ABSTRACT
INTRODUCTION: Intrahepatic cholangiocarcinoma (iCCA) is a primary liver malignancy with poor prognosis. Current prognostic methods are most accurate for patients with surgically resectable disease. However, a significant proportion of patients with iCCA are not surgical candidates. We aimed to develop a generalizable staging system based on clinical variables to determine prognosis of all patients with iCCA. METHODS: The derivation cohort included 436 patients with iCCA seen between 2000 and 2011. For external validation, 249 patients with iCCA seen from 2000 to 2014 were enrolled. Survival analysis was performed to identify prognostic predictors. All-cause mortality was the primary end point. RESULTS: Eastern Cooperative Oncology Group status, tumor number, tumor size, metastasis, albumin, and carbohydrate antigen 19-9 were incorporated into a 4-stage algorithm. Kaplan-Meier estimates for 1-year survival were 87.1% (95% confidence interval [CI] 76.1-99.7), 72.7% (95% CI 63.4-83.4), 48.0% (95% CI 41.2-56.0), and 16% (95% CI 11-23.5), respectively, for stages I, II, III, and IV. Univariate analysis yielded significant differences in risk of death for stages II (hazard ratio [HR] 1.71; 95% CI 1.0-2.8), III (HR 3.32; 95% CI 2.07-5.31), and IV (HR 7.44; 95% CI 4.61-12.01) compared with stage I (reference). Concordance indices showed the new staging system was superior to the TNM staging for predicting mortality in the derivation cohort, P < 0.0001. In the validation cohort, however, the difference between the 2 staging systems was not significant. DISCUSSION: The proposed independently validated staging system uses nonhistopathologic data to successfully stratify patients into 4 stages. This staging system has better prognostic accuracy compared with the TNM staging and can assist physicians and patients in treatment of iCCA.
Subject(s)
Bile Duct Neoplasms , Cholangiocarcinoma , Humans , Prognosis , Neoplasm Staging , Bile Ducts, Intrahepatic/pathology , Bile Duct Neoplasms/pathologyABSTRACT
Animal behavior emerges from collective dynamics of interconnected neurons, making it vulnerable to connectome damage. Paradoxically, many organisms maintain significant behavioral output after large-scale neural injury. Molecular underpinnings of this extreme robustness remain largely unknown. Here, we develop a quantitative behavioral analysis pipeline to measure previously uncharacterized long-lasting latent memory states in planarian flatworms during whole-brain regeneration. By combining >20,000 animal trials with neural population dynamic modeling, we show that long-range volumetric peptidergic signals allow the planarian to rapidly reestablish latent states and restore coarse behavior after large structural perturbations to the nervous system, while small-molecule neuromodulators gradually refine the precision. The different time and length scales of neuropeptide and small-molecule transmission generate incoherent patterns of neural activity which competitively regulate behavior and memory. Controlling behavior through opposing communication mechanisms creates a more robust system than either alone and may serve as a generic approach to construct robust neural networks.
ABSTRACT
OBJECTIVES: In this international study, we aimed to investigate the opinions of physicians dealing with patients with functional seizures (FS) worldwide on working restrictions and disability benefits eligibility. METHODS: International online survey of neurologists/mental health professionals from Argentina, Venezuela, Colombia, Italy, France, Iran, Iraq, United Arab Emirates (UAE), Qatar, Saudi Arabia, Georgia, and Russia. RESULTS: Six hundred and twenty-seven physicians from 12 countries participated in the study. Working as a neurologist was a predictor to think that patients with FS should not be counseled to avoid performing all jobs or professions as long as they have active disease (OR: 0.46; 95% CI: 0.30 to 0.68; pâ¯<â¯0.001). Having managed more than 200 patients was associated with the opinion that patients should not be counseled to avoid performing any type of work (OR: 2.17; 95% CI: 1.02 to 4.59; pâ¯=â¯0.043). Working as a psychiatrist/psychologist was associated with the idea that patients with FS should be qualified for disability benefits (OR: 1.97; 95% CI: 1.21-3.21; pâ¯=â¯0.006), and receive these benefits lifelong (OR: 0.43; 95% CI: 0.22-0.84; pâ¯=â¯0.014). CONCLUSION: Neurologists and mental health professionals have different attitudes and opinions toward working restrictions and disability benefits for patients with FS. Further studies should investigate the reasons for these differences, and propose solutions to avoid discrimination and unequal access to employment and disability benefits.
Subject(s)
Physicians , Seizures , Argentina , Attitude , Colombia , France , Humans , Iran , Italy , Qatar , Russia , Saudi Arabia , United Arab EmiratesABSTRACT
Trabalho desenvolvido no Departamento de Fisioterapia e Terapia Ocupacional da Universidade Federal de Sao Carlos. O objetivo do presente trabalho foi de examinar as características da produçao científica relativa à fisioterapia e que foi objeto de divulgaçao nas Reunioes Anuais da SBPC. Para isso foram utilizados, como fonte de informaçoes, os resumos da SBPC dos anos de 1978 a 1988. Desses resumos foram coletados dados que permitiram um mapeamento da produçao científica na área, de maneira a:1) localizá-la geograficamente; 2) quantificá-la; 3) identificar concentraçoes e 4) analisar o que está sendo produzido, em relaçao à área de conhecimento e, consequentemente, à profissao. Através dos resultados pode-se identificar:a) uma insuficiência da produçao de conhecimento científico relativo ao objeto de estudo da área; b) uma concentraçao de trabalhos voltados para a assistência curativa e c) uma significativa diferença entre a quantidade de trabalhos produzidos pelos diversos tipos de instituiçao
