Monocentric prospective study for the evaluation of the role of hepato-splenic elastometry as a predictor of the onset of hepatocarcinoma in patients with liver cirrhosis.

Introduzione Nell'ambito della storia naturale della cirrosi epatica, il carcinoma epatocellulare (CE) è una complicazione dell’ipertensione portale (PH). Recenti dati sperimentali correlano valori elevati di misurazione del gradiente pressorio venoso epatico (HVPG), metodica invasiva, con un aumentato rischio di sviluppare CE, indipendentemente dalla gravità della cirrosi. Recentemente, la misurazione della rigidità (stiffness) del fegato (LSM) e della milza (SSM), valutata utilizzando mediante l’utilizzo dell'elastografia transiente (TE, Fibroscan®, Parigi, Francia) sono state proposte come test non invasivo per la valutazione dell'ipertensione del portale. Attualmente vi sono solo dati riguardanti il ruolo prognostico di LSM nei confronti dello sviluppo di CE, mentre non vi sono dati riguardanti il ruolo prognostico della SSM. Scopo dello studio Scopo dello studio è la valutazione del ruolo dell’elastometria epato-splenica come predittore di insorgenza di epatocarcinoma in pazienti con cirrosi epatica Metodi Abbiamo arruolato consecutivamente e prospetticamente tra il 2012 e il 2016 pazienti con malattia epatica compensata avanzata cronica che afferivano presso il nostro Dipartimento e senza pregressa diagnosi di CE. Abbiamo seguito i pazienti per almeno 12 mesi o fino alla chiusura dello studio. Abbiamo eseguito un’analisi uni- e multivariata al fine di valutare il ruolo predittivo dei test non invasivi studiati per lo sviluppo di CE. Risultati Abbiamo arruolato in modo prospettico 140 pazienti, di cui 92 pazienti sono stati valutati per lo studio; tra questi 21 pazienti hanno sviluppato CE. L’età (HR 1.076, p = 0.018, CI 1.026-1.128) e la misurazione della rigidità della milza (HR 1.035, p = 0.037, CI 1.002-1.068) sono predittori indipendenti di sviluppo di CE. Conclusioni Nella nostra popolazione l’età e la misurazione della rigidità della milza (SSM) del paziente sono gli unici predittori dello sviluppo di CE, essendo quest’ultima direttamente correlata al grado di malattia epatica e ipertensione portale, entrambi coinvolti nella carcinogenesi.Background Hepatocellular carcinoma (HCC) is a further complication of portal hypertension (PH) in the natural history of liver cirrhosis. Recent experimental data correlate the hepatic venous pressure gradient (HVPG), a method both invasive and risky, with the risk of HCC. Recently, liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), using transient elastography (TE, Fibroscan®, Paris, France) have been proposed as non-invasive tools(NITs) for the evaluation of PH. To date, only data reporting the prognostic role of LSM for HCC development are available, while there are no data for SSM. Aim To evaluate the role of LSM and SSM as predictors of the onset of HCC in patients with liver cirrhosis. Methods We consecutively and prospectively enrolled patients with chronic advanced compensated liver disease referring to our Department without prior diagnosis of HCC between 2012 and 2016. We followed up patients for at least 12 months or until the study ending. We performed a univariate and multivariate analysis in order to evaluate the predictive role of NITs for the development of HCC. Results We prospectively enrolled 140 patients of whom 92 patients were suitable for the study. Among them, 21 patients developed HCC. Age (HR 1.076, p = 0.018, CI 1.026-1.128) and SSM (HR 1.035, p = 0.037, CI 1.002-1.068) were independent predictors of development of HCC. Conclusions In our population, the age and the spleen stiffness measurement (SSM) of the patient are the only predictors for the development of HCC, the latter correlated to the degree of severity of liver disease and portal hypertension, both involved in carcinogenesis

Prognostic role of nutritional status in elderly patients hospitalized for COVID-19: a monocentric study

BackgroundSymptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection incidence is higher in the elderly patients. Pre-existing geriatric conditions such as comorbidity and frailty seem related to worse hospital outcomes.AimsTo assess the role of nutritional status as an independent prognostic factor for in-hospital death in elderly patients.MethodsConsecutive elderly patients (age > 65 years) hospitalized for novel coronavirus disease (COVID-19) were enrolled. Demographics, laboratory and comorbidity data were collected. Nutritional status was evaluated using the Geriatric Nutri-tional Risk Index (GNRI). Uni- and multivariate Cox regression analyses to evaluate predictors for in-hospital death were performed.ResultsOne hundred and nine hospitalized elderly patients (54 male) were consecutively enrolled. At univariate analysis, age (HR 1.045 [CI 1.008\u20131.082]), cognitive impairment (HR 1.949 [CI 1.045\u20133.364]), C-reactive protein (HR 1.004 [CI 1.011\u20131.078]), lactate dehydrogenases (HR 1.003 [CI 1.001\u20131.004]) and GNRI moderate\u2013severe risk category (HR 8.571 [CI 1.096\u201367.031]) were risk factors for in-hospital death, while albumin (HR 0.809 [CI 0.822\u20130.964]), PaO2/FiO2 ratio (HR 0.996 [CI 0.993\u20130.999]) and body mass index (HR 0.875 [CI 0.782\u20130.979]) were protective factors. Kaplan\u2013Meier survival curves showed a significative higher survival in patients without GNRI moderate or severe risk category (p = 0.0013).At multivariate analysis, PaO2/FiO2 ratio (HR 0.993 [CI 0.987\u20130.999], p = 0.046) and GNRI moderate\u2013severe risk category (HR 9.285 [1.183\u201372.879], p = 0.034) were independently associated with in-hospital death.ConclusionNutritional status assessed by GNRI is a significative predictor of survival in elderly patients hospitalized for COVID-19. The association between GNRI and PaO2/FiO2 ratio is a good prognostic model these patients

Pathophysiology and Clinical Management of Bile Acid Diarrhea

Bile acid malabsorption (BAM) represents a common cause of chronic diarrhea whose prevalence is under-investigated. We reviewed the evidence available regarding the pathophysiology and clinical management of bile acid diarrhea (BAD). BAD results from dysregulation of the enterohepatic recirculation of bile acids. It has been estimated that 25-33% of patients with functional diarrhea and irritable bowel syndrome with diarrhea have BAM. Currently, the selenium homotaurocholic acid test is the gold standard for BAD diagnosis and severity assessment. However, it is an expensive method and not widely available. The validation of the utility in the clinical practice of several other serum markers, such as 7 alpha-hydroxy-4-cholesten-3-one (C4) and the fibroblast growth factor 19 (FGF19) is ongoing. The first-line treatment of patients with BAD is bile acid sequestrants. Patients that are refractory to first-line therapy should undergo further diagnostics to confirm the diagnosis and to treat the underlying cause of BAD. An early and correct diagnosis of BAD would improve patient's quality of life, avoiding additional diagnostic tests that burden health care systems. Considering the limited availability and tolerability of specific medications for BAD treatment, future research is awaited to identify other therapeutic approaches, such as gut microbiota modulating therapies

Bio-Inspired Dielectric Resonator Antenna for Wideband Sub-6 GHz Range

Through the years, inspiration from nature has taken the lead for technological development and improvement. This concept firmly applies to the design of the antennas, whose performances receive a relevant boost due to the implementation of bio-inspired geometries. In particular, this idea holds in the present scenario, where antennas working in the higher frequency range (5G and mm-wave), require wide bandwidth and high gain; nonetheless, ease of fabrication and rapid production still have their importance. To this aim, polymer-based 3D antennas, such as Dielectric Resonator Antennas (DRAs) have been considered as suitable for fulfilling antenna performance and fabrication requirements. Differently from numerous works related to planar-metal-based antenna development, bio-inspired DRAs for 5G and mm-wave applications are at their beginning. In this scenario, the present paper proposes the analysis and optimization of a bio-inspired Spiral shell DRA (SsDRA) implemented by means of Gielis' superformula, with the goal of boosting the antenna bandwidth. The optimized SsDRA geometrical parameters were also determined and discussed based on its fabrication feasibility exploiting Additive Manufacturing technologies. The results proved that the SsDRA provides relevant bandwidth, about 2 GHz wide, and satisfactory gain (3.7 dBi and 5 dBi, respectively) at two different frequencies, 3.5 GHz and 5.5 GHz

Liver collision lesion: inflammatory hepatocellular adenoma within focal nodular hyperplasia

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Pre-supernova stellar feedback in nearby starburst dwarf galaxies

Context. Stellar feedback in dwarf galaxies remains, to date, poorly explored, yet is crucial to understanding galaxy evolution in the early Universe. In particular, pre-supernova feedback has recently been found to play a significant role in regulating and disrupting star formation in larger spiral galaxies, but it remains uncertain if it also plays this role in dwarfs.Aims. We study the ionised gas properties and stellar content of individual star-forming regions across three nearby, low-metallicity (12 + log(O/H)∼7.5), dwarf (M* ∼ 40 × 106 M⊙), starburst (log(SFR)∼ − 2.8) galaxies (J0921, KKH046, and Leo P) to investigate how massive stars influence their surroundings and how this influence changes as a function of environment.Methods. We extracted integrated spectra of 30 HII regions from archival VLT/MUSE integral field spectroscopic observations of these three dwarf starburst galaxies. We fitted the HII regions’ main emission lines with Gaussian profiles to derive their oxygen abundances, electron densities, and luminosities, and we used the Stochastically Lighting Up Galaxies (SLUG) code to derive the stellar mass, age, and bolometric luminosity of the stellar populations driving the HII regions. We quantified two pre-supernova stellar feedback mechanisms, namely the direct radiation pressure and photoionisation feedback, and explored how feedback strength varies with HII region properties.Results. Our findings suggest that stellar feedback has less of an impact on evolved regions, with both the pressure of the ionised gas and the direct radiation pressure decreasing as a function of HII region size (i.e. the evolutionary stage). We find that these stellar feedback mechanisms are also dependent on the metallicity of the HII regions. These findings extend results from stellar feedback studies of more massive star-forming galaxies to the low-mass, low-metallicity regime. In addition, we conclude that the use of stochastic stellar population models significantly affects the relationships found between feedback-related pressure terms and HII region properties, and in particular that non-stochastic models can severely underestimate the bolometric luminosity of low-mass stellar populations

Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis

The burden of post-operative complications of patients undergoing liver resection for hepatocellular carcinoma (HCC) is a cause of morbidity and mortality. Recently, sarcopenia has been reported to influence the outcome of patients with cirrhosis. We aimed to assess factors associated with sarcopenia and its prognostic role in liver surgery candidates. We included all patients with compensated advanced chronic liver disease (cACLD) undergoing liver resection for primary HCC consecutively referred to the University of Bologna from 2014 to 2019 with an available preoperative abdominal CT-scan performed within the previous three months. A total of 159 patients were included. The median age was 68 years, and 80.5% of the patients were male. Sarcopenia was present in 82 patients (51.6%). Age and body mass index (BMI) were associated with the presence of sarcopenia at multivariate analysis. Thirteen (8.2%) patients developed major complications and 14 (8.9%) presented PHLF grade B-C. The model for end-stage liver disease score was associated with the development of major complications, whereas cACLD presence, thrombocytopenia, portal hypertension (PH), Child-Pugh score and Albumin-Bilirubin score were found to be predictors of clinically significative PHLF. The rate of major complications was 11.8% in sarcopenic patients with cACLD compared with no complications (0%) in patients without sarcopenia and cACLD (p = 0.032). The rate of major complications was significantly higher in patients with (16.3%) vs. patients without (0%) sarcopenia (p = 0.012) in patients with PH. In conclusion, sarcopenia, which is associated with age and BMI, may improve the risk stratification of post-hepatectomy major complications in patients with cACLD and PH

Liver Stiffness Measurement Allows Early Diagnosis of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome in Adult Patients Who Undergo Hematopoietic Stem Cell Transplantation: Results from a Monocentric Prospective Study

ABSTRACT Veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is a life-threatening complication affecting patients undergoing hematopoietic stem cell transplantation (HSCT). The survival rate is higher when specific therapy is initiated early; thus, improving early, noninvasive diagnosis of VOD/SOS is an important need. In an adult population undergoing HSCT, we aimed to assess the role of liver stiffness measurement (LSM), evaluated by transient elastography (TE), for diagnosing VOD/SOS. Between April 2016 and March 2018, 78 consecutive adult patients with indications for allogeneic HSCT were prospectively included. LSM was performed before HSCT and at days +9/10, +15/17, and +22/24 post-HSCT. New European Society for Blood and Marrow Transplantation criteria were used to establish VOD/SOS diagnosis. Four patients developed VOD/SOS (5.1%) during the study period, with a median time of +17 days post-HSCT. A sudden increase in LSM compared with previously assessed values and pre-HSCT values, was seen in all patients who developed VOD/SOS. LSM increases occurred from 2 to 12 days before clinical SOS/VOD appearance. The VOD/SOS diagnostic performance of increased LSM over pre-HSCT assessment showed an area under the receiver operating characteristic curve of 0.997 (sensitivity 75%; specificity 98.7%). LSM gradually decreased following successful VOD/SOS-specific treatment. Interestingly, LSM values did not increase significantly in patients experiencing hepatobiliary complications (according to the Common Terminology Criteria) other than VOD/SOS. LSM by TE can be considered a promising method to perform an early, preclinical diagnosis and follow-up of VOD/SOS

Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP)

The irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction. IBS is still associated with areas of uncertainties, especially regarding the optimal diagnostic work-up and the more appropriate management. Experts from 7 Italian Societies conducted a Delphi consensus with literature summary and voting process on 27 statements. Recommendations and quality of evidence were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was defined as >80% agreement and reached for all statements.In terms of diagnosis, the consensus supports a positive diagnostic strategy with a symptom-based approach, including the psychological comorbidities assessment and the exclusion of alarm symptoms, together with the digital rectal examination, full blood count, C- reactive protein, serology for coeliac disease, and fecal calprotectin assessment. Colonoscopy should be recommended in patients with alarm features. Regarding treatment, the consensus strongly supports a dietary approach for patients with IBS, the use of soluble fiber, secretagogues, tricyclic antidepressants, psychologically directed therapies and, only in specific IBS subtypes, rifaximin. A conditional recommendation was achieved for probiotics, polyethylene glycol, antispasmodics, selective serotonin reuptake inhibitors and, only in specific IBS subtypes, 5-HT3 antagonists, 5-HT4 agonists, bile acid sequestrants