministry of Health and FILAS Regione Lazio
文摘As all branches of science grow and new experimental techniques become readily accessible,our knowledge of medicine is likely to increase exponentially in the coming years.Recently developed technologies have revolutionized our analytical capacities,leading to vast knowledge of many genes or genomic regions involved in the pathogenesis of congenital heart diseases,which are often associated with other genetic syndromes,coronary artery disease and non-ischemic cardiomyopathies and channelopathies.The knowledge-base of the genesis of cardiovascular diseases is likely going to be further revolutionized in this new era of genomic medicine.Here,we review the advances that have been made over the last several years in this field and discuss different genetic mechanisms that have been shown to underlie a variety of cardiovascular diseases.
文摘Modern liver ultrasonography(US)has become a“one-stop shop”able to provide not only anatomic and morphologic but also functional information about vascularity,stiffness and other various liver tissue properties.Modern US techniques allow a quantitative assessment of various liver diseases.US scanning is no more limited to the visualized plane,but three-dimensional,volumetric acquisition and consequent post-processing are also possible.Further,US scan can be consistently merged and visualized in real time with Computed Tomography and Magnetic Resonance Imaging examinations.Effective and safe microbubble�based contrast agents allow a real time,dynamic study of contrast kinetic for the detection and characterization of focal liver lesions.Ultrasound can be used to guide loco-regional treatment of liver malignancies and to assess tumoral response either to interventional procedures or medical therapies.Microbubbles may also carry and deliver drugs under ultrasound exposure.US plays a crucial role in diagnosing,treating and monitoring focal and diffuse liver disease.On the basis of personal experience and literature data,this paper is aimed to review the main topics involving recent advances in the field of liver ultrasound.
文摘Introduction: Granulomatous mastitis (GM) is a rare benign histopathologic lesion, associated with tissue inflammation, architectural distortions and heterogeneous parenchymal inflammation upon radiological evaluation. The treatment of GM is controversial, and currently, there is no consensus about the most appropriate therapy. Case Presentation: We presented a unique, atypical GM case with a prolonged disease course that ultimately led to a bilateral mastectomy. A conservative therapeutic approach and limited or wide surgical excisions have failed to prevent unfavorable outcomes in both the initial presentation and recurrent disease. Conclusions: There’re no clear data in the literature delineating persistent recurrences of GM after conservative treatment and multiple surgeries. Obtaining a disease-free surgical margin might be an important prognostic factor for a lasting relapse-free clinical resolution.
基金MSD(Merck Sharp and Dohme)AVENIR.Grant Number:HEART。
文摘To the editor Soft-tissue sarcomas(STS)represent a very heterogeneous group of rare tumors including more than 100 different subtypes[1].Surgery and neo/adjuvant radiation therapy represent the cornerstone of treatment for STS.However,despite an optimal resection of the tumor,up to 40%of patients will develop metastatic relapse and will die from the disease[1].Doxorubicin represents the first-line standard of care for patients with advanced disease since the 1970s,despite several attempts to identify better regimens.The median overall survival(OS)of patients with metastatic disease is<18 months and has only modestly improved over the past 20 years[2].
文摘Theγδcells are a unique population of T lymphocytes that combine innate-like features and adaptive-type responses and play an important role in the early host response to infections and malignancies.Different fromαβT cells,γδT cells recognize a limited set of antigens,which are shared by a variety of microbial pathogens and tumor cells in a non-MHC restricted manner;1 thus,these cells use the TCR in a manner similar to a pattern recognition receptor(PRR).Moreover,whereasαβT cells require antigen-and cytokine-driven clonal expansion,γδT cells are equipped with immediate effector functions.1 However,the potentialγδrepertoire with junctional diversity is estimated at∼10^(18),which is much greater than theαβrepertoire(∼10^(16)),thus raising questions concerning the forces governing the selection of such a huge TCR repertoire during ontogeny and whether and how theγδTCR repertoire is shaped under physiological and pathological conditions.
