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Studio prospettico sui fattori di rischio di progressione del danno epatico in una coorte di soggetti con Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Full text linkPremessa e obiettivi
La definizione di Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) è stata
recentemente proposta per identificare i soggetti affetti da steatosi epatica e comorbidità
metaboliche ed ha sostituito la definizione di Non-Alcoholic Fatty Liver Disease (NAFLD).
La Lipasi Acida Lisosomiale (LAL) è un enzima coinvolto nel metabolismo lipidico, che
idrolizza gli esteri del colesterolo e i trigliceridi. Mutazioni del gene LIPA determinano
una ridotta attività di questo enzima, determinando l’accumulo di esteri del colesterolo e
trigliceridi in molti organi, compreso il fegato. Studi precedenti hanno dimostrato una
riduzione dell’attività enzimatica della LAL nei pazienti con NAFLD e NASH-cirrosi.
Non vi sono in letteratura studi prospettici sulla relazione tra attività della LAL ed
evoluzione della MASLD. Obiettivo dello studio è stato quello di valutare l’associazione
tra l’attività enzimatica della LAL e la progressione della fibrosi epatica nei soggetti affetti
da MASLD.
Metodi e risultati
Lo studio è stato condotto nell’ambito dello studio PLINIO (Progression of Liver Damage and
Cardiometabolic Disorders in Non-alcoholic Fatty Liver disease: an Observational Cohort study.
ClinicalTrials.gov. Id. NCT04036357). Revisionando i criteri di inclusione nello studio in
maniera concorde a quelli diagnostici di MASLD è stata identificata una coorte di 847
pazienti. Tutti i pazienti erano negativi per abuso alcolico, epatiti virali, autoimmuni o
iatrogene, escludendo eziologie miste. Sono stati inclusi nell’analisi i soggetti a cui era stata
dosata l’attività enzimatica della LAL all’arruolamento, e dei quali era disponibile un
follow-up laboratoristico di almeno 6 mesi(n=272). Sono stati esclusi dall’analisi i pazienti
con dati incompleti per il calcolo di FIb-4 in almeno due momenti successivi. La
progressione della fibrosi è stata definita come la variazione dello score Fib4 da negativo
(<1.3 se paziente di età <65 anni o <2.0 se età ≥65 anni) a indeterminato o positivo.
6
L’insorgenza di fibrosi avanzata è stata valutata come la variazione del Fib4 da ≤2.67 a
>2.67.
Il follow-up mediano è stato di 70.5 [43.8-112.2] mesi, per un totale di 1720 pazienti/anno.
Al baseline l’attività LAL ed il Fib4 score sono risultati inversamente associati (rS=-0.126,
p=0.038). Durante il follow-up, 49 pazienti hanno mostrato progressione della fibrosi. I
pazienti con progressione presentavano valori più bassi di attività di LAL all’arruolamento
(0.9 [0.7-1.2] vs 0.7 [0.4-0.8] nmol/spot/h; p=0.026). Successivamente, la popolazione è stata
suddivisa in terzili, in base ai valori basali di attività della LAL; i pazienti con più bassa
attività enzimatica sono risultati essere a maggior rischio di sviluppare la progressione
della fibrosi (I vs II+III tertile log-rank test p=0.008) e l’insorgenza di fibrosi avanzata (I vs
II+III tertile log-rank test p=0.028). All’analisi multivariata, valori più bassi di attività LAL
sono risultati essere associati sia alla progressione della fibrosi (HR [Hazard Ratio]=1.879;
95% C.I. 1.063 – 3.32; p=0.030) che all’insorgenza di fibrosi avanzata (HR=5.390, 95% C.I.
1.216 – 23.896, 0.027).
Conclusioni
Nei pazienti affetti da MASLD, la ridotta attività enzimatica della LAL si associa al
progressivo peggioramento della fibrosi epatica, fino alle forme più avanzate. Il dosaggio
dell’attività enzimatica della LAL potrebbe quindi rappresentare un efficace predittore di
progressione, utile a identificare il sottogruppo di pazienti MASLD a maggior rischio di
progressione di malattia. Tali risultati necessitano di una conferma su popolazioni più
ampie. Infine, terapie mirate al miglioramento dell’attività enzimatica della LAL,
potrebbero rappresentare una nuova strategia terapeutica nei pazienti con MASLD
Clinical features of colorectal cancer patients in advanced age: a population-based approach
No full textIn the immediate future, the number of geriatric patients will continue to rise; consequently we should expect an increase of colorectal cancer, a disease of the elderly population. Through the data of a Cancer Registry, we examined (a) the effect of ageing on the main features of colorectal cancer; (b) changes in management, especially for individuals older than 80 years; and (c) changes in prognosis and survival in subgroups of patients with different age. The Registry provided information on colorectal cancer up to 2010 (27 years). A total of 5293 patients were registered; these were divided into three groups: A (0â64 years), B (65â79) and C (80 or more). Three periods of observation were chosen: 1 (1984â1992), 2 (1993â2001) and 3 (2001â2010). Group A included 1571 patients (29 %), Group B 2539 (48 %) and Group C 1183 (22.3 %). The fraction of old individuals increased during the 27 years of the investigation. In these patients, tumours were predominantly localized to the right colon (42.6 %). The rate of surgery and ratio between curative and palliative approaches were similar among the three groups (p 
Psychiatric referral in the terminally ill patient
No full textThe distinction between physiological and dysfunctional emotions in end-of-life care may be hard, for a twofold reason: on the one hand, the patient as a subject, with specific clinical features, personality, system of values; on the other hand, the clinical judgment by involved health professionals, particularly their specific cut-offs in discrimination between normal suffering and psychopathology. Both excessive/untimely medicalization and underestimation of medical conditions such as anxiety, depression, suicidal ideation, and insomnia may be a risk while dealing with end-of-life patients. Prompt, reliable psychiatric diagnosing contributes significantly to the major goal of dignity in death. The aims of a psychiatric consultation for patients with end-stage diseases should be: controlling concomitant psychiatric symptoms, managing pain and physical symptoms, assisting patient and relatives in the crisis-management, mediating conflicts between patient, family and ward personnel, and planning advocacy
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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