Two-Dimensional Shear Wave Elastography Versus Transient Elastography: A Non-Invasive Comparison for the Assessment of Liver Fibrosis in Patients With Chronic Hepatitis C

In recent years, several non-invasive methods have been developed for staging liver fibrosis in patients with chronic hepatitis C. A 2D-Shear wave elastography (SWE) technique has been recently introduced on the EPIQ 7 US system (ElastQ), but its accuracy has not been validated in patients with chronic hepatitis C virus (HCV) infection. We enrolled 178 HCV patients to assess their liver fibrosis stage with ElastQ software using transient elastography as a reference standard. The best cut-off values to diagnose ≥ F2, ≥ F3, and F4 were 8.15, 10.31, and 12.65 KPa, respectively. Liver stiffness values had a positive correlation with transient elastography (r = 0.57; p < 0.001). The area under the receiver operating characteristics (AUROC) was 0.899 for ≥ F2 (moderate fibrosis), 0.900 for ≥ F3 (severe fibrosis), and 0.899 for cirrhosis. 2D-SWE has excellent accuracy in assessing liver fibrosis in patients with chronic hepatitis C and an excellent correlation with transient elastograph

Risk of Statin-Induced Hypertransaminasemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: To assess the effect of statins compared with placebo on the risk of developing hypertransaminasemia. Patients and methods: We performed a systematic review of electronic databases and included articles published between January 1, 1965, and April 10, 2017. Randomized clinical trials (RCTs) comparing statins vs placebo were included. Odds ratios (ORs) were pooled in random-effect meta-analyses according to established methods recommended by the Cochrane Collaboration. Results: Seventy-three eligible RCTs, comprising 123,051 patients, were identified. Statins associated with a significantly risk of hypertransaminasemia (OR 1.45; 95% confidence interval [CI], 1.24-1.69; P<.001). Atorvastatin showed the highest odds (OR 2.66; 95% CI, 1.74-4.06; P<.001) followed by rosuvastatin (OR 1.35; 95% CI, 1.06-1.70; P=.01) and lovastatin (OR 1.53; 95% CI, 1.03-2.28; P=.04). Pravastatin, fluvastatin, and simvastatin yielded no statistically different odds compared with placebo. Conclusions: A dose-dependent risk of developing hypertransaminasemia occurs in patients taking atorvastatin, rosuvastatin, and lovastatin

DIRECT-ACTING antivirals restore systemic redox homeostasis in chronic HCV patients

Chronic hepatitis C therapy has completely changed in the last years due to the availability of direct-acting antivirals (DAAs). Removing the virus may be not enough since chronic infection deeply modifies immune system and cellular metabolism along decades of inflammation. Oxidative stress plays a significant role in maintaining systemic inflammation during chronic HCV infection. Other than removing the virus, effective therapy could counteract oxidative stress. This study investigated the impact of DAA treatment on circulating markers of oxidative stress and antioxidant defence in a cohort of patients affected by chronic hepatitis C. To this, an observational study on 196 patients who started therapy with DAA for HCV-related hepatitis was performed. Patients were assessed at baseline, 4 weeks after the initiation of therapy (4wks), at the end of treatment (EoT), and 12 weeks after the EoT (SVR12). Circulating oxidative stress was determined by measuring serum hydroxynonenal (HNE)- and malondialdehyde (MDA)-protein adducts, and 8-hydroxydeoxyguanosine (8-OHdG). Antioxidant status was evaluated by measuring the enzymatic activity and mRNA expression of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) in peripheral blood mononuclear cells. We observed a reduction of serum 8-OHdG at 4wks, while the circulating level of both HNE- and MDA-protein adducts diminished at EoT; all these markers persisted low at SVR12. On the other side, we reported an increase in the enzymatic activity of all the antioxidant enzymes in PBMC at EoT and SVR12. Taking into account circulating 8-OHdG and antioxidant enzyme activities, patients with high fibrosis stage were those that had the most benefit from DAA therapy. To conclude, this study indicates that treatment with DAAs improves the circulating redox status of patients affected by chronic hepatitis C. This positive impact of DAA therapy may be related to its effectiveness on cutting down viremia and pro-inflammatory markers

High prevalence of false positive SARS-CoV2 serology in a cohort of patients with liver autoimmune diseases

Aim Monitoring the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) immunization in patients with autoimmune diseases is of particular concern to understand their response to the infection and to the vaccine. In fact, the immunological disorder and the immunosuppressive therapies could affect the serological response. SARS-CoV2 serological tests potentially provide this information, although they were rapidly commercialized with internal verifications. Here, we analysed the seroprevalence to SARS-CoV2 in a cohort of patients with liver autoimmune diseases. Methods From May to December 2020, a cohort of patients affected by primary biliary cholangitis (PBC), autoimmune hepatitis (AIH) and PBC/AIH overlap syndrome were screened with (reverse transcription-polymerase chain reaction) RT-PCR of nasopharyngeal swabs, rapid antigenic test and chemiluminescent serological test during routine follow-up. Results The analysis of 42 patients was carried out: 18 (42.85%) PBC, 12 (28.57%) AIH and 12 (28.57%) PBC/AIH overlap syndromes. Only 2 patients (4.76%) resulted positive to the RNA, antigen and antibody detection tests, hence affected by SARS-CoV2 infection. 14 subjects out of 40 negative cases presented a positive serology for SARS-CoV2 antibodies, hence with a false positivity in the 35% of cases without infection. Among these, 6 (42.86%) patients presented only immunoglobulin (Ig)M positivity, 6 (42.86%) patients presented positivity for only IgG and 2 (14.28%) patients were positive to both IgM and IgG. Notably, the presence of autoantibodies did not correlate with the serological false positivity, highlighting that there is no cross-reactivity with autoantibodies. The presence of polyclonal hypergammaglobulinemia did not interfere with the serological test as well. Interestingly, the patients with false positive serology showed higher levels of gamma-glutamyltransferase (GGT) and C-reactive protein (CRP). Conclusions Patients with liver autoimmune diseases present a high rate of false positive SARS-CoV2 serology. Therefore, new strategies are needed to study the serological response in this patient category

BeppoSAX observations of PKS 0528+134

We report on the BeppoSAX observations of the gamma-ray blazar PKS 0528+134 performed in Feb and Mar 1997, during a multiwavelength campaign involving EGRET and ground based telescopes. The source was in a faint and hard state, with energy spectral index alpha=0.48+-0.04 between 0.1 and 10 keV, and [2-10] keV flux of 2.7E-12 erg/cm2/s. No significant variability was observed. The source was detected in the 20-120 keV band by the PDS, with a flux lying slightly above the extrapolation from lower X-ray energies. Comparing this low state with previous higher states of the source, there is an indication that the X-ray spectrum hardens and the gamma-ray spectrum steepens when the source is fainter.Comment: 4 pages, LateX, 5 figures (included). Uses espcrc2.sty and epsf.sty (included). To appear in The Active X-ray Sky: Results from BeppoSAX and Rossi-XTE, Rome, Italy, 21-24 October, 1997. Eds.: L. Scarsi, H. Bradt, P. Giommi and F. Fior

Valutazione del rischio NaTech in uno stabilimento che tratta sostanze esplosive

Gli eventi NaTech - Natural Hazard Triggering Technological Disasters sono incidenti tecnologici, come incendi, esplosioni e rilasci tossici, che si verificano all’interno di complessi industriali, lungo le vie di trasporto e le reti di distribuzione, a seguito di eventi naturali. Le catastrofi naturali sono una fonte diretta di rischio per le persone ed i beni materiali; nel caso di stabilimenti industriali l’impatto di questi eventi con gli impianti può determinare un incremento della frequenza e dell’intensità degli scenari incidentali. La gestione di un evento NaTech è una sfida complessa, che necessita di un’adeguata valutazione preliminare della suscettibilità dello stabilimento ai vari eventi naturali che possono verificarsi sul territorio su cui insiste e di piani di risposta e ripristino adeguati. La valutazione del rischio NaTech può essere condotta con metodi volti ad indicare quali impianti siano maggiormente vulnerabili, come si possano stimare la frequenza e le conseguenze dell’evento NaTech e quale sia l’influenza sul rischio delle misure di sicurezza applicabili. Lo scopo del presente lavoro di tesi è di effettuare una valutazione del rischio NaTech per un’azienda che detiene e produce sostanze esplosive. Il Capitolo 1, che ha carattere introduttivo, riporta considerazioni di carattere generale sul rischio NaTech ed illustra la struttura della tesi. Il Capitolo 2 presenta lo stabilimento e riporta un inquadramento territoriale del sito, mirato anche all’identificazione dei fenomeni naturali che sono maggiormente pericolosi per l’azienda. Il Capitolo 3 descrive le metodologie disponibili per la valutazione dei rischi NaTech dovuti a fulminazioni, terremoti ed alluvioni. Nel Capitolo 4 i metodi di valutazione dei rischi NaTech descritti nel Capitolo 3 sono applicati allo stabilimento descritto nel Capitolo 2. Il Capitolo 5 contiene le considerazioni conclusive relative allo studio effettuato e delinea alcuni possibili sviluppi futuri

A web-based simulation environment for techinical staff tutoring in computer network domain

This paper focuses on a WEB-based didactical simulation system that can be integrated in distance training and learning systems. In particular, our system refers to real systems that can be modelled by a discrete event system. Simulation systems are addressed to the phase of learning process called interactive phase. Learner has to study the theory related to a specific system and then uses the simulation system to solve exercises. Both learners and tutors are deeply involved in the solution we discuss. Tutor defines the model to be simulated using an interface, specifies each entity, their proprieties and relationships between them and sends it to the learner. Moreover tutor establishes some parameters that the learner can change. Learner receives an “exercise” from the system and interacts with it changing the behaviour of the entities and running the simulation. In such a way the system we introduce in this paper is a good answer to the need of advanced training and learning systems, by integrating simulation techniques to build exercises that stimulate and increase learner insight and his facility in facing real problems. The simulation system we discuss is part of InTraSys project (Esprit programme EP 29082, partially funded by EC). It is important to underline that it has been identified an application domain inside which this simulation system has been introduced. Namely we refer to hi-tech employees in the field of computer network and we use a java library (the simjava library) to implement all needed modules as briefly described in the following