It is well known that intermediate stage hepatocellular carcinoma (HCC) encompasses the widest class of patients with this disease. The main characteristic of this special sub-group of patients is that it is extensively heterogenous. This substantial heterogeneity is due to the wide range of liver functions of such patients and variable tumor numbers and sizes. Real world clinical data show huge support for transarterial chemo-embolization (TACE) as a therapeutic modality for intermediate stage HCC, applied in 50%-60% of those class of patients. There are special considerations in various international guidelines regarding treatment allocation in intermediate stage HCC. There is an epidemiological difference in HCC in eastern and western cohorts, and various guidelines have been proposed. In patients with HCC, it has frequently been reported that there is poor correlation between the clinical benefit and real gain in patient condition and the conventional way of tumor response assessment after locoregional treatments. This is due to the evaluation criteria in addition to the scoring systems used for treatment allocation in those patients. It became clear that intermediate stage HCC patients receiving TACE need a proper prognostic score that offers valid clinical prediction and supports proper decision-making. Also, it is the proper time to study more treatment options beyond TACE, such as multimodal regimens for this class of patients. In this review, we tried to provide a summary of the challenges and future directions in managing patients with intermediate stage HCC.

A biopharmaceutical manufacturing control system and associated methods are disclosed herein.

This book presents a rich collection of case studies exploring the ecology of pastoralism. Its aim is to examine the ways in which pastoralism operates as a highly flexible system, through the adaptations of both the domestic animals and the socioeconomic strategies of human groups to different environments and contexts. The volume achieves this through taking a comparative approach, drawing together a range of case studies from Asia, Europe, Africa and the Americas, and importantly through including both present and past perspectives on pastoral societies.

Background: The present standard dose of gemcitabine (Gem), a pyrimidine antimetabolite, is 1,000-1,250 mg/m(2), and the infusion time is 30 min However, pharmacological studies have demonstrated that Gem with prolonged infusion could attain a better accumulation rate of Gem triphosphate (active metabolites of Gem), indicating that Gem with prolonged infusion is superior to 30-min infusion. Thus, this systematic review aims to provide some references for Gem administered as a prolonged infusion. Methods: We searched electronic databases, including PubMed, EMBASE, Cochrane Library, and CNKI, for trials. Keywords were "Gem," "prolonged infusion," and "low-dose." In addition, we used the Cochrane Handbook V5.1.0 and methodological index for non-randomized studies to evaluate the quality of randomized controlled trials (RCTs) and non-RCTs, respectively. Furthermore, Cochrane Collaboration guidelines and the PRISMA statement were adopted. Results: We systematically reviewed 19 studies (5 RCTs and 14 non-RCTs). All studies assessed the efficacy and safety of Gem administered as a prolonged low-dose infusion (P-LDI) and reported that Gem administered as P-LDI was effective and well tolerated. Conclusion: Gem administered as P-LDI is effective, safe, and economical, especially suited for patients with poor performance status or without good economic condition.

Embodiments are disclosed that relate to enforcement of user policies in a multi-user interactive computing environment by end user review. For example, one disclosed embodiment provides, on a computing device, a method comprising receiving a notification of a current policy controversy, and sending information regarding the current policy controversy to each end user reviewer of a plurality of end user reviewers, each end user reviewer being a member of an enforcement federation of a plurality of enforcement federations. The method further comprises receiving enforcement decisions from one or more responding end user reviewers of the plurality of end user reviewers, and if the enforcement decisions received meet an enforcement threshold, then automatically enforcing a policy rule.