AIM To assess the safety and efficacy of transarterial chemoembolization(TACE) of hepatocellular carcinoma(HCC) using a new generation of 40 μm drug eluting beads in patients not eligible for curative treatment.METHO...AIM To assess the safety and efficacy of transarterial chemoembolization(TACE) of hepatocellular carcinoma(HCC) using a new generation of 40 μm drug eluting beads in patients not eligible for curative treatment.METHODS Drug eluting bead TACE(DEB-TACE) using a new generation of microspheres(embozene tandem,40 μm) preloaded with 100 mg of doxorubicin was performed on 48 early or intermediate HCC patients with compensatedcirrhosis.Response to therapy was assessed with Response Evaluation Criteria in Solid Tumors(RECIST) and modified RECIST(m RECIST) guidelines applied to computed tomography or magnetic resonance imaging.Eleven out of the 48 treated patients treated progressed on to receive liver orthotopic transplantation(OLT).This allowed for histological analysis on the treated explanted nodules.RESULTS DEB-TACE with 40 μm showed a good safety profile without major complications or 30-d mortality.The objective response rate of treated tumors was 72.6% and 26.7% according to m RECIST and RECIST respectively.Histological examination in 11 patients assigned to OLT showed a necrosis degree > 90% in 78.6% of cases.The overall time to progression was 13 mo(11-21).CONCLUSION DEB-TACE with 40 μm particles is an effective treatment for the treatment of HCC in early-intermediate patients(Barcelona Clinic Liver Cancer stage A/B) with a good safety profile and good results in term of objective response rate and necrosis.展开更多
High-throughput DNA sequence analysis was used to screen for TET2 mutations in peripheral blood derived DNA from 97 patients with BCR-ABL-negative-myeloproliferative neoplasms (MPNs). Overall six mutations in the codi...High-throughput DNA sequence analysis was used to screen for TET2 mutations in peripheral blood derived DNA from 97 patients with BCR-ABL-negative-myeloproliferative neoplasms (MPNs). Overall six mutations in the coding region of the gene were identified in 7 patients with an overall mutational frequency of 7.2%. In polycythemia vera patients (n = 25) were identified 2 mutations (8%);in those with essential thrombocythemia (n = 55) 2 mutations (3.6%);in those with unclassifiable MPN (n = 8) 3 mutations (37.5%). No primary myelofibrosis patiens (n = 6) harboured TET2 mutations. Three unreported mutations were identified (p.P177fs, p.C1298del, p.P411del) the first two in patients with unclassifiable MPN, the last in a patient with essential thrombocythemia. On multivariate analysis the diagnosis of an unclassifiable MPN was significantly related to the presence of TET2 mutations (p = 0.02;OR: 2.81;95% CI 1.11 - 7.06). We conclude that TET2 mutations occur in both JAK2V617F-positive and -negative MPN and are more frequent in MPN-U patients. This could represent the biological link between the different classes of myeloid malignancies.展开更多
This work aims at developing the actor-to-actor （A2A） relationship concept in service contexts enhancing the contribution of the systems theories. The most recent progresses related to the research on the service, a...This work aims at developing the actor-to-actor （A2A） relationship concept in service contexts enhancing the contribution of the systems theories. The most recent progresses related to the research on the service, as a matter of fact, highlight how the nowadays co-creation processes are key elements in each service context. Both the Service Science （SS） and the Service Dominant （S-D） logic analyse the importance of the role played by the numerousness of actors involved in the service exchange because of the resources held （and released） and the contribution they can offer. System theories, and in particular the Viable System Approach, offer the possibility of an holistic perspective able to re-interpret the same characterizing mechanisms of the value co-creation. In the following parts of the work it will presented a conceptual analysis based on the contribution of the VSA, the SS and the S-D logic, whose scientific proposals will be developed and critically analysed in order to verify the proposition coherence in terms of A2A relationships within the value co-creation process. The relational perspective of the Service Eco-systems shows a view open to network in relation to economic and social actors, where each organization can be considered as an actor because it is actively committed in the value co-creation development, going beyond the difference between the user, the producer, or the exchange facilitator. Therefore, the contribution proposes some progresses compared with the business to business （B2B） approach and literature, through the introduction of the new A2A interaction concept within the service context for the indistinct role that the actors play in the value co-creation process. In this perspective, the contribution introduces the research line focused on the service, giving attention, afterwards, to the service system context, in order to analyse the features of these systems with the specific goal of identifying its peculiarity. The contribution proceed with the presentation of the systems thinking, and in particular the VSA contribution, directed toward the description of the gaps that the authors identify in the present research attempting to offer some orientations for the comprehension and the improvement of the service systems and of their planning and management implications. The contribution finally proposes an integrated interpretation of the several emerging paradigms （VSA, SS and S-D logic） seeking an in-depth-analysis of the A2A relationships in the service contexts.展开更多
Cholelithiasis is characterized by impaired metabolism of bile acids,cholesterol and bilirubin resulting in deposition of gallstones within the gallbladder(1).The article by Fujita et al.outlines the third revision of...Cholelithiasis is characterized by impaired metabolism of bile acids,cholesterol and bilirubin resulting in deposition of gallstones within the gallbladder(1).The article by Fujita et al.outlines the third revision of the evidence-based practice guidelines issued by the Japanese Society of Gastroenterology(JSGE)on cholelithiasis(2).For these current guidelines,52 questions were adopted through discussions among committee members,covering epidemiology,pathogenesis,diagnosis,treatments,complications,and prognostic aspects of cholelithiasis in Japan(2).The strengths of recommendations were determined by voting by committee members after assessing current available literature,patient preferences,and cost-benefit balance(2).Similar to the previous guideline(second revision),consensus among committee members was defined as the acquisition of 70%votes or over(2).展开更多
文摘AIM To assess the safety and efficacy of transarterial chemoembolization(TACE) of hepatocellular carcinoma(HCC) using a new generation of 40 μm drug eluting beads in patients not eligible for curative treatment.METHODS Drug eluting bead TACE(DEB-TACE) using a new generation of microspheres(embozene tandem,40 μm) preloaded with 100 mg of doxorubicin was performed on 48 early or intermediate HCC patients with compensatedcirrhosis.Response to therapy was assessed with Response Evaluation Criteria in Solid Tumors(RECIST) and modified RECIST(m RECIST) guidelines applied to computed tomography or magnetic resonance imaging.Eleven out of the 48 treated patients treated progressed on to receive liver orthotopic transplantation(OLT).This allowed for histological analysis on the treated explanted nodules.RESULTS DEB-TACE with 40 μm showed a good safety profile without major complications or 30-d mortality.The objective response rate of treated tumors was 72.6% and 26.7% according to m RECIST and RECIST respectively.Histological examination in 11 patients assigned to OLT showed a necrosis degree > 90% in 78.6% of cases.The overall time to progression was 13 mo(11-21).CONCLUSION DEB-TACE with 40 μm particles is an effective treatment for the treatment of HCC in early-intermediate patients(Barcelona Clinic Liver Cancer stage A/B) with a good safety profile and good results in term of objective response rate and necrosis.
文摘High-throughput DNA sequence analysis was used to screen for TET2 mutations in peripheral blood derived DNA from 97 patients with BCR-ABL-negative-myeloproliferative neoplasms (MPNs). Overall six mutations in the coding region of the gene were identified in 7 patients with an overall mutational frequency of 7.2%. In polycythemia vera patients (n = 25) were identified 2 mutations (8%);in those with essential thrombocythemia (n = 55) 2 mutations (3.6%);in those with unclassifiable MPN (n = 8) 3 mutations (37.5%). No primary myelofibrosis patiens (n = 6) harboured TET2 mutations. Three unreported mutations were identified (p.P177fs, p.C1298del, p.P411del) the first two in patients with unclassifiable MPN, the last in a patient with essential thrombocythemia. On multivariate analysis the diagnosis of an unclassifiable MPN was significantly related to the presence of TET2 mutations (p = 0.02;OR: 2.81;95% CI 1.11 - 7.06). We conclude that TET2 mutations occur in both JAK2V617F-positive and -negative MPN and are more frequent in MPN-U patients. This could represent the biological link between the different classes of myeloid malignancies.
文摘This work aims at developing the actor-to-actor （A2A） relationship concept in service contexts enhancing the contribution of the systems theories. The most recent progresses related to the research on the service, as a matter of fact, highlight how the nowadays co-creation processes are key elements in each service context. Both the Service Science （SS） and the Service Dominant （S-D） logic analyse the importance of the role played by the numerousness of actors involved in the service exchange because of the resources held （and released） and the contribution they can offer. System theories, and in particular the Viable System Approach, offer the possibility of an holistic perspective able to re-interpret the same characterizing mechanisms of the value co-creation. In the following parts of the work it will presented a conceptual analysis based on the contribution of the VSA, the SS and the S-D logic, whose scientific proposals will be developed and critically analysed in order to verify the proposition coherence in terms of A2A relationships within the value co-creation process. The relational perspective of the Service Eco-systems shows a view open to network in relation to economic and social actors, where each organization can be considered as an actor because it is actively committed in the value co-creation development, going beyond the difference between the user, the producer, or the exchange facilitator. Therefore, the contribution proposes some progresses compared with the business to business （B2B） approach and literature, through the introduction of the new A2A interaction concept within the service context for the indistinct role that the actors play in the value co-creation process. In this perspective, the contribution introduces the research line focused on the service, giving attention, afterwards, to the service system context, in order to analyse the features of these systems with the specific goal of identifying its peculiarity. The contribution proceed with the presentation of the systems thinking, and in particular the VSA contribution, directed toward the description of the gaps that the authors identify in the present research attempting to offer some orientations for the comprehension and the improvement of the service systems and of their planning and management implications. The contribution finally proposes an integrated interpretation of the several emerging paradigms （VSA, SS and S-D logic） seeking an in-depth-analysis of the A2A relationships in the service contexts.
文摘Cholelithiasis is characterized by impaired metabolism of bile acids,cholesterol and bilirubin resulting in deposition of gallstones within the gallbladder(1).The article by Fujita et al.outlines the third revision of the evidence-based practice guidelines issued by the Japanese Society of Gastroenterology(JSGE)on cholelithiasis(2).For these current guidelines,52 questions were adopted through discussions among committee members,covering epidemiology,pathogenesis,diagnosis,treatments,complications,and prognostic aspects of cholelithiasis in Japan(2).The strengths of recommendations were determined by voting by committee members after assessing current available literature,patient preferences,and cost-benefit balance(2).Similar to the previous guideline(second revision),consensus among committee members was defined as the acquisition of 70%votes or over(2).
