A Review of Current and Emerging Therapies for Advanced Hepatocellular Carcinoma.

Hepatocellular carcinoma remains a leading cause of cancer-related deaths worldwide. Liver disease including cirrhosis and viral hepatitis remains among the leading causes of hepatocellular carcinoma and despite increased screening, many patients are diagnosed in the advanced stages precluding them from locoregional therapy. Therapeutic agents for advanced hepatocellular carcinoma were limited to Sorafenib for several years; however, with the emergence of molecular targeted therapies including tyrosine kinase inhibitors and vascular endothelial growth factor inhibitors, in addition to immunotherapies, the way hepatocellular carcinoma is treated has changed significantly. In this review, we summarize the key clinical trials that lead to the approval of these agents for systemic treatment of hepatocellular carcinoma and discuss the preferred sequence of treatment options as well as prospective studies for management of hepatocellular carcinoma.

Autism and psychosis: Clinical implications for depression and suicide.

There is increasing recognition of the co-occurrence of autism and schizophrenia spectrum disorders. However, the clinical significance of this on outcomes such as depression and suicidal thinking has not been explored. This study examines the association of autism spectrum traits, depressive symptoms and suicidal behaviour in individuals with psychotic experiences. In two cross sectional studies, individuals from a non-help seeking university student sample and patients with first episode psychosis (FEP) service completed standardized measures of autism spectrum traits, psychotic experiences, depressive symptoms and suicidal thinking. In healthy non-help seeking students, increased autism traits and increased subclinical psychotic experiences were significantly associated with depressive symptoms; a significant interaction effect suggests their combined presence has a greater impact on depression. In FEP, high autism traits and positive symptoms were associated with increased depression, hopelessness and suicidality, however there was no significant interaction effect. In FEP a multiple mediation model revealed that the relationship between autism traits and risk for suicidality was mediated through hopelessness. Young people with subclinical psychotic experiences and all patients with FEP should be screened for autism spectrum traits, which may have significant impact on clinical outcomes. Tailored interventions for patients with high levels of autistic spectrum co-morbidities in FEP should be a priority for future research.

Cultural affordance, social relationships, and narratives of independence: Understanding the meaning of social care for adults with intellectual disabilities from minority ethnic groups in the UK.

Objectives: To explore the perspective of adults with intellectual disabilities from minority ethnic groups, on their relationship with social care services. Methods: Thirty-two adults took part in semi-structured interviews. Transcripts were analyzed within a Pluralist framework, adopting the structure of Template Analysis and then drawing on phenomenological, narrative, and discursive approaches. Results: Our participants were generally positive about the services which they received, which they evaluated primarily in terms of their continuing good relationship(s) with specific workers. Our respondents were sophisticated users of cultural resources and identities; the concept of 'cultural affordance' may be useful alternative to 'cultural competence'. We discuss three distinctive narratives about independence (Stability; Progress; Resistance). Each highlights the importance of maintaining connectedness to others, and the crucial role played by ownership of decision-making. Conclusions: We have developed a set of resources which service providers (and researchers) can use with people with intellectual disabilities, in order to support mutual understanding, service planning and delivery.

Suicidality in Autistic Spectrum Disorders.

BACKGROUND: It is suggested that people with autistic spectrum disorders (ASD) may be at increased risk of suicide; however, research on this topic has been minimal and there are conflicting reports in existing studies. AIM: To bring together research investigating the prevalence, risk factors, and comorbid factors of suicidality in ASD. METHOD: A systematic search was performed of Medline, Psych Info, Embase, and the Web of Science following PRISMA guidelines. After exclusion criteria were applied, 70 full-text articles were screened. The final review contained 12 papers with a total sample size of 2,651. RESULTS: Prevalence of suicide attempts varied between 7% and 47%, while suicidal ideation was reported in up to 72% of cases. Being male and having a history of self-harm and depression were cited as significant risk factors. LIMITATIONS: Papers were cross sectional and contained a number of limitations. Only one paper used the gold standard for diagnosis of ASD and one a standardized measure of suicidal behavior. CONCLUSION: Suicidal attempts and ideation are increased in ASD; however, the extent of the increase and the risk factors identified within this group remain under-investigated. There is a lack of research on protective factors. The correlation between ASD and suicidality needs further examination with longitudinal research.