Background and Objectives: The publication of MSLT-II shifted recommendations for management of sentinel lymph node biopsy positive (SLNB+) melanoma to favor active surveillance. We examined trends in immediate completion lymph node dissection (CLND) following publication of MSLT-II. Methods: Using a prospective melanoma database at a high-volume center, we identified a cohort of consecutive SLNB+ patients from July 2016 to April 2019. Patient and disease characteristics were analyzed with multivariate logistic regression to examine factors associated with CLND. Results: Two hundred and thirty-five patients were included for analysis. CLND rates were 67%, 33%, and 26% for the year before, year after, and second-year following MSLT-II. Factors associated with undergoing CLND included primary located in the head and neck (59% vs 33%, P = .003 and odds ratio [OR], 5.22, P = .002) and higher sentinel node tumor burden (43% vs 10% for tumor burden ≥0.1 mm, P < .001 and OR, 8.64, P = .002). Conclusions: Rates of CLND in SLNB+ melanoma decreased dramatically, albeit not uniformly, following MSLT-II. Factors that increased the likelihood of immediate CLND were primary tumor located in the head and neck and high sentinel node tumor burden. These groups were underrepresented in MSLT-II, suggesting that clinicians are wary of implementing active surveillance recommendations for patients perceived as higher risk.
As the incidence of hepatocellular carcinoma (HCC) and subsequent treatments with liver‐directed therapies rise, the complexity of assessing lesion response has also increased. The Liver Imaging Reporting and Data Systems (LI‐RADS) treatment response algorithm (LI‐RADS TRA) was created to standardize the assessment of response after locoregional therapy (LRT) on contrast‐enhanced CT or MRI. Originally created based on expert opinion, these guidelines are currently undergoing revision based on emerging evidence. While many studies support the use of LR‐TRA for evaluation of HCC response after thermal ablation and intra‐arterial embolic therapy, data suggest a need for refinements to improve assessment after radiation therapy. In this manuscript, we review expected MR imaging findings after different forms of LRT, clarify how to apply the current LI‐RADS TRA by type of LRT, explore emerging literature on LI‐RADS TRA, and highlight future updates to the algorithm. Evidence Level 3. Technical Efficacy Stage 2.
Background Copeptin, C-terminal segment of pro-arginine vasopressin, is expected to be a strong novel biomarker for prognosis in acute heart failure (AHF). Aim Evaluate the prognostic role of copeptin in AHF either de novo or on top of chronic heart failure and its correlation with adverse cardiac events. Methods The study included 45 patients with acute decompensated heart failure (ADHF) to assess the relationship of serum copeptin level on admission and 72 hours after admission with adverse cardiac events (death, re-hospitalization and arrhythmias) in patients hospitalized with ADHF between May 2019 and November 2019 with median follow up period 6 months. Results In this study, 15 patients died, re-admission for heart failure occurred in 22 patients and arrhythmias were documented in 14 patients with atrial fibrillation (n = 9) and ventricular arrhythmias (n = 5). Mortality rate was higher among the elderly, smokers and patients with higher heart rate, lower left ventricular ejection fraction, more frequent arrhythmias, impaired kidney function and higher copeptin level. Furthermore, copeptin level at day 1 with cutoff value of > 2.54 pmol/l predicted mortality with sensitivity of 86.67% and specificity of 53.33% while at day 3 copeptin level with cutoff value > 2.74 pmol/l predicted mortality with sensitivity of 93.33% and specificity of 83.33%. Finally, change in copeptin level between day 1 and day 3 was associated with increased mortality. (p<0.001) Conclusion Serum copeptin is suggested to be a strong biomarker to predict adverse clinical outcomes in patients with acute decompensated heart failure.
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