RESUMO
OBJECTIVES: The prognosis of patients with perihilar-cholangiocarcinoma (PHC) is poor. The only potential curative treatment for patients with PHC is surgical resection, but the large majority present with unresectable disease at diagnosis. The standard of care in patients with unresectable PHC is palliative chemotherapy (CHT).Irreversible electroporation (IRE) has been introduced as a novel ablation technique, working predominantly nonthermal. This review aims to analyse the efficacy and safety of IRE in treating unresectable PHC. METHODS: This systematic review and meta-analysis was performed according to a specific protocol designed a priori, and reported according to the PRISMA. PubMed/MEDLINE, Scopus, and Cochrane CENTRAL were used for the bibliographic research through December 2023. Primary Outcome of interest of our meta-analysis was the mean Overall Survival. Secondary outcomes were Progression-Free Survival and Adverse Event rate. RESULTS: Mean OS is estimated to be 25.49 months (CI 21.47-38.72 I2, 81.37%), PSF 17.86 (CI 13.00-22.72, I2 11.42%), with 12% (CI -7% to 31%, I2 83.57%) of AE incidence. High heterogeneity was found among studies, with no single study fully responsible for it, suggesting high variability among facilities\populations. CONCLUSION: IRE is an effective and relatively safe method in this group of patients. The lack of prospective studies and randomized trials comparing chemotherapy or locoregional treatment with IRE prevents drawing sufficiently robust conclusions. ADVANCES IN KNOWLEDGE: IRE appears is a safe and effective technique for treating unresectable perihilar cholangiocarcinoma.
RESUMO
BACKGROUND: COVID-19 patients with any pre-existing major cardio-vascular disease (CVD) are at the highest risk of viral infection and of developing severe disease. The pathophysiological mechanism is characterized by the viral link to angiotensin-converting enzyme 2 (ACE2) and the involvement of the endothelial system with the release of cytokines and the inflicting of direct damage to the myocardium, the induction of microthrombosis, and the initiation of alterations in oxygen diffusion. The aim of the study is to analyze the clinical course and outcomes in patients (gender-stratified) with pre-existing major CVD. METHODS: Out of the 1833 (973 M/860 F) patients admitted to the Internal Medicine COVID-19 Unit of "Castelli Hospital", Lazio, Italy, from 1 January 2021 to 31 December 2021, 600 patients (320 M/280 F) with a mean age of 77 (78.6 M/75.1 F) previously had CVD. Demographic characteristics, length of the stay (LOS) and oxygen therapy were evaluated. RESULTS: All of the CVD COVID-19 patients underwent non-invasive ventilation (NIV). CVD was linked with increased LOS (21 days F/22 M) compared to no CVD (19 days). In total, 32.7% of total patients had major CVD. CONCLUSIONS: Timely identification and evaluation of patients with pre-existing major CVD are fundamental for adequate treatment based on gender, severity, state of illness and for risk reduction.
Assuntos
COVID-19 , Cardiopatias , Humanos , Idoso , SARS-CoV-2 , COVID-19/epidemiologia , Polimedicação , Cardiopatias/epidemiologia , Hospitais , OxigênioRESUMO
The purpose of our study is to examine whether cancer and treatments are associated with job loss or changes in employment status. Eight prospective studies were included in the systematic review and meta-analysis, with a population aged 18-65 years, analyzing treatment regimen and psychophysical and social status in post-cancer follow-up of at least 2 years. In the meta-analysis, a comparison was made between recovered unemployed cases and cases from a standard reference population. Results are summarized graphically using a forest plot. We showed that cancer and subsequent treatment are risk factors for unemployment with an overall relative risk of 7.24 (lnRR: 1.98, 95% CI: 1.32-2.63) or for change in employment status. Individuals undergoing chemotherapy and/or radiation treatment and those with brain and colorectal cancers are more likely to develop disabilities that negatively affect the risk of unemployment. Finally, variables such as low level education, female sex, older age, and being overweight before starting therapy are associated with higher risk of unemployment. In the future, it will be necessary for people with cancer to have access to specific health, social welfare, and employment support programs. In addition, it is desirable that they become more involved in their choice of therapeutic treatment.