The efficacy of sorafenib gemcitabine combination therapy is similar to the sorafenib alone treatment. However, frequent dose adjustments due to gemcitabine-related toxicities, delays, and corrective treatments make this combination therapy unsafe in the treatment of advanced HCC.

PurposeTo document survival for patients treated with stereotactic radiosurgery (SRS) alone for brain metastases either at initial presentation or for salvage in conjunction with other known prognostic factors in a single institutional community setting with comparison to current literature.MethodsAll patients treated for brain metastases with SRS between October 2006 and October 2013 were reviewed. We identified 91 patients treated with SRS alone for first brain metastatic event (FBME) and 87 patients treated with SRS for second brain metastatic event (SBME). We excluded the 14 patients treated with SRS for both FBME and SBME to satisfy the independence assumption for comparison of groups. Patient demographics, including age, gender, primary cancer type, presence of extracranial metastases, number of brain metastases, initial site of metastases (brain vs. other), recursive partitioning analysis (RPA), and Karnofsky Performance status (KPS) were documented.ResultsThere were no significant differences in overall survival for patients treated with SRS for FBME compared with SBME (log-rank p = 0.9347). Univariate and multivariable Cox regression modeling revealed KPS (p = 0.0003) and RPA (p = 0.0143) were the only independent prognostic factors for survival. Specifically, patients with RPA 1 had a 61% decreased risk of death compared to those with RPA 3. Patients with RPA 2 had a 33% decreased risk of death compared to those with RPA 3. The 1-year survival rate was 36.5% for patients with RPA1, 33.3% for those with RPA 2, and 17.1% for those with RPA 3. Patients with KPS 90–100 had a 62% decreased risk of death compared to those with KPS < 70. The 1-year survival rate for patients KPS 90–100, 70–80, and <70 were 60.7, 24.6, and 16.7%, respectively.ConclusionNo difference in survival was noted for FBME and SBME with performance status, the single most important prognostic factor following SRS. Aggressive treatment should be considered for patients with good performance status regardless if presenting with FBME or SBME. Our results are consistent with single, multi-institutional, and randomized trials after literature review.

The limited availability of fossil fuels, as well as its negative ecological repercussions, has prompted humanity to seek other renewable technologies. One of the obvious options is solar energy, especially for energy deficient and solar rich countries like Pakistan. Flat plate, evacuated tube, and parabolic trough collectors are among the primary solar thermal collectors being employed. However, energy saving can be further enhanced by applying the thermosiphoning concept. Therefore, in the current study, an experimental analysis of a thermosiphoning-based heat transfer mechanism with two different nanofluids (Fe2O3 and Al2O3) in a compound parabolic trough collector (CPC) is presented. Initially, a numerical analysis is performed through ANSYS to determine fluid flow under free convection at a certain temperature gradient. Afterwards, a laboratory-scale thermosiphoning experimental setup is developed under controlled conditions. Finally, the same phenomena is applied in CPC and analysis is performed under real climate conditions of Taxila, Pakistan. The highest numerical flow rate attained with Fe2O3 was 9.3 mL/s, according to the research. In outdoor setup, 10.78 mL/s was the highest flow rate achieved. With some variation, theoretical and analytical results were confirmed with prior studies. As a result, using nanofluids and thermosiphon to lower a pump's mechanical strain can considerably improve the efficiency of the solar thermal system.

The finite nature of fossil fuels and their adverse effects on the environment have forced mankind to look for alternate energy sources. Solar energy is one of them, and Pakistan has immense potential. This paper specifically focuses on achieving these purposes by using compound parabolic collectors. They are non-tracking and are used for low to medium temperature ranges. To achieve thermosiphoning, nanofluids, which have a high heat transfer rate, are used. Flow rates and outlet temperatures are obtained, by experimentation and by a numerical analysis with water and nanofluids (Fe2O3 and Al2O3). The maximum numerical flow rate achieved was 9.3 mL/s with Fe2O3. The maximum flow rate achieved in the outdoor setup was 10.78 mL/s. Numerical and experimental results were validated with previous research with some deviation. The use of nanofluids and thermosiphoning can greatly enhance the performance of our system and reduce the mechanical work of a pump in a hybrid system.