Diagnostic imaging for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) occurs mostly in individuals with cirrhosis, which is why the guidelines of the most important scientific societies indicate that these patients are included in surveillance programs through the repetition of an ultrasound examination every 6 months. The aim is to achieve early identification of the neoplasia in order to increase the possibility of curative therapies (liver transplantation, surgery or local ablative therapies) and to increase patient survival. HCC nodules arising in cirrhotic livers show characteristic angiographic behavior that can be evaluated with dynamic multidetector computed tomography and dynamic magnetic resonance imaging (MRI). However, the use of these techniques in real life is often hindered by the lack of uniform terminology in reporting and in the interpretation of the exams reflected in the impossibility of comparing examinations performed in different centers and/or at different times. Liver Imaging Reporting and Data System® was created to standardize reporting and data collection of computed tomography and MRI for HCC. In some cases HCC arises in patients with healthy livers and, although there is evidence that angiographic behavior is not different from cirrhotic patients in this clinical situation, the guidelines still indicate the execution of a biopsy. Frequent use of palliative therapeutic techniques such as transarterial chemoembolization, transarterial radioembolization or administration of antiangiogenic drugs (sorafenib) poses problems of interpretation of the therapeutic response with repercussions on the subsequent choices that have been attempted to resolve with the use of stringent criteria such as Modified Response Evaluation Criteria In Solid Tumors

TIPS and HCC: friends or foes ?

Portal hypertension and hepatocellular carcinoma [HCC] are major complications of liver cirrhosis and may coexist in the same patient. Transjugular intrahepatic portosystemic shunt [TIPS] is an effective treatment for recurrent variceal bleeding and refractory ascites although accumulating evidence has shown that its indication is gradually expanding. TIPS placement reduces portal flow by connecting splanchnic vessels to systemic circulation. As a consequence parenchymal portal venous flow is decreased so inducing an ischemic injury. In this condition, a possible activation of hepatic stellate cells, an induction of neoangiogenesis and an increase in secretion of HGF and VEGF may represent possible triggers for hepatocarcinogenesis. On these bases, several studies have explored a possible influence of TIPS on the onset of hepatocellular carcinoma [HCC] in cirrhotic patients. To date the results are controversial and the role of TIPS as risk factor for HCC is still unclear. Moreover, the diversion of portal flow and the onset of arterioportal shunts following TIPS insertion, may reduce the efficacy and the safety profile of transarterial treatments. Until now, very little evidence has been collected regarding this topic and the results are conflicting. Therefore, whether TIPS and hepatocellular carcinoma are either "Friends or Foes" is still an ongoing dilemma

ALS mutant FUS proteins are recruited into stress granules in induced pluripotent stem cells- derived motoneurons

Patient-derived induced Pluripotent Stem Cells (iPSCs) provide an opportunity to study human diseases mainly in those cases where no suitable model systems are available. Here we have taken advantage of in vitro iPSCs derived from patients affected by Amyotrophic Lateral Sclerosis and carrying mutations in the RNA-binding proteins FUS to study the cellular behavior of the mutant proteins in the appropriate genetic background. Moreover, the ability to differentiate iPSCs into spinal cord neural cells provides an in vitro model mimicking the physiological conditions. iPSCs were derived from FUS(R514S) and FUS(R521C) patients' fibroblasts, while in the case of the severe FUS(P525L) mutation, where fibroblasts were not available, a heterozygous and a homozygous iPSC lines were raised by TALEN-directed mutagenesis. We show that aberrant localization and recruitment of FUS into stress granules (SGs) is a prerogative of the FUS mutant proteins and occurs only upon induction of stress in both undifferentiated iPSCs and spinal cord neural cells. Moreover, we show that the incorporation into SGs is proportional to the amount of cytoplasmic FUS, nicely correlating with the cytoplasmic delocalization phenotype of the different mutants. Therefore, the available iPSCs represent a very powerful system for understanding the correlation between FUS mutations, the molecular mechanisms of SG formation and ALS ethiopathogenesis

Avaliação da influência de agregados leves de argila calcinada no desempenho de concretos estruturais

Este trabalho tem por objetivo a avaliação de desempenho de concretos leves produzidos com agregados leves de argila calcinada. Primeiramente, foram coletadas e caracterizadas diferentes amostras de solo (argila) do estado de São Paulo. Em seguida, foram confeccionados corpos de prova de argila calcinada com as diferentes massas cerâmicas coletadas. Os corpos de prova confeccionados com essas massas cerâmicas, queimados à temperatura de 900 ºC, foram caracterizados por meio da avaliação da absorção de água, porosidade aparente, massa específica aparente, expansão por umidade e resistência à compressão. Em seguida, foram moldados corpos de prova de concreto com agregados leves de argila calcinada produzidos com massas cerâmicas provenientes das cidades de Itu, SP, e Porto Ferreira, SP, com argila expandida e também com brita. Os concretos foram submetidos aos ensaios de massa específica e abatimento do tronco de cone, no estado fresco e de resistência à compressão, resistência à tração por compressão diametral, módulo de deformação e massa específica no estado endurecido. Os resultados desta pesquisa indicam a viabilidade técnica da produção de agregados leves de argila calcinada para utilização em concretos, uma vez que o desempenho de concretos produzidos com agregados leves de argila calcinada é semelhante ao de concretos produzidos com argila expandida e basalto

Incorporation of SCBA in Red Ceramics and Sintering in Microwave Oven

The present study investigated the incorporation of sugarcane bagasse ash (SCBA) in red ceramics, sintered in conventional oven and microwave oven, aiming to provide an alternative product, and a sintering process with higher energy efficiency in the production of red ceramics. The raw materials were characterized by XRF, XRD, thermogravimetry, particle size distribution and specific mass analyses. The specimens were shaped by extrusion in two different compositions, red clay and red clay with addition of 20 % SCBA and sintered at temperatures from 700 to 1100 ºC. The conventional sintering occurred for 60 min with heating rate of 10 ºC/min. In the microwave oven the sintering occurred in a hybrid way, with heating rate of 50 ºC/min for 5, 10 and 15 mins. After sintering the tests of linear shrinkage, compressive strength, water absorption, apparent porosity and apparent specific mass were performed. The addition of SCBA causes an increase in the values of water absorption and decreases the compressive strength and specific mass of the red ceramic. This occurs due to the creation of pores inside the material from the volatilization of organic matter present in the ashes. The sintering in microwave oven, when compared to conventional sintering, promotes an increase in the values of compressive strength and specific mass and reduction of water absorption values of ceramics, probably due to the refinement of the microstructure and the higher densification. Thus the incorporation of ashes can be partially compensated by a more efficient sintering. The use of SCBA and the sintering in microwave oven, showed to be viable alternatives in the development of a more sustainable and light material, promoting the management of waste, reduction in the consumption of raw materials and energy saving

Minimally invasive aortic valve replacement: short-term efficacy of sutureless compared with stented bioprostheses

Sutureless aortic valve prostheses have been introduced to facilitate the implant process, speed up the operating time and improve haemodynamic performance. The goal of this study was to assess the potential advantages of using sutureless prostheses during minimally invasive aortic valve replacement in a large multicentre population

Reduced lysosomal acid lipase activity in blood and platelets is associated with nonalcoholic fatty liver disease

OBJECTIVES: To investigate whether blood total lysosomal acid lipase activity (BT-LAL) levels are uniquely associated with the noncirrhotic and cirrhotic stages of nonalcoholic fatty liver disease (NAFLD) and with protection from NAFLD in metabolically/genetically predisposed subjects and a normal liver. To clarify which enzyme-carrying circulating cells are involved in reduced BT-LAL of NAFLD.METHODS: In a cross-sectional study, BT-LAL was measured by a fluorigenic method in patients with NAFLD (n = 118), alcoholic (n = 116), and hepatitis C virus-related disease (n = 49), in 103 controls with normal liver and in 58 liver transplant recipients. Intracellular platelet and leukocyte LAL was measured in 14 controls and 28 patients with NAFLD.RESULTS: Compared with controls, (i) BT-LAL and LAL in platelets, but not in leukocytes, were progressively reduced in noncirrhotic NAFLD and in nonalcoholic steatohepatitis-related cirrhosis; (ii) platelet and leukocyte counts did not differ in patients with noncirrhotic NAFLD; and (iii) BT-LAL did not differ in alcoholic and hepatitis C virus noncirrhotic patients. BT-LAL progressively increased in controls with metabolic syndrome features according to their PNPLA3 rs738409 steatosis-associated variant status (II vs IM vs MM), and their BT-LAL was higher than that of noncirrhotic NAFLD, only when carriers of the PNPLA3 unfavorable alleles were considered. Liver transplant recipients with de novo NAFLD compared with those without de novo NAFLD had lower BT-LAL.DISCUSSION: LAL in blood and platelets is progressively and uniquely reduced in NAFLD according to disease severity. High BT-LAL is associated with protection from NAFLD occurrence in subjects with metabolic and genetic predisposition. Low LAL in platelets and blood could play a pathogenetic role in NAFLD