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| 1 | Trans-arterial chemo-embolization is safe and effective for very elderly patients with hepatocellular carcinoma显示文摘AIM: To assess the safety and efficacy of trans-arterial chemo-embolization (TACE) in very elderly patients. METHODS: A prospective cohort study, from 2001 to 2010, compared clinical outcomes following TACE between patients ≥ 75 years old and younger patients (aged between 65 and 75 years and younger than 65 years) with hepatocellular carcinoma (HCC), diagnosed according to the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases criteria. The decision that patients were not candidates for curative therapy was made by a multidisciplinary HCC team. Data collected included demographics, co-morbidities, liver disease etiology, liver disease severity and the number of procedures. The primary outcome was mortality; secondary outcomes included post-embolization syndrome (nausea, fever, abdominal right upper quadrant pain, increase in liver enzymes with no evidence of sepsis and with a clinical course limited to 3-4 d post procedure) and 30-d complications. Additionally, changes in liver enzyme measurements were assessed [alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transpeptidase and alkaline phosphatase] in the week following TACE. Analysis employed both univariate and multivariate methods (Cox regression models). RESULTS: Of 102 patients who underwent TACE as sole treatment, 10 patients (9.8%) were > 80 years old at diagnosis; 13 (12.7%) were between 75 and 80 years, 45 (44.1%) were between 65 and 75 years and 34 (33.3%) were younger than 65 years. Survival analysis demonstrated similar survival patterns between the elderly patients and younger patients. Age was also not associated with the adverse event rate. Survival rates at 1, 2 and 3 years from diagnosis were 74%, 37% and 31% among patients < 65 years; 83%, 66% and 48% among patients aged 65 to 75 years; and 86%, 41% and 23% among patients ≥ 75 years. There were no differences between the age groups in the pre-procedural care, including preventive treatment for contrast nephropathy and prophylactic antibiotics. Multivariate survival analysis, controlling for disease stage at diagnosis with the Barcelona Clinic Liver Cancer score, number of TACE procedures, sex and alphafetoprotein level at the time of diagnosis, found no significant difference in the mortality hazard for elderly vs younger patients, and there were no differences in post-procedural complications. Serum creatinine levels did not change after 55% of the procedures, in all age groups. In 42% of all procedures, serum creatinine levels increased by no more than 25% above the baseline levels prior to TACE. Overall, there were 69 post-embolization events (23%). Hepatocellular enzymes often increased following TACE, with no association with prognosis. In 40% of the procedures, ALT and AST levels rose by at least 100%. The increases in hepatocellular enzymes occurred similarly in all age groups. CONCLUSION: TACE is safe and effective in very elderly patients with HCC, and is not associated with decreased survival or increased complication rates. | Matan J Cohen Allan I Bloom Orly Barak Alexander Klimov Tova Nesher Daniel Shouval Izhar Levi Oren Shibolet | 2013 | World Journal of Gastroenterology2013，19，16： | 13 |
| 2 | The influence of calcium phosphate biomaterials on human bone cell activities 显示文摘 | Gregoire M Orly I Menanteau J | 1990 | J Biomed Mater Res1990，24，2： | 1 |
| 3 | A cellular mineral deposition in collagen-based biomaterials incubated in cell culture media 显示文摘 | Chevallay B Orly I | 2000 | Caicif Tissue Int2000，66，3： | 1 |
| 4 | Chemical changes in hydroxyapatite biomaterial under in vivo and in vitro biological conditions显示文摘 | Orly I Gregoire M Menanteau J | 1989 | Calcif Tissue Int1989，45，1： | 1 |
| 5 | The influence of calcium phosphate biomaterials on human bone cell activitives; an in vitro approach显示文摘 | Gregoire M Orly I Menanteau J | 1990 | J Biomed Mater Res1990，24，02： | 1 |
| 6 | Acellular mineral deposition in collagen-based biomaterials incubated in cell culture media显示文摘 | Andre-Frei V Chevallay B Orly I | 2000 | Calcif Tissue Int2000，66，3： | 1 |
| 7 | Acellular mineral deposition in collagen-based biomaterials incubated in cell culture media 显示文摘 | Andre-Frei V Chevallay B Orly I | 2000 | Caleif Tissue Int2000，66，3： | 1 |
| 8 | Chemical changes in hydroxyapatite biomaterial under in vivo and in vitro biological conditions显示文摘 | Orly I Gregoire M Menanteau J | 1989 | Cacifi Tissue Int1989，4，1： | 1 |
| 9 | Acellular mineral depostition in collagen-based biomaterials incubated in cell culture medial显示文摘 | Andre FV Chevallay B Orly I | 2000 | Caicif Tissue Int2000，66，3： | 1 |
| 10 | Systemically administered bone morphogenetie protein 6 restores bone in aged OVX rats by increasing bone formation and suppressing bone resorption 显示文摘 | Simic P Culej J B Orlie I | 2006 | J Biol Chem2006，281，25： | 1 |
| 11 | Acellular mineral deposition in collagen-based biomaterials incubated in cell culture media显示文摘 | Andre-Frei V Chevallay B Orly I | 2000 | Calcif Tissue Int2000，66，3： | 1 |
| 12 | Acellular mineral deposition in collagen-based biomaterials in cubated incell culture media 显示文摘 | Andre-Frei V ChevaUay B Orly I | 2000 | Calcif Tissue Int2000，66，： | 1 |
| 13 | Thermal degradation of epoxy-silica organic-inorganic hybrid materials显示文摘 | MACAN J BRNARDIC'I ORLI C'S | 2006 | Polymer Degradation and Stability2006，91，1： | 1 |
| 14 | Impact of COVID-19 on presentation,management,and outcomes of acute care surgery for gallbladder disease and acute appendicitis显示文摘BACKGROUND The ongoing coronavirus disease 2019(COVID-19)pandemic has significantly disrupted both elective and acute medical care.Data from the early months suggest that acute care patient populations deferred presenting to the emergency department(ED),portending more severe disease at the time of presentation.Additionally,care for this patient population trended towards initial non-operative management.AIM To examine the presentation,management,and outcomes of patients who developed gallbladder disease or appendicitis during the pandemic.METHODS A retrospective chart review of patients diagnosed with acute cholecystitis,symptomatic cholelithiasis,or appendicitis in two EDs affiliated with a single tertiary academic medical center in Northern California between March and June,2020 and in the same months of 2019.Patients were selected through a research repository using international classification of diseases(ICD)-9 and ICD-10 codes.Across both years,313 patients were identified with either type of gallbladder disease,while 361 patients were identified with acute appendicitis.The primary outcome was overall incidence of disease.Secondary outcomes included presentation,management,complications,and 30-d re-presentation rates.Relationships between different variables were explored using Pearson’s r correlation coefficient.Variables were compared using the Welch’s t-Test,Chi-squared tests,and Fisher’s exact test as appropriate.RESULTS Patients with gallbladder disease and appendicitis both had more severe presentations in 2020.With respect to gallbladder disease,more patients in the COVID-19 cohort presented with acute cholecystitis compared to the control cohort[50%(80)vs 35%(53);P=0.01].Patients also presented with more severe cholecystitis in 2020 as indicated by higher mean Tokyo Criteria Scores[mean(SD)1.39(0.56)vs 1.16(0.44);P=0.02].With respect to appendicitis,more patients were diagnosed with a perforated appendix at presentation in 2020[20%(36)vs 16%(29);P=0.02]and a greater percentage were classified as emergent cases using the emergency severity index[63%(112)vs 13%(23);P<0.001].While a greater percentage of patients were admitted to the hospital for gallbladder disease in 2020[65%(104)vs 50%(76);P=0.02],no significant differences were observed in hospital admissions for patients with appendicitis.No significant differences were observed in length of hospital stay or operative rate for either group.However,for patients with appendicitis,30-d re-presentation rates were significantly higher in 2020[13%(23)vs 4%(8);P=0.01].CONCLUSION During the COVID-19 pandemic,patients presented with more severe gallbladder disease and appendicitis.These findings suggest that the pandemic has affected patients with acute surgical conditions. | Orly Nadell Farber Giselle I Gomez Ashley L Titan Andrea T Fisher Christopher J Puntasecca Veronica Toro Arana Arielle Kempinsky Clare E Wise Kovi E Bessoff Mary T Hawn James R Korndorffer Jr Joseph D Forrester Micaela M Esquivel | 2021 | World Journal of Gastrointestinal Surgery2021，13，8： | 0 |
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