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

Metabolic disorders across hepatocellular carcinoma in Italy

BACKGROUND: Metabolic disorders are well-known risk factors for HCC. Conversely, their impact on the natural history of HCC is not established. This study aimed at evaluating the impact of metabolic disorders on clinical features, treatment and survival of HCC patients regardless of its aetiology. METHODS: We analysed the ITA.LI.CA database regarding 839 HCC patients prospectively collected. The following metabolic features were analysed: BMI, diabetes, arterial hypertension, hypercholesterolaemia and hypertriglyceridaemia. According to these features, patients were divided into 3 groups: 0-1, 2 and 3-5 metabolic features. RESULTS: As compared with patients with 0-1 metabolic features, patients with 3-5 features showed lower percentage of HCC diagnosis on surveillance (P = .021), larger tumours (P = .038), better liver function (higher percentage of Child-Pugh class A [P = .007] and MELD &lt; 10 [P = .003]), higher percentage of metastasis (P = .024) and lower percentage of portal vein thrombosis (P = .010). The BCLC stage and treatment options were similar among the 3 groups, with the exception of a less frequent access to loco-regional therapies for BCLC stage B patients with 3-5 features (P = .012). Overall survival and survival according to BCLC stage and/or treatment did not significantly differ among the 3 groups. Only using a probabilistic sensitivity analysis, diabetic patients showed a lower survival (P = .046). MELD score, HCC morphology, nodule size, BCLC stage, portal vein thrombosis and metastasis were independent predictors of lead-time adjusted survival. CONCLUSIONS: Our "real world" study suggests that metabolic disorders shape the clinical presentation of HCC but do not seem to play a major role in setting patient survival.Background: Metabolic disorders are well-known risk factors for HCC. Conversely, their impact on the natural history of HCC is not established. This study aimed at evaluating the impact of metabolic disorders on clinical features, treatment and survival of HCC patients regardless of its aetiology. Methods: We analysed the ITA.LI.CA database regarding 839 HCC patients prospectively collected. The following metabolic features were analysed: BMI, diabetes, arterial hypertension, hypercholesterolaemia and hypertriglyceridaemia. According to these features, patients were divided into 3 groups: 0-1, 2 and 3-5 metabolic features. Results: As compared with patients with 0-1 metabolic features, patients with 3-5 features showed lower percentage of HCC diagnosis on surveillance (P&nbsp;=.021), larger tumours (P&nbsp;=.038), better liver function (higher percentage of Child-Pugh class A [P&nbsp;=.007] and MELD&nbsp;&lt;&nbsp;10 [P&nbsp;=.003]), higher percentage of metastasis (P&nbsp;=.024) and lower percentage of portal vein thrombosis (P&nbsp;=.010). The BCLC stage and treatment options were similar among the 3 groups, with the exception of a less frequent access to loco-regional therapies for BCLC stage B patients with 3-5 features (P&nbsp;=.012). Overall survival and survival according to BCLC stage and/or treatment did not significantly differ among the 3 groups. Only using a probabilistic sensitivity analysis, diabetic patients showed a lower survival (P&nbsp;=.046). MELD score, HCC morphology, nodule size, BCLC stage, portal vein thrombosis and metastasis were independent predictors of lead-time adjusted survival. Conclusions: Our \u201creal world\u201d study suggests that metabolic disorders shape the clinical presentation of HCC but do not seem to play a major role in setting patient survival

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR &lt; 60 mL/min/1.73 m2) or eGFR reduction &gt; 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR &lt; 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR &gt; 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Strategie di autoregolazione ed emozioni legateallo studio:un intervento per la promozione delle abilit\ue0\ua0 di studio con gruppi di studenti universitari.

In questi anni la ricerca psicologica ha preso in esame le abitudini di studio degli studenti universitari e ha cercato di mettere in luce le relazioni tra il modo di studiare e il rendimento accademico allo scopo di descrivere gli aspetti strategici, metacognitivi, motivazionali che caratterizzano lo studente di successo. \uc8 stato dimostrato che gli studenti di successo sono flessibili nella scelta delle strategie (Wood, Motz e Willoughby, 1998), preferiscono adottare strategie basate sulla schematizzazione ed elaborazione personale del materiale piuttosto che strategie guidate dal testo (Ley e Young, 1998), mettono in atto molteplici comportamenti che facilitano uno studio strategico e motivato, adattando le proprie conoscenze e abilit\ue0 alle diverse situazioni (Mo\ue8 e De Beni, 2000; Chemers, Hu e Garcia, 2001), sono pi\uf9 metacognitivi (De Beni, Mo\ue8 e Rizzato, 2003; Mo\ue8 e De Beni, 2003; Pressley, Yokoi, Van Meter, Van Etten e Freebern, 1997), hanno una buona autoregolazione della propria attivit\ue0 di studio (Hofer, Yu e Pintrich, 1998), sono pi\uf9 organizzati (Mo\ue8 e De Beni, 2000) e pi\uf9 abili nella valutazione della propria preparazione (Drew e Watkins, 1998). Presentano inoltre uno stile attributivo centrato sull\u2019impegno (Sinkavich, 1994; Mo\ue8 e De Beni, 2002), si pongono principalmente obiettivi di padronanza piuttosto che di prestazione (Archer, 1994; Dweck, 1999), hanno alti livelli di motivazione intrinseca (Albaili, 1997) e di autoefficacia (Wolters, 1998). Altri studi hanno dimostrato come le emozioni legate allo studio svolgano un ruolo importante nel processo di apprendimento e siano strettamente collegate agli aspetti cognitivi e motivazionali (Hareli e Weiner, 2002; Boekaerts, 2003; Pekrun, Goetz, Titz e Perry, 2002). Infatti \ue8 stato dimostrato che le reazioni emotive provate dallo studente sono un elemento essenziale per comprendere numerose variabili cognitivo- motivazionali (Boekaerts, 2003; Turner, Husman e Schallert, 2002) connesse all\u2019apprendimento e contribuiscono a spiegare il successo nello studio a livello accademico (Mega, Mo\ue8, Pazzaglia, Rizzato e De Beni, 2007). Fredrickson (2001) ha evidenziato che quando le emozioni positive sono provate in stretta associazione a quelle negative, possono annullare gli effetti dannosi che queste ultime hanno sulla prestazione e questo tipo di bilanciamento sarebbe in grado di predire il successo nello studio universitario. Infatti gli studenti in regola con gli esami, pur riportando emozioni negative, vivono maggiori emozioni positive nei confronti dello studio (Mega et al., 2007). Inoltre gli studenti che riportano emozioni positive usano strategie flessibili e creative, quali l\u2019organizzazione e l\u2019elaborazione del materiale, mentre coloro che provano in prevalenza emozioni negative si limitano ad utilizzare strategie pi\uf9 rigide e superficiali (Pekrun et al., 2002). Le emozioni positive dirigono l\u2019attenzione dello studente verso il compito e sostengono un approccio autoregolato nello studio, come il monitoraggio e l\u2019autovalutazione del proprio modo di studiare, facilitando l\u2019apprendimento e la prestazione. Partendo da tali premesse teoriche l\u2019equipe del SAP-DSA (Servizio di Assistenza Psicologica per gli studenti dell\u2019Universit\ue0 degli Studi di Padova per le Difficolt\ue0 di Studio e Apprendimento) ha sviluppato una modalit\ue0 di intervento per la promozione delle abilit\ue0 di studio con gruppi di studenti universitari (De Beni e Mo\ue8, 1997; De Beni e Rizzato, 2002). La finalit\ue0 dei gruppi di studio organizzati dal SAPDSA \ue8 di migliorare o di perfezionare il metodo di studio degli studenti al fine di renderlo meno dispendioso e pi\uf9 efficace. Vengono favorite e incoraggiate da una parte la riflessione e la discussione sui diversi ambiti dell\u2019apprendimento, dall\u2019altra l\u2019analisi e l\u2019approfondimento delle abitudini e dei comportamenti di studio. La metodologia di lavoro si basa su un approccio di tipo metacognitivo che mira a sviluppare negli studenti maggiore consapevolezza e controllo circa le strategie di studio da loro adottate e la loro efficacia, allo scopo di aiutarli ad individuare i punti di forza e di debolezza del proprio modo di studiare. Con il presente lavoro si intende analizzare se tale intervento metacognitivo pu\uf2 da una parte aiutare lo studente a migliorare il suo metodo di studio rendendolo pi\uf9 autonomo, flessibile e consapevole, e dall\u2019altra portarlo a vivere positivamente il proprio ruolo di studente, riportando piacere e interesse nell\u2019apprendimento

LA PROMOZIONE DELLE ABILITa' DI STUDIO: L'INTERVENTO METACOGNITIVO CON GRUPPI DI STUDENTI UNIVERSITARI

Servizio di Aiuto Psicologico per le Difficolt\ue0 di Studio e Apprendimento (S.A.P.-D.S.A.) e il Servizio di Aiuto Psicologico Benessere Senza Rischio (S.A.P.-B.S.R.) rappresentano due importanti realt\ue0 istituite dall'Universit\ue0 di Padova in collaborazione con l'ESU (Azienda Regionale per il Diritto allo Studio Universitario) per offrire agli studenti universitari la possibilit\ue0 di trovare un aiuto specifico e competente, sia esso legato ad attivit\ue0 di prevenzione o a interventi terapeutici. Il servizio \ue8 gratuito e si fonda sulla collaborazione, a vario titolo, di docenti ricercatori e dottorandi, tutti psicologi o psicoterapeuti della Facolt\ue0 di Psicologia. Lo scopo di questo testo \ue8 di far conoscere il modo in cui si svolge l'attivit\ue0 di questi due servizi, supportata dalla descrizione puntuale degli interventi psicoterapici e dai dati di ricerca raccolti

Protective ventilation in patients with acute respiratory distress syndrome related to COVID-19: always, sometimes or never?

none4noSupported in part by Progetti di Ricerca di Interesse Nazionale (PRIN 2017, project J4BE7A) of the Italian Ministry of University.Purpose of review: To review current evidence on the pathophysiology of COVID-19-related acute respiratory distress syndrome (ARDS) and on the implementation of lung protective ventilation. Recent findings: Although multiple observations and physiological studies seem to show a different pathophysiological behaviour in COVID-19-ARDS compared with 'classical' ARDS, numerous studies on thousands of patients do not confirm these findings and COVID-19-ARDS indeed shares similar characteristics and interindividual heterogeneity with ARDS from other causes. Although still scarce, present evidence on the application of lung protective ventilation in COVID-19-ARDS shows that it is indeed consistently applied in ICUs worldwide with a possible signal towards better survival at least in one study. The levels of positive end-expiratory pressure (PEEP) usually applied in these patients are higher than in 'classical' ARDS, proposing once again the issue of PEEP personalization in hypoxemic patients. In the absence of robust evidence, careful evaluation of the patient is needed, and empiric settings should be oriented towards lower levels of PEEP. Summary: According to the present evidence, a lung protective strategy based on low tidal volume and plateau pressures is indicated in COVID-19-ARDS as in ARDS from other causes; however, there are still uncertainties on the appropriate levels of PEEP.mixedMega, Chiara; Cavalli, Irene; Ranieri, Vito Marco; Tonetti, TommasoMega, Chiara; Cavalli, Irene; Ranieri, Vito Marco; Tonetti, Tommas

Disfiguring papular sarcoidosis of the face: dramatic improvement with pimecrolimus

Letter to the Edito