rome and Liver-Neoplasms

Topics: Carcinoma, Hepatocellular; Hepatitis C; Humans; Liver Neoplasms; Risk Assessment; Rome

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in adults and children. Along with obesity, diabetes and insulin resistance, genetic factors strongly impact on NAFLD development and progression. Dysregulated bile acid metabolism and the fibroblast growth factor 19 (FGF19) pathway play a pivotal role in NAFLD pathogenesis. However, the mechanism through which the FGF19 receptor system is associated with liver damage in NAFLD remains to be defined.. We evaluated the impact of the rs17618244 G>A β-Klotho (KLB) variant on liver damage in 249 pediatric patients with biopsy-proven NAFLD and the association of this variant with the expression of hepatic and soluble KLB. In vitro models were established to investigate the role of the KLB mutant.. The KLB rs17618244 variant was associated with an increased risk of ballooning and lobular inflammation. KLB plasma levels were lower in carriers of the rs17618244 minor A allele and were associated with lobular inflammation, ballooning and fibrosis. In HepG2 and Huh7 hepatoma cell lines, exposure to free fatty acids caused a severe reduction of intracellular and secreted KLB. Finally, KLB downregulation obtained by the expression of a KLB mutant in HepG2 and Huh7 cells induced intracellular lipid accumulation and upregulation of p62, ACOX1, ACSL1, IL-1β and TNF-α gene expression.. In conclusion, we showed an association between the rs17618244 KLB variant, which leads to reduced KLB expression, and the severity of NAFLD in pediatric patients. We can speculate that the KLB protein may exert a protective role against lipotoxicity and inflammation in hepatocytes.. Genetic and environmental factors strongly impact on the pathogenesis and progression of non-alcoholic fatty liver disease (NAFLD). The FGF19/FGFR4/KLB pathway plays a pivotal role in the pathogenesis of NAFLD. The aim of the study was to investigate the impact of a genetic variant in the KLB gene on the severity of liver disease. Our data suggest that the KLB protein plays a protective role against lipotoxicity and inflammation in hepatocytes.

Topics: Adolescent; Alleles; Carcinoma, Hepatocellular; Case-Control Studies; Child; Down-Regulation; Female; Fibroblast Growth Factors; Hep G2 Cells; Humans; Inflammation; Klotho Proteins; Liver; Liver Cirrhosis; Liver Neoplasms; Male; Membrane Proteins; Non-alcoholic Fatty Liver Disease; Polymorphism, Single Nucleotide; Receptor, Fibroblast Growth Factor, Type 4; Rome

To report clinical effectiveness, toxicity profile, and prognostic factors of combined 100 μm ± 25 and 200 μm ± 50 epirubicin-loaded polyethylene glycol (PEG) microsphere drug-eluting embolic transcatheter arterial chemoembolization protocol in patients with hepatocellular carcinoma.. In this prospective, single-center, single-arm study with 18 months of follow-up, 36 consecutive patients (mean age 69.9 y ± 10.8; 26 men, 10 women; 54 naïve lesions) were treated. Embolization was initiated with 100 μm ± 25 microspheres, and if stasis (10 heart beats) was not achieved, 200 μm ± 50 microspheres were administered. Each syringe (2 mL) of PEG microsphere was loaded with 50 mg of epirubicin. Results were evaluated using Modified Response Evaluation Criteria In Solid Tumors with multidetector computed tomography/magnetic resonance imaging at 1, 3-6, 9-12, and 15-18 months. Toxicity profile was assessed by laboratory testing before and after the procedure. Complications were recorded. Postembolization syndrome (PES) was defined as onset of fever/nausea/pain after the procedure. Patient/lesion characteristics and treatment results were correlated with predicted outcome using regression analysis. Child-Pugh score was A in 86.1% of patients (31/36) and B in 13.9% (5/36).. In 10 of 21 lesions, < 2 cm in diameter (47.5%) stasis was achieved with 100 μm ± 25 microspheres only, whereas all other lesions required adjunctive treatment with 200 μm ± 50 microspheres. Reported adverse events were grade 1 acute liver bile duct injury (3/39 cases, 7.7%) and PES (grade 2; 3/39 cases, 7.7%). Complete response (CR) at 1, 3-6, 9-12, and 15-18 months was 61.1%, 65.5%, 63.63%, and 62.5%. Objective response (CR + partial response) at 1, 3-6, 9-12, and 15-18 months was 83.3%, 65.85%, 63.63%, and 62.5%. No single factor (laboratory testing, etiology, patient status, hepatic status, tumor characteristics, administration protocol) predicted outcomes except for albumin level at baseline for CR (P < .05, odds ratio = 1.09).. The combined microsphere sizing strategy was technically feasible and yielded promising results in terms of effectiveness and toxicity.

Topics: Aged; Aged, 80 and over; Antibiotics, Antineoplastic; Biopsy; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Disease Progression; Drug Carriers; Epirubicin; Feasibility Studies; Female; Humans; Liver Neoplasms; Male; Microspheres; Middle Aged; Particle Size; Polyethylene Glycols; Progression-Free Survival; Prospective Studies; Rome; Time Factors; Tomography, X-Ray Computed; Tumor Burden

Greater tumor aggressiveness and different management modalities of hepatocellular cancer (HCC) before liver transplantation (LT) may explain the higher recurrence rates reported in Asia. This study investigates the prognostic factors for HCC recurrence in a Western and an Eastern HCC patient cohort in order to analyze the respective roles of tumor- and management-related factors on the incidence of post-LT HCC recurrence.. Data of 273 HCC patients, transplanted during the period January 1999-March 2009, were obtained from the Rome Inter-University Liver Transplant Consortium (n=157) and Hong Kong University (n=116) databases. Median follow-up was 4.3 years (range: 0.2-12). Recurrence rate and multivariate logistic regression analysis was performed on the entire population and on Milan criteria-in (MC-in) patients.. Multivariate analysis on the entire population identified four independent risk factors for post-LT HCC recurrence: microvascular invasion (odds ratio, OR=4.88; p=0.001), poor tumor grading (OR=6.86; p=0.002), diameter of the largest tumor (OR=4.72; p=0.05), and previous liver resection (LR) (OR=3.34; p=0.04). After removal of LR, only tumor-related variables were independent risk factors for recurrence. When only MC-in patients were analyzed, no difference was observed between the two cohorts in terms of recurrence rate after LR patient removal.. LR followed by salvage "for HCC recurrence" LT represents the main reason for a higher HCC recurrence rate in the Hong Kong patients, but not LR followed by salvage "for liver failure" LT in the Roman group. This approach towards HCC before LT may not be universally applicable. The precise patient background must be taken into account in order to identify the best pre-LT strategy.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Disease Management; Female; Hong Kong; Humans; Incidence; Liver Neoplasms; Liver Transplantation; Logistic Models; Male; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Risk Factors; Rome; Salvage Therapy; Treatment Outcome

The virtual hospitalization can be considered as the telematic evolution of the Day-Hospital, implementing the integration between hospital care and home care and predefining an hospital system which "goes to the patient home". In this paper the authors describe characteristics, motivations and advantages of this proposal, as well as the interaction model. Then the medical problem is illustrated: the liver tumors, which are the more frequent malignant neoplasms, and, in particular, the hepatocellular carcinomas, which represent about the 50% of these tumors. The Organization Model, the Information System and the Modalities of Telemonitoring for Hepatocellular Carcinoma are still illustrated and a brief conclusion is given.

Topics: Carcinoma, Hepatocellular; Cost Control; Home Care Services, Hospital-Based; Humans; Liver Neoplasms; Models, Organizational; Rome; Telemedicine; Telemetry

The mortality of a cohort of 168 pesticide applicators employed in the disinfestation service of the city of Rome for an average of 20 years is examined. Exposure data were abstracted from work records, and causes of death for the 42 workers who had died, were obtained from death certificates. Standardized mortality ratios (SMR) for specific causes of death were computed on the basis of provincial mortality rates. An excess in mortality from cancer of the liver and bile ducts with four cases observed and 0.7 expected (SMR = 571, 95% confidence interval (CI): 154-1463) was found. Increased risk for other cancers was also observed, but the SMR were not statistically different from unity. An increased risk of liver cancer occurs in those exposed to organochlorine pesticides between 1960 and 1965.

Topics: Bile Duct Neoplasms; Cause of Death; Cohort Studies; Confidence Intervals; Death Certificates; Humans; Hydrocarbons, Chlorinated; Insecticides; Liver Neoplasms; Male; Mortality; Occupational Exposure; Pesticides; Population Surveillance; Rome; Urban Population