scholarly journals Recurrence after Curative Resection for Intrahepatic Cholangiocarcinoma: How to Predict the Chance of Repeat Hepatectomy?

2021 ◽  
Vol 10 (13) ◽  
pp. 2820
Author(s):  
Serena Langella ◽  
Nadia Russolillo ◽  
Paolo Ossola ◽  
Andrea-Pierre Luzzi ◽  
Michele Casella ◽  
...  
Keyword(s):  
Liver Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Major Hepatectomy ◽  
Multivariable Analysis ◽  
Study Data ◽  
Good Survival ◽  
Lower Probability ◽  
Factors Affecting ◽  
Time To Recurrence ◽  
Second Resection

(1) Background: Tumor recurrence after liver resection (LR) for intrahepatic cholangiocarcinoma (ICC) is common. Repeat liver resection (RLR) for recurrent ICC results in good survival outcomes in selected patients. The aim of this study was to investigate factors affecting the chance of resectability of recurrent ICC. (2) Methods: LR for ICC performed between January 2001 and December 2020 were retrospectively reviewed. Patients who had undergone first LR were considered for the study. Data on recurrences were analyzed. A logistic regression model was used for multivariable analysis of factors related to RLR rate. (3) Results: In total, 140 patients underwent LR for ICC. Major/extended hepatectomies were required in 105 (75%) cases. The 90-day mortality was 5.7%, Clavien–Dindo grade 3, 4 complications were 9.3%, N+ disease was observed in 32.5%, and the median OS was 38.3 months. Recurrence occurred in 91 patients (65%). The site of relapse was the liver in 53 patients (58.2%). RLR was performed in 21 (39.6%) patients. Factors that negatively affected RLR were time to recurrence ≤12 months (OR 7.4, 95% CI 1.68–33.16, p = 0.008) and major hepatectomy (OR 16.7, 95% CI 3.8–73.78, p < 0.001) at first treatment. Survival after recurrence was better in patients who underwent RLR as compared with not resected patients (31 vs. 13.2 months, p = 0.02). (4) Conclusions: Patients with ICC treated at first resection with major hepatectomy and those who recurred in ≤12 months had significantly lower probability to receive a second resection for recurrence.

scholarly journals Factors affecting improvement of neurologic status evaluated by Quantitative Myasthenia Gravis Score for patients with thymomatous myasthenia gravis after extended thymectomy

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhu Haoshuai ◽  
Zou Jianyong ◽  
Yang Lei ◽  
Zeng Bo ◽  
Jiefei Xiao ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Median Time ◽  
Multivariable Analysis ◽  
Lower Probability ◽  
Extended Thymectomy ◽  
Factors Affecting ◽  
End Point ◽  
Point Reduction ◽  
The Mean ◽  
Worse Prognosis

Abstract Background The length of time for clinical improvement of patients with thymomatous myasthenia gravis (MG) after extended thymectomy is not clear. The purpose of this study was to determine the length of time after thymectomy in patients with thymomatous MG to achieve a 3-point reduction of Quantitative Myasthenia Gravis Score (QMGS), and identify variables associated with a failure to achieve the reduction. Methods The records of patients with thymomatous MG who underwent extended thymectomy from January 2005 to December 2018 were retrospectively reviewed. The primary end point was a reduction of 3 points of QMGs and the secondary end point was another reduction of 3 points of QMGs. Results A total of 481 patients were included in the analysis, the mean age of the patients was 41.63 ± 8.55 years, and approximately 60% were male. The median time to achieve a 3 point decrease in QMGS was 6 months, and the median time to achieve another 3 point decrease was 30 months. Multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a 3 point decrease in QMGS (HR = 0.55 and 0.65, respectively). Likewise, multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a second 3 point decrease in QMGS (HR = 0.53 and 0.53, respectively). Conclusions In patients with thymomatous MG who receive thymectomy, age ≥ 42 years and Masaoka-Koga stage > I are associated with a worse prognosis and failure to achieve a 3 point decrease in QMGS.

scholarly journals Acute kidney injury after liver resection: A systematic review, meta-analysis, and metaregression of factors affecting it.

2021 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
HARDIK PATEL
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Liver Resection ◽  
Major Hepatectomy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Final Analysis ◽  
P Value ◽  
Factors Affecting ◽  
Male Sex

Aim: This systematic review and meta-analysis aimed to study the incidence of acute kidney injury after liver resection and to analyze various factors affecting it by metaregression analysis. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (2020) and MOOSE guidelines. The meta-analysis was done using Review Manager 5.4 and the JASP Team (2020). JASP (Version 0.14.1)(University of Amsterdam). Weighted percentage incidence with 95% confidence intervals were used. Univariate metaregression was done by DerSimonian-Laird methods. Factors with a p-value less than 0.05 in the univariate metaregression model were entered in the multivariate metaregression model. Heterogeneity was assessed using the Higgins I2 test. The random-effects model was used in meta-analysis. Results: Total 14 studies including 15510 patients were included in the final analysis. 1247 patients developed Acute Kidney Injury. Weighted Acute kidney injury percentage after liver resection was 15% with a 95% confidence interval of 11%-19%. On univariate metaregression analysis major hepatectomy (p=0.001), Underlying cirrhosis of liver (p=0.031), AKIN definition used (0.017), male sex (p<0.001), open surgery (p=0.032), underlying diabetes (0.026). On multivariate metaregression analysis major hepatectomy (p=0.003), underlying cirrhosis (p<0.001), male sex (p<0.001), AKIN classification used for defining acute kidney injury (p < 0.001, independently predicted heterogeneity and hence acute kidney injury. Conclusion: Liver resection is associated with a high incidence of acute kidney injury. Major hepatectomy, male sex, underlying cirrhosis were independently predicting acute kidney injury.

scholarly journals Factors Affecting Improvement of Neurologic Status Evaluated by Quantitative Myasthenia Gravis Score for Patients With Thymomatous Myasthenia Gravis After Extended Thymectomy

2021 ◽  
Author(s):  
Haoshuai Zhu ◽  
Jianyong Zou ◽  
Lei Yang ◽  
Bo Zeng ◽  
Jiefei Xiao ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Median Time ◽  
Multivariable Analysis ◽  
Lower Probability ◽  
Extended Thymectomy ◽  
Factors Affecting ◽  
End Point ◽  
Point Reduction ◽  
The Mean ◽  
Worse Prognosis

Abstract Background: The length of time for clinical improvement of patients with thymomatous myasthenia gravis (MG) after extended thymectomy is not clear. The purpose of this study was to determine the length of time after thymectomy in patients with thymomatous MG to achieve a 3-point reduction of Quantitative Myasthenia Gravis Score (QMGS), and identify variables associated with a failure to achieve the reduction. Methods: The records of patients with thymomatous MG who underwent extended thymectomy from January 2005 to December 2018 were retrospectively reviewed. The primary end point was a reduction of 3 points of QMGs and the secondary end point was another reduction of 3 points of QMGs. Results: A total of 481 patients were included in the analysis, the mean age of the patients was 41.63 ± 8.55 years, and approximately 60% were male. The median time to achieve a 3 point decrease in QMGS was 6 months, and the median time to achieve another 3 point decrease was 30 months. Multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a 3 point decrease in QMGS (HR = 0.55 and 0.65, respectively). Likewise, multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a second 3 point decrease in QMGS (HR = 0.53 and 0.53, respectively).Conclusions: In patients with thymomatous MG who receive thymectomy, age ≥ 42 years and Masaoka-Koga stage > I are associated with a worse prognosis and failure to achieve a 3 point decrease in QMGS.

scholarly journals Real Life Use of Bendamustine in Elderly Patients with Lymphoid Neoplasia

2021 ◽  
Vol 11 (4) ◽  
pp. 249
Author(s):  
Irene Dogliotti ◽  
Simone Ragaini ◽  
Francesco Vassallo ◽  
Elia Boccellato ◽  
Gabriele De Luca ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Rating Scale ◽  
Single Agent ◽  
Multivariable Analysis ◽  
Real Life ◽  
Lymphocytic Leukemia ◽  
Factors Affecting ◽  
Lymphoid Neoplasia ◽  
Baseline Factors ◽  
Grade 3

Background. Bendamustine is a cytotoxic alkylating drug with a broad range of indications as a single agent or in combination therapy in lymphoid neoplasia patients. However, its tolerability in elderly patients is still debated. Methods: An observational, retrospective study was carried out; patients with chronic lymphocytic leukemia (CLL) or lymphoma, aged ≥ 65 years old, treated with bendamustine-based regimens in first or subsequent lines between 2010 and 2020 were considered eligible. Results: Overall, 179 patients aged ≥ 65 years were enrolled, 53% between 71 and 79 years old. Cumulative Illness Rating Scale (CIRS) comorbidity score was ≥6 in 54% patients. Overall survival (OS) at 12 months was 95% (95% confidence interval [CI]: 90–97%); after a median follow up of 50 months, median OS was 84 months. The overall response rate was 87%, with 56% complete responses; the median time to progression (TTP) was 61 months. The baseline factors affecting OS by multivariable analysis were sex, histological diagnosis, renal function, and planned bendamustine dose, while only type of lymphoma and bendamustine dose impacted on TTP. Main adverse events were neutropenia (grade ≥ 3: 43%) and infections (any grade: 36%), with 17% of patients requiring hospital admission. Conclusions: The responses to bendamustine, as well as survival, are relevant even in advanced age patients, with a manageable incidence of acute toxicity.

Understanding Gap Acceptance Behavior at Unsignalized Intersections using Naturalistic Driving Study Data

2021 ◽  
pp. 036119812110071
Author(s):  
Yingfeng (Eric) Li ◽  
Haiyan Hao ◽  
Ronald B. Gibbons ◽  
Alejandra Medina
Keyword(s):  
Road Traffic ◽  
Wait Time ◽  
Study Data ◽  
Gap Acceptance ◽  
Factors Affecting ◽  
Unsignalized Intersections ◽  
Research Activities ◽  
Stop Sign ◽  
Naturalistic Driving Study ◽  
Naturalistic Driving

Even though drivers disregarding a stop sign is widely considered a major contributing factor for crashes at unsignalized intersections, an equally important problem that leads to severe crashes at such locations is misjudgment of gaps. This paper presents the results of an effort to fully understand gap acceptance behavior at unsignalized intersections using SHPR2 Naturalistic Driving Study data. The paper focuses on the findings of two research activities: the identification of critical gaps for common traffic/roadway scenarios at unsignalized intersections, and the investigation of significant factors affecting driver gap acceptance behaviors at such intersections. The study used multiple statistical and machine learning methods, allowing a comprehensive understanding of gap acceptance behavior while demonstrating the advantages of each method. Overall, the study showed an average critical gap of 5.25 s for right-turn and 6.19 s for left-turn movements. Although a variety of factors affected gap acceptance behaviors, gap size, wait time, major-road traffic volume, and how frequently the driver drives annually were examples of the most significant.

scholarly journals Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

2021 ◽  
pp. 155335062199122
Author(s):  
Daniel Heise ◽  
Jan Bednarsch ◽  
Andreas Kroh ◽  
Sandra Schipper ◽  
Roman Eickhoff ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Laparoscopic Liver Surgery ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

Multivariable analysis of factors affecting length of stay and hospital charges after single-level corpectomy

2017 ◽  
Vol 44 ◽  
pp. 279-283 ◽  
Author(s):  
Jian Guan ◽  
Michael Karsy ◽  
Meic H. Schmidt ◽  
Andrew T. Dailey ◽  
Erica F. Bisson
Keyword(s):  
Length Of Stay ◽  
Multivariable Analysis ◽  
Hospital Charges ◽  
Factors Affecting ◽  
Single Level

scholarly journals Liver resection for concomitant colorectal liver metastases and intrahepatic cholangiocarcinoma: a rare combination

2009 ◽  
Vol 24 (11) ◽  
pp. 1349-1349
Author(s):  
Georgios C. Sotiropoulos ◽  
Evangelos Tagkalos ◽  
Andreas Kreft ◽  
Vasiliy Moskalenko ◽  
Ursula Gönner ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Intrahepatic Cholangiocarcinoma ◽  
Colorectal Liver Metastases ◽  
Rare Combination

Prioritizing the influencing factors of utaut-2 model toward mobile network service providers

2021 ◽  
pp. 178359172110553
Author(s):  
Ishani Patharia ◽  
Anjana Pandey ◽  
Sanjay Gupta
Keyword(s):  
Technology Acceptance ◽  
Communication Networks ◽  
Service Providers ◽  
User Behavior ◽  
Mobile Network ◽  
Study Data ◽  
Jel Classification ◽  
Network Service ◽  
Factors Affecting ◽  
Use Of Technology

Technological developments have a major impact on user behavior. The rapidly evolving communication system and technology have provided numerous choices for people. The ever-shifting changes in the generation of communication networks have posed challenges for mobile network service providers to attract and retain customers. This study aims to prioritize the determinants of the adoption of mobile network service providers using the unified theory of acceptance and use of technology (UTAUT-2). In this study, data were collected from 660 mobile phone users in Haryana, India. A fuzzy analytical hierarchy process (F-AHP) was applied to arrange the priority or rank the factors based on the significance of the factors in explaining the adoption of mobile network service providers. Results of the study reveal that efforts expectancy is the highest-ranked and prioritized factor for the adoption of mobile network service providers followed by performance expectancy and facilitating conditions. However, social influence emerged as the least important factor. The present study provides theoretical implications for future researchers by synthesizing and prioritizing the important factors affecting technology acceptance. The practical implications offer a clearer insight to marketers for developing focused pragmatic strategies to retain customer loyalty. The study has considered only UTAUT-2 model constructs and used the F-AHP technique. Other factors may be considered in future studies. Other priority analysis techniques can also be used such as ISM and MICMAC analysis for further study. The research has been conducted in Haryana, India, and therefore, it needs to be tested in other areas/countries for generalizability. JEL Classification: O1, O2, O4

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