Intermediate hepatocellular carcinoma: current treatments and future perspectives

Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment of Barcelona-Clinic Liver Cancer (BCLC)-B patients. However, the long-term survival outcomes of patients managed with this technique do not appear fully satisfactory; in addition, intermediate-stage hepatocellular carcinoma (HCC) includes a heterogeneous population of patients with varying tumour burdens, liver function and disease aetiology. Therefore, not all patients with intermediate-stage HCC may derive similar benefit from TACE, and some patients may benefit from other treatment options, which are currently approved or being explored. These include different TACE modalities, such as selective TACE or drug-eluting beads TACE and radioembolization. The introduction of sorafenib in the therapeutic armamentarium for HCC has provided a new therapeutic option for the treatment of BCLC-B patients who are unsuitable to TACE or in whom TACE resulted in unacceptable toxicity. In addition, clinical trials aimed at investigating the potential role of this molecule in the treatment of patients with intermediate-stage HCC within combination therapeutic regimens are ongoing. This narrative review will present and discuss the most recent evidence on the locoregional or medical treatment with sorafenib in patients with intermediate-stage HCC.

Clinical decision rules and D-Dimer in venous thromboembolism: current controversies and future research priorities

Venous thromboembolism (VTE) is a potentially lethal clinical condition that is suspected in patients with common clinical complaints, in many and varied, clinical care settings. Once VTE is diagnosed, optimal therapeutic management (thrombolysis, IVC filters, type and duration of anticoagulants) and ideal therapeutic management settings (outpatient, critical care) are also controversial. Clinical prediction tools, including clinical decision rules and D-Dimer, have been developed, and some validated, to assist clinical decision making along the diagnostic and therapeutic management paths for VTE. Despite these developments, practice variation is high and there remain many controversies in the use of the clinical prediction tools. In this narrative review, we highlight challenges and controversies in VTE diagnostic and therapeutic management with a focus on clinical decision rules and D-Dimer.

The English of The Sleeping Lady: An exploration of the historical and current influences on the English of Kosrae

Kosrae, or ‘The Island of The Sleeping Lady’ as it is known to locals, is the most remote island of the Federated States of Micronesia (FSM), located in the western Pacific. FSM is an independent sovereign nation consisting of four state in total: Pohnpei, Chuuk, Yap and Kosrae. First claimed by the Spanish, who were forced to cede FSM to Germany in 1899. In 1914, the Japanese took military possession of the region resulting in considerable economic, social and political change for the islands’ inhabitants. By 1947 after WWII, the islands formed part of the Trust Territory of the Pacific Islands commissioned by the UN and administered by the US. The FSM became an independent nation in 1986 while still retaining affiliation with the US under a ‘Compact of Free Association’ encouraging the officiating of English as a language of FSM, alongside local languages. Here I examine the presence and uses of English in Kosrae with reference to these socio-historical influences. First, I discuss the extralinguistic factors which have shaped the English that is currently found on Kosrae. Secondly, I assess the use of English in this community in light of Schneider’s (2007) ‘Dynamic Model’. Finally, an overview of the salient linguistic characteristics of Kosraean English, based on data collected in informal conversations on the island, will be presented. The overall objective is to present a socio-historical, political and linguistic description of a hitherto unexamined English emerging in a postcolonial environment. Schneider, E. (2007). Postcolonial Englishes. Cambridge: Cambridge University Press. Research Interests: Global Englishes