Sources of Variability in the Use of Standardized Perfusion Value for HCC Studies

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The Role of Immunotherapy in a Tolerogenic Environment: Current and Future Perspectives for Hepatocellular Carcinoma

In contrast to several tumors whose prognoses are radically affected by novel immunotherapeutic approaches and/or targeted therapies, the outcomes of advanced hepatocellular carcinoma (HCC) remain poor. The underlying cirrhosis that is frequently associated with it complicates medical treatment and often determines survival. The landscape of HCC treatment had included sorafenib as the only drug available for ten years, until 2018, when lenvatinib was approved for treatment. The second-line systemic treatments available for hepatocellular carcinoma include regorafenib, cabozantinib, ramucirumab, and, more recently, immune checkpoint inhibitors. However, the median survival remains below 15 months. The results obtained in clinics should be interpreted whilst considering the peculiar role of the liver as an immune organ. A healthy liver microenvironment ordinarily experiences stimulation by gut-derived antigens. This setup elucidates the response to chronic inflammation and the altered balance between tolerance and immune response in HCC development. This paper provides an overview of the mechanisms involved in HCC pathogenesis, with a special focus on the immune implications, along with current and future clinical perspectives

A proposal of a new index to guide planning replacement of fume hoods.

Decisions to replace medical and in vitro diagnostic medical devices are often subjective, based largely on perception rather than factual data. In this work we developed a model recommending and prioritizing fume hoods replacement. A group of attribute and subattribute were chosen and weighted (using Saaty’s theory) to obtain a numerical output (Replacement Priority Value-RPV). This model is applied to simulated data. Results confirm that RPV is a reliable index that can be used to guide planning replacement of fume hoods

Reliability of perfusion maps in HCC patients

Evaluation of quantitative parameters about tumour perfusion, such as arterial blood flow (BFa), by CT perfusion is gaining acceptance in clinical applications. ROI based analysis can be considered the gold standard technique to derive quantitative parameters, although it does not allow to depict the heterogeneous vascularisation of tumour tissue. On the contrary, pixel by pixel analysis, which has this potentiality,leads only to qualitative depiction of tumour perfusion by means of colour scale since still lacks of robust processing methods. In this work, we propose an algorithm for parametric estimation (pixel by pixel) of BFa values and used it for the analysis of a group of seventeen patients with primary liver tumour. Then, we compared obtained BFa values with those estimated by a ROI based approach, by using the same image processing, to investigate the reliability of parametric maps computed with the algorithm developed

Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review

The efficacy of mandibular advancement devices (MADs) in the treatment of obstructive sleep apnea (OSA) ranges between 42% and 65%. However, it is still unclear which predictive factors can be used to select suitable patients for MAD treatment. This study aimed to systematically review the literature on the predictive value of cephalometric analysis for MAD treatment outcomes in adult OSA patients

Diagnostic accuracy of screening questionnaires for obstructive sleep apnea in children: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated the diagnostic accuracy of screening questionnaires for pediatric obstructive sleep apnea (OSA). Studies comparing any questionnaire with polysomnography for OSA detection in subjects aged ≤18 y were considered eligible for qualitative analysis. The quality assessment of diagnostic accuracy studies (QUADAS-2) tool was used for bias assessment. Only questionnaires adopted by at least four studies using the currently accepted diagnostic threshold of apnea-hypopnea index (AHI) ≥1 were included for further selective quantitative analyses. A bivariate meta-analysis was performed to calculate sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio; summary receiver operator characteristic curves were constructed. 37 studies (20 questionnaires) were eligible for qualitative analysis; none were considered of low quality. Among these articles, 13 studies and two questionnaires (sleep-related breathing disorder scale of the pediatric sleep questionnaire (SRBD-PSQ) and OSA-18) satisfied the criteria for quantitative synthesis. SRBD-PSQ had higher sensitivity (0.76) than OSA-18 (0.56), while OSA-18 exhibited higher specificity (0.73) than SRBD-PSQ (0.43). SRBD-PSQ performed well and was the most sensitive screening questionnaire using the diagnostic threshold of AHI ≥1 for pediatric OSA. However, further well-designed studies are still required to assess the role of SRBD-PSQ in real-world clinical population

Large defect-tailored composite scaffolds for in vivo bone regeneration

The discovery of new strategies to repair large segmental bone defects is currently an open challenge for worldwide clinicians. In the treatment of critical-sized bone defects, an alternative strategy to traditional bone grafting is always more frequently the use of tailor-made scaffolds modelled on the final size and shape of the implant site. Here, poly-ε-caprolactone-based composite scaffolds including poly-L-lactic acid continuous fibres and hyaluronan derivates (i.e. HYAFF11®) have been investigated for the peculiar 3D architecture characterized by interconnected macroporous networks and tunable mechanical properties. Composite scaffolds were immersed in simulated body fluid solution in order to support in vivo tissue in-growth. Scaffolds loaded with autologous cells (bone marrow stromal cells) plus platelet-rich plasma and osteoconductive protein such bone morphogenetic protein-7 were also tested to evaluate eventual enhancement in bone regeneration. The morphological and mechanical properties of poly-L-lactic acid-reinforced composite scaffolds have been studied to identify the optimal scaffold design to match the implant-site requirements of sheep metatarsal defects. Dynamic mechanical tests allowed to underline the viscoelastic response of the scaffold - resulting in elastic moduli from 2.5 to 1.3 MPa, suitable to temporarily support the structural function of damaged bone tissue. In vivo preliminary investigations in a sheep model of metatarsus shaft defect also showed the attitude of the scaffold to promote osteogenesis, preferentially in association with bone marrow stromal cell and platelet-rich plasma, even if the highest amount of mature bone was reached in the case of scaffold loaded with human bone morphogenetic protein-7 released via hydrolytic degradation of HYAFF11® phases in the implant site

Factors Enhancing Treatment of Hepatitis C Virus–Infected Italian People Who Use Drugs: The CLEO-GRECAS Experience

We assessed the performance of direct-acting antivirals (DAAs) in hepatitis C virus (HCV)-infected people who use drugs (PWUDs) in terms of sustained virological response (SVR) and adherence rates in comparison to a location-matched cohort of non-PWUD HCV patients

Factors Enhancing Treatment of Hepatitis C Virus-Infected Italian People Who Use Drugs: The CLEO-GRECAS Experience

We assessed the performance of direct-acting antivirals (DAAs) in hepatitis C virus (HCV)-infected people who use drugs (PWUDs) in terms of sustained virological response (SVR) and adherence rates in comparison to a location-matched cohort of non-PWUD HCV patients