1,235 research outputs found
Performance of Biomarkers FibroTest, ActiTest, SteatoTest, and NashTest in Patients with Severe Obesity: Meta Analysis of Individual Patient Data
No full textBackground
Liver biopsy is considered as the gold standard for assessing non-alcoholic fatty liver disease (NAFLD) histologic lesions in patients with severe obesity. The aim of this study was to perform an overview of 3 studies which assessed the performance of non-invasive markers of fibrosis (FibroTest), steatosis (SteatoTest) and steato-hepatitis (NashTest, ActiTest) in these patients.
Methods
494 patients with interpretable biopsy and biomarkers using of three prospective cohorts of patients with severe obesity (BMI >35 kg/m2) were included. Histology (NAS score) and the biochemical measurements were blinded to any other characteristics. The area under the ROC curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (wAUROC Obuchowski method) was used to prevent multiple testing and spectrum effect. Two meta-analyses were performed; one used the individual patient, and the other a classical meta-analysis.
Results
Prevalence of advanced fibrosis (bridging) was 9.9%, advanced steatosis (>33%) 54.2%, and steato-hepatitis (NAS score >4) 17.2%. The mean wAUROCs were: FibroTest for advanced fibrosis (95%CI; significance) = 0.85 (0.83–0.87;
The Interactions of Nonalcoholic Fatty Liver Disease and Cardiovascular Diseases
No full textA complex interaction among metabolic factors, adipose tissue lipolysis, oxidative stress, and insulin resistance results in a deleterious process that may link nonalcoholic fatty liver disease (NAFLD) with severe cardiovascular (CV) outcomes. Patients with NAFLD are at higher risk of atherosclerosis, new onset of CV events, and overall mortality. The strong association between NAFLD and CV disease should affect clinical practice, with screening and surveillance of patients with NAFLD. This review discusses the data linking these major diseases
The External Dimension of EU Justice and Home Affairs: Tools, Processes, Outcomes
No full textThis working document offers a conceptual framework for understanding the processes underpinning the external dimension of EU Justice and Home Affairs (ED-JHA). Practically, it defines how the export of JHA principles and norms inform the geopolitical ambitions of the EU, i.e. the use of space for political purposes, or the control and management of people, objects and movement. The author begins by investigating how the ENP reconfigures the ED-JHA, and then goes on to discuss various conceptual stances on governance, specifically institutionalism, constructivism, and policy instruments. To conclude he traces the evolution of this external dimension, emphasising, whenever possible, its continuities and bifurcations. Overall, the aim is to ascertain the extent to which conceptual designs clarify or advance our knowledge of the contents and rationales of the ED-JHA.neighbourhood policy, international politics, geopolitics, migration,immigration, European security, policy instruments, governance, Security and Justice,Justice and Home Affairs
Recommended from our members
Corrigendum to: "FibroTest is an independent predictor of virologic response in chronic hepatitis C patients retreated with pegylated interferon alfa-2b and ribavirin in the EPIC.sup.3 program" [J Hepatol 2011;54:227-235]
No full textByline: Thierry Poynard, Mona Munteanu, Massimo Colombo, Jordi Bruix, Eugene Schiff, Ruben Terg, Steven Flamm, Ricardo Moreno-Otero, Flair Carrilho, Warren Schmidt, Thomas Berg, Thomas Mcgarrity, E. Jenny Heathcote, Fernando Goncales, Moises Diago, Antonio Craxi, Marcelo Silva, Navdeep Boparai, Louis Griffel, Margaret Burroughs, Clifford Brass, Janice AlbrechtAcademi
First-line assessment of patients with chronic liver disease with non-invasive techniques and without recourse to liver biopsy
No full textNon-invasive markers of steatosis and liver fibrosis.
No full textLes méthodes non invasives d'évaluation des lésions tissulaires hépatiques les plus utilisées et les mieux validées sont l'élastométrie et le FibroTest. La stéatopathie non-alcoolique (NAFLD) est devenue la forme la plus fréquente de maladie hépatique. Différentes études suggèrent que la NAFLD est associée à un risque accru de mortalité, en particulier d'origine cardiovasculaire. Les objectifs de cette thèse étaient 1) de mieux définir certaines limites des méthodes non invasives d'évaluation de la fibrose hépatique; 2) d'évaluer la valeur pronostique du FibroTest et d'un biomarqueur de stéatose, le SteatoTest chez les patients ayant un diabète et/ou une dyslipidémie. Le travail réalisé a permis de montrer une variabilité interobservateur notable de l'élastométrie entre deux opérateurs expérimentés dans l'hépatite chronique virale C. La stéatose du foie, estimée par le SteatoTest, a été identifiée comme un facteur indépendant associé à la surestimation de la fibrose du foie par l'élastométrie chez les sujets ayant un diabète de type 2. Nous avons également mis en évidence une variabilité du test APRI et l'impact de l'activité nécrotico-inflammatoire sur ce test dont la formule comprend l'aspartate transaminase exprimée en multiple de la normale dans l'hépatite chronique virale C. Chez des patients à haut risque de NAFLD, nous avons pu démontrer la valeur pronostique à 10 ans du FibroTest et du SteatoTest, pour prédire la mortalité globale indépendamment des facteurs métaboliques. Le FibroTest était également prédictif de la mortalité d'origine hépatique et de l'incidence des complications cardiovasculaires et le SteatoTest de la mortalité d'origine cardiovasculaireSeveral non-invasive methods have been proposed to replace liver biopsy. Transient elastography and FibroTest are the most widely used and best validated non-invasive methods to assess liver fibrosis. Subjects with metabolic disorders such as type-2 diabetes or dyslipidemia, have a high risk of non-alcoholic fatty liver disease (NAFLD). Evidence was previously provided to indicate that NAFLD is associated with an increased risk of cardiovascular disease and overall mortality. The aims of this thesis were. 1) to evaluate the main limitations of non-invasive methods to assess liver fibrosis. 2) to evaluate the prognostic value of liver biomarkers, such as FibroTest and SteatoTest, in patients with type-2 diabetes and/or dyslipidemia. We demonstrated a marked interobserver variability of transient elastography between two experienced operators in chronic hepatitis C. Hepatic steatosis, estimated by SteatoTest, was identified as an independent factor associated with an overestimation of liver fibrosis by transient elastography in patients with type-2 diabetes. We could also show the variability of the APRI test, based on the expression of aspartate aminotransferase relative to the upper limit of normal and the risk of overestimating fibrosis stage by this test due to necro-inflammatory activity in chronic hepatitis C. We reported that FibroTest and SteatoTest had a 10-year prognostic value for prediction of overall mortality independently of metabolic factors in patients at high risk of NAFLD. FibroTest was also predictive of liver-related death and incidence of cardiovascular events. In addition, SteatoTest had a prognostic value for cardiovascular-related death
Assessment of liver fibrosis and associated risk factors in HIV-infected individuals using transient elastography and serum biomarkers
No full textBackground: Liver fibrosis in human immunodeficiency virus (HIV)-infected individuals is mostly attributable to co-infection with hepatitis B or C. The impact of other risk factors, including prolonged exposure to combined antiretroviral therapy (cART) is poorly understood. Our aim was to determine the prevalence of liver fibrosis and associated risk factors in HIV-infected individuals based on non-invasive fibrosis assessment using transient elastography (TE) and serum biomarkers (Fibrotest [FT]).
Methods: In 202 consecutive HIV-infected individuals (159 men; mean age 47 ± 9 years; 35 with hepatitis-C-virus [HCV] co-infection), TE and FT were performed. Repeat TE examinations were conducted 1 and 2 years after study inclusion.
Results: Significant liver fibrosis was present in 16% and 29% of patients, respectively, when assessed by TE (≥ 7.1 kPa) and FT (> 0.48). A combination of TE and FT predicted significant fibrosis in 8% of all patients (31% in HIV/HCV co-infected and 3% in HIV mono-infected individuals). Chronic ALT, AST and γ-GT elevation was present in 29%, 20% and 51% of all cART-exposed patients and in 19%, 8% and 45.5% of HIV mono-infected individuals. Overall, factors independently associated with significant fibrosis as assessed by TE (OR, 95% CI) were co-infection with HCV (7.29, 1.95-27.34), chronic AST (6.58, 1.30-33.25) and γ-GT (5.17, 1.56-17.08) elevation and time on dideoxynucleoside therapy (1.01, 1.00-1.02). In 68 HIV mono-infected individuals who had repeat TE examinations, TE values did not differ significantly during a median follow-up time of 24 months (median intra-patient changes at last TE examination relative to baseline: -0.2 kPa, p = 0.20).
Conclusions: Chronic elevation of liver enzymes was observed in up to 45.5% of HIV mono-infected patients on cART. However, only a small subset had significant fibrosis as predicted by TE and FT. There was no evidence for fibrosis progression during follow-up TE examinations
The External Dimension of EU Justice and Home Affairs: Tools, Processes, Outcomes. CEPS Working Document No. 303, September 2008
No full textThis working document offers a conceptual framework for understanding the processes underpinning the external dimension of EU Justice and Home Affairs (ED-JHA). Practically, it defines how the export of JHA principles and norms inform the geopolitical ambitions of the EU, i.e. the use of space for political purposes, or the control and management of people, objects and movement. The author begins by investigating how the ENP reconfigures the ED-JHA, and then goes on to discuss various conceptual stances on governance, specifically institutionalism, constructivism, and policy instruments. To conclude he traces the evolution of this external dimension, emphasising, whenever possible, its continuities and bifurcations. Overall, the aim is to ascertain the extent to which conceptual designs clarify or advance our knowledge of the contents and rationales of the ED-JHA
Guglielmo di Saint-Thierry: teologo dell’Eucaristia
No full textThe study is about the Eucharistic theology in the work of the medieval Cistercian theologian, William of Saint-Thierry Abbey. First, his general concept of the spirituality of monastic life is presented, which William based on the paradigm of the liturgical celebration which by sign (signum) refers to reality (res). Then, his concept of spiritual communion as inseparably connected with the sacramental communion is discussed. In this part of the study, William’s images appear as important factors for understanding his theology: a spiritual kiss as a way of touching the sacrament mystically, as well as an episode from the monastic life, showing the necessity of receiving the sacrament in a spiritual way so that it can be properly received in a physical one. In the third part of the study, the author attempts to summarize the Eucharistic theology of William of Saint-Thierry, which seems to contrast with the colloquial vision of medieval intellectualism, deprived of mysterious and spiritual elements. Wilhelm z Saint-Thierry: teolog EucharystiiOpracowanie dotyczy teologii eucharystycznej w twórczości średniowiecznego teologa cysterskiego, Wilhelma z opactwa Saint-Thierry. Po omówieniu ogólnej koncepcji duchowości życia monastycznego, którą Wilhelm oparł na paradygmacie celebracji liturgicznej, która przez znak (signum) odsyła do rzeczywistości (res), następuje prezentacja jego koncepcji Komunii duchowej jako nierozerwalnie związanej z Komunią sakramentalną. W tej części studium pojawiają się ważne dla zrozumienia teologii Wilhelma obrazy: pocałunek duchowy jako sposób dotykania sakramentu w sposób mistyczny, a także epizod z życia klasztornego, ukazujący konieczność przyjęcia sakramentu w sposób duchowy, aby móc właściwie przyjąć go na sposób fizyczny. W trzeciej części opracowania autor podejmuje próbę podsumowania teologii eucharystycznej Wilhelma z Saint-Thierry, która okazje się kontrastować z potoczną wizją średniowiecznego intelektualizmu sakramentalnego, wyzbytego pierwiastka misteryjnego i duchowego.
Contractual savings institutions and banks'stability and efficiency
No full textThe authors analyze the relationship between the development of contractual savings institutions and banks'efficiency, credit, and liquidity risks. They discuss the potential mechanisms through which the development of contractual savings institutions may affect the banking sector. They show that the development of contractual savings institutions has a significant impact on bank spreads and loan maturity. After controlling for banks'characteristics, macroeconomic factors, and more standard indicators of financial development, they show that the development of contractual savings institutions is associated with increased efficiency of the banking system and greater resilience to credit and liquidity risks.Payment Systems&Infrastructure,Banks&Banking Reform,Economic Theory&Research,Financial Intermediation,Insurance&Risk Mitigation,Contractual Savings,Banks&Banking Reform,Financial Intermediation,Economic Theory&Research,Insurance&Risk Mitigation
- …
