| 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 |
| 3 | Gibberellin induced shot berry formation in cv.Early Sweet is a direct consequence of high fruit set显示文摘The‘seedless’table grape industry relies mainly on stenospermocarpic cultivars,in which endosperm abortion results in berries with seed rudiments and low levels of bioactive gibberellin(GA).Application of GA to enhance berry sizing in these cultivars is often accompanied by adverse effects,one of which is increased proportions of very small berries(termed shot berries).Manual removal of these berries,which is essential to improve uniformity and market value,increases production cost and exposes the cluster to damage.Unraveling the physiological causes of shot berry formation is thus of both scientific and practical value.This study focuses on understanding the GA-mediated regulation of shot berry formation in Vitis vinifera cv.Early Sweet,known for a high proportion of shot berries,which severely damage cluster appearance.As GA is known to induce the parthenocarpic fruit set,we first tested the assumption that the parthenocarpic nature of a fruitlet is a primary cause for shot berry development.We then examined the consequence of the flower load on the proportion of shot berries in the cluster.Our data suggests that:(1)contrary to prior assumptions,the parthenocarpic nature of a fruitlet is not the primary cause for shot berry development,demonstrated by the fact that parthenocarpic fruitlets develop into a full-size berries;(2)the proportion of shot berries on a cluster is a function of the initial flower load on the inflorescence,with high initial flower load resulting in greater shot berry percentage in the cluster;(3)GA treatment bypasses the natural regulation of flower load,resulting in high fruitlet density and increased competition among fruitlets;(4)variation of flower load within the cluster influences berry size uniformity to a greater extent than does the variation in number of cluster per vine.The identity of the factors that determine the fate of a given flower on a high-load cluster remains an open question. | Etti Or Orly Oren Tamar Halaly-Basha Padmalatha Koilkonda Zhaowan Shi Chuanlin Zheng Atiako Kwame Acheampong | 2020 | Horticulture Research2020，7，1： | 0 |
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