scholarly journals Increase of non- HBV, non- HCV related hepatocellular carcinoma -Over 20 years single institution study-

2020 ◽  
Author(s):  
Yuko Nagaoki ◽  
Hideyuki Hyogo ◽  
Yuwa Ando ◽  
Yumi Kosaka ◽  
Shinsuke Uchikawa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
The Other ◽  
University Hospital ◽  
Early Group ◽  
Single Institution ◽  
Regional University ◽  
Late Group

Abstract Background: We previously reported the trends of etiologies of hepatocellular carcinoma (HCC) between 1995 and 2009. By updating this study, we aimed to evaluate the incidence of HCC with non- hepatitis B viral and non- hepatitis C viral (NBNC) etiologies and explore the clinical characteristics, also.Methods: Consecutive 2171 HCC patients at our institution were enrolled between 1992 and 2018 in this retrospective cohort study. A comparative study was conducted by dividing into two groups, an early group from 1992 to 2009 and a late group from 2010 to 2018.Results: NBNC-HCC account for 514 patients (23.6%). The proportion of NBNC-HCC has continued to increase from 26.5% in 2009 to 46.3% in 2018. NBNC-HCC were getting older (median ages, 67 to 73 years). Type 2 diabetes mellitus (48.5% to 60.3%: P=0.008), hypertension (48.5% to 57.4%: P=0.047), and hyperlipidemia (39.2% to 53.8%: P=0.001) has increased significantly in recent years. The median FIB-4 index have decreased (4.37 to 3.61: P=0.026) and the median platelet counts have increased (15.1 to 17.9: P=0.013) significantly. Among 514 NBNC-HCC, 194 patients underwent hepatic resection in which 14.9%, 29.3%, and 55.8% were based on nonalcoholic steatohepatitis (NASH), alcoholic liver disease (ALD), and cryptogenic, respectively. Cirrhosis was detected in 72.4%, 38.6%, and 15.5% of NASH, ALD and cryptogenic, respectively. The prevalence of cirrhosis in NASH were significantly higher than other groups (P<0.001), overall, 70% of the background liver of NBNC-HCC was not cirrhosis. On the other hands, the median FIB-4 index in cryptogenic HCC were 2.56 and significantly lower than other groups, FIB-4 index considered as one of useful screening of HCC.Conclusions: NBNC-HCC has rapidly been increasing in recent years even in regional university hospital. The presence of metabolic syndrome may be important risk factors. Furthermore, HCC from non-cirrhotic liver needs attention carefully. Accordingly, it is speculated that these patients should receive periodic surveillance for HCC development.

scholarly journals Increase of non-HBV, non-HCV related hepatocellular carcinoma - Over 20 years single institution study-

2020 ◽  
Author(s):  
Yuko Nagaoki ◽  
Hideyuki Hyogo ◽  
Yuwa Ando ◽  
Yumi Kosaka ◽  
Shinsuke Uchikawa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
The Other ◽  
University Hospital ◽  
Early Group ◽  
Single Institution ◽  
Regional University ◽  
Late Group

Abstract Background We previously reported the trends of etiologies of hepatocellular carcinoma (HCC) between 1995 and 2009. By updating this study, we aimed to evaluate the incidence of HCC with non- hepatitis B viral and non- hepatitis C viral (NBNC) etiologies and also explore the clinical characteristics. Methods Consecutive 2171 HCC patients at our institution were enrolled between 1992 and 2018 in this retrospective cohort study. A comparative study was conducted by dividing into two groups, an early group from 1992 to 2009 and a late group from 2010 to 2018. Results NBNC-HCC account for 514 patients (23.6%). The proportion of NBNC-HCC has continued to increase from 26.5% in 2009 to 46.3% in 2018. NBNC-HCC were getting older (median ages, 67 to 73 years). Type 2 diabetes mellitus (48.5–60.3%: P = 0.008), hypertension (48.5–57.4%: P = 0.047), and hyperlipidemia (39.2–53.8%: P = 0.001) has increased significantly in recent years. The median FIB-4 index have decreased (4.37 to 3.61: P = 0.026) and the median platelet counts have increased (15.1 to 17.9: P = 0.013) significantly. Among 514 NBNC-HCC, 194 patients underwent hepatic resection in which 14.9%, 29.3%, and 55.8% were based on nonalcoholic steatohepatitis (NASH), alcoholic liver disease (ALD), and cryptogenic, respectively. Cirrhosis was detected in 72.4%, 38.6%, and 15.5% of NASH, ALD and cryptogenic, respectively. The prevalence of cirrhosis in NASH were significantly higher than other groups (P < 0.001), overall, 70% of the background liver of NBNC-HCC was not cirrhosis. On the other hands, the median FIB-4 index in cryptogenic HCC were 2.56 and significantly lower than other groups, FIB-4 index considered as one of useful screening of HCC. Conclusions NBNC-HCC has rapidly been increasing in recent years even in regional university hospital. The presence of metabolic syndrome may be important risk factors. Also, HCC from non-cirrhotic liver needs attention. Accordingly, it is speculated that these patients should receive periodic surveillance for HCC development.

scholarly journals Increasing incidence of non-HBV- and non-HCV-related hepatocellular carcinoma: single-institution 20-year study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuko Nagaoki ◽  
Hideyuki Hyogo ◽  
Yuwa Ando ◽  
Yumi Kosaka ◽  
Shinsuke Uchikawa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Medical Records ◽  
Screening Method ◽  
The Other ◽  
University Hospital ◽  
Single Institution ◽  
Regional University ◽  
Cryptogenic Hepatitis ◽  
Malignant Liver

Abstract Background We previously reported on the trends in the etiologies of hepatocellular carcinoma (HCC) diagnosed in patients between 1995 and 2009. The aims of our updated study were to evaluate the incidence, nonhepatitis B and nonhepatitis C viral (NBNC) etiologies, and clinical characteristics of HCCs occurring in patients between 1992 and 2018. Methods The study enrolled 2171 consecutive patients with HCC between 1992 and 2018. Their medical records were reviewed. The patients were divided into two groups, patients with early diagnoses from 1992 to 2009 and those with late diagnoses from 2010 to 2018. Results NBNC-HCC occurred in 514 patients (23.6%). The percentage of patients with HCC who had NBNC-HCC increased from 26.5% in 2009 to 46.3% in 2018. Patients with NBNC-HCC were older (median ages from 67 to 73 years). Type 2 diabetes mellitus (48.5–60.3%: P = 0.008), hypertension (48.5–57.4%: P = 0.047), and hyperlipidemia (39.2–53.8%: P = 0.001) increased significantly in recent years. The median FIB-4 index decreased (4.37–3.61: P = 0.026) and the median platelet count increased (15.1–17.9 × 104/μL: P = 0.013). Among the 514 patients with NBNC-HCC, 194 underwent hepatic resection for nonalcoholic steatohepatitis (NASH) (15%), alcoholic liver disease (ALD) (29%), and cryptogenic hepatitis (56%). Cirrhosis was detected in 72%, 39%, and 16% of patients with NASH, ALD, and cryptogenic hepatitis, respectively. The prevalence of cirrhosis in patients with NASH was significantly higher than the prevalence of cirrhosis in the other groups (P < 0.001). Overall, 70% of the non-malignant liver tissue of patients with NBNC-HCC was not involved with cirrhosis. On the other hand, the median FIB-4 index in patients with cryptogenic HCC was 2.56, which was a significantly lower value than those values in the other groups of patients. The FIB-4 index considered as one of useful screening of HCC. Conclusions The prevalence of NBNC-HCC has increased rapidly even in a regional university hospital. Metabolic syndrome may be an important risk factor for HCC. HCC was also found in patients with non-cirrhotic livers. The FIB-4 index may be a useful screening method for HCC in patients with NBNC.

Grazing behaviour and weight change of cattle turned out to pasture in spring

2003 ◽  
Vol 83 (4) ◽  
pp. 801-808 ◽  
Author(s):  
E. Charmley ◽  
R. W. Jannasch ◽  
J. Boyd
Keyword(s):  
Weight Loss ◽  
Weight Change ◽  
Dry Matter ◽  
The Other ◽  
Early Group ◽  
Initial Weight ◽  
Sward Height ◽  
Behavioural Patterns ◽  
Late Group ◽  
Grazing Behaviour

In the first of two trials, 20 Hereford steers were allocated to two adjacent 1.6-ha pastures on 29 May 1996. Steers in one pasture were given no supplement, while those in the other received supplemental silage each day. All steers on each treatment grazed their allocated paddock continuously for 28 d. Steers on pasture were weighed and their behaviour was monitored periodically throughout the 4 wk of grazing. The dry matter (DM) availability at turnout (651 kg hd-1) was considered in excess to requirement, since neither availability nor sward height declined over 28 d. In spite of this, steers lost 15 kg after turnout and took 12 d to regain their initial weight. There were no treatment effects. Nutrient composition of the sward changed in accordance with advancing maturity. Percent of time observed grazing (51%) did not change over the 28-d period; however, rumination time increased from around 10 to 30%. Grazing behaviour was similar for steers on both treatments. Silage intake averaged only 1.3 kg DM hd-1d-1. In 1997, 28 yearling steers were used in a 2 × 2 factorial design to study the effect of turnout date to pasture [21 May (E) vs. 4 June (L)] and supplemental silage feeding on weight change, grazing behaviour, pasture productivity and forage quality over 28 d. The DM availability at turnout was 391 kg hd-1. Available DM and sward height declined in both early and late treatments after turnout. The early group had to be removed from the trial after 16 d when sward height dropped below 4 cm. Sward quali ty after turnout declined only for the late group. Loss of body weight (BW) and days to regain initial BW after turnout were greater for early versus late steers. Steers ate only 0.5 kg silage DM hd-1d-1, but this reduced weight loss in late steers. Cattle turned out later spent less time grazing (P < 0.001 at 5 and 14 d) but no less time ruminating. Transient weight loss associated with turnout to pasture cannot be wholly explained by behavioural patterns. Other factors, such as altered ruminal conditions, must also play an important role. Key words: Pasture, steer performance, grazing behaviour, weight change

The First 150 Endovascular AAA Repairs at a Single Institution: How Steep is the Learning Curve?

2002 ◽  
Vol 9 (3) ◽  
pp. 269-276 ◽  
Author(s):  
W. Anthony Lee ◽  
Yehuda G. Wolf ◽  
Bradley B. Hill ◽  
Paul Cipriano ◽  
Thomas J. Fogarty ◽  
...  
Keyword(s):  
Learning Curve ◽  
Medical Center ◽  
Primary Repair ◽  
Fluoroscopy Time ◽  
Early Group ◽  
Technical Success ◽  
Single Institution ◽  
Proximal Neck ◽  
Frequent Use ◽  
Late Group

Purpose: To determine whether increasing experience with endovascular abdominal aortic aneurysm (AAA) repair in a single institution will result in improved outcome. Methods: A retrospective review was undertaken of 150 consecutive cases of endovascular AAA repairs performed using the AneuRx device between October 1996 and April 2000 in a university-based medical center. The population was divided into early and late groups of 75 patients each. Endpoints included technical success; complications; early (≤30-day) morbidity, mortality and rupture; endoleak at discharge and at 1 month; early secondary intervention; proximal neck and iliac tortuosity; extender cuff placement; femoral reconstructions beyond primary repair; total fluoroscopy time; and contrast load. Results: Baseline patient and aneurysm characteristics were similar between the 2 groups. Technical success was 98.7%; 2 cases were converted intraprocedurally owing to difficult iliac access (early group) and a severely angulated proximal neck (late group). There was a tendency toward more frequent use of intraoperative proximal extender cuffs in the early group (12% versus 4% in the late group, p=0.13). Femoral reconstructions were more frequent in the early group (36% versus 19%, p<0.025). While total contrast volume was similar (111 ± 56 versus 105 ± 45 mL, p=NS), total fluoroscopy time was significantly reduced (p<0.05) between the early and late groups. Conclusions: With attention to detail and careful patient selection, successful endovascular AAA repair can be achieved with very few conversions and low perioperative mortality even during the center's early experience. Evidence indicates, however, that a learning curve definitely exists, as shown by fewer access site problems, more accurate device deployments, and decreased fluoroscopy times as proficiency is attained.

scholarly journals Urgent-start peritoneal dialysis after laparoscopic dialysis catheter implantation: a single-center experience

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Naohiro Toda ◽  
Motoko Yanagita ◽  
Hideki Yokoi
Keyword(s):  
Peritoneal Dialysis ◽  
Early Initiation ◽  
University Hospital ◽  
Early Group ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Single Center Experience ◽  
Catheter Malfunction ◽  
Catheter Implantation ◽  
Late Group

Abstract Background Appropriate timing of peritoneal dialysis (PD) catheter implantation and PD initiation is important. Several guidelines suggest starting PD at least 2 weeks after PD catheter implantation. Recently, urgent-start PD is widespread throughout the world. However, the ideal time to start PD after laparoscopic catheter implantation is not known. We investigated the safety and feasibility of early initiation (within 7 days) PD following laparoscopic peritoneal catheter implantation. Methods We retrospectively analyzed patients who underwent laparoscopic PD catheter implantation at the Kyoto University Hospital from January 1, 2006, to December 31, 2016. Based on when PD was initiated, the patients were divided into two groups, namely, early group, ≤ 7 days and late group, > 7 days after catheter implantation. Catheter-related complications and catheter survival were analyzed. Results We analyzed 29 and 26 patients in early and late groups, respectively. The age, sex, the incidence of diabetes and APD, and the follow-up period were not significantly different between the two groups. The interval from catheter implantation to the start of PD was 4.28 ± 1.83 and 162 ± 157.8 days in the early and late groups, respectively (P < 0.01). In a late group, 17 patients (65.4%) underwent catheter implantation using the Moncrief–Popovich technique. The use of bridge hemodialysis was higher in the early group (P < 0.01). No patients developed dialysate leakage in both groups, and no significant differences were observed for catheter malfunction (24.1% vs. 19.2%, P = 0.66), exit-site infection (ESI, 24.1% vs. 28%, P = 0.87), and peritonitis (7.14% vs. 8.0%, P = 0.91) within 6 months. Furthermore, early initiation of PD did not increase the risk of ESI, peritonitis, and PD withdrawal at 1, 2, and 5 years compared to that in the late group. Conclusions Urgent-start of PD with laparoscopic catheter implantation did not increase infection-related complications and PD withdrawal. Laparoscopic PD catheter implantation may allow the initiation of PD earlier than 7 days after implantation.

scholarly journals Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shmeylan A. Al Harbi ◽  
Hasan M. Al-Dorzi ◽  
Albatool M. Al Meshari ◽  
Hani Tamim ◽  
Sheryl Ann I. Abdukahil ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Serum Phosphate ◽  
The Other ◽  
Icu Admission ◽  
Surgical Icus

Abstract Objective The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods In this retrospective cohort study, all adult patients who were admitted to the medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, normophosphatemia and hyperphosphatemia based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes. Results Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. The patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required more mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, the hyperphosphatemia group showed significantly higher ICU and hospital mortality in comparison with the other two groups. Conclusion Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

scholarly journals Characteristics of Kawasaki Disease Patients during the COVID-19 Pandemic in Japan: A Single-Center, Observational Study

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 913
Author(s):  
Shoichi Shimizu ◽  
Mamoru Ayusawa ◽  
Hidetoshi Go ◽  
Kimitaka Nakazaki ◽  
Hidemasa Namiki ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Observational Study ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Macrophage Activation Syndrome ◽  
Macrophage Activation ◽  
Single Center ◽  
Present Stage ◽  
Single Center Observational Study

Background: Under the Coronavirus disease 2019 (COVID-19) pandemic, manifestations in children with Kawasaki disease (KD) are different between the Western and the Eastern countries. Particularly, there has not been a report comparing a series of KD in Japan, where KD was originally discovered and has a large number of registered cases. Methods: We compared patients with KD under the period of the COVID-19 pandemic in Japan with the report from Italy during its reported period by a retrospective, cohort, observational study in a Japanese single center. Results: Thirty-two patients with typical KD were treated during the study period, while the Italian study reported 10 patients with the signs of KD. Concerning the proof of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, none (0%) of our KD cases showed a positive result and one and no patients developed the macrophage activation syndrome (MAS) and Kawasaki disease shock syndrome (KDSS), respectively; however, eight (80%) patients in the Italian series were confirmed with SARS-CoV-2 infection. MAS and KDSS developed in six and five patients, respectively. Conclusions: Cases reported as COVID-19 pandemic-related KD in Italy showed significantly different clinical characteristics from the typical KD symptoms known in Japan. Although they show KD-like manifestations, we cannot conclude that SARS-CoV-2 has the same etiology of our ‘classic‘ KD at the present stage.

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