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Background: Transarterial chemoembolization (TACE) is widely used for hepatocellular carcinoma treatment but side effects hamper tolerance. Dexamethasone reduces TACE side effects in patients with viral hepatitis, but data regarding alcohol and metabolic liver diseases are lacking. We aimed to evaluate the efficacy of dexamethasone in preventing TACE-associated adverse events in European populations with predominantly alcoholic and metabolic cirrhosis., Methods: All cirrhotic patients undergoing TACE in our center between 2017 and 2021 were included. Dexamethasone was added to our protocol from 2019. Using a quasi-experimental study design, patients before and after introduction of dexamethasone in our procedure were compared. Factors associated with TACE adverse events were assessed by univariate and multivariate analysis. A sensitivity analysis was performed using propensity scores for covariate adjustment., Results: 234 patients undergoing 398 TACE procedure were included. Cirrhosis was predominantly of alcohol or metabolic etiology (86.7 %). Dexamethasone was administered in 99 procedures (24.9 %). Incidence of fever and encephalopathy at day 2 after TACE was lower in the Dexamethasone group (p < 0.001; p = 0.02 respectively). In multivariate analysis, dexamethasone was associated with lower occurrence of fever (OR=0.03; p < 0.001), lower analgesics use (OR=0.11; p = 0.002), milder liver and kidney function impairment (OR=0.98; p = 0.001 and OR=0.94; p < 0.001 for bilirubin and creatinine variation respectively). Propensity score-adjusted analyses yielded similar results., Conclusion: Dexamethasone improves TACE tolerance in a population of predominantly metabolic and alcohol cirrhosis., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Aims: The muscle retracting sign (MRS) can be present during endoscopic submucosal dissection (ESD) of macronodular colorectal lesions. The prevalence of MRS and its pathologic and clinical implications is unclear. This study evaluated the effect of MRS on the technical and clinical outcomes of ESD., Methods: All patients referred for ESD of protruding lesions or granular mixed lesions with >10 mm macronodule granular mixed laterally spreading tumors (LST-GMs) in 2 academic centers from January 2017 to October 2022 were prospectively included. Size of the macronodule was analyzed retrospectively. The primary outcome was the curative resection rate according to MRS status. Secondary outcomes were R0 resection, perforation, secondary surgery rate, and risk factors for MRS., Results: Of 694 lesions, 84 (12%) had MRS (MRS+). The curative resection rate was decreased by MRS (MRS+ 41.6% vs lesions without MRS [MRS-] 81.3%), whereas the perforation (MRS+ 22.6% vs MRS- 9.2%), submucosal cancer (MRS+ 34.9% vs MRS- 9.2%), and surgery (MRS+ 45.2% vs MRS- 6%) rates were increased. The R0 resection rate of MRS+ colonic lesions was lower than that of rectal lesions (53% vs 74.3%). In multivariate analysis, protruding lesions (odds ratio, 2.47; 95% confidence interval, 1.27-4.80) and macronodules >4 cm (odds ratio, 4.24; 95% confidence interval, 2.23-8.05) were risk factors for MRS., Conclusions: MRS reduces oncologic outcomes and increases the perforation rate. Consequently, procedures in the colon should be stopped if MRS is detected, and those in the rectum should be continued due to the morbidity of alternative therapy., Competing Interests: Disclosure The following authors disclosed financial relationships: J. Albouys: support for meeting from Amgen; consulting for Boston Scientific; remunerated lecture for Fujifilm; and ESD training for Erbe. M. Schaefer: Consultant for AbbVie; honoraria from Alfasigma, Boston Scientific, Duomed Endoscopy, Erbe Medical, Ferring, and Norgine; and meeting support from Boston Scientific, Cook, Cousin Endoscopy, Erbe, Ipsen, Janssen, Medtronic, Olympus, MSD, and Takeda R. Legros: training event for Pentax Medical, Fujifilm, Erbe, Olympus; and consulting for Boston Scientific. P. Leclercq: speaker fee and advisory board for Medtronic; speaker fee for Erbe; and travel grant from Olympus. M. Dahan: remunerated lecture for MSD; meeting support from Amgen; and training event for Fujifilm. A. Guyot: remunerated lecture for MSD. P. Carrier: consulting for AbbVie; support for meeting from Ipsen; and remunerated lecture for Gilead. V. Loustaud-Ratti: consulting for AbbVie and Gilead; and remunerated lecture for Ipsen. H. Lepetit: remunerated lecture for Fujifilm; and ESD training for Erbe. S. Geyl: remunerated lecture for AbbVie, Galapagos, and Ipsen; and support for meeting from Janssen and Takeda. T. Wallenhorst: training event for Fujifilm and Olympus; and support for meeting from AbbVie. M. Pioche: training event for Olympus, Fujifilm, and Viatris; and educational purposes for Boston Scientific, Olympus, Norgine, and AlfaSigma. J. Jacques: training event for Pentax Medical, Fujifilm, Erbe, and Olympus; and consulting for Boston Scientific. All other authors disclosed no financial relationships., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: To identify with children, parents and physicians the objectives to be used as parameters for algorithmic decision-making systems (ADMSs) adapting treatments in childhood asthma., Methods: We first conducted a qualitative study based on semi-structured interviews to explore the objectives that children aged 8-17 years, their parents, and their physicians seek to achieve when taking/giving/prescribing a treatment for asthma. Following the grounded theory approach, each interview was independently coded by two researchers; reconciled codes were used to assess code frequency, categories were defined, and the main objectives identified. We then conducted a quantitative study based on questionnaires using these objectives to determine how children/parents/physicians ranked these objectives and whether their responses were aligned., Results: We interviewed 71 participants (31 children, 30 parents and 10 physicians) in the qualitative study and identified seven objectives associated with treatment uptake and five objectives associated with treatment modalities. We included 291 participants (137 children, 137 parents, and 17 physicians) in the quantitative study. We found little correlation between child, parent, and physician scores for each of the objectives. Each child's asthma history influenced the choice of scores assigned to each objective by the child, parents, and physician., Conclusion: The identified objectives are quantifiable and relevant to the management of asthma in the short and long term. They can therefore be incorporated as parameters for future ADMS. Shared decision-making seems essential to achieve consensus among children, parents, and physicians when choosing the weight to assign to each of these objectives., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)