Non-Invasive Tests of Liver Fibrosis Help in Predicting the Development of Hepatocellular Carcinoma among Patients with NAFLD

Carcinoma hepatocelular; Elastografía transitoriaCarcinoma hepatocel·lular; Elastografia transitòriaHepatocellular carcinoma; Transient elastographyBackground: The potential role of non-invasive tests (NITs) for liver fibrosis for hepatocellular carcinoma (HCC) prediction remains poorly known. Methods: Retrospective analysis of a NAFLD cohort from a single university hospital in Barcelona, Spain. Incidence rates and cumulative incidence for the overall cohort, as well as cirrhotic and non-cirrhotic patients were calculated. Logistic regression analyses were carried out to investigate risk factors of HCC. Results: From the entire cohort of 1040 patients, 996 patients (95.8%) were analyzed, in whom 35 cases of HCC were detected, of which 26 (72.4%) HCC incident cases were newly diagnosed during a median follow-up of 2.5 (1.9–3.6) years. Two-hundred and thirty-one (23.2%) were cirrhotic at baseline. With the exception of 2 (7.7%) cases of HCC, the rest were diagnosed in cirrhotic patients. Overall HCC cumulative incidence was 9.49 (95% CI 6.4–13.9) per 1000 person-years. The incidence rate for cirrhotic patients was 41.2 (95% CI 27.6–61.6) per 1000 person-years and 0.93 (95% CI 0.23–3.7) per 1000 person-years for patients without cirrhosis. Overall mortality was significantly higher amongst patients with HCC (4.4% vs. 30.8%, p < 0.001). In patients with available liver biopsy (n = 249, 25%), advanced fibrosis (F3–F4) was significantly associated with higher HCC incidence, but not steatosis, lobular inflammation, nor ballooning. In the overall cohort, FIB-4 ≥1.3 (HR 8.46, 95% CI 1.06–67.4, p = 0.044) and older age (HR 1.06, 95% CI 1.01–1.11, p = 0.025) were associated with increasing risk of HCC over time, whereas in cirrhotic patients predictors of HCC included decreasing values of albumin (HR 0.34, 95% CI 0.13–0.87, p = 0.024), platelets (HR 0.98, 95% CI 0.98–0.99, p = 0.001), and increasing values of liver stiffness (HR 1.03, 95% CI 1.00–1.06, p = 0.016). Conclusions: In a Spanish cohort of NAFLD patients, HCC was rare in non-cirrhotic patients. NITs might play a relevant role at predicting HCC.The study was conducted in accordance with the Declaration of Helsinki and approved by the Vall d’Hebron University Hospital Campus Institutional Review Board (study protocol code PR(AG)626/2021)

Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study

Background In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. Objectives We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. Method Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. Results Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. Conclusions Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. Trial registration clinicaltrials.gov identifier: NCT02464592

Risk of infections in patients with NAFLD and Type 2 Diabetes under treatment with SGLT2 inhibitors and relationship with liver outcomes: A retrospective case-control study

Hepatic outcomes; Infections; Sodium-glucose co-transporter-2 inhibitorsResultados hepáticos; Infecciones; Inhibidores del cotransportador de sodio-glucosa-2Resultats hepàtics; Infeccions; Inhibidors del cotransportador de sodi-glucosa-2Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developed countries, with its incidence growing parallel to the epidemics of obesity and type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are becoming a cornerstone in the management of cardiovascular health and some studies suggest the potential role in NAFLD. However, patients under treatment with SGLT2i are at risk of developing genitourinary fungal infections (GFIs). Moreover, both NAFLD and SGLT2i have a strong influence on the immune system, and therefore the risk of infections other than GFIs could be increased in NAFLD patients treated with SGLT2i. We aimed to examine the possible association of SGLT2i with infections and hepatic outcomes in NAFLD patients. Methods: We conducted a case-control study including NAFLD patients with T2DM visited at the Liver Unit outpatient clinic from 2016 to 2021 with a minimum follow-up of 6 months by selecting 65 patients receiving SGLT2i and 130 matched patients with other types of antidiabetic treatment. Results: During follow-up, GFIs were significantly higher in the SGLT2i group (15.4% vs. 3.8%; p=0.008), whereas there were no differences in the occurrence of overall infections (41.5% vs. 30%; p=0.1) nor in other types of specific infections. In the multivariable analysis, treatment with SGLT2i was not independently associated with higher odds of overall infection. On the other hand, SGLT2i patients showed a significantly lower incidence of hepatic events (1.5% vs. 10.7%; p=0.02). There were no significant different in all-cause mortality between cases and controls. Conclusions: NAFLD patients with T2DM receiving SGLT2i more frequently presented GFIs, whereas the incidence of other types of infections was not found to be higher than in other patients with NAFLD and T2DM treated with other drugs. Moreover, SGLT2i-treated patients had a lower occurrence of hepatic events. Further studies are warranted to validate our data.Funds from European Commission/EFPIA IMI2 853966-2, IMI2 777377, H2020 847989, and ISCIII PI19/01898

La generación de riqueza en las agencias de viajes ubicadas en las regiones de Arequipa, Cusco, Lambayeque y La Libertad, año 2013 y el aporte al producto interno bruto regional

Describes the research carried out by the Observatory Tourist of Peru of the Professional School of Tourism and Hospitality of the University of San Martin de Porres, who poses as an aim to see the generation of the gross domestic product (GDP) of the travel agencies in the regions of Arequipa, Cusco, Lambayeque and La Libertad; as well as its contribution to the GDP of each region. The methodology used was exploratory, transverse, descriptive and hermeneutic. We gave a quantitative approach, where applied techniques of accounting and economic research of the satellite accounts. The documentary and technical field technique were used. The universe was made up of 100 % of the travel agencies in the regions of Arequipa, Cusco, Lambayeque and La Libertad. The surveys were applied to executives and heads of establishments.Se describe la investigación realizada por el Observatorio Turístico del Perú de la Escuela Profesional de Turismo y Hotelería de la Universidad de San Martín de Porres, que plantea como objetivo conocer la generación del Producto Interno Bruto (PIB) de las agencias de viajes en las regiones de Arequipa, Cusco, Lambayeque y La Libertad; así como su aporte al PIB de cada región. La metodología utilizada fue de carácter exploratorio, transversal, descriptivo y hermenéutico. Se le dio un enfoque cuantitativo, donde se aplicaron técnicas propias de la investigación económica y contable de las cuentas satélites. Se utilizó la técnica documental y técnica de campo. El universo estuvo constituido por el 100 % de las agencias de viajes de las regiones de Arequipa, Cusco, Lambayeque y La Libertad. Las encuestas fueron aplicadas a los ejecutivos y jefes de los establecimientos

La generación de riqueza en los establecimientos de hospedaje ubicados en las regiones de Arequipa, Cusco, Lambayeque y La Libertad, año 2013 y el aporte al producto interno bruto regional

Describes the research carried out by the Observatory Tourist of Peru of the Professional School of Tourism and Hospitality of the University of San Martin de Porres, who poses as an aim to see the generation of the gross domestic product (GDP) of the hotel companies in the regions of Arequipa, Cusco, Lambayeque and La Libertad; as well as its contribution to the GDP of each region. The methodology used was exploratory, transverse, descriptive and hermeneutic. We gave a quantitative approach, where we applied techniques of accounting and economic research of the satellite accounts. The documentary and technical field technique were used. The universe was made up of 100 % of the establishments in the regions of Arequipa, Cusco, Lambayeque and La Libertad hosting. The surveys were applied to executives and heads of establishments. &nbsp; &nbsp;Se describe la investigación realizada por el Observatorio Turístico del Perú de la Escuela Profesional de Turismo y Hotelería de la Universidad de San Martín de Porres, que plantea como objetivo conocer la generación del Producto Interno Bruto (PIB) de las empresas hoteleras en las regiones de Arequipa, Cusco, Lambayeque y La Libertad; así como su aporte al PIB de cada región. La metodología utilizada fue de carácter exploratorio, transversal, descriptivo y hermenéutico. Se le dio un enfoque cuantitativo, donde se aplicaron técnicas propias de la investigación económica y contable de las cuentas satélites. Se utilizó la técnica documental y técnica de campo. El universo estuvo constituido por el 100 % de los establecimientos de hospedaje de las regiones de Arequipa, Cusco, Lambayeque y La Libertad. Las encuestas fueron aplicadas a los ejecutivos y jefes de los establecimientos. &nbsp

La generación de riqueza en las empresas de transporte ubicadas en las regiones de Arequipa, Cusco, Lambayeque y La Libertad, año 2013 y el aporte al producto interno bruto regional

Describes the research carried out by the Observatory Tourist of Peru of the Professional School of Tourismand Hospitality of the University of San Martin de Porres, who poses as an aim to see the generation of the grossdomestic product (GDP) of the transportation companies in the regions of Arequipa, Cusco, Lambayeque and LaLibertad; as well as its contribution to the GDP of each region. The methodology used was exploratory, transverse,descriptive and hermeneutic. We gave a quantitative approach, where we applied techniques of accounting andeconomic research of the satellite accounts. The documentary and technical field technique were used. Theuniverse was made up of 100 % of the companies of transport in the regions of Arequipa, Cusco, Lambayeque andLa Libertad. The surveys were applied to executives and heads of establishments.Se describe la investigación realizada por el Observatorio Turístico del Perú de la Escuela Profesional de Turismo y Hotelería de la Universidad de San Martín de Porres, que plantea como objetivo conocer la generación del Producto Interno Bruto (PIB) de las empresas de transporte en las regiones de Arequipa, Cusco, Lambayeque y La Libertad; así como su aporte al PIB de cada región. La metodología utilizada fue de carácter exploratorio, transversal, descriptivo y hermenéutico. Se le dio un enfoque cuantitativo, donde se aplicaron técnicas propias de la investigación económica y contable de las cuentas satélites. Se utilizó la técnica documental y técnica de campo. El universo estuvo constituido por el 100 % de las empresas de transporte de las regiones de Arequipa, Cusco, Lambayeque y La Libertad. Las encuestas fueron aplicadas a los ejecutivos y jefes de los establecimientos. &nbsp

Las cuentas satélites del turismo en el Perú, año 2013 : museos, restos arqueológicos y sitios naturales de las regiones de Arequipa, Cusco, Lambayeque y La Libertad

Se describe el trabajo realizado por el Observatorio Turístico del Perú de la Escuela Profesional de Turismo y Hotelería de la Universidad de San Martín de Porres, que plantea como objetivo determinar la riqueza generada en el derrotero económico de los museos, restos arqueológicos y sitios naturales de las regiones de Arequipa, Cusco, Lambayeque y La Libertad. Además, se presenta antecedentes referentes a las investigaciones realizadas, así como deficiencias tanto desde el punto de vista cuantitativo como cualitativo en el sector turístico. Para efectos de la medición del PIB de cada una de las unidades de producción correspondiente se utilizó el método de la retribución a los factores de producción

Las cuentas satélites del turismo en el Perú, año 2013

They describes the work carried out by the Observatory Tourist of Peru of the Professional School of Tourism and Hospitality of the University of San Martin de Porres, they posed as an aim to determine the wealth generated in the economic course of the museums, archaeological rests and natural sites of the regions of Arequipa, Cusco, Lambayeque and La Libertad. In addition, it arises from background relating to the investigations carried out, as well as, differences from the quantitative and qualitative point of view in the tourism sector. For the purposes of the measurement of the GDP of each of the corresponding production, units used the method of remuneration to the factors of production. &nbsp;Se describe el trabajo realizado por el Observatorio Turístico del Perú de la Escuela Profesional de Turismo y Hotelería de la Universidad de San Martín de Porres, que plantea como objetivo determinar la riqueza generada en el derrotero económico de los museos, restos arqueológicos y sitios naturales de las regiones de Arequipa, Cusco, Lambayeque y La Libertad. Además, se presenta antecedentes referentes a las investigaciones realizadas, así como deficiencias tanto desde el punto de vista cuantitativo como cualitativo en el sector turístico. Para efectos de la medición del PIB de cada una de las unidades de producción correspondiente se utilizó el método de la retribución a los factores de producción. &nbsp

Cianuración intensiva de un concentrado aurífero

The need arises to take advantage of the best way to increase the added value of our mining products, specifically concentrates containing precious metals, to obtain maximum economic benefit. A method is formulated to determine optimal conditions for leaching concentrates. This method is fundamentally based on cyaniding gold concentrates that respond efficiently to this process, then developing alternatives for the recovery of Au and Ag from pregnant solutions, using the known methods of carbon in pulp and merrill crowe or another that consists of selectively precipitating silver with sodium sulfide and from the remaining solution, recover the gold with activated carbon, efficiently obtaining high quality separate products.Se plantea la necesidad de aprovechar la mejor forma de aumentar el valor agregado de nuestros productos mineros, específicamente de concentrados que contienen metales preciosos, para obtener un máximo beneficio económico. Se formula un método que permite determinar condiciones óptimas para lixiviar concentrados. Este método se basa fundamentalmente en cianurar concentrados auríferos que respondan eficientemente a este proceso, luego desarrollar alternativas de recuperación de Au y Ag de las soluciones pregnant, mediante los métodos conocidos de carbón en pulpa y merril crowe u otro que consiste en precipitar selectivamente la plata con sulfuro de sodio y de la solución remanente recuperar el oro con carbón activado, obteniendo eficientemente productos separados de alta calidad