Management of bacterial infection in the liver transplant candidate

Bacterial infection (BI) is a common cause of impairment of liver function in patients with cirrhosis, especially in the liver transplant candidates. These patients share an immunocompromised state and increased susceptibility to develop community and hospital-acquired infections. The changing epidemiology of BI, with an increase of multidrug resistant strains, especially in healthcare-associated settings, represents a critical issue both in the waiting list and in the post-operative management. This review focused on the role played by BI in patients awaiting liver transplantation, evaluating the risk of drop-out from the waiting list, the possibility to undergo liver transplantation after recovery from infection or during a controlled infection

Machine Learning for Early Diagnosis of ATTRv Amyloidosis in Non-Endemic Areas: A Multicenter Study from Italy

Background: Hereditary transthyretin amyloidosis with polyneuropathy (ATTRv) is an adult-onset multisystemic disease, affecting the peripheral nerves, heart, gastrointestinal tract, eyes, and kidneys. Nowadays, several treatment options are available; thus, avoiding misdiagnosis is crucial to starting therapy in early disease stages. However, clinical diagnosis may be difficult, as the disease may present with unspecific symptoms and signs. We hypothesize that the diagnostic process may benefit from the use of machine learning (ML). Methods: 397 patients referring to neuromuscular clinics in 4 centers from the south of Italy with neuropathy and at least 1 more red flag, as well as undergoing genetic testing for ATTRv, were considered. Then, only probands were considered for analysis. Hence, a cohort of 184 patients, 93 with positive and 91 (age- and sex-matched) with negative genetics, was considered for the classification task. The XGBoost (XGB) algorithm was trained to classify positive and negative TTR mutation patients. The SHAP method was used as an explainable artificial intelligence algorithm to interpret the model findings. Results: diabetes, gender, unexplained weight loss, cardiomyopathy, bilateral carpal tunnel syndrome (CTS), ocular symptoms, autonomic symptoms, ataxia, renal dysfunction, lumbar canal stenosis, and history of autoimmunity were used for the model training. The XGB model showed an accuracy of 0.707 ± 0.101, a sensitivity of 0.712 ± 0.147, a specificity of 0.704 ± 0.150, and an AUC-ROC of 0.752 ± 0.107. Using the SHAP explanation, it was confirmed that unexplained weight loss, gastrointestinal symptoms, and cardiomyopathy showed a significant association with the genetic diagnosis of ATTRv, while bilateral CTS, diabetes, autoimmunity, and ocular and renal involvement were associated with a negative genetic test. Conclusions: Our data show that ML might potentially be a useful instrument to identify patients with neuropathy that should undergo genetic testing for ATTRv. Unexplained weight loss and cardiomyopathy are relevant red flags in ATTRv in the south of Italy. Further studies are needed to confirm these findings

What's in a Name? Shifting Identities of Traditional Organized Crime in Canada in the Transnational Fight against the Calabrian ‘Ndrangheta

The Italian antimafia authorities have warned Canadian law enforcement about the risks and the growing concerns for the infiltration of clans of the Calabrian mafia, known as ‘ndrangheta, in Eastern Canada. The alarm linked to the rise of the ‘ndrangheta challenges the paradigms of traditional organized crime in Canada, because the ‘ndrangheta is presented as traditional but also innovative and more pervasive than other mafia-type groups. Through access to confidential investigations and interviews to key specialist law enforcement teams in Toronto and Montreal, this article investigates today's institutional perception of mafia – the ‘ndrangheta in particular – in Canada when compared to Italian conceptualizations. I will argue that the changes in narratives in Canada can be read in relation to changes in the Italian identity in the country, moving towards regionalization and specialist knowledge of ethnic differences

Role of Female Sex Hormones in ADPKD Progression and a Personalized Approach to Contraception and Hormonal Therapy

This review navigates the intricate relationship between gender, hormonal influences, and the progression of autosomal dominant polycystic kidney disease (ADPKD), highlighting the limited literature on this crucial topic. The study explores the impact of female sex hormones on liver and renal manifestations, uncovering gender-specific differences in disease progression. Actually, hormonal therapy in women with ADPKD remains a challenging issue and is a source of concern regarding its potential impact on disease outcomes, particularly at the hepatic level. Notably, women with ADPKD exhibit a slower renal disease progression compared to men, attributed to hormonal dynamics. This review sheds light on the role of estrogen in regulating pathways of the renin–angiotensin–aldosterone system, revealing its complex interplay and implications for cardiovascular and renal health. Therapeutic considerations for fertile women with ADPKD, including contraception options, are discussed, emphasizing the necessity for personalized approaches. In the postmenopausal phase, the review evaluates the role of hormonal replacement therapy, considering its potential benefits and risks in the context of ADPKD. The review concludes by underscoring the imperative need for tailored treatment approaches for ADPKD patients, considering individual risks and benefits. The scarcity of literature underlines the call for further research to enhance our understanding of optimal hormonal therapies in the context of ADPKD, ultimately paving the way for innovative and personalized therapeutic interventions

The impact of sarcopenia on the outcome of patients with cirrhosis with and without hepatocellular carcinoma who undergo liver transplantation

Background: The impact of sarcopenia on the outcome of patients with cirrhosis who undergo liver transplantation (LT) has been analysed in heterogeneous cohorts with mixed results. We sought to determine the prevalence and the impact of pre-LT sarcopenia on morbidity and mortality after LT in a cohort of patients with cirrhosis with and without hepatocellular carcinoma (HCC).Methods: Patients with cirrhosis who underwent LT between 2010 and 2016 at Padua University Hospital were retrospectively evaluated. Using image software analysis, cross-sectional area of skeletal muscle at 3rd lumbar vertebra was measured and skeletal muscle index (SMI) was calculated. Sarcopenia was defined by SMI < 50 cm2/m2 in males and < 39 cm2/m2 in females, respectively. Primary outcome was post-LT survival. Secondary outcomes included hospitalization length and post-LT complications.Results: 197 patients were included, of whom, 122 (62%) had sarcopenia. Demographics and severity of cirrhosis were comparable in patients with vs. without sarcopenia. Overall survival was similar between the groups. When survival analysis was adjusted for severity of liver disease, sarcopenia was associated with a significantly reduced survival in decompensated (80% vs. 91%, 1-year post-LT; P = 0.04) but not in compensated (93% vs. 90%, 1-year post-LT; P = 0.7) patients. In patients with HCC, sarcopenia was associated with a trend towards lower survival but only in those with HCC beyond Milan criteria. Among secondary outcomes, bacterial infections were more frequent in patients with vs. without sarcopenia (50% vs. 35%; P = 0.02), whereas hospitalization length and other complications were comparable between the groups.Conclusion: Sarcopenia is a common finding in patients awaiting LT and, in those with decompensated cirrhosis, it is associated with reduced survival after transplantation

GrailQuest and HERMES: hunting for gravitational wave electromagnetic counterparts and probing space-time quantum foam

106nonenoneBurderi, Luciano; Di Salvo, Tiziana; Riggio, Alessandro; Gambino, Angelo Francesco; Sanna, Andrea; Fiore, Fabrizio; Amarilli, Fabrizio; Amati, Lorenzo; Ambrosino, Filippo; Amelino-Camelia, Giovanni; Anitra, Alessio; Barbera, Marco; Bechini, Michele; Bellutti, Paolo; Bertaccin, Roberto; Bertuccio, Giuseppe; Campana, Riccardo; Cao, Jiewei; Capozziello, Salvatore; Ceraudo, Francesco; Chen, Tianxiang; Cinelli, Marco; Citossi, Marco; Clerici, Aurora; Colagrossi, Andrea; Costa, Enrico; Curzel, Serena; De Laurentis, Mariafelicia; Della Casa, Giovanni; Della Valle, Massimo; Demenev, Evgeny; Del Santo, Melania; Dilillo, Giuseppe; Efremov, Pavel; Evangelista, Yuri; Feroci, Marco; Ferruglio, Chiara; Ferrandi, Fabrizio; Fiorini, Mauro; Fiorito, Michele; Frontera, Filippo; Fuschino, Fabio; Gacnik, Dejan; Galgoczi, Gabor; Gao, Na; Gandola, Massimo; Ghirlanda, Giancarlo; Gamboc, Andreja; Grassi, Marco; Guidorzi, Cristiano; Guzman, Alejandro; Iaria, Rosario; Karlica, Mile; Kostic, Uros; Labanti, Claudio; La Rosa, Giovanni; Lo Cicero, Ugo; Lopez Fernandez, Borja; Lunghi, Paolo; Malcovati, Piero; Maselli, Alessandro; Manca, Arianna; Mele, Filippo; Milankovich, Dorottya; Monge, Angel; Morgante, Gianluca; Nava, Lara; Negri, Barbara; Nogara, Paolo; Ohno, Masanori; Ottolina, Daniele; Pasquale, Andrea; Pal, Andras; Perri, Matteo; Piccinin, Margherita; Piazzolla, Raffaele; Pirrotta, Simone; Pliego-Caballero, Samuel; Prinetto, Jacopo; Pucacco, Giuseppe; Puccetti, Simonetta; Rapisarda, Massimo; Rashevskaya, Irina; Rashevsky, Alexander; Ripa, Jakub; Russo, Francesco; Papitto, Alessandro; Piranomonte, Silvia; Santangelo, Andrea; Scala, Francesca; Sciarrone, Giulia; Selcan, David; Silvestrini, Stefano; Sottile, Giuseppe; Rotovnik, Tomaz; Tenzer, Christoph; Troisi, Ivan; Vacchi, Andrea; Virgilli, Enrico; Werner, Norbert; Wang, Lingjun; Xu, Yupeng; Zampa, Gianluigi; Zampa, Nicola; Zane, Silvia; Zanotti, GiovanniBurderi, Luciano; Di Salvo, Tiziana; Riggio, Alessandro; Gambino, Angelo Francesco; Sanna, Andrea; Fiore, Fabrizio; Amarilli, Fabrizio; Amati, Lorenzo; Ambrosino, Filippo; Amelino-Camelia, Giovanni; Anitra, Alessio; Barbera, Marco; Bechini, Michele; Bellutti, Paolo; Bertaccin, Roberto; Bertuccio, Giuseppe; Campana, Riccardo; Cao, Jiewei; Capozziello, Salvatore; Ceraudo, Francesco; Chen, Tianxiang; Cinelli, Marco; Citossi, Marco; Clerici, Aurora; Colagrossi, Andrea; Costa, Enrico; Curzel, Serena; De Laurentis, Mariafelicia; Della Casa, Giovanni; Della Valle, Massimo; Demenev, Evgeny; Del Santo, Melania; Dilillo, Giuseppe; Efremov, Pavel; Evangelista, Yuri; Feroci, Marco; Ferruglio, Chiara; Ferrandi, Fabrizio; Fiorini, Mauro; Fiorito, Michele; Frontera, Filippo; Fuschino, Fabio; Gacnik, Dejan; Galgoczi, Gabor; Gao, Na; Gandola, Massimo; Ghirlanda, Giancarlo; Gamboc, Andreja; Grassi, Marco; Guidorzi, Cristiano; Guzman, Alejandro; Iaria, Rosario; Karlica, Mile; Kostic, Uros; Labanti, Claudio; La Rosa, Giovanni; Lo Cicero, Ugo; Lopez Fernandez, Borja; Lunghi, Paolo; Malcovati, Piero; Maselli, Alessandro; Manca, Arianna; Mele, Filippo; Milankovich, Dorottya; Monge, Angel; Morgante, Gianluca; Nava, Lara; Negri, Barbara; Nogara, Paolo; Ohno, Masanori; Ottolina, Daniele; Pasquale, Andrea; Pal, Andras; Perri, Matteo; Piccinin, Margherita; Piazzolla, Raffaele; Pirrotta, Simone; Pliego-Caballero, Samuel; Prinetto, Jacopo; Pucacco, Giuseppe; Puccetti, Simonetta; Rapisarda, Massimo; Rashevskaya, Irina; Rashevsky, Alexander; Ripa, Jakub; Russo, Francesco; Papitto, Alessandro; Piranomonte, Silvia; Santangelo, Andrea; Scala, Francesca; Sciarrone, Giulia; Selcan, David; Silvestrini, Stefano; Sottile, Giuseppe; Rotovnik, Tomaz; Tenzer, Christoph; Troisi, Ivan; Vacchi, Andrea; Virgilli, Enrico; Werner, Norbert; Wang, Lingjun; Xu, Yupeng; Zampa, Gianluigi; Zampa, Nicola; Zane, Silvia; Zanotti, Giovann