How to Distinguish between Alcoholic and Non-Alcoholic Liver Disease?

Jedan od najčešćih etioloških čimbenika jetrene lezije gotovo u svim dijelovima svijeta i dalje je alkohol. Konzumacija alkohola u brojnim je društvima opće prihvaćeni i često nezaobilazni dio različitih socijalnih zbivanja, dio je kulture i načina ophođenja, što alkohol u svijetu stavlja među vodeće uzročnike mortaliteta i morbiditeta. Bilo da govorimo o svakodnevnoj konzumaciji ili periodičnom ispijanju veće količine alkohola, njegov se hepatotoksični učinak očituje nizom kliničkih i patohistoloških slika od steatoze, alkoholnog hepatitisa, pa sve do razvoja fibroze i ciroze jetre. Postavljanje dijagnoze alkoholne bolesti jetre (engl. alcoholic liver disease, ALD) i dalje predstavlja izazov jer ne postoje dijagnostički parametri kojima bi se bolest potvrdila ili isključila, već se ista temelji na anamnestičkim podacima o kroničnoj konzumaciji alkohola i isključnim kriterijima drugih mogućih etioloških uzročnika jetrene lezije. Kombinacija specifičnih biomarkera može govoriti u prilog ALD-u, no kako bismo razlučili radi li se o alkoholnoj ili nealkoholnoj bolesti jetre, obrada mora biti usmjerena na isključivanje virusnih, imunoloških, metaboličkih bolesti i morfoloških promjena jetrenog parenhima. U posljednjih nekoliko godina raste incidencija nealkoholne masne bolesti jetre (engl. non-alcoholic fatty liver disease, NAFLD), entiteta koji patohistološkim spektrom i kliničkim tijekom nalikuje ALD-u, a koji se smatra jetrenom prezentacijom metaboličkog sindroma. Budući da količina ispijenog alkohola čini temeljnu razliku između ALD-a i NAFLD-a, do dijagnoze je danas ponekad teže doći zbog porasta broja oboljelih s prekomjernom tjelesnom težinom i drugim elementima metaboličkog sindroma, a koji konzumiraju veće količine alkohola.Alcohol is still one of the most common etiologic factors of liver injury in nearly every part of the world. In many societies alcohol consumption is generally accepted and often an indispensable part of various social events, practically integrated into human culture, making alcohol one of the leading causes of mortality and morbidity in the world. Whether we are talking about daily consumption or periodic intake of a large amount of alcohol, its hepatotoxic effect is manifested by a series of clinical and histopathological features ranging from steatosis and alcoholic hepatitis to liver fibrosis and cirrhosis. Diagnosing alcoholic liver disease (ALD) remains a challenge, as there are no diagnostic parameters to confirm or exclude the disease, and the diagnosis is mainly based on anamnestic data on chronic alcohol consumption and the exclusion of other possible etiologic agents of liver injury. The combination of specific biomarkers may be an indication of ALD, but in order to distinguish whether it is a case of alcoholic or non-alcoholic liver disease, diagnostic workup must be aimed at excluding viral, autoimmune and metabolic diseases, as well as morphological changes in hepatic parenchyma. Over the last few years, we have been witnessing an increase in the incidence of non-alcoholic fatty liver disease (NAFLD), an entity considered hepatic manifestation of metabolic syndrome whose histopathological spectrum and clinical course resemble ALD. Since the fundamental difference between ALD and NAFLD is in the amount of alcohol consumed, correct diagnosis is sometimes more difficult to reach due to a growing number of overweight patients with other metabolic syndrome elements who consume large amounts of alcohol

How to Distinguish between Alcoholic and Non-Alcoholic Liver Disease?

Jedan od najčešćih etioloških čimbenika jetrene lezije gotovo u svim dijelovima svijeta i dalje je alkohol. Konzumacija alkohola u brojnim je društvima opće prihvaćeni i često nezaobilazni dio različitih socijalnih zbivanja, dio je kulture i načina ophođenja, što alkohol u svijetu stavlja među vodeće uzročnike mortaliteta i morbiditeta. Bilo da govorimo o svakodnevnoj konzumaciji ili periodičnom ispijanju veće količine alkohola, njegov se hepatotoksični učinak očituje nizom kliničkih i patohistoloških slika od steatoze, alkoholnog hepatitisa, pa sve do razvoja fibroze i ciroze jetre. Postavljanje dijagnoze alkoholne bolesti jetre (engl. alcoholic liver disease, ALD) i dalje predstavlja izazov jer ne postoje dijagnostički parametri kojima bi se bolest potvrdila ili isključila, već se ista temelji na anamnestičkim podacima o kroničnoj konzumaciji alkohola i isključnim kriterijima drugih mogućih etioloških uzročnika jetrene lezije. Kombinacija specifičnih biomarkera može govoriti u prilog ALD-u, no kako bismo razlučili radi li se o alkoholnoj ili nealkoholnoj bolesti jetre, obrada mora biti usmjerena na isključivanje virusnih, imunoloških, metaboličkih bolesti i morfoloških promjena jetrenog parenhima. U posljednjih nekoliko godina raste incidencija nealkoholne masne bolesti jetre (engl. non-alcoholic fatty liver disease, NAFLD), entiteta koji patohistološkim spektrom i kliničkim tijekom nalikuje ALD-u, a koji se smatra jetrenom prezentacijom metaboličkog sindroma. Budući da količina ispijenog alkohola čini temeljnu razliku između ALD-a i NAFLD-a, do dijagnoze je danas ponekad teže doći zbog porasta broja oboljelih s prekomjernom tjelesnom težinom i drugim elementima metaboličkog sindroma, a koji konzumiraju veće količine alkohola.Alcohol is still one of the most common etiologic factors of liver injury in nearly every part of the world. In many societies alcohol consumption is generally accepted and often an indispensable part of various social events, practically integrated into human culture, making alcohol one of the leading causes of mortality and morbidity in the world. Whether we are talking about daily consumption or periodic intake of a large amount of alcohol, its hepatotoxic effect is manifested by a series of clinical and histopathological features ranging from steatosis and alcoholic hepatitis to liver fibrosis and cirrhosis. Diagnosing alcoholic liver disease (ALD) remains a challenge, as there are no diagnostic parameters to confirm or exclude the disease, and the diagnosis is mainly based on anamnestic data on chronic alcohol consumption and the exclusion of other possible etiologic agents of liver injury. The combination of specific biomarkers may be an indication of ALD, but in order to distinguish whether it is a case of alcoholic or non-alcoholic liver disease, diagnostic workup must be aimed at excluding viral, autoimmune and metabolic diseases, as well as morphological changes in hepatic parenchyma. Over the last few years, we have been witnessing an increase in the incidence of non-alcoholic fatty liver disease (NAFLD), an entity considered hepatic manifestation of metabolic syndrome whose histopathological spectrum and clinical course resemble ALD. Since the fundamental difference between ALD and NAFLD is in the amount of alcohol consumed, correct diagnosis is sometimes more difficult to reach due to a growing number of overweight patients with other metabolic syndrome elements who consume large amounts of alcohol

Study of milling time impact on hydrogen desorption from LiAlH4-Fe2O3 composites

LiAlH4 was modified by mechanical milling and with the addition of 5 wt.% Fe2O3 in order to improve its hydrogen desorption properties. The composite was milled for 1, 3, 5, 7 or 15min, and depending on the milling time, various phenomena took place. Up to a milling time of 5min, the particle size of the composite decreases. Further milling leads to the particles agglomeration reaching the size of the starting material after 15min. Moreover, the mechanical milling process leads to the transformation of AlH - 4 to AlH 3 - 6 structure as a result of partial hydrogen desorption. Hydrogen desorption during the milling is the most pronounced in the sample milled for 15min, so this sample has only one hydrogen desorption peak in the temperature-programmed desorption measurements.Mechanical milling with the addition of Fe2O3 for up to 15min improves LiAlH4 hydrogen desorption properties as hydrogen desorption temperature and apparent activation energies decrease

Usefulness of noninvasive elastographic methods and biochemical markers in detections of steatosis, fibrosis and inflamation in nonalcoholic fatty liver disease patients

Uvod: Nealkoholna masna bolest jetre (NAFLD) kronična je bolest jetre povezana s metaboličkim sindromom i njegovim komponentama. Jedna je od najčešćih kroničnih bolesti i rastući etiološki faktor za cirozu jetre i hepatocelularni karcinom te će u budućnosti postati glavna indikacija za transplantaciju jetre. Stoga je bitno da razvijemo neinvazivne metode detekcije i praćenja rizičnih pacijenata. Cilj: Svrha ovog istraživanja je procjena dijagnostičke točnosti elastografskih parametara steatoze – CAP (eng. controlled attenuation parameter) i fibroze – LSM (eng. liver stiffness measurement) izmjerenih M ili XL FibroScan® sondom, biokemijskih markera (M30, M65, APRI i FIB-4) i njihovih kombinacija u usporedbi sa biopsijom jetre koja je zlatni standard u detekciji jetrene steatoze i fibroze, kao i nealkoholnog steatohepatitisa (NASH). Metode: Ovo je retrospektivna studija u kojoj je sudjelovalo 146 pacijenata s NAFLD-om. Koristili smo Fibroscan® 502 Touch. Rezultati: CAP je identificirao steatozu kod pacijenata s NAFLD-om sa AUROC vrijednostima 0.92 za S≥S1, 0.8 za S≥S2, 0.86 za S≥S3 s graničnim vrijednostima 296 dB/m, 327 dB/m i 368 dB/m. LSM je identificirao fibrozu kod NAFLD pacijenata s AUROC vrijednostima 0.90 za F≥F1, 0.91 za F≥F2, 0.87 za F≥F3 pri graničnim vrijednostima 8.5kPa, 9.5kPa i 13.6kPa. FIB-4, APRI i receptori stanične smrti M30 i M65 također su se pokazali korisnima u detekciji stadija fibroze. Zaključak: Primjenom biokemijskih testiranja i transijentne elastografije možemo pravovremeno otkriti pacijente sa značajnim histološkim promjenama, kao i identificirati one kojima nije potrebna daljnja obrada (biopsija jetre) što bi trebalo rezultirati boljom skrbi za pacijente, ali znatnim dugoročnim uštedamaIntroduction: Non-alcoholic fatty liver disease (NAFLD) is chronic liver disease strongly associated with metabolic syndrome and its components. NAFLD is one of the most common chronic diseases and a growing etiological factor for liver cirrhosis and hepatocellular carcinoma. In the future, it will become the main indication for liver transplatation. Therefore, it is important to develope non-invasive methods of detection and monitoring of at-risk patients. Aim: Aim of this study was to assess the diagnostic accuracy of elastographic parameters of steatosis (controlled attenuation parameter, CAP) and fibrosis (liver stiffness measurement, LSM) measured by either M or XL probes, biochemical markers (M30, M65, APRI and FIB-4) and their combination against liver biopsy which is a gold standard in detection of liver steatosis and fibrosis, as well as nonalcoholic steatohepatitis (NASH). Methods: This study was retrospective study that in the included 146 nonalcoholic fatty liver disease (NAFLD) patients. We used the Fibroscan® 502 Touch operating software. Results: We found that CAP identified NAFLD patients with steatosis with an AUROC of 0.92 for S≥S1, 0.8 for S≥S2, and 0.86 for S≥S3, with the corresponding cutoff values 296 dB/m, 327 dB/m and 368 dB/m, respectively. LSM identified NAFLD patients with fibrosis with AUROCs of 0.90 for F≥F1, 0.91 for F≥F2 and 0.87) for F≥F3, with the cutoff values of 8.5kPa, 9.5kPa and 13.6kPa, respectively. FIB-4, APRI and cell death markers M30 and M65 were also found to be useful in detecting each fibrosis stage. Conclusion: With the application of both biochemical testing and transient elastography, we can timely detect patients with significant histological changes as well as identify those that do not require further workup (liver biopsy) which should result in better patient care and substantial long-term saving

Usefulness of noninvasive elastographic methods and biochemical markers in detections of steatosis, fibrosis and inflamation in nonalcoholic fatty liver disease patients

Uvod: Nealkoholna masna bolest jetre (NAFLD) kronična je bolest jetre povezana s metaboličkim sindromom i njegovim komponentama. Jedna je od najčešćih kroničnih bolesti i rastući etiološki faktor za cirozu jetre i hepatocelularni karcinom te će u budućnosti postati glavna indikacija za transplantaciju jetre. Stoga je bitno da razvijemo neinvazivne metode detekcije i praćenja rizičnih pacijenata. Cilj: Svrha ovog istraživanja je procjena dijagnostičke točnosti elastografskih parametara steatoze – CAP (eng. controlled attenuation parameter) i fibroze – LSM (eng. liver stiffness measurement) izmjerenih M ili XL FibroScan® sondom, biokemijskih markera (M30, M65, APRI i FIB-4) i njihovih kombinacija u usporedbi sa biopsijom jetre koja je zlatni standard u detekciji jetrene steatoze i fibroze, kao i nealkoholnog steatohepatitisa (NASH). Metode: Ovo je retrospektivna studija u kojoj je sudjelovalo 146 pacijenata s NAFLD-om. Koristili smo Fibroscan® 502 Touch. Rezultati: CAP je identificirao steatozu kod pacijenata s NAFLD-om sa AUROC vrijednostima 0.92 za S≥S1, 0.8 za S≥S2, 0.86 za S≥S3 s graničnim vrijednostima 296 dB/m, 327 dB/m i 368 dB/m. LSM je identificirao fibrozu kod NAFLD pacijenata s AUROC vrijednostima 0.90 za F≥F1, 0.91 za F≥F2, 0.87 za F≥F3 pri graničnim vrijednostima 8.5kPa, 9.5kPa i 13.6kPa. FIB-4, APRI i receptori stanične smrti M30 i M65 također su se pokazali korisnima u detekciji stadija fibroze. Zaključak: Primjenom biokemijskih testiranja i transijentne elastografije možemo pravovremeno otkriti pacijente sa značajnim histološkim promjenama, kao i identificirati one kojima nije potrebna daljnja obrada (biopsija jetre) što bi trebalo rezultirati boljom skrbi za pacijente, ali znatnim dugoročnim uštedamaIntroduction: Non-alcoholic fatty liver disease (NAFLD) is chronic liver disease strongly associated with metabolic syndrome and its components. NAFLD is one of the most common chronic diseases and a growing etiological factor for liver cirrhosis and hepatocellular carcinoma. In the future, it will become the main indication for liver transplatation. Therefore, it is important to develope non-invasive methods of detection and monitoring of at-risk patients. Aim: Aim of this study was to assess the diagnostic accuracy of elastographic parameters of steatosis (controlled attenuation parameter, CAP) and fibrosis (liver stiffness measurement, LSM) measured by either M or XL probes, biochemical markers (M30, M65, APRI and FIB-4) and their combination against liver biopsy which is a gold standard in detection of liver steatosis and fibrosis, as well as nonalcoholic steatohepatitis (NASH). Methods: This study was retrospective study that in the included 146 nonalcoholic fatty liver disease (NAFLD) patients. We used the Fibroscan® 502 Touch operating software. Results: We found that CAP identified NAFLD patients with steatosis with an AUROC of 0.92 for S≥S1, 0.8 for S≥S2, and 0.86 for S≥S3, with the corresponding cutoff values 296 dB/m, 327 dB/m and 368 dB/m, respectively. LSM identified NAFLD patients with fibrosis with AUROCs of 0.90 for F≥F1, 0.91 for F≥F2 and 0.87) for F≥F3, with the cutoff values of 8.5kPa, 9.5kPa and 13.6kPa, respectively. FIB-4, APRI and cell death markers M30 and M65 were also found to be useful in detecting each fibrosis stage. Conclusion: With the application of both biochemical testing and transient elastography, we can timely detect patients with significant histological changes as well as identify those that do not require further workup (liver biopsy) which should result in better patient care and substantial long-term saving

Usefulness of noninvasive elastographic methods and biochemical markers in detections of steatosis, fibrosis and inflamation in nonalcoholic fatty liver disease patients

Uvod: Nealkoholna masna bolest jetre (NAFLD) kronična je bolest jetre povezana s metaboličkim sindromom i njegovim komponentama. Jedna je od najčešćih kroničnih bolesti i rastući etiološki faktor za cirozu jetre i hepatocelularni karcinom te će u budućnosti postati glavna indikacija za transplantaciju jetre. Stoga je bitno da razvijemo neinvazivne metode detekcije i praćenja rizičnih pacijenata. Cilj: Svrha ovog istraživanja je procjena dijagnostičke točnosti elastografskih parametara steatoze – CAP (eng. controlled attenuation parameter) i fibroze – LSM (eng. liver stiffness measurement) izmjerenih M ili XL FibroScan® sondom, biokemijskih markera (M30, M65, APRI i FIB-4) i njihovih kombinacija u usporedbi sa biopsijom jetre koja je zlatni standard u detekciji jetrene steatoze i fibroze, kao i nealkoholnog steatohepatitisa (NASH). Metode: Ovo je retrospektivna studija u kojoj je sudjelovalo 146 pacijenata s NAFLD-om. Koristili smo Fibroscan® 502 Touch. Rezultati: CAP je identificirao steatozu kod pacijenata s NAFLD-om sa AUROC vrijednostima 0.92 za S≥S1, 0.8 za S≥S2, 0.86 za S≥S3 s graničnim vrijednostima 296 dB/m, 327 dB/m i 368 dB/m. LSM je identificirao fibrozu kod NAFLD pacijenata s AUROC vrijednostima 0.90 za F≥F1, 0.91 za F≥F2, 0.87 za F≥F3 pri graničnim vrijednostima 8.5kPa, 9.5kPa i 13.6kPa. FIB-4, APRI i receptori stanične smrti M30 i M65 također su se pokazali korisnima u detekciji stadija fibroze. Zaključak: Primjenom biokemijskih testiranja i transijentne elastografije možemo pravovremeno otkriti pacijente sa značajnim histološkim promjenama, kao i identificirati one kojima nije potrebna daljnja obrada (biopsija jetre) što bi trebalo rezultirati boljom skrbi za pacijente, ali znatnim dugoročnim uštedamaIntroduction: Non-alcoholic fatty liver disease (NAFLD) is chronic liver disease strongly associated with metabolic syndrome and its components. NAFLD is one of the most common chronic diseases and a growing etiological factor for liver cirrhosis and hepatocellular carcinoma. In the future, it will become the main indication for liver transplatation. Therefore, it is important to develope non-invasive methods of detection and monitoring of at-risk patients. Aim: Aim of this study was to assess the diagnostic accuracy of elastographic parameters of steatosis (controlled attenuation parameter, CAP) and fibrosis (liver stiffness measurement, LSM) measured by either M or XL probes, biochemical markers (M30, M65, APRI and FIB-4) and their combination against liver biopsy which is a gold standard in detection of liver steatosis and fibrosis, as well as nonalcoholic steatohepatitis (NASH). Methods: This study was retrospective study that in the included 146 nonalcoholic fatty liver disease (NAFLD) patients. We used the Fibroscan® 502 Touch operating software. Results: We found that CAP identified NAFLD patients with steatosis with an AUROC of 0.92 for S≥S1, 0.8 for S≥S2, and 0.86 for S≥S3, with the corresponding cutoff values 296 dB/m, 327 dB/m and 368 dB/m, respectively. LSM identified NAFLD patients with fibrosis with AUROCs of 0.90 for F≥F1, 0.91 for F≥F2 and 0.87) for F≥F3, with the cutoff values of 8.5kPa, 9.5kPa and 13.6kPa, respectively. FIB-4, APRI and cell death markers M30 and M65 were also found to be useful in detecting each fibrosis stage. Conclusion: With the application of both biochemical testing and transient elastography, we can timely detect patients with significant histological changes as well as identify those that do not require further workup (liver biopsy) which should result in better patient care and substantial long-term saving

Screening for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography - a prospective, cross sectional study

Aim: To investigate the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) in patients with diabetes mellitus type 2 (T2DM), based on increased controlled attenuation parameter (CAP) and liver stiffness measurements obtained by transient elastography. In addition, we aimed to identify parameters that correlate with increased elastographic parameters of steatosis and fibrosis to provide a better indication when a patient with T2DM should be screened for NAFLD. Methods: We conducted prospective, cross-sectional study of 679 consecutive adult patients with diagnosed T2DM mean age 65.2±11.6. NAFLD was defined by transient elastography. In 105 patients a percutaneous liver biopsy (LB) was done. Results: The prevalence of NAFLD based on transient elastography was 83.6%. Independent factors associated with increased CAP were higher body mass index, longer T2DM duration, higher serum triglyceride, lower levels of vitamin D, higher C-reactive protein, and higher HOMA-IR. The prevalence of moderate liver fibrosis was 26.9% and advanced liver fibrosis 12.6%. Independent factors associated with moderated fibrosis based on elastography were higher body mass index and higher levels of alanine aminotransferase (ALT), while independent factors associated with advanced fibrosis were female gender, higher body mass index, higher levels of ALT, gama-glutamil transferase and C-reactive protein. Sixty-four (60.9%) of 105 patients with LB had NAFLD activity score ≥5. Regarding the presence and stages of fibrosis based on LB, moderate fibrosis was found in 29.5% of patients, while 29.5% had advanced fibrosis and 6.7% cirrhosis. Conclusion: This study supports more aggressive screening for NAFLD and fibrosis in patients with T2DM

Студија - Београд_Корак ка политици здравог града [IX Међународни салон пејзажне архитектуре]

Studija "BEOGRAD KORAK KA POLITICI ZDRAVOG GRADA" je rezultat rada studenata Arhitektonskog fakulteta Univerziteta u Beogradu na predmetu Politike urbanog razvoja, školske 2020/ 2021. godine. Rad je usmeren ka boljem razumevanju politika urbanog razvoja kao dela savremenih napora na polju povezivanja, planiranja izgradnje sa realnim izvorima finansiranja, koji su utvrđeni merama, kako UN i EU politika, tako i Strategijom održivog urbanog razvoja Republike Srbije do 2030. godine i lokalnim politikama urbanog razvoja. Studija je namenjena transparentnom predstavljanju projekata urbanog razvoja, koje grad Beograd realizuje u sa radnji sa međunarodnim programima i bankama, uz podršku nacionalnih institucija, gradske uprave, organizacija i ustanova, nevladinih organizacija. U okviru studije, dat je mogući model za prikazivanje, praćenje realizacije i evaluacije projekata od značaja za urbani razvoj Beograda i/ili urbanih naselja u Srbiji. Ovaj model predstavlja i nov način sticanja znanja, uvođenja inovacija i podsticanje razvoja platforme za eksperiment u okviru visokog obrazovanja arhitekata i urbanista, uz podršku stručnjaka iz prakse