Valutazione della stiffness epato-splenica mediante Acoustic Radiation Force Impulse (ARFI) nella stadiazione delle epatopatie croniche

La valutazione non invasiva della fibrosi epatica costituisce un tema di ampio dibattito e di grande interesse nel campo dell'epatologia clinica. L'Acoustic radiation Force Impulse (ARFI) è una metodica elastometrica che può essere effettuata utilizzato alcuni ecografi di ultima generazione. Lo scopo del lavoro è quello di valutarne la capacità di stadiazione e il valore prognostico in una popolazione di pazienti affetti da malattia epatica cronica a diversa eziologia e gravità. Sono inoltre presentati dati inerenti allo studio e al monitoraggio dell'ipertensione portale attraverso l'utilizzo dell'elastometria splenica

Valutazione della stiffness epato-splenica mediante Acoustic Radiation Force Impulse (ARFI) nella stadiazione delle epatopatie croniche

La valutazione non invasiva della fibrosi epatica costituisce un tema di ampio dibattito e di grande interesse nel campo dell'epatologia clinica. L'Acoustic radiation Force Impulse (ARFI) è una metodica elastometrica che può essere effettuata utilizzato alcuni ecografi di ultima generazione. Lo scopo del lavoro è quello di valutarne la capacità di stadiazione e il valore prognostico in una popolazione di pazienti affetti da malattia epatica cronica a diversa eziologia e gravità. Sono inoltre presentati dati inerenti allo studio e al monitoraggio dell'ipertensione portale attraverso l'utilizzo dell'elastometria splenica

Epidemiology of primary biliary cholangitis in Italy: Evidence from a real-world database

Abstract Background Primary biliary cholangitis is an autoimmune disease affecting the interlobular bile ducts. Limited information is available on its epidemiology and treatment in Italy. Aims To describe primary biliary cholangitis epidemiology and investigate treatment patterns for Italian patients with this disease. Methods Electronic medical records from 900 general practitioners (part of the QuintilesIMS™ Longitudinal Patient Databases) were examined. Demographics were compared with those from the Italian National Institute of Statistics dataset. The International Classification of Diseases, Ninth Revision, biliary cirrhosis code 571.6 was used for diagnosis, and data on comorbidities, concomitant medications, medical examinations, specialist referrals, and treatments were collected. Results This dataset was representative of the Italian population. Point prevalence of primary biliary cholangitis was calculated as 27.90 per 100,000 and incidence as 5.31 per 100,000 inhabitants/year. Some associations between the disease and comorbidities were sex specific. The most common laboratory assays requested were for liver enzymes, and the majority of patients were not referred to a specialist. Ursodeoxycholic acid was the most common therapy. Conclusion This can be used as a benchmark for monitoring and identifying unmet needs to improve treatment in Italy

The human gut microbiota and virome: potential therapeutic implications

Human gut microbiota is a complex ecosystem with several functions integrated in the host organism (metabolic, immune, nutrients absorption, etc.). Human microbiota is composed by bacteria, yeasts, fungi and, last but not least, viruses, whose composition has not been completely described. According to previous evidence on pathogenic viruses, the human gut harbours plant-derived viruses, giant viruses and, only recently, abundant bacteriophages. New metagenomic methods have allowed to reconstitute entire viral genomes from the genetic material spread in the human gut, opening new perspectives on the understanding of the gut virome composition, the importance of gut microbiome, and potential clinical applications. This review reports the latest evidence on human gut "virome" composition and its function, possible future therapeutic applications in human health in the context of the gut microbiota, and attempts to clarify the role of the gut "virome" in the larger microbial ecosystem

Clinical Outcome of Third-Line Pazopanib in a Patient with Metastatic Renal Cell Carcinoma

Background. Renal cell carcinoma accounts for about 2-3% of all malignant tumors. The prevalence of brain metastases from RCC is less than 20% of cases. Traditionally, whole brain radiotherapy as well as the latest stereotactic radiosurgery improves both survival and local tumor control. These treatments also allow stabilization of clinical symptomatology. However, validated treatment guidelines for RCC patients with brain metastases are not yet available on account of the frequent exclusion of such patients from clinical trials. Moreover, limited data about the sequential use of three therapies, changing the class of agent, have been published up to now. Case Report. We report the case of a patient with metastatic RCC who developed disease progression after sunitinib and everolimus as first-line and second-line therapy, respectively. Thus, he underwent a multimodality treatment with pazopanib, as third-line therapy, to control systemic disease and radiosurgery directed on the new brain metastasis. To date, the patient is still receiving pazopanib, with progression-free survival and overall survival of 43 and 103 months, respectively. Conclusion. In a context characterized by different emerging options, with no general consensus on the optimal treatment strategy, the use of pazopanib in pretreated patients could be a suitable choice

Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy

In patients with renal cancer, brain metastasis is associated with poor survival and high morbidity. Poor life expectancy is often associated with widespread extracranial metastases. In such patients, a multidisciplinary approach is paramount. Brain metastases-specific therapies may include surgery, radiosurgery, conventional radiation and targeted therapies (TT) or a combination of these treatments. Some factors are important prognostically when choosing the best strategy: performance status, the number, size and location of brain metastases, the extension of systemic metastases and a well-controlled primary tumour. Failure of chemical therapy has always been attributed to an intact blood-brain barrier and acquired drug resistance by renal cancer cells. Recent studies have demonstrated objective responses with TT in a variety of cancer types, including renal cancer. In most cases, these agents have been used in combination and in conjunction with whole-brain radiation therapy and radiosurgery. Local control appears to be better with the combined method if the patient has a good performance status and may improve overall survival. This review summarizes current literature data on multidisciplinary approach in the management of renal brain metastasis with radiation, surgery and TT with an emphasis on potential better outcomes with a combination of current treatment methods