Estimation of lifetime costs for patients receiving a transplant: the case of liver transplantation related to hepatitis B in Italy

IntroductionIn Italy, post-liver transplant (LT) hepatitis B virus (HBV) reinfection prophylaxis is frequently based on a combined regimen of anti-HBV immunoglobulin (HBIG) and oral antivirals. However, little information is available at the national level on the cost of LT and the contribution of HBV prophylaxis. This study aimed to quantify the direct healthcare cost for adult patients undergoing LT for HBV-related disease over a lifetime horizon and from the perspective of a National Healthcare Service.MethodsA pharmaco-economic model was implemented with a 4-tiered approach consisting of 1) preliminary literature research to define the research question; 2) pragmatic literature review to retrieve existing information and inform the model; 3) micro-simulated patient cycles; and 4) validation from a panel of national experts.ResultsThe average lifetime healthcare cost of LT for HBV-related disease was €395,986. The greatest cost drivers were post-transplant end-stage renal failure (31.9% of the total), immunosuppression (20.6%), and acute transplant phase (15.8%). HBV reinfection prophylaxis with HBIG and antivirals accounted for 12.4% and 6.4% of the total cost, respectively; however, lifetime HBIG prophylaxis was only associated with a 6.6% increase (~€422 k). Various sensitivity analyses have shown that discount rates have the greatest impact on total costs.ConclusionThis analysis showed that the burden of LT due to HBV is not only clinical but also economic

I Romani nella media valle del Volturno: il santuario del Monte San Nicola a Pietravairano

Sulla base dei risultati delle indagini e delle campagne di scavo archeologico condotte dall'Università del Salento fra il 2002 e il 2015 in loc. Monte San Nicola, presso Pietravairano (Caserta, Italia), l'articolo mira ad analizzare alcuni aspetti connessi alla costruzione del monumentale e scenografico complesso santuariale di età tardo-repubblicana. In particolare, l'attenzione si evidenziano il rapporto intercorrente con le coeve attestazioni dell'architettura santuariale tardo-repubblicana di area campana e laziale, e la relazione, in termini di discontinuità, con la preesistente cinta muraria di età sannitica

San Gregorio Matese (Caserta). La necropoli di Serra Santa Croce

Risultati della campagna di scavo 2010 condotta dall'Università del Salento sul sito di San Gregorio Matese (Ce): dati preliminari dalla necropoli arcaic

Pietravairano (CE): il santuario del Monte San Nicola

Breve presentazione dei risultati delle campagne di scavo archeologico condotte nel monumentale santuario tardo-repubblicano del Monte San Nicola presso Pietravairano (CE). Il santuario è incentrato su un complesso teatro-tempio

La necropoli sannitica di San Gregorio Matese (Ce), loc. Serra Santa Croce

Sulla base dei risultati della campagna di scavo condotta dall’Università del Salento e dalla Soprintendenza per i Beni Archeologici di Salerno, Avellino, Benevento e Caserta nell’anno 2010, l’articolo illustra le pratiche funerarie che caratterizzarono nel corso dell’età tardo arcaica il settore esplorato della necropoli sannitica in loc. Serra Santa Croce (San Gregorio Matese, Caserta, Italy). Lo studio dei corredi funerari e l’analisi antropologica dei resti scheletrici evidenziano gli usi funerari e la cultura materiale della locale comunità, così come il ricorrente riscontro di traumi sui resti uman

La necropoli sannitica di San Gregorio Matese (CE), loc. Serra Santa Croce

Sulla base dei risultati della campagna di scavo condotta dall’Università del Salento e dalla Soprintendenza per i Beni Archeologici di Salerno, Avellino, Benevento e Caserta nell’anno 2010, l’articolo illustra alcuni aspetti delle pratiche funerarie che caratterizzarono nel corso dell’età tardo arcaica il settore esplorato della necropoli sannitica in loc. Serra Santa Croce (San Gregorio Matese, Caserta, Italy). Lo studio dei corredi funerari e l’analisi antropologica dei resti scheletrici evidenziano gli usi funerari e la cultura materiale della locale comunità, così come il ricorrente riscontro di traumi sui resti umani

Discovery of a Potent Dual Inhibitor of Acetylcholinesterase and Butyrylcholinesterase with Antioxidant Activity that Alleviates Alzheimer-like Pathology in Old APP/PS1 Mice

International audienc

Discovery of a Potent Dual Inhibitor of Acetylcholinesterase and Butyrylcholinesterase with Antioxidant Activity that Alleviates Alzheimer-like Pathology in Old APP/PS1 Mice

Combination of the scaffolds of the cholinesterase inhibitor huprine Y and the antioxidant capsaicin results in compounds with nanomolar potencies toward human acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) that retain or improve the antioxidant properties of capsaicin. Crystal structures of their complexes with AChE and BChE revealed the molecular basis for their high potency. Brain penetration was confirmed by biodistribution studies in C57BL6 mice, with one compound (5i) displaying better brain/plasma ratio than donepezil. Chronic treatment of 10 month-old APP/PS1 mice with 5i (2 mg/kg, ip, 3 times per week, 4 weeks) rescued learning and memory impairments, as measured by 3 different behavioral tests, delayed the Alzheimer-like pathology progression, as suggested by a significantly reduced Aβ42/Aβ40 ratio in hippocampus, improved basal synaptic efficacy, and significantly reduced hippocampal oxidative stress and neuroinflammation. Compound 5i emerges as an interesting anti-Alzheimer lead with beneficial effects on cognitive symptoms and on some underlying disease mechanisms

The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients

IntroductionThe study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators. MethodsCase collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate. ResultsAmong the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP. DiscussionAccording to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different from NL-SOTRs, probably related to the ability of the grafted liver to induce immunotolerance