In many countries, the allocation of liver grafts is based on the Model of End-stage Liver Disease (MELD) score and the use of exception points for patients with hepatocellular carcinoma (HCC). With this strategy, HCC patients have easier access to transplantation than non-HCC ones. In addition, this system does not allow for a dynamic assessment, which would be required to picture the current use of local tumor treatment. This study was based on the Scientific Registry of Transplant Recipients and included 5,498 adult candidates of a liver transplantation for HCC and 43,528 for non-HCC diagnoses. A proportional hazard competitive risk model was used. The risk of dropout of HCC patients was independently predicted by MELD score, HCC size, HCC number, and alphafetoprotein. When combined in a model with age and diagnosis, these factors allowed for the extrapolation of the risk of dropout. Because this model and MELD did not share compatible scales, a correlation between both models was computed according to the predicted risk of dropout, and drop-out equivalent MELD (deMELD) points were calculated. Conclusion: The proposed model, with the allocation of deMELD, has the potential to allow for a dynamic and combined comparison of opportunities to receive a graft for HCC and non-HCC patients on a common waiting list. (HEPATOLOGY 2012;56:149-156) S ince the publication of the Milan selection criteria in 1996, liver transplantation has been recognized as the best treatment for selected patients with nonresectable hepatocellular carcinoma (HCC). 1Over the years, HCC has become one of the main indications for liver transplantation as a result of the combined effects of an increasing incidence of new HCC cases (matching the incidence of hepatitis C infection) and the use of more extended selection criteria.2-4 These factors combined exert an increasing pressure on the limited liver donor pool.Access to transplantation for HCC and non-HCC patients is granted on the basis of different approximations of utility. In nonmalignant patients, utility is represented by transplantation benefit (i.e., survival compared to death), whereas HCC patients are selected according to a longer term utility perspective (Milan: expected 5-year survival over 70%). The Model for End-Stage Liver Disease (MELD) score allows for the selection and priority transplantation of patients with the highest short-term risk of death. 5,6 Because most HCC candidates maintain relatively good liver function, they are poorly served (and infrequently transplanted) with the use of the raw MELD score; as such, ''exception'' points that increase their priority ranking have been artificially allocated. Originally, U.S. patients within Milan criteria (single HCC 5 cm in diameter and 3 HCCs 3 cm) were attributed 24

Rationale and objectivesProne positioning as a complement to oxygen therapy to treat hypoxemia in coronavirus disease (COVID-19) pneumonia in spontaneously breathing patients has been widely adopted, despite a lack of evidence for its benefit.To test the hypothesis that a simple incentive to self-prone for a maximum of 12 h per day would decrease oxygen needs in patients admitted to the ward for COVID-19 pneumonia on low-flow oxygen therapy.MethodsTwenty-seven patients with confirmed COVID-19 pneumonia admitted to Geneva University Hospitals were included in the study. Ten patients were randomised to self-prone positioning and 17 to usual care.Measurements and Main ResultsOxygen needs assessed by oxygen flow on nasal cannula at inclusion were similar between groups. Twenty-four hours after starting the intervention, the median oxygen flow was 1.0 L·min−1 (interquartile range, 0.1–2.9) in the prone position group and 2.0 L·min−1 (interquartile range, 0.5–3.0) in the control group (p=0.507). Median oxygen saturation/fraction of inspired oxygen ratio was 390 (interquartile range, 300–432) in the prone position group and 336 (interquartile range, 294–422) in the control group (p=0.633). One patient from the intervention group who did not self-prone was transferred to the high-dependency unit. Self-prone positioning was easy to implement. The intervention was well tolerated and only mild side-effects were reported.ConclusionsSelf-prone positioning in patients with COVID-19 pneumonia requiring low-flow oxygen therapy resulted in a clinically meaningful reduction of oxygen flow, but without reaching statistical significance.

Adult asthma phenotypes identified by a clustering approach, 10 years apart, were highly consistent. This study is the first to model the probabilities of transitioning over time between comprehensive asthma phenotypes.

Advances in knowledge:1) Abdominal radiography (AR) achieves a limited sensitivity (77%) for the screening of illegal intra-corporeal containers when compared to low-dose CT 2) Illegal intra-corporeal packets are difficult to detect by AR when they are in small number (< 12) 3) The sensitivity of AR for detection of illegal intra-corporeal containers is lower (50%) when they appear iso-dense to the bowel content at low-dose CT than when they appear denser (89%). Implications for patient care:Performing low-dose CT instead of AR will improve the detection of illegal intra-corporeal packets, without increasing the radiation dose. Summary statement:The use of low-dose CT may constitute a reasonable alternative to abdominal radiography to improve the detection of illegal intra-abdominal packets 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Abstract Purpose: To evaluate the diagnostic performance of the abdominal radiography (AR) to a low-dose CT (LDCT) in the detection of illegal intra-corporeal containers ("packets") using LDCT as a reference standard. Materials and Methods:This study was approved by the institutional ethical review board ; a written informed consent was required (CER 06-023).330 consecutive persons, suspected of having ingested drug packets, underwent a supine AR. The presence or absence of packets at AR were reported and compared to the result of LDCT , considered reference standard. The density and the number of packets (<12 or above) at LDCT were recorded and analyzed to determine if they may influence the AR interpretation. Results:Packets were detected at LDCT in 53 (16%) suspects. The sensitivity of AR for depiction of packets was 77% (41/53), the specificity 96% (267/277). The packets appeared iso-dense to the bowel contents on LDCT in sixteen (30%) of the 53 positive cases. Nineteen (36%) of the 53 positive LDCT displayed fewer than 12 packets. Iso-dense packets on LDCT and having a low number of packets (<12) were both significantly associated with false negative AR exams.Conclusion: AR is mainly limited by a low sensitivity when compared to LDCT for the screening of persons suspected of carrying drug packets. LDCT constitutes an efficient imaging alternative to AR.