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Рабочая группа по диагностике и лечению обмороков Европейского общества кардиологов (ESC) Подготовлены в сотрудничестве с Европейской ассоциацией сердечного ритма (EHRA) 1 , Ассоциацией сердечной недостаточности (HFA) 2 и Обществом сердечного ритма (HRS) 3 Одобрены Европейским обществом неотложной медицины (EuSEM) 4 , Европейской федерацией внутренней медицины (EFIM) 5 , Европейским обществом гериатрической медицины (EUGMS) 6 , Американским обществом гериатрии (AGS), Европейским неврологическим обществом (ENS) 7 , Европейской федерацией обществ вегетативной нервной системы (EFAS) 8 , Американским обществом вегетативной нервной системы (AAS) 9 Авторы (члены рабочей группы): Angel Moya (Председатель) (Испания)*, Richard Sutton (Сопредседатель) (Великобритания)*

Two treatments are accepted for patients with solitary hepatocellular carcinoma Յ5 cm in size and with preserved hepatic function: (1) liver resection, which can be performed without delay but has a high recurrence rate, and (2) liver transplantation, which has a better long-term survival, but is not easily available because grafts are scarce. A third possibility is to offer liver resection first and liver transplantation for tumor recurrence or deteriorating liver function (''salvage'' transplantation). We investigated the implications of such a strategy with a Markov-based decision analytic model. Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide, and its incidence is increasing in the western world because of the epidemics of the hepatitis C virus. 1 In patients aged less than 65 years, 2 therapies are currently accepted for early HCC (Յ5 cm): partial hepatectomy (PH) and orthotopic liver transplantation (OLT). 2,3 Although studies comparing the 2 treatments are retrospective and concern patients with disparate tumor characteristics and liver function, 4-6 it is agreed that OLT is preferable to partial hepatectomy in patients with hepatic insufficiency and in patients with more than 1 tumor, in whom the results of liver resection are poor.Patients with single tumors and preserved liver function present a therapeutic dilemma. Partial hepatectomy can cure the tumor immediately, with low mortality. The underlying cirrhosis, however, is responsible for a high recurrence rate, and the patient is exposed to the long-term complications of portal hypertension and hepatocellular failure. 7 OLT, by treating both the tumor and the cirrhosis, offers a better long-term survival. The tumor, however, can outgrow the criteria accepted for transplantation while waiting for donor organs, affecting the ultimate outcome as shown in a previous analysis. 2 For patients with a single resectable HCC, an alternative strategy to either partial hepatectomy or OLT would be to offer resection first and transplantation if the tumor recurs or if the liver function deteriorates (salvage OLT). Before such a strategy can be tested in a prospective controlled trial, the present study examines its implications in terms of patient outcome, graft use, and costs, using a decisional analysis model based on the data available in the literature. PATIENTS AND METHODS Decision Analytic ModelWe investigated the impact of 2 options: (1) primary liver transplantation and (2) partial hepatectomy followed by salvage liver transplantation (Fig. 1A) in patients with compensated cirrhosis and solitary HCC Յ5 cm in diameter, with a Markov simulation (Decision Maker 7

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Cadaveric liver transplantation (CLT) is an excellent treatment for early hepatocellular carcinoma (HCC). Its use, however, is limited by the shortage of grafts, with up to 30% of patients developing contraindications to the procedure while waiting for a donor. Living donor liver transplantation (LDLT) has emerged as an alternative to overcome this limitation. We compared the consequences of LDLT versus CLT using a Markov model balancing the gains and losses in life expectancy among donors and recipients. For a 60-yearold recipient with a 70% 5-year survival after transplantation, a 4% monthly drop-out rate, and a donor with 1% mortality, LDLT became more effective than CLT after 3.5 months on the waiting list. These results varied with the probability of developing contraindications to transplantation, the survival after transplantation, and the donor's mortality. For a 12-month delay saved on the waiting list, the gain in survival provided by LDLT compared with CLT ranged between 0 and 2.8 life years depending on survival after transplantation, time spent on the waiting list, and drop-out rate. LDLT was cost-effective (less than $50,000 per quality-adjusted life year saved) in all scenarios of waiting lists exceeding 7 months, and this figure ranged from 2 to 16 months when varying the drop-out rate. LDLT for early HCC offered substantial gains in life expectancy with acceptable cost-effectiveness ratios when the waiting list exceeds 7 months. The gain in life expectancy and the costeffectiveness of LDLT were more dependent on the drop-out rate and the outcome after transplantation than on donor's mortality. (HEPATOLOGY 2001;33:1073-1079.)Liver transplantation is an excellent treatment for early hepatocellular carcinoma (HCC). Theoretically, this procedure is able to cure the tumor and the underlying cirrhosis, and can be applied to patients with end-stage liver disease. Five-year survival rates above 70% with a low tumor recurrence rate are obtained in well selected candidates. [1][2][3][4] In practice, however, the results of cadaveric liver transplantation (CLT) for HCC depend on the time waiting for an organ donor, which commonly exceeds 1 year in many centers, both in Europe and in the United States, with many patients developing contraindications (e.g., tumor spread) and becoming ineligible for the procedure. [5][6][7] In addition, there is an increasing demand for organs due to the worldwide rising incidence of HCC. 8,9 Living donor liver transplantation (LDLT) with a partial liver graft (usually, for an adult, the right half of the liver), has emerged as a possible solution to the shortage of organs. [10][11][12][13][14] LDLT has been performed in the pediatric population with results similar to CLT. Data from adult-to-adult LDLT are still scarce, but short-term figures are equivalent to CLT. [10][11][12][13][14] LDLT has the advantage of decreasing the waiting time before receiving a transplant, thereby eliminating the risk of adverse events related to the waiting list. On the other hand, there are co...

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The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency with profound mental health consequences. The psychiatric emergency department (ED) plays a key role during this mental health crisis. This study aimed to investigate differences in admissions at a Swiss psychiatric ED from 1 April to 15 May during a “pandemic-free” period in 2016 and a “during-pandemic” period in 2020. The study included 579 consultations at psychiatric ED in the “during-pandemic” period and 702 in the “pandemic-free” period. Sociodemographic and clinical characteristics were compared, and logistic regression analysis was performed to identify variables associated with psychiatric admissions during the pandemic. A reduction in total psychiatric ED admissions was documented during COVID-19. Logistic regression analysis predicted the independent variable (ED admission during the pandemic) and estimated odds ratio (OR) for being unmarried/not in a relationship, arrival in an ambulance, suicidal behavior, behavioral disorders and psychomotor agitation. Though only statistically significant in bivariate analysis, patients were also more likely to be involuntarily hospitalized. This picture appears to be reversed from a sociodemographic and clinical point of view to our observation of psychiatric ED consultation in 2016. These findings highlight that the reduction in psychiatric ED admissions during the pandemic seems to be associated with living alone and more severe psychopathologies, which must alert psychiatrists to ensure access to mental health care in times of pandemic.

clinicaltrials.gov; Identifier: NCT00448604.