DEB-DOX results, with high rates of 5-year survival for patients, not amenable to curative treatments. Number of lesions, lesion vascularity, and local response were significant independent determinants of 5-year survival.

The purpose of this study was to assess the safety and efficacy of doxorubicin-loaded beads (DC Beads) delivered by transarterial embolization for the treatment of unresectable hepatocellular carcinoma (HCC). This open-label, single-center, single-arm study included 62 cirrhotic patients with documented single unresectable HCC. Mean tumor diameter was 5.6 cm (range, 3-9 cm) classified as Okuda stages 1 (n = 53) and 2 (n = 9). Patients received repeat embolizations with doxorubicin-loaded beads every 3 months (maximum of three). The maximum doxorubicin dose was 150 mg per embolization, loaded in DC Beads of 100-300 or 300-500 microm. Regarding efficacy, overall, an objective response according to the European Association for the Study of the Liver criteria was observed in 59.6%, 81.8%, and 70.8% across three treatments. A complete response was observed in 4.8% after the first procedure and 3.6% and 8.3% after the second and third procedures, respectively. At 9 months a complete response was seen in 12.2%, an objective response in 80.7%, progressive disease in 6.8%, and 12.2% showed stable disease. Mean tumor necrosis ranged from 77.4% to 83.9% (range, 28.6%-100%) across three treatments. alpha-Fetoprotein levels showed a mean decrease of 1123 ng/ml (95% CI = 846-1399; p = 3 x 10(-11)) after the first session and remained stable after the second and third embolizations (42 and 70 ng/ml decrease, respectively). Regarding safety, bilirubin, gamma-glutamyl transferase, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase showed only transient increases during the study period. Severe procedure-related complications were seen in 3.2% (cholecystitis, n = 1; liver abscess, n = 1). Postembolization syndrome was observed in all patients. We conclude that hemoembolization using doxorubicin-loaded DC Beads is a safe and effective treatment of HCC as demonstrated by the low complication rate, increased tumor response, and sustained reduction of alpha-fetoprotein levels.

shimoto's disease, 1,2 as well as of thyroid autoantibodies and/ The prevalence of antithyroid peroxidase antibodies or thyroid dysfunction among patients with chronic hepatitis (ATPO) and/or of thyroid dysfunction was studied in 422 C. [3][4][5] However, the suggested link between hepatitis C and patients with chronic viral hepatitis C, B, and D. Baseline thyroid disease is still uncertain. Data in the literature are results were compared with those during and 6 months after few and differ widely among studies, depending on the charinterferon alfa (IFN-a) therapy. The overall prevalence of acteristics of the populations tested and the sensitivity of the ATPO among untreated patients was 14.1%, with no signifimethods used. [6][7][8] Moreover, in most reports, no comparison cant differences between chronic hepatitis C, B, or D, as well has been made between chronic hepatitis C and the other as between males and females. However, high ATPO titers known types of chronic viral hepatitis (B and D). (¢18 IU/mL) clustered significantly among females (8.7% vs.Therapy with interferon alfa (IFN-a), widely used in 3.4%; P Å .022), especially those with chronic hepatitis C chronic viral hepatitis B or C and in various malignant dis-(11.2% vs. 3.6%; P Å .036). Before treatment, 3.7% of the eases, has also been associated with a high prevalence of patients had thyroid dysfunction, mostly hypothyroidism autoantibodies, and rarely with the development of overt (3.5%), the latter increasing to 14.3% among patients with autoimmune diseases. Thyroid disease, with clinical manifes-ATPO titers ¢18 IU/mL. IFN-a treatment significantly intations of hypothyroidism or hyperthyroidism, has been recreased overall thyroid dysfunction (9.7%; P Å .001) and ported in 5% to 12% of patients who received IFN-a for hypothyroidism (7.8%; P Å .01), particularly among patients various diseases, 9-11 while antithyroid autoantibodies were with high baseline ATPO (38.5%; P Å .0002). Six months present in a high percentage. 11-14 Indeed, only a minority of after stopping IFN-a treatment, the prevalence of thyroid dyspatients with chronic viral hepatitis who are positive for function was 8.0%, still significantly higher than at baseline.antimicrosomal or antithyroid antibodies have thyroid dysBy multivariate analysis, the only predictor positively associfunction, which is usually subclinical. transcriptase polymerase chain reaction method (Amplicor, Roche

XDR bacteria are an independent life-threatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.

In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.