XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

CA : A Cancer Journal for Clinicians

EASL–EORTC Clinical Practice Guidelines (CPG) on the management of hepatocellular carcinoma (HCC) define the use of surveillance, diagnosis, and therapeutic strategies recommended for patients with this type of cancer. This is the first European joint effort by the European Association for the Study of the Liver (EASL) and the European Organization for Research and Treatment of Cancer (EORTC) to provide common guidelines for the management of hepatocellular carcinoma. These guidelines update the recommendations reported by the EASL panel of experts in HCC published in 2001 [1]. Several clinical and scientific advances have occurred during the past decade and, thus, a modern version of the document is urgently needed. The purpose of this document is to assist physicians, patients, health-care providers, and health-policy makers from Europe and worldwide in the decision-making process according to evidencebased data. Users of these guidelines should be aware that the recommendations are intended to guide clinical practice in circumstances where all possible resources and therapies are available. Thus, they should adapt the recommendations to their local regulations and/or team capacities, infrastructure, and cost– benefit strategies. Finally, this document sets out some recommendations that should be instrumental in advancing the research and knowledge of this disease and ultimately contribute to improve patient care. The EASL–EORTC CPG on the management of hepatocellular carcinoma provide recommendations based on the level of evidence and the strength of the data (the classification of evidence is adapted from National Cancer Institute [2]) (Table 1A) and the strength of recommendations following previously reported systems (GRADE systems) (Table 1B).

http://www.bclc.cat/download/easl-guidelines.pdf

EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma European Association for the Study of the Liver ⇑ , European Organisation for Research and Treatment of Cancer

https://www.emcdda.europa.eu/attachements.cfm/att_231442_EN_INT17_easl-recommendations-on-treatment-of-hepatitis-C.pdf

EASL Recommendations on Treatment of Hepatitis C

Cardiovascular disease (CVD) is the main cause of mortality in subjects with non‐alcoholic fatty liver disease (NAFLD). We investigated the association between CVD risk and metabolic dysfunction‐associated fatty liver disease (MAFLD) or NAFLD and the influence of significant liver fibrosis on the CVD risk.

Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease

https://www.ahbps.org/journal/download_pdf.php?doi=10.14701/ahbps.2022S1.OP-5-4

Laparoscopic liver resection versus percutaneous radiofrequency ablation for single small hepatocellular carcinoma (≤ 3 cm): Optimal indication based on the tumor size and the level of PIVKA-II

Fine suspended solids from coal mine drainage were treated in the treating plant, using two different pilot-scale inclinedclarifiers: radial and lamella types. Suspended solids in the mine drainage were monitored along with other geochemicalfactors, and metal contents. Fe and Mn are the main chemical components in the drainage, which exist predominantly astotal metal forms, whereas dissolved portion is negligible. The raw mine drainage is subject to physical and chemicaltreatment using CaCO 3 and NaOH ,therefore the suspended solids are thought to be composed of Fe and Mn precipitates,possibly Fe(OH) 3 , along with carbonate precipitates. The elemental composition of precipitates are confirmed by SEM-EDS analysis. As nearly all the dissolved ions were precipitated in the primary process by CaCO 3 , no further aeration orprolonged oxygenation are of necessity in this plant. Adoption of inclined clarifier proved to be effective in treating finesuspended solids in the current plant. Successful application of the inclined clarifier will also be beneficial to improve thecurrent treating process by excluding the current application of chemical agent in the first stage. The final effluents fromthe pilot plant meet the national standards and the low dissolved Fe and Mn contents are expected not to cause secondaryprecipitation after discharge. Key words :Coal mine drainage, Suspended solids, Fe precipitates, Sand bed, Inclined clarifier

Geochemical Reaction Processes and Controls on the Coal Mine Drainage using Pilot-scale Inclined Clarifiers

Although proper selection of patients with liver cancer minimizes the probability of occurrence of hepatic dysfunction, radiotherapy for patients with underlying liver diseases such as cirrhosis or chronic hepatitis B might lead to classic or non-classic radiation-induced liver disease. Clinically, hepatic dysfunction includes ascites, jaundice, variceal hemorrhage, hepatorenal syndrome and hepatic encephalopathy. Several factors such radiation dose, residual liver function, and treatment other than radiotherapy are involved in the development of hepatic dysfunction. Ascites is the most common manifestation of hepatic dysfunction after radiotherapy in patients with liver cancer. A strict adherence to a low-salt diet and medical therapies including diuretics and therapeutic paracentesis can control ascites. In patients with refractory ascites, liver transplantation should be considered if tumor extent after radiotherapy is decreased within usual criteria for transplantation. When patients develop jaundice during or after radiotherapy, radiation oncologists or hepatologists differentiate between obstructive jaundice and hepatocelluar jaundice, which often implies poor prognosis. Esophageal or gastric variceal bleeding is a medical emergency requiring intensive fluid resuscitation and endoscopic or interventional treatment. To prevent rebleeding from esophageal varices, endoscopic variceal ligation combined with pharmacologic therapy is necessary. Hepatic encephalopathy is a neurological or psychiatric manifestation of hepatic dysfunction resulting from inability to detoxify endogenous or exogenous compounds. Hepatic encephalopathy usually occurs late during hepatic dysfunction, requiring liver transplantation when tumor control is enough. It is essential for radiation oncologists and hepatologists to cooperate to properly manage liver cancer patients with radiation therapy.

Hepatic Dysfunction Following Radiotherapy and Management

Cardiac rupture is rarely diagnosed in blunt chest trauma patients since 80% of patients die at the scene of the accident (1). However, immediate surgery can save up to 80% of the survivors (1-3). Detection of cardiac rupture relies mainly on clinical suspicion and echocardiography, especially transesophageal echocardiography (2, 3). In rare cases, leaking of the contrast material in hemopericardium patients can be detected on the initial CT examination, allowing early diagnosis of cardiac rupture (3-5). However, there have been no reports on early diagnosis of cardiac rupture using two phase contrast enhanced CT. Therefore, we report a case of a blunt traumatic rupture of the left ventricle wall using two phase contrast enhanced multidetector-row computed tomography (MDCT).

/pdf/blunt-rupture-of-left-ventricle-diagnosed-using-two-phase-4xikt3s6hj.pdf

Do Young Kim

Papers

Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease

Laparoscopic liver resection versus percutaneous radiofrequency ablation for single small hepatocellular carcinoma (≤ 3 cm): Optimal indication based on the tumor size and the level of PIVKA-II

Geochemical Reaction Processes and Controls on the Coal Mine Drainage using Pilot-scale Inclined Clarifiers

Hepatic Dysfunction Following Radiotherapy and Management

Blunt Rupture of Left Ventricle Diagnosed Using Two Phase Contrast Enhanced CT: A Case Report