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Background: Hepatic angiosarcoma is a rare type of tumour. In adults, the diagnosis remains challenging as the clinical manifestations are generally nonspecific and are usually made too late when complications or metastases are already present, associated with a poor prognosis. Due to the lack of agreement regarding the optimal treatment approach, a comprehensive analysis of the evidence in the literature on the surgical and survival outcomes in terms of disease-free survival time (DFS) and overall survival (OS) for patients treated for primary hepatic angiosarcoma is needed. Study design: A systematic review of articles published in Pubmed, EMBASE, and Scopus, from 2000 to 2023 with the search terms hepatic angiosarcoma and liver resection or hepatectomy. Pooled individual data concerning the prognosis following various therapies was analyzed. Results: A total of 15 articles involving 886 patients were eligible for inclusion. The male population represents 66.2% (n=586) of the population, with a median age of 57 years (41-66). The median survival rate was 7 months. The median OS after surgical resection was 17.18 months (SD 12.6) vs. 3.72 months (SD 4.6) for patients treated without a surgical approach. The median DFS was 15.2 months (SD 11). Conclusion: Primary liver angiosarcoma remains a surgical challenge with a poor prognosis even with complete surgical resection and adjuvant therapy. Surgical management shows increased overall survival in comparison with non-surgical management. Early diagnosis could change the natural history of the disease. The literature available is scarce, and further studies are required to create standardized diagnostic and treatment protocols.
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Aim: To compare the safety in terms of hypoglycemic events and continuous glucose monitoring (CGM) metrics during aerobic exercise (AE) of using temporary target (TT) versus suspension of insulin infusion (SII) in adults with type 1 diabetes (T1D) using advanced hybrid closed-loop systems. Methods: This was a randomized crossover clinical trial. Two moderate-intensity AE sessions were performed, one with TT and one with SII. Hypoglycemic events and CGM metrics were analyzed during the immediate (baseline to 59 min), early (60 min to 6 h), and late (6 to 36 h) post-exercise phases. Results: In total, 33 patients were analyzed (44.6 ± 13.8 years), basal time in range (%TIR 70-180 mg/dL) was 79.4 ± 12%, and time below range (%TBR) <70 mg/dL was 1.8 ± 1.7% and %TBR <54 mg/dL was 0.5 ± 0.9%. No difference was found in the number of hypoglycemic events, %TBR <70 mg/dL and %TBR <54 mg/dL between TT and SII. Differences were found in the early phase, with better values when using TT for %TIR 70-180 mg/dL (83.0 vs. 65.3, P = 0.005), time in tight range (%TITR 70-140 mg/dL) (56.3 vs. 41.5, P = 0.04), and time above range (%TAR >180 mg/dL) (15.3 vs. 31.8, P = 0.01). In the diurnal period, again %TIR was better for TT use (82.1 vs. 73.1, P = 0.02) and %TAR (15.0 vs. 22.96, P = 0.04). No significant differences were found in the CGM metrics during the different phases of AE. Conclusion: Our data appear to show that the use of TT compared with SII is equally safe in all phases of AE. However, the use of TT allows for a better glycemic profile in the early phase of exercise.
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AIMS: To describe Hybrid closed-loop (HCL) and advanced hybrid closed-loop (AHCL) performance in the hospital setting based on the continuous glucose monitoring (CGM) metrics description. METHODS: This was an observational study from a cohort of patients with T1D using HCL/AHCL with history of hospitalization. CGM metrics were analyzed during the hospital stay. CGM metrics sub-analysis of the population with active Automated Mode (AM) and SmartGuard (SG) during hospitalization and/or surgical procedure was performed. RESULTS: Twenty-four patients were included (50 % women; mean age, 49 years [inter-quartile range (IQR), 39-62 years]). During hospitalization 70.8 % patients achieved %Time in Range (TIR) between 70 and 180 mg/dL ≥ 70 %. The overall %TIR was 75.5 % (IQR, 67.3-81.5 %), % time below range (TBR) < 70 mg/dL was 2.1 % (IQR, 0.7-5.4 %) and %TBR < 54 mg/dL was 0 % (IQR, 0-5.4 %). Users of the AHCL with active SG achieved a non-significant higher %TIR during hospitalization (79 % [73.8.88 %] vs. 76 % [72.81 %], p = 0.312) and had a shorter stay (3[IQR, 2.4] vs. 6 days[IQR, 5.7], p = 0.045) compared to the users of the HCL with AM active. No device-related serious adverse events occurred for users of either system. CONCLUSIONS: HCL/AHCL systems with active AM/SG in patients with T1D in the hospital environment leads to %TIR > 70 % in ranges of 70-180 mg/dL in patients without increasing hypoglycemia.