Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests

Unlike for advanced liver fibrosis, the practical rules for the early non-invasive diagnosis of cirrhosis in NAFLD remain not well defined. Here, we report the derivation and validation of a stepwise diagnostic algorithm in 1568 patients with NAFLD and liver biopsy coming from four independent cohorts. The study algorithm, using first the elastography-based tests Agile3+ and Agile4 and then the specialized blood tests FibroMeterV3G and CirrhoMeterV3G, provides stratification in four groups, the last of which is enriched in cirrhosis (71% prevalence in the validation set). A risk prediction chart is also derived to allow estimation of the individual probability of cirrhosis. The predicted risk shows excellent calibration in the validation set, and mean difference with perfect prediction is only −2.9%. These tools improve the personalized non-invasive diagnosis of cirrhosis in NAFLD

Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)

Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described

Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests

AbstractUnlike for advanced liver fibrosis, the practical rules for the early non-invasive diagnosis of cirrhosis in NAFLD remain not well defined. Here, we report the derivation and validation of a stepwise diagnostic algorithm in 1568 patients with NAFLD and liver biopsy coming from four independent cohorts. The study algorithm, using first the elastography-based tests Agile3+ and Agile4 and then the specialized blood tests FibroMeterV3G and CirrhoMeterV3G, provides stratification in four groups, the last of which is enriched in cirrhosis (71% prevalence in the validation set). A risk prediction chart is also derived to allow estimation of the individual probability of cirrhosis. The predicted risk shows excellent calibration in the validation set, and mean difference with perfect prediction is only −2.9%. These tools improve the personalized non-invasive diagnosis of cirrhosis in NAFLD.</jats:p

Effects of BDNF polymorphism and physical activity on episodic memory in the elderly: a cross sectional study

International audienceBackground:The brain-derived neurotrophic factor (BDNF) concentration is highest in the hippocampus comparedwith that in other brain structures and affects episodic memory, a cognitive function that is impaired in olderadults. According to the neurotrophic hypothesis, BDNF released during physical activity enhances brain plasticity andconsequently brain health. However, even if the physical activity level is involved in the secretion of neurotrophin, thisprotein is also under the control of a specific gene. The aim of the present study was to examine the effect of theinteraction between physical activity and BDNF Val66Met(rs6265), a genetic polymorphism, on episodic memory.Methods:Two hundred and five volunteers aged 55 and older with a Mini Mental State Examination score≥24participated in this study. Four groups of participants were established according to their physical activity level andpolymorphism BDNF profile (Active Val homozygous, Inactive Val homozygous, Active Met carriers, Inactive Met carriers).Episodic memory was evaluated based on the delayed recall of the Logical Memory test of the MEM III battery.Results:As expected, the physical activity level interacted with BDNF polymorphism to affect episodic memoryperformance (p< .05). The active Val homozygous participants significantly outperformed the active Met carriers andinactive Val homozygous participants.Conclusion:This study clearly demonstrates an interaction between physical activity andBDNF Val66Metpolymorphismthat affects episodic memory in the elderly and confirms that physical activity contributes to the neurotrophic mechanismimplicated in cognitive health. The interaction shows that only participants with Val/Val polymorphism benefited fromphysical activit

Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management

PURPOSE: Providers’ communication skills play a key role in encouraging breast cancer survivors to report symptoms and adhere to long-term treatments such as adjuvant endocrine therapy (AET). The purpose of this study was to examine provider perspectives on patient-provider communication regarding AET symptom management and to explore whether provider perspectives vary across the multi-disciplinary team of providers involved in survivorship care. METHODS: We conducted three one-hour focus groups with a multi-disciplinary group of health care providers including oncology specialists, primary care physicians, and non-physician providers experienced in caring for breast cancer survivors undergoing AET (n = 13). Themes were organized using Epstein and Street’s (2007) Framework for Patient-Centered Communication in Cancer Care. RESULTS: The findings of this study suggest providers’ communication behaviors including managing survivors’ uncertainty, responding to survivors’ emotions, exchanging information, and enabling self-management influences the quality of patient-provider communication about AET symptoms. Additionally, lack of systematic symptom assessment tools for AET requires providers to use discretion in determining which symptoms to discuss with survivors resulting in approaches that vary based on providers’ discipline. CONCLUSION: There may be AET-specific provider communication skills and behaviors that promote effective patient-provider communication but additional research is needed to identify practices and policies that encourage these skills and behaviors among the many providers involved in survivorship care. Efforts are also needed to coordinate AET symptom assessment across providers, clarify providers’ roles in symptom assessment, and determine best practices for AET symptom communication