Years of life that could be saved from prevention of hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. AIM: To assess how many years of life are lost after HCC diagnosis. METHODS: Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. RESULTS: Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour 65 2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. CONCLUSIONS: Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost

Selection of rendezvous sites and reuse of pup raising areas among wolves <i>Canis lupus</i> of north-eastern Apennines, Italy

A coarse scale analysis was carried out of factors affecting rendezvous site selection and fidelity to pup raising areas in wolf Canis lupus Linnaeus, 1758 packs inhabiting the north eastern Apennines, Italy. From 1993 to 2004, 44 rendezvous sites were identified, and compared with random sites for variables related to topography, habitat, and human presence. Rendezvous sites were significantly more frequent inside protected areas and at a significantly greater distance from paved roads and villages than random sites. Moreover, they were located on a significantly steeper slope and at a higher absolute elevation than random sites, whereas we did not observe selection of a particular aspect. Deciduous forests were selected, whereas open areas were not used. Canopy cover above 70% was positively selected. Distance from protected areas border and paved roads, and presence of deciduous forest proved the main factors affecting rendezvous site distribution. In four cases we observed the reuse of the same rendezvous sites for two consecutive years. Some packs tended to locate their rendezvous sites in small portions of their territory, thus implying that some areas are more suitable for pup raising

Treatment with aromatase inhibitors and markers of cardiovascular disease

Purpose: The cardiovascular effects of estrogen deprivation induced by aromatase inhibitors are unknown. We carried out a cross-sectional study to evaluate the effect of estrogen deprivation induced by aromatase inhibitors on markers of cardiovascular risk. Methods: We enrolled 410 postmenopausal women: 200 consecutive breast cancer patients treated with aromatase inhibitors for a median of 53\uc2&nbsp;months (range 23\ue2\u80\u93122) and 210 volunteer controls. Carotid intima-media thickness, presence of carotid stenosis, and presence of abdominal aortic aneurism were evaluated through an ultrasound examination. Results: Average carotid intima-media thickness was 0.97\uc2&nbsp;\uc2\ub1\uc2&nbsp;0.02\uc2&nbsp;mm and 1.08\uc2&nbsp;\uc2\ub1\uc2&nbsp;0.02\uc2&nbsp;mm for breast cancer group and control group, respectively (p\uc2&nbsp

Il profilo dello stato nutrizionale in pazienti “grandi anziani” (≥ 80 anni ospedalizzati

Per introdurre sistematicamente scale di valutazione dei problemi dei pazienti geriatrici (valutazione dello stato nutrizionale, delle funzioni cognitive e del profilo generale di rischio, nelle UO di medicina generale e lungodegenza, è stato attivato uno studio osservazionale che ha consentito l’identificazione dei pazienti a rischio. Metodi. I dati sono stati raccolti su 198 degenti, per 5 mesi. Risultati. L’età media dei pazienti era di 86.6 anni (range 80-99). Non è stato possibile raccogliere alcuni dati (ad esempio un calo ponderale nei tre mesi precedenti il ricovero) per 54 pazienti: avevano tutti >90 anni. Il 49% dei pazienti avevano un livello elevato di dipendenza ed il 30% erano gravemente malnutriti (la malnutrizione era prevalente tra i pazienti oncologici). Dei 19 pazienti morti durante lo studio, 6 erano malnutriti, 6 a rischio e per 6 non è stato possibile effettuare una valutazione completa. Discussione. È ampiamente riconosciuto il valore prognostico di un calo ponderale nei precedenti 6 mesi, però questa informazione non è sempre facilmente ricavabile nei pazienti geriatrici. La raccolta di dati sullo stato nutrizionale consente di identificare i pazienti che hanno bisogno di una stretta sorveglianza e dell’applicazione di interventi preventivi

Effect of SARS-CoV-2 mRNA vaccination in MS patients treated with disease modifying therapies

Background: In patients with Multiple Sclerosis (pwMS) disease-modifying therapies (DMTs) affects immune response to antigens. Therefore, post-vaccination serological assessments are needed to evaluate the effect of the vaccine on SARS-CoV-2 antibody response.Methods: We designed a prospective multicenter cohort study enrolling pwMS who were scheduled for SARS-Cov-2 vaccination with mRNA vaccines (BNT162b2, Pfizer/BioNTech,Inc or mRNA-1273, Moderna Tx, Inc). A blood collection before the first vaccine dose and 4 weeks after the second dose was planned, with a centralized serological assessment (electrochemiluminescence immunoassay, ECLIA, Roche-Diagnostics). The log-transform of the antibody levels was analyzed by multivariable linear regression.Findings: 780 pwMS (76% BNT162b2 and 24% mRNA-1273) had pre- and 4-week post-vaccination blood assessments. 87 (11.2%) were untreated, 154 (19.7%) on ocrelizumab, 25 (3.2%) on rituximab, 85 (10.9%) on fingolimod, 25 (3.2%) on cladribine and 404 (51.7%) on other DMTs. 677 patients (86.8%) had detectable post-vaccination SARS-CoV-2 antibodies. At multivariable analysis, the antibody levels of patients on ocrelizumab (201-fold decrease (95%CI=128-317), p &lt; 0.001), fingolimod (26-fold decrease (95%CI=16-42), p &lt; 0.001) and rituximab (20-fold decrease (95%CI=10-43), p &lt; 0.001) were significantly reduced as compared to untreated patients. Vaccination with mRNA-1273 resulted in a systematically 3.25-fold higher antibody level (95%CI=2.46-4.27) than with the BNT162b2 vaccine (p &lt; 0.001). The antibody levels on antiCD20 therapies correlated to the time since last infusion, and rituximab had longer intervals (mean=386 days) than ocrelizumab patients (mean=129 days).Interpretation: In pwMS, anti-CD20 treatment and fingolimod led to a reduced humoral response to mRNA-based SARS-CoV-2 vaccines. As mRNA-1273 elicits 3.25-higher antibody levels than BNT162b2, this vaccine may be preferentially considered for patients under anti-CD20 treatment or fingolimod. Combining our data with those on the cellular immune response to vaccines, and including clinical follow-up, will contribute to better define the most appropriate SARS-CoV-2 vaccine strategies in the context of DMTs and MS. Funding: FISM[2021 /Special-Multi/001]; Italian Ministry of Health 'Progetto Z844A 5 x 1000'. (C) 2021 The Authors. Published by Elsevier B.V