Non-alcoholic fatty liver disease (NAFLD) is a major public health problem worldwide. NAFLD (both simple steatosis and steatohepatitis) is characterized by alterations in hepatic lipid metabolism, which may lead to the development of severe liver complications including cirrhosis and hepatocellular carcinoma. Thus, an exhaustive examination of lipid disorders in the liver of NAFLD patients is much needed. Mass spectrometry-based lipidomics platforms allow for in-depth analysis of lipid alterations in a number of human diseases, including NAFLD. This review summarizes the current research on lipid alterations associated with NAFLD and related complications, with special emphasis on the changes in long-chain and short-chain fatty acids levels in both serum and liver tissue, as well as in the hepatic expression of genes encoding the enzymes catalyzing lipid interconversions.
The therapy of colorectal cancer (CRC) patients is often unsuccessful because of the presence of cancer stem cells (CSCs) resistant to conventional approaches. Dendritic cells (DC)-based protocols are believed to effectively supplement CRC therapy. Our study was aimed to assess how the number and properties of CSCs isolated from tumor tissue of CRC patients will affect the biological characteristics of in vitro modified DCs. Similar procedures were conducted with the using of CRC HCT116 and HT29 cell lines. We found that the detailed configuration of CSC-like markers significantly influenced the maturation and activation of DCs after stimulation with cancer cells lysates or culture supernatants. This basic stimulatory effect was enhanced by LPS that is normally present in CRC CSCs niche. The increased number of CD29+ and CD44+ CSCs presented the opposite impact on treated DCs as showed by many significant correlations. The CD133+ CSCs seemed to impair the functions of DCs. The more CD133+ CSCs in tumor sample the lower number of activated DCs evidenced after stimulation. Moreover, our results showed superiority of the spherical culture model over the adherent one since spherical HCT116 and HT29 cells presented similar influence on DCs properties as CRC patients cancer cells. We concluded that the DCs features may depend directly on the properties of CSCs affected by progression status of tumor.
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related death. Cirrhosis is a major contributing factor, accounting for over 90% of HCC cases. With the high mortality rate of HCC, earlier detection of HCC is critical. When added to magnetic resonance imaging (MRI), artificial intelligence (AI) has been shown to improve HCC detection. Nonetheless, to date no cost-effectiveness analyses have been conducted on an AI tool to enhance earlier HCC detection. This study reports on the cost-effectiveness of detection of liver lesions with AI improved MRI in the surveillance for HCC in patients with a cirrhotic liver compared to usual care (UC). The model structure included a decision tree followed by a state-transition Markov model from an Italian healthcare perspective. Lifetime costs and quality-adjusted life years (QALY) were simulated in cirrhotic patients at risk of HCC. One-way sensitivity analyses and two-way sensitivity analyses were performed. Results were presented as incremental cost-effectiveness ratios (ICER). For patients receiving UC, the average lifetime costs per 1,000 patients were €16,604,800 compared to €16,610,250 for patients receiving the AI approach. With a QALY gained of 0.55 and incremental costs of €5,000 for every 1,000 patients, the ICER was €9,888 per QALY gained, indicating cost-effectiveness with the willingness-to-pay threshold of €33,000/QALY gained. Main drivers of cost-effectiveness included the cost and performance (sensitivity and specificity) of the AI tool. This study suggests that an AI-based approach to earlier detect HCC in cirrhotic patients can be cost-effective. By incorporating cost-effective AI-based approaches in clinical practice, patient outcomes and healthcare efficiency are improved.
1 January 2012 in Videosurgery and Other Miniinvasive Techniques
Introduction : In the era of flowering minimally invasive surgical techniques there is a need for new methods of teaching surgery and supervision of progress in skills and expertise. Virtual and physical box-trainers seem especially fit for this purpose, and allow for improvement of...
Background. Despite success of thoracic sympathectomy (ETS), there are patients that develop postoperatively intensive sweating of the trunk. The aim of the study was to present outcomes of three of those methods: removal of the clips, clipping of T6-9, and regional abdomino-lumbar iontophoresis (RALI).Methods. Out of the group of 229 patients treated with ETS, there were 9 that requested removal of the clips, 3 were treated with T6-9 video thoracoscopic block, and 5 were treated with RALI. The intensity of the side effect has been evaluated subjectively (with overall and localized perception of intensity of sweating) and objectively (with gravimetry).Results. The removal of the clips resulted in slow (about 12 months) diminishing of the intensity of sweating of the trunk; but the symptom did not disappear to the degree satisfactory for the patients. The T6-9 block resulted in partial and transient diminishing of the symptom. The iontophoresis resulted in very promising short-term results.Conclusion. Removal of the clips from the sympathetic trunk does not provide resolution of compensatory sweating in 1 year of observation. T6-9 block does not provide remedy for compensatory hyperhidrosis. Regional abdomino-lumbar iontophoresis seems to be very promising, but further research and followup are mandatory.
1 January 2015 in Videosurgery and Other Miniinvasive Techniques
Introduction : Gastroesophageal reflux disease (GERD) has a negative impact on global quality of life (QOL) of patients. In patients affected by GERD, laparoscopic Nissen fundoplication is one of the most commonly performed laparoscopic procedures worldwide. Aim : To prospectively analyze...