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Encyclopedia of Clinical Neuropsychology
Ganger (1998), a brain injury claim. Review of the judge's written decision in Chapple v. ... Ganger outlined that all neuropsychological testimony (even partial HRB protocols from two other neuropsychologists) was admitted into evidence and the fact that the judge had placed more emphasis on testimony ...doi:10.1007/978-3-319-56782-2_952-2 fatcat:nw2tufwdmvg77klqjodszazhcu
Robert Grimm is currently at the University of Washington, Seattle. Copyright c 1995 by the Association for Computing Machinery, Inc. ... Ordered disk writes Another difficulty XN must face is guaranteeing the rules Ganger and Patt  give for achieving strict file system integrity across crashes: First, never reuse an on-disk resource ...doi:10.1145/269005.266644 fatcat:zr3vvpmjazehtd76wizxyq457q
& Aims: Acute liver failure (ALF) due to hepatitis B virus (HBV) infection can occur after immunosuppressive treatment and be fatal, although it might be preventable. We aimed to characterize the causes, clinical course, and short-term outcomes of HBV-associated ALF after immune suppressive therapy, compared to patients with HBV-associated ALF without immunosuppression (controls). Methods: We performed a retrospective multi-center study of 156 consecutive patients diagnosed with HBV-associateddoi:10.1016/j.cgh.2016.06.008 pmid:27311622 pmcid:PMC6055519 fatcat:ixwm5ayc25habiqyii774gi2ly
more »... LF (22 with a solid or blood malignancy) enrolled in the Acute Liver Failure Study Group registry from January 1998 through April 2015. We collected data on results of serologic and hepatic biochemistry analyses, grade of hepatic encephalopathy, model for endstage liver disease (MELD) score, and King's College criteria. We also collected data on clinical features, medical therapies, and complications in the first 7 days following study enrollment. Logistic regression was used to identify factors associated with transplant-free survival 21 days in HBV-associated ALF (the primary outcome). Results: Among patients with HBV-associated ALF, 28 cases (18%) occurred after immunosuppressive therapy (15 patients received systemic corticosteroids and 21 received chemotherapy); and 128 cases did not (controls, 82%). Significantly greater proportions of patients with Hepatitis B-associated ALF after immunosuppression were non-white, and had anemia or thrombocytopenic than controls (P<.02 for all). The serologic profile of HBV infection, severity of liver failure (based on MELD score), and complications (hepatic encephalopathy or need for mechanical ventilation, vasopressors, or renal replacement therapy) were similar between the groups (P>.17 for all). Significantly smaller proportions of patients with ALF after immunosuppression than controls survived for 21 days (42.9% vs 62.5% of controls; P=.0096). Factors associated with 21 day transplant-free survival (c-statistic = 0.866) were increased MELD score (odds ratio, 0.894 per increment), requirement for mechanical ventilation (odds ratio, 0.111), and immunosuppressive therapy (odds ratio, 0.274). Conclusion: Within a cohort study of HBV-associated ALF patients, 18% had received immunosuppressive therapy. Significantly smaller proportions of HBV-associated ALF patients after immunosuppression survive beyond 21 days than patients with HBV-associated ALF who did not receive immunosuppression. Patients undergoing chemotherapy should be screened for HBV infection and given appropriate anti-viral therapies to reduce preventable mortality.
Robert Grimm is currently at the University of Washington, Seattle. Copyright c 1995 by the Association for Computing Machinery, Inc. ... Ordered disk writes Another difficulty XN must face is guaranteeing the rules Ganger and Patt  give for achieving strict file system integrity across crashes: First, never reuse an on-disk resource ...doi:10.1145/268998.266644 dblp:conf/sosp/KaashoekEGBHMPGM97 fatcat:vi3bh76jnbbllklhaxdisy7fyq
Purpose-To compare the utility of different staging systems and analyzed independent predictors of survival in patients with hepatocellular carcinoma (HCC) treated with 90 Y radioembolization. Materials and Methods-428 HCC patients were treated with 90 Y fromdoi:10.1016/j.jvir.2014.01.010 pmid:24613269 pmcid:PMC5097871 fatcat:pu4pqhrvyrgxzkdb7zh7q57prq
Roberts et al. ...doi:10.1016/j.cgh.2016.09.007 pmid:27641661 pmcid:PMC5528860 fatcat:khixgibeljbujhgpjxwsbub5i4
We compared the efficacy of the ALBI (albumin–bilirubin) score to the established Child–Pugh (CP) grade in hepatocellular carcinoma (HCC) patients treated with yttrium-90 radioembolization (Y90). We further assessed the individual contributions of albumin and bilirubin to survival prediction. Methods: 1000 consecutive HCC patients treated with Y90 were included. Overall survival (OS) was assessed using Kaplan Meier analysis. Sub-stratification analyses were performed using CP and ALBI and indoi:10.3390/cancers11060879 pmid:31238514 pmcid:PMC6627853 fatcat:ikayq3ak3ndyxgeo3zus3f5jri
more »... groups determined by United Network for Organ Sharing (UNOS) or Barcelona Clinic Liver Cancer (BCLC) staging. The independent impact (hazard ratio (HR)) of ALBI, CP, albumin, and bilirubin on survival was assessed using Cox proportional hazards analysis. Results: Median OS for ALBI 1, 2, and 3 grades was 46.7, 19.1, and 8.8 months, respectively. The HR for death for ALBI 2 vs. ALBI 1 was 3.39 (1.75–6.57); ALBI 3 vs. ALBI 1 was 7.58 (3.89–14.79); and the c-index was 0.623. Median OS for CP A, B, and C was 21.7, 11.3, and 6.0 months, respectively. The HR for death for CP B vs. CP A was 2.04 (1.71–2.43); CP C vs. CP A was 3.27 (2.08–5.14); and the c-index was 0.616. Stratified OS showed unique prognostic groups identified by ALBI within CP-B and CP-C. Median OS for albumin grades 1, 2, and 3 was 46.0, 17.1, and 9.1 months, respectively. Median OS for bilirubin grades 1, 2, and 3 was 15.6, 21.0, and 5.8 months, respectively. The HR for death for albumin 2 vs. 1 was 2.48 (1.81–3.41); albumin 3 vs. 1 was 4.74 (3.44–6.54); and the c-index was 0.640. The HR for death for bilirubin 2 vs. 1 was 1.09 (0.82–1.44); bilirubin 3 vs. 1 was 2.37 (1.66–3.40); and the c-index was 0.533. Conclusions: ALBI outperforms CP in survival prognosis in Y90 treated patients. On sub-analyses, serum albumin (not bilirubin) appears to be the main driver of survival prediction. Our study supports the prognostic ability of ALBI and may suggest a role of albumin alone as a biomarker for patients with HCC.
& Aims-Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with 90 Y-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed at testing this concept by performing a comprehensive timedependent analysis of liver volumes followingdoi:10.1016/j.jhep.2013.06.015 pmid:23811303 pmcid:PMC5085290 fatcat:sklpr6yi5vcnfcu7lgywifrzay
more »... radioembolization. Methods-83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N = 67), cholangiocarcinoma (CC; N = 8) or colorectal cancer (CRC; N = 8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre-and post-Y90 CT/MRI scans in a dynamic fashion. Results-Right lobe atrophy (p = 0.003), left lobe hypertrophy (p <0.001), and FLR hypertrophy (p <0.001) were observed 1 month after Y90 and this was consistent at all follow-up time points. Median %FLR hypertrophy reached 45% (5-186) after 9 months (p <0.001). The median maximal %FLR hypertrophy was 26% (−14→86). Portal vein thrombosis was correlated to %FLR hypertrophy (p = 0.02). Median Child-Pugh score worsening (6→7) was seen at 1 to 3 months (p = 0.03) and 3 to 6 months (p = 0.05) after treatment. Five patients underwent successful right lobectomy (HCC N = 3, CRC N = 1, CC N = 1) and 6 HCCs were transplanted. Conclusions-Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-toresection setting. Statistics Baseline patient/tumor characteristics were compared using the Fisher's exact (categorical variables) and Kruskal-Wallis tests (continuous variables). Volumetric measurements values were expressed as median/range due to non-normal distribution. Volumetric measurements changes (lobes, tumor, FLR) and AFP changes were compared to baseline using the Wilcoxon test for non-normal distributions. Baseline/follow-up FLRs were compared using Vouche et al.
doi:10.2214/ajr.10.4580 pmid:21343496 pmcid:PMC3093963 fatcat:tyawflxgu5ay3allpvkp7acusy
The aim of this study was to compare radiological and pathological changes and test the adjunct efficacy of Sorafenib to Y90 as a bridge to transplantation in hepatocellular carcinoma (HCC). 15 patients with 16 HCC lesions were randomized to Y90 without (Group A, n 5 9) or with Sorafenib (Group B, n 5 7). Size (WHO, RECIST), enhancement (EASL, mRECIST) and diffusion-weighted imaging criteria (apparent diffusion coefficient, ADC) measurements were obtained at baseline, then at 1 and every 3doi:10.1002/hep.26487 pmid:23703789 pmcid:PMC5097874 fatcat:v737oqeodvcrfispwy6akbe3pi
more »... s after treatment until transplantation. Percentage necrosis in explanted tumors was correlated with imaging findings. 100%, 50%-99% and <50% pathological necrosis was observed in 6 (67%), 1 (11%), and 2 (22%) tumors in Group A and 3 (42%), 2 (28%), and 2 (28%) in Group B, respectively (P 5 0.81). While ADC (P 5 0.46) did not change after treatment, WHO (P 5 0.06) and RECIST (P 5 0.08) response at 1 month failed to reach significance, but significant responses by EASL (P < 0.01/0.03) and mRECIST (P < 0.01/0.03) at 1 and 3 months were observed. Response was equivalent by EASL or mRECIST. No difference in response rates was observed between groups A and B at 1 and 3 months by WHO, RECIST, EASL, mRECIST or ADC measurements. Despite failing to reach significance, smaller baseline size was associated with complete pathological necrosis (CPN) (RECIST: P 5 0.07; WHO: P 5 0.05). However, a cut-off size of 35 mm was predictive of CPN (P 5 0.005). CPN could not be predicted by WHO (P 5 0.25 and 0.62), RECIST (P = 0.35 and 0.54), EASL (P 5 0.49 and 0.46), mRECIST (P 5 0.49 and 0.60) or ADC (P 5 0.86 and 0.93). Conclusion: The adjunct of Sorafenib did not augment radiological or pathological response to Y90 therapy for HCC. Equivalent significant reduction in enhancement at 1 and 3 months by EASL/mRECIST was noted. Neither EASL nor mRECIST could reliably predict CPN. (HEPATOLOGY 2013;58:1655-1666 T he development of surrogate markers for locoregional therapies (LRTs) in hepatocellular carcinoma (HCC) is desirable to improve treatment planning and accelerate design and endpoints in clinical trials. Before validation, early imaging surrogate markers face different challenges, including methodological considerations, reproducibility, accuracy to detect real treatment response, and, potentially most important,
and Aims-Conventional transarterial chemoembolization (cTACE) is used to treat patients with hepatocellular carcinoma (HCC). Radioembolization is a minimally invasive procedure that involves implantation of radioactive micron-sized particles loaded with yttrium-90 (Y90) inside the blood vessels that supply a tumor. We performed a randomized, phase 2 study to compare the effects of cTACE and Y90 radioembolization in patients with HCC. Methods-From October 2009 through October 2015, we revieweddoi:10.1053/j.gastro.2016.08.029 pmid:27575820 pmcid:PMC5124387 fatcat:gbinx7em5zcwdne3kgxshnhwti
more »... tients with HCC of all Barcelona Clinic Liver Cancer (BCLC) stages for eligibility. Of these, 179 patients with BCLC stages A or B met our enrollment criteria and were candidates for cTACE or Y90 therapy. Patients were randomly assigned to groups that received Y90 therapy (n=24, 50% Child-Pugh A) or cTACE (n=21, 71% Child-Pugh A). The primary outcome was time to progression (TTP), evaluated by intention to treat analysis. Secondary outcomes included safety, rate of response (based on tumor size and necrosis criteria), and KM survival time. We performed inverse probability of censoring weighting and competing risk analyses. Results-Patients in the Y90 radioembolization group had significant longer median TTP (>26 months) than patients in the cTACE group (6.8 months) (P=.0012) (hazard ratio=0.122; 95% CI, 0.027-0.557; P=.007). This was confirmed by competing risk and inverse probability of censoring weighting analyses accounting for transplantation or death. A significantly greater proportion of patients in the cTACE group developed diarrhea (21%) than in the Y90 group (0%; P=.031) or hypoalbuminemia (58% in the cTACE group vs 4% in the Y90 group) (P<.001). Similar proportions of patients in each group had a response to therapy, marked by necrosis (74% in the cTACE group vs 87% in the Y90 group) (P=.433). Median survival time, censored to liver transplantation, was 17.7 months for the cTACE group (95% CI, 8.3-NC) vs 18.6 months for the Y90 group (95% CI, 7.4-32.5) (P=.99). Conclusions-In a phase 2 study of patients with HCC of BCLC stages A or B, we found Y90 radioembolization to provide significantly longer TTP than cTACE. Y90 radioembolization provides better tumor control and could reduce dropout from transplant waitlists. ClinicalTrials.gov no. NCT00956930
Among liver transplant candidates, obesity and frailty are associated with increased risk of death while they are on the wait-list. However, use of body mass index (BMI) may not detect candidates at a higher risk of death owing to the fact that ascites and muscle wasting are seen across transplant candidates of all BMI measurements. To evaluate whether the association between wait-list mortality and frailty varied by BMI of liver transplant candidates. A prospective cohort study was conducteddoi:10.1001/jamasurg.2019.2845 pmid:31509169 pmcid:PMC6739734 fatcat:4fkkbecs6jfr3ko2ohmall2vfe
more »... 9 liver transplant centers in the United States from March 1, 2012, to May 1, 2018, among 1108 adult liver transplant candidates without hepatocellular carcinoma. At outpatient evaluation, the Liver Frailty Index score was calculated (grip strength, chair stands, and balance), with frailty defined as a Liver Frailty Index score of 4.5 or more. Candidates' BMI was categorized as nonobese (18.5-29.9), class 1 obesity (30.0-34.9), and class 2 or greater obesity (≥35.0). The risk of wait-list mortality was quantified using competing risks regression by candidate frailty, adjusting for age, sex, race/ethnicity, Model for End-stage Liver Disease Sodium score, cause of liver disease, and ascites, including an interaction with candidate BMI. Of 1108 liver transplant candidates (474 women and 634 men; mean [SD] age, 55  years), 290 (26.2%) were frail; 170 of 670 nonobese candidates (25.4%), 64 of 246 candidates with class 1 obesity (26.0%), and 56 of 192 candidates with class 2 or greater obesity (29.2%) were frail (P = .57). Frail nonobese candidates and frail candidates with class 1 obesity had a higher risk of wait-list mortality compared with their nonfrail counterparts (nonobese candidates: adjusted subhazard ratio, 1.54; 95% CI, 1.02-2.33; P = .04; and candidates with class 1 obesity: adjusted subhazard ratio, 1.72; 95% CI, 0.99-2.99; P = .06; P = .75 for interaction). However, frail candidates with class 2 or greater obesity had a 3.19-fold higher adjusted risk of wait-list mortality compared with nonfrail candidates with class 2 or greater obesity (95% CI, 1.75-5.82; P < .001; P = .047 for interaction). This study's finding suggest that among nonobese liver transplant candidates and candidates with class 1 obesity, frailty was associated with a 2-fold higher risk of wait-list mortality. However, the mortality risk associated with frailty differed for candidates with class 2 or greater obesity, with frail candidates having a more than 3-fold higher risk of wait-list mortality compared with nonfrail patients. Frailty assessments may help to identify vulnerable patients, particularly those with a BMI of 35.0 or more, in whom a clinician's visual evaluation may be less reliable to assess muscle mass and nutritional status.
Yttrium-90 ((90)Y) radioembolization is a microembolic procedure. Hence, it is commonly used in hepatocellular carcinoma (HCC) patients with portal venous thrombosis (PVT). We analyzed liver function, imaging findings, and treatment options (local/systemic) at disease progression following (90)Y treatment in HCC patients with PVT. We treated 291 HCC patients with (90)Y radioembolization. From this cohort, we included patients with liver-only disease, PVT and Child-Pugh (CP) score ≤ 7; thisdoi:10.1016/j.jhep.2012.09.003 pmid:23000237 pmcid:PMC3527660 fatcat:we2hfukirva2teew3yqx66eaby
more »... ified 63 patients with HCC and PVT (CP-A:35, CP-B7:27). Liver function, CP status, and imaging findings at progression were determined in order to assess potential candidacy for systemic treatment/clinical trials. Survival, time-to-progression (TTP), and time-to-hepatic decompensation analyses were performed using Kaplan-Meier methodology. Of 35 CP-A and 28 CP-B7 patients, 29 and 15 progressed, respectively. Median survival and TTP were 13.8 and 5.6 months in CP-A and 6.5 and 4.9 months in CP-B7 patients, respectively. Of the 29 CP-A patients who progressed, 45% maintained their CP status at progression (55% decompensated to CP-B). Of the 15 CP-B7 patients who progressed, 20% improved to CP-A, 20% maintained their CP score and 60% decompensated. Knowledge of liver function and CP score of HCC with PVT progressing after (90)Y is critically relevant information, as these patients may be considered for systemic therapy/clinical trials. If a strict CP-A status is mandated, our study demonstrated that 64% of cases exhibited inadequate liver function and were ineligible for systemic therapy/clinical trials. An adjuvant approach using local therapy and systemic agents prior to progression should be investigated.
doi:10.1111/liv.12632 pmid:25039930 pmcid:PMC4291312 fatcat:of4ddrqo4nffjezyqxhpbaql6a
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