Systematic review and meta-analysis on the adverse events of rimonabant treatment: Considerations for its potential use in hepatology

<p>Abstract</p> <p>Background</p> <p>The cannabinoid-1 receptor blockers have been proposed in the management of obesity and obesity-related liver diseases (fatty liver as NAFLD or NASH). Due to increasing number of patients to be potentially treated and the need to assess the advantage of this treatment in terms of risk/benefit, we analyze the side events reported during the treatment with rimonabant by a systematic review and meta-analysis of all randomized controlled studies.</p> <p>Methods</p> <p>All published randomized controlled trials using rimonabant <it>versus </it>placebo in adult subjects were retrieved. Relative risks (RR) with 95% confidence interval for relevant adverse events and number needed to harm was calculated.</p> <p>Results</p> <p>Nine trials (n = 9635) were considered. Rimonabant 20 mg was associated with an increased risk of adverse event (RR 1.35; 95%CI 1.17-1.56), increased discontinuation rate (RR 1.79; 95%CI 1.35-2.38), psychiatric (RR 2.35; 95%CI 1.66-3.34), and nervous system adverse events (RR 2.35; 95%CI 1.49-3.70). The number needed to harm for psychiatric adverse events is 30.</p> <p>Conclusion</p> <p>Rimonabant is associated with an increased risk of adverse events. Despite of an increasing interest for its use on fatty liver, the security profile and efficacy it is needs to be carefully assessed before its recommendation. At present the use of rimonabant on fatty liver cannot be recommended.</p

Predictors of Hepatocellular Carcinoma Early Recurrence in Patients Treated with Surgical Resection or Ablation Treatment: A Single-Center Experience

Introduction: Hepatocellular carcinoma (HCC) is the sixth most diagnosed malignancy and the fourth leading cause of cancer-related death worldwide, with poor overall survival despite available curative treatments. One of the most crucial factors influencing survival in HCC is recurrence. The current study aims to determine factors associated with early recurrence of HCC in patients with BCLC Stage 0 or Stage A treated with surgical resection or local ablation. Materials and Methods: We retrospectively enrolled 58 consecutive patients diagnosed with HCC within BCLC Stage 0 or Stage A and treated either by surgical resection or local ablation with maximum nodule diameter 20 mm (HR 4.5, 95% C.I. 3.9–5.1), platelet count 2 (HR 2.7, 95% C.I. 2.2–3.3). Discussion and Conclusions: Our results are in line with the current literature. Male gender and tumor nodule dimension are the main risk factors associated with early HCC recurrence. Platelet count and other combined scores can be used as predictive tools for early HCC recurrence, although more studies are needed to define cut-offs

Content validity of the EQ-HWB and EQ-HWB-S in a sample of Italian patients, informal caregivers and members of the general public.

BACKGROUND The EuroQol Group recently developed two new instruments, the EQ Health and Wellbeing (EQ-HWB) and the EQ Health and Wellbeing short version (EQ-HWB-S). The EQ-HWB and EQ-HWB-S are intended to capture a broad range of health and broader quality of life aspects, which may be relevant to general public members, patients, their families, social care users and informal carers. This study assesses the content validity of the Italian version of the two instruments in a sample of Italian patients, social care users and informal carers. METHODS Participants were recruited using a convenience sampling approach. One-on-one interviews were carried out using video-conferencing interviews. A semi-structured topic guide was used to guide the interview procedures, with open-ended questions supplemented by probes. Participants were asked to explain important aspects of their health and quality of life, to complete the questionnaires and verbalize their thoughts. RESULTS Twenty participants comprising of patients (n = 9), informal carers (n = 6), and members of the general public (n = 5) participated to the study. Content validity was summarized into six main themes: comprehension, interpretation, acceptability, relevance, response options and recall period. All participants found the instruments easy or quite easy to understand and to respond to. Items were relevant for all three groups of participants, and response options appropriate. CONCLUSIONS The Italian version of the EQ-HWB showed content validity in measuring health and wellbeing in a mixed Italian population

DNA markers to disentangle complexes of cryptic taxa in mealybugs (Hemiptera: Pseudococcidae).

Mealybugs (Hemiptera: Pseudococcidae) are major pests of a wide range of crops and ornamental plants worldwide. Their high degree of morphological similarity makes them difficult to identify and limits their study and management. We aimed to identify a set of markers for the genetic characterization and identification of complexes of taxa in the Pseudococcidae. We surveyed and tested the genetic markers used in previous studies and then identified new markers for particularly relevant genomic regions for which no satisfactory markers were available. We tested all markers on a subset of four taxa distributed worldwide. Five markers were retained after this first screening: two regions of the mitochondrial cytochrome oxidase I gene, 28S-D2, the entire internal transcriber space 2 locus and the rpS15-16S region of the primary mealybug endosymbiont Tremblaya princeps. We then assessed the utility of these markers for the characterization and identification of 239 samples from 43 sites in France and Brazil. The five markers studied (i) successfully distinguished all species identified by morphological examination, (ii) disentangled complexes of species by revealing intraspecific genetic variation and identified a set of closely related taxa for which taxonomic status requires clarification through further studies, and (iii) facilitated the inference of phylogenetic relationships between the characterized taxa

Aplicação de sistemas de avaliação da aptidão agrícola das terras em solos do Estado do Acre, Amazônia.

Os métodos de avaliação da aptidão agrícola tem como objetivo orientar o uso adequado das terras, porém seus resultados apresentam elevado grau de subjetividade devido a serem dependentes da experiência do usuário. Neste trabalho objetivou-se avaliar o uso de um algoritmo para interpretação de propriedades do solo e características da paisagem e compará-lo com a interpretação obtida por um grupo controle, constituído por seis especialistas. Foram utilizadas amostras de solo coletadas por tradagem ao lado dos perfis pedológicos da IX Reunião Brasileira de Correlação e Classificação de Solos, de modo a obter os dados de entrada do algoritmo, enquanto os avaliadores utilizaram os dados físicos, químicos e morfológicos dos perfis pedológicos. A avaliação do grupo controle não identificou as potencialidades para o uso dos solos na Amazônia de forma consistente, enquanto, o algoritmo mostrou-se promissor na avaliação da aptidão para Latossolo, Argissolos, Vertissolos e Luvissolo, no entanto, ainda requer revisões em algumas regras de interpretação para uma avaliação mais coerente da aptidão, principalmente, para o Espodossolo

The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population

BACKGROUND: Fatty liver (FL) is the most frequent liver disease in Western countries. We used data from the Dionysos Nutrition & Liver Study to develop a simple algorithm for the prediction of FL in the general population. METHODS: 216 subjects with and 280 without suspected liver disease were studied. FL was diagnosed by ultrasonography and alcohol intake was assessed using a 7-day diary. Bootstrapped stepwise logistic regression was used to identify potential predictors of FL among 13 variables of interest [gender, age, ethanol intake, alanine transaminase, aspartate transaminase, gamma-glutamyl-transferase (GGT), body mass index (BMI), waist circumference, sum of 4 skinfolds, glucose, insulin, triglycerides, and cholesterol]. Potential predictors were entered into stepwise logistic regression models with the aim of obtaining the most simple and accurate algorithm for the prediction of FL. RESULTS: An algorithm based on BMI, waist circumference, triglycerides and GGT had an accuracy of 0.84 (95%CI 0.81–0.87) in detecting FL. We used this algorithm to develop the "fatty liver index" (FLI), which varies between 0 and 100. A FLI < 30 (negative likelihood ratio = 0.2) rules out and a FLI ≥ 60 (positive likelihood ratio = 4.3) rules in fatty liver. CONCLUSION: FLI is simple to obtain and may help physicians select subjects for liver ultrasonography and intensified lifestyle counseling, and researchers to select patients for epidemiologic studies. Validation of FLI in external populations is needed before it can be employed for these purposes

Evidence for an Invasive Aphid “Superclone”: Extremely Low Genetic Diversity in Oleander Aphid (Aphis nerii) Populations in the Southern United States

The importance of genetic diversity in successful biological invasions is unclear. In animals, but not necessarily plants, increased genetic diversity is generally associated with successful colonization and establishment of novel habitats. The Oleander aphid, Aphis nerii, though native to the Mediterranean region, is an invasive pest species throughout much of the world. Feeding primarily on Oleander (Nerium oleander) and Milkweed (Asclepias spp.) under natural conditions, these plants are unlikely to support aphid populations year round in the southern US. The objective of this study was to describe the genetic variation within and among US populations of A. nerii, during extinction/recolonization events, to better understand the population ecology of this invasive species.We used five microsatellite markers to assess genetic diversity over a two year period within and among three aphid populations separated by small (100 km) and large (3,700 km) geographic distances on two host plant species. Here we provide evidence for A. nerii "superclones". Genotypic variation was absent in all populations (i.e., each population consisted of a single multilocus genotype (MLG) or "clone") and the genetic composition of only one population completely changed across years. There was no evidence of sexual reproduction or host races on different plant species.Aphis nerii is a well established invasive species despite having extremely low genetic diversity. As this aphid appears to be obligatorily asexual, it may share more similarities with clonally reproducing invasive plants, than with other animals. Patterns of temporal and geographic genetic variation, viewed in the context of its population dynamics, have important implications for the management of invasive pests and the evolutionary biology of asexual species

Avaliação da aptidão agrícola de solos do Acre por diferentes especialistas.

Os sistemas de avaliação da aptidão ou do potencial agrícola das terras têm sido utilizados nas diversas regiões do Brasil, por várias equipes e com múltiplas aplicações. O objetivo deste trabalho foi avaliar, para solos no Estado do Acre, como diferentes especialistas percebem a importância relativa dos indicadores de um sistema de aptidão agrícola e como eles interpretam esses atributos para a definição das diferentes classes de aptidão. Foram utilizados 10 perfis de solos analisados para a IX Reunião Brasileira de Classificação e Correlação de Solos, localizados entre os municípios de Rio Branco e Cruzeiro do Sul, Amazônia - região caracterizada por sedimentos da Formação Solimões como material de origem dos solos. As interpretações da aptidão agrícola dos solos foram feitas por seis especialistas, os quais avaliaram os indicadores de aptidão agrícola, aplicando cinco graus dos fatores de limitação: deficiência de fertilidade, deficiência de água, deficiência de oxigênio, suscetibilidade à erosão e impedimentos à mecanização. A partir desses fatores, foram estabelecidas as classes e os grupos de aptidão para cada perfil de solo, que foram comparados usando análise discriminante e por similaridade. Os resultados indicaram que as variáveis relacionadas a estoque de nutrientes, tipo de argila, classe textural e de drenagem e relevo local foram as mais relevantes na distinção dos ambientes pelos especialistas. A interpretação da aptidão agrícola por especialistas não foi inteiramente reproduzível para todos os solos, estando sujeita a variações decorrentes da experiência dos avaliadores e de seu conhecimento sobre o ambiente e os diferentes tipos de uso da terra

Systematic review and meta-analysis on the adverse events of rimonabant treatment: Considerations for its potential use in hepatology

<p>Abstract</p> <p>Background</p> <p>The cannabinoid-1 receptor blockers have been proposed in the management of obesity and obesity-related liver diseases (fatty liver as NAFLD or NASH). Due to increasing number of patients to be potentially treated and the need to assess the advantage of this treatment in terms of risk/benefit, we analyze the side events reported during the treatment with rimonabant by a systematic review and meta-analysis of all randomized controlled studies.</p> <p>Methods</p> <p>All published randomized controlled trials using rimonabant <it>versus </it>placebo in adult subjects were retrieved. Relative risks (RR) with 95% confidence interval for relevant adverse events and number needed to harm was calculated.</p> <p>Results</p> <p>Nine trials (n = 9635) were considered. Rimonabant 20 mg was associated with an increased risk of adverse event (RR 1.35; 95%CI 1.17-1.56), increased discontinuation rate (RR 1.79; 95%CI 1.35-2.38), psychiatric (RR 2.35; 95%CI 1.66-3.34), and nervous system adverse events (RR 2.35; 95%CI 1.49-3.70). The number needed to harm for psychiatric adverse events is 30.</p> <p>Conclusion</p> <p>Rimonabant is associated with an increased risk of adverse events. Despite of an increasing interest for its use on fatty liver, the security profile and efficacy it is needs to be carefully assessed before its recommendation. At present the use of rimonabant on fatty liver cannot be recommended.</p