Subclinical liver fibrosis in patients with idiopathic 1 pulmonary fibrosis.

Background - Data on the presence of subclinical fibrosis across multiple organs in patients with idiopathic lung fibrosis (IPF) are lacking. Our study aimed at investigating through hepatic transient elastography (HTE) the prevalence and clinical impact of subclinical liver fibrosis in a cohort of patients with IPF. Methods - Patients referred to the Centre for Rare Lung Disease of the University Hospital of Modena (Italy) from March 2012 to February 2013with established diagnosis of IPF and without a documented history of liver diseases were consecutively enrolled and underwent HTE. Based on hepatic stiffness status as assessed through METAVIR score patients were categorized as \u201c with liver fibrosis \u201d (corresponding to a METAVIR score of F1-F4) and \u201c without liver fibrosis\u201d (METAVIR F0). Potential predictors of liver fibrosis were investigated through logistic regression model among clinical and serological variables. The overall survival (OS) was assessed according to liver fibrosis and multivariate Cox regression analysis was used to identify independent predictors. Results - In 13 out of 37 patients (35%) with IPF a certain degree of liver fibrosis was documented.No correlation was found between liver stiffness and clinical-functional parameters. OS was lower in patients \u2018 with liver fibrosis\u2019 than in patients \u2018 without liver fibrosis\u2019 (median months 33[23-55] vs. 63[26-94], p=0.038). Patients \u2018 with liver fibrosis\u2019 presented a higher risk of death at seven years as compared to patients \u2018without liver fibrosis\u2019 (HR=2.6, 95%CI[1.003\u20136.7],p= 0.049). Higher level of AST to platelet ratio Index (APRI)was an independent predictor of survival (HR=4.52 95%CI[1.3\u201315.6], p=0.02). Conclusions - In our cohort, more than one third of IPF patients had concomitant subclinical liver fibrosis that negatively affected OS. These preliminary claims further investigation aimed at clarifying the mechanisms beyond multiorgan fibrosis and its clinical implication in patients with IPF

Does the acidity of self-etching primers affect bond strength and surface morphology of enamel?

Purpose: This study examined the ultrastructure and microtensile bond strengths (TBS) of self-etching (with different acidity) and conventional adhesive systems bonded to unground enamel. Materials and Methods: Resin composite (Filtek Z250) buildups were bonded to unground enamel surfaces of third molars after adhesive application with the following materials: Clearfil SE Bond (CSE); Optibond Solo Plus Self-Etch (OP); Tyrian Self Priming Etching (TY), and the controls Scotchbond Multi-Purpose Plus (SBMP) and Single Bond (SB). Six teeth were assigned to each material. After storage in water for 24 h at 37 degrees C, the bonded specimens were sectioned into beams of approximately 0.8 mm(2) and subsequently subjected to mu TBS testing at a crosshead speed of 0.5 mm/min. The average values were subjected to one-way ANOVA (alpha = 0.05). The effect of surface conditioning of each material was observed under scanning electron microscopy (SEM). Results: The highest resin-enamel bond strength was observed for SBMP (22.7 +/- 5.2) and SB (26.7 +/- 5.2 MPa). The lowest mean bond strengths were 10.9 +/- 3.2 and 7.8 +/- 1.5 MPa for TY and OP, respectively. CSE showed an intermediate performance (18.7 +/- 4.6 MPa). An overall increase in porosity was evident along the entire enamel surface treated with the self-etching primers; however, no selective demineralization similar to that with 35% phosphoric acid was observed. Conclusion: The highest bond strength means and the more retentive etching pattern were observed for the two-step etch-and-rinse adhesives. Among the self-etching systems studied, Clearfil SE Bond should be preferred.82758

Transarterial Chemoembolization for Hepatocellular Carcinoma in Clinical Practice: Temporal Trends and Survival Outcomes of an Iterative Treatment

Background: Transarterial chemoembolization (TACE) is one of the most frequently applied treatments for hepatocellular carcinoma (HCC) worldwide. In this study, we aimed at evaluating whether and how TACE application and repetition, as well as the related outcome, have changed over the last three decades in Italy. Methods: Data of 7,184 patients with HCC were retrieved from the Italian Liver Cancer (ITA.LI.CA) database. Patients were divided according to the period of diagnosis in six cohorts: P1 (1988–1993), P2 (1994–1998), P3 (1999–2004), P4 (2005–2009), P5 (2010–2014), and P6 (2015–2019). All the analyses were repeated in the overall patient population and in Barcelona Clinic Liver Cancer (BCLC) B patients, who are the subgroup of HCC patients originally supposed to receive TACE according to guidelines. TACE was defined as either the first or the main (more effective) treatment. Results: The proportion of patients receiving TACE as first or main therapy declined over time, and less than 50% of BCLC B patients were treated with chemoembolization from P3 onward. Conversely, TACE was widely used even outside the intermediate stage. Survival of TACE-treated patients progressively increased from P1 to P6. Although TACE was performed only once in the majority of patients, there was an increasing proportion of those receiving 2 or ≥3 treatments sessions over time. The overall survival (OS) of patients undergoing repeated treatments was significantly higher compared to those managed with a single TACE (median OS 40.0 vs. 65.0 vs. 71.8 months in 1, 2, and ≥3 TACE groups, respectively; p < 0.0001). However, after a first-line TACE, the adoption of curative therapies provided longer survival than repeating TACE (83.0 vs. 42.0 months; p < 0.0001), which in turn was associated with better outcomes compared to systemic therapies or best supportive care (BSC). Conclusions: Despite a decline in the percentage of treated patients over time, TACE has still an important role in the management of HCC patients. The survival of TACE-treated patients gradually improved over time, probably due to a better patient selection. Iterative TACE is effective, but an upward shift to curative therapies provides better outcomes while transition to systemic therapies and BSC leads to a worse prognosis

A nomogram-based prognostic model for advanced hepatocellular carcinoma patients treated with sorafenib: A multicenter study

Among scores and staging systems used for HCC, none showed a good prognostic ability in patients with advanced HCC treated with Sorafenib. We aimed to evaluate predictive factors of overall survival (OS) and drug response in HCC patients undergoing Sorafenib included in the Italian Liver Cancer (ITA.LI.CA.) multicenter cohort. Patients in the ITA.LI.CA database treated with Sorafenib and updated on 30 June 2019 were included. Demographic and clinical data before starting Sorafenib treatment were considered. For the evaluation of predictive factors for OS, a time-dependent Cox proportional hazard model was used. A total of 1107 patients were included in our analysis. The mean age was 64.3 years and 81.7% were male. Most patients were staged as BCLC B (205, 18.9%) or C (706, 65.1%). The median time of Sorafenib administration was 4 months (interquartile range (IQR) 2–12), and the median OS was 10 months (IQR: 4–20). A total of 263 patients (33.8%) out of 780 with available evaluation experienced objective tumoral response to Sorafenib. The Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) (hazard ratio (HR) 1.284), maximum tumoral diameter (HR 1.100), plasma total bilirubin (HR 1.119), aspartate amino transferase assessed as multiple of the upper normal value (HR 1.032), alpha-fetoprotein ≥200 ng/mL (HR 1.342), hemoglobin (HR 0.903) and platelet count (HR 1.002) were associated with OS at multivariate Cox regression analysis. Drug response was predicted by maximum tumoral diameter and platelet count. A novel prognostic nomogram for patients undergoing Sorafenib is hereby proposed. The novelty introduced is the comprehensive patient’s assessment using common markers of patient’s general status, liver damage and function and HCC biology. Further studies are required to test its accuracy and provide external validation

Coffee and hepatocellular carcinoma: Epidemiologic evidence and biologic mechanisms

Coffee is one of the most widely consumed beverages worldwide. It is a complex chemical mixture composed of thousands of physiologically active compounds, including caffeine, chlorogenic acid, and diterpenes (cafestol and kahweol). Recently, coffee has emerged as a beverage with various health benefits, in particular in liver disease. Several epidemiological and observational studies demonstrated an inverse association between coffee consumption and primary liver cancer risk. The biological mechanisms underlying the hepatoprotective effect of coffee are still not completely understood. This article reviews the current available literature about the association between coffee consumption and hepatocellular carcinoma risk and the proposed mechanisms by which coffee exerts its chemopreventive properties

Machine learning in liver transplantation: a tool for some unsolved questions?

Machine learning has recently been proposed as a useful tool in many fields of Medicine, with the aim of increasing diagnostic and prognostic accuracy. Models based on machine learning have been introduced in the setting of solid organ transplantation too, where prognosis depends on a complex, multidimensional and nonlinear relationship between variables pertaining to the donor, the recipient and the surgical procedure. In the setting of liver transplantation, machine learning models have been developed to predict pretransplant survival in patients with cirrhosis, to assess the best donor-to-recipient match during allocation processes, and to foresee postoperative complications and outcomes. This is a narrative review on the role of machine learning in the field of liver transplantation, highlighting strengths and pitfalls, and future perspectives