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1. NAIF: A novel artificial intelligence-based tool for accurate diagnosis of stage F3/F4 liver fibrosis in the general adult population, validated with three external datasets

Author

Hassoun, S, Bruckmann, C, Ciardullo, S, Perseghin, G, Marra, F, Curto, A, Arena, U, Broccolo, F, Di Gaudio, F, Hassoun, Samir, Bruckmann, Chiara, Ciardullo, Stefano, Perseghin, Gianluca, Marra, Fabio, Curto, Armando, Arena, Umberto, Broccolo, Francesco, Di Gaudio, Francesca, Hassoun, S, Bruckmann, C, Ciardullo, S, Perseghin, G, Marra, F, Curto, A, Arena, U, Broccolo, F, Di Gaudio, F, Hassoun, Samir, Bruckmann, Chiara, Ciardullo, Stefano, Perseghin, Gianluca, Marra, Fabio, Curto, Armando, Arena, Umberto, Broccolo, Francesco, and Di Gaudio, Francesca

Abstract

Objective: The purpose of this study was to determine the effectiveness of a new AI-based tool called NAIF (NAFLD-AI-Fibrosis) in identifying individuals from the general population with advanced liver fibrosis (stage F3/F4). We compared NAIF's performance to two existing risk score calculators, aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (Fib4). Methods: To set up the algorithm for diagnosing severe liver fibrosis (defined as Fibroscan® values E ≥ 9.7 KPa), we used 19 blood biochemistry parameters and two demographic parameters in a group of 5,962 individuals from the NHANES population (2017–2020 pre-pandemic, public database). We then assessed the algorithm's performance by comparing its accuracy, precision, sensitivity, specificity, and F1 score values to those of APRI and Fib4 scoring systems. Results: In a kept-out sub dataset of the NHANES population, NAIF achieved a predictive precision of 72 %, a sensitivity of 61 %, and a specificity of 77 % in correctly identifying adults (aged 18–79 years) with severe liver fibrosis. Additionally, NAIF performed well when tested with two external datasets of Italian patients with a Fibroscan® score E ≥ 9.7 kPa, and with an external dataset of patients with diagnosis of severe liver fibrosis through biopsy. Conclusions: The results of our study suggest that NAIF, using routinely available parameters, outperforms in sensitivity existing scoring methods (Fib4 and APRI) in diagnosing severe liver fibrosis, even when tested with external validation datasets. NAIF uses routinely available parameters, making it a promising tool for identifying individuals with advanced liver fibrosis from the general population. Word count abstract: 236.

Published
2024

4. Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease

Author

Papatheodoridi, M. Hiriart, J.B. Lupsor-Platon, M. Bronte, F. Boursier, J. Elshaarawy, O. Marra, F. Thiele, M. Markakis, G. Payance, A. Brodkin, E. Castera, L. Papatheodoridis, G. Krag, A. Arena, U. Mueller, S. Cales, P. Calvaruso, V. de Ledinghen, V. Pinzani, M. Tsochatzis, E.A.

Abstract

Background: The Baveno VI consensus proposed a dual liver stiffness (LS) by transient elastography threshold of 15 kPa for excluding and diagnosing compensated advanced chronic liver disease (cACLD) in the absence of other clinical signs. Herein, we aimed to validate these criteria in a real-world multicentre study. Methods: We included 5,648 patients (mean age 51 ± 13 years, 53% males) from 10 European liver centres who had a liver biopsy and LS measurement within 6 months. We included patients with chronic hepatitis C (n = 2,913, 52%), non-alcoholic fatty liver disease (NAFLD, n = 1,073, 19%), alcohol-related liver disease (ALD, n = 946, 17%) or chronic hepatitis B (n = 716, 13%). cACLD was defined as fibrosis stage ≥F3. Results: Overall, 3,606 (66%) and 987 (18%) patients had LS 15 kPa, respectively, while cACLD was histologically confirmed in 1,772 (31%) patients. The cut-offs of 15 kPa showed 75% sensitivity and 96% specificity to exclude and diagnose cACLD, respectively. Examining the ROC curve, a more optimal dual cut-off at 12 kPa, with 91% sensitivity and 92% specificity for excluding and diagnosing cACLD (AUC 0.87; 95% CI 0.86–0.88; p 15 kPa dual cut-offs, we found that the 12 kPa dual cut-offs have better diagnostic accuracy in cACLD. Lay summary: The term compensated advanced chronic liver disease (cACLD) was introduced in 2015 to describe the spectrum of advanced fibrosis and cirrhosis in asymptomatic patients. It was also suggested that cACLD could be diagnosed or ruled out based on specific liver stiffness values, which can be non-invasively measured by transient elastography. Herein, we assessed the suggested cut-off values and identified alternative values that offered better overall accuracy for diagnosing or ruling out cACLD. © 2020 European Association for the Study of the Liver

Published
2021

5. Hypoalbuminemia and Risk of Portal Vein Thrombosis in Cirrhosis

Author

Roberto Cangemi, Valeria Raparelli, Giovanni Talerico, Stefania Basili, Francesco Violi, Palasciano Giuseppe, D’Alitto Felicia, Palmieri Vincenzo Ostilio, Santovito Daniela, Di Michele Dario, Croce Giuseppe, Sacerdoti David, Brocco Silvia, Fasolato Silvano, Cecchetto Lara, Bombonato Giancarlo, Bertoni Michele, Restuccia Tea, Andreozzi Paola, Liguori Maria Livia, Perticone Francesco, Caroleo Benedetto, Perticone Maria, Staltari Orietta, Manfredini Roberto, De Giorgi Alfredo, Averna Maurizio, Giammanco Antonina, Granito Alessandro, Pettinari Irene, Marinelli Sara, Bolondi Luigi, Falsetti Lorenzo, Salvi Aldo, Durante-Mangoni Emanuele, Cesaro Flavio, Farinaro Vincenza, Ragone Enrico, Morana Ignazio, Andriulli Angelo, Ippolito Antonio, Iacobellis Angelo, Niro Grazia, Merla Antonio, Raimondo Giovanni, Maimone Sergio, Cacciola Irene, Varvara Doriana, Drenaggi Davide, Staffolani Silvia, Picardi Antonio, Vespasiani-Gentilucci Umberto, Galati Giovanni, Gallo Paolo, Davì Giovanni, Schiavone Cosima, Santilli Francesca, Tana Claudio, Licata Anna, Soresi Maurizio, Bianchi Giovanni Battista, Carderi Isabella, Pinto Antonio, Tuttolomondo Antonino, Ferrari Giovanni, Gresele Paolo, Fierro Tiziana, Morelli Olivia, Laffi Giacomo, Romanelli Roberto Giulio, Arena Umberto, Stasi Cristina, Gasbarrini Antonio, Gargovich Matteo, Zocco Maria Assunta, Riccardi Laura, Ainora Maria Elena, Capeci William, Martino Giuseppe Pio, Nobili Lorenzo, Cavallo Maurizio, Frugiuele Pierluigi, Greco Antonio, Pietrangelo Antonello, Ventura Paolo, Cuoghi Chiara, Marcacci Matteo, Serviddio Gaetano, Vendemiale Gianluigi, Villani Rosanna, Gargano Ruggiero, Vidili Gianpaolo, Di Cesare Valentina, Masala Maristella, Delitala Giuseppe, Invernizzi Pietro, Di Minno Giovanni, Tufano Antonella, Purrello Francesco, Privitera Graziella, Forgione Alessandra, Curigliano Valentina, Senzolo Marco, Rodríguez-Castro Kryssia Isabel, Giannelli Gianluigi, Serra Carla, Neri Sergio, Pignataro Pietro, Rizzetto Mario, Debernardi Venon Wilma, Svegliati Baroni Gianluca, Bergamaschi Gaetano, Masotti Michela, Costanzo Filippo, Corazza Gino Roberto, Caldwell Stephen Hugh, Angelico Francesco, Del Ben Maria, Napoleone Laura, Polimeni Licia, Proietti Marco, Raparelli Valeria, Romiti Giulio Francesco, Ruscio Eleonora, Severoni Andrea, Talerico Giovanni, Toriello Filippo, and Vestri Annarita

Subjects
Albumin, Cirrhosis, Portal Vein Thrombosis, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and Aims: Hypoalbuminemia, as defined by serum albumin (SA) levels ≤35 g/L, is associated to venous and arterial thrombosis in general population and in patients at risk of cardiovascular disease. It is unknown if SA ≤35 g/L is also associated to portal vein thrombosis (PVT) in cirrhosis. Methods: Cirrhotic patients enrolled in the Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry (PRO-LIVER) study (n = 753), were followed-up for 2 years to assess the risk of PVT, that was diagnosed by Doppler ultrasonography. Child-Pugh classes, Model for End-Stage Liver Disease score, presence of hepatocellular carcinoma and laboratory variables including SA, D-dimer, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline. Results: SA ≤35 g/L was detected in 52% of patients. A logistic multivariate regression analysis showed that higher Child-Pugh class, hepatocellular carcinoma and thrombocytopenia were significantly associated to SA ≤35 g/L. In a subgroup of patients where data regarding hs-CRP and D-dimer were available, SA ≤35 g/L was inversely associated with hs-CRP and D-dimer. During the follow-up, a total of 61 patients experienced PVT. A Kaplan Meier survival analysis showed SA ≤35 g/L was associated to increased risk of PVT compared to SA >35 g/L (P = .005). A multivariate Cox proportional hazards regression analysis showed that male sex, lower platelet count, and SA ≤35 g/L remained associated to PVT after adjusting for confounding factors. Conclusion: Cirrhotic patients with SA ≤35 g/L are at higher risk of experiencing PVT compared to those with SA >35 g/L and could be considered as potential candidates to anticoagulant prophylaxis for PVT prevention.

Published
2024
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6. Under-dilated TIPS Associate With Efficacy and Reduced Encephalopathy in a Prospective, Non-randomized Study of Patients With Cirrhosis

Author

Schepis, F, Vizzutti, F, Garcia-Tsao, G, Marzocchi, G, Rega, L, De Maria, N, Di Maira, T, Gitto, S, Caporali, C, Colopi, S, De Santis, M, Arena, U, Rampoldi, A, Airoldi, A, Cannavale, A, Fanelli, F, Mosconi, C, Renzulli, M, Agazzi, R, Nani, R, Quaretti, P, Fiorina, I, Moramarco, L, Miraglia, R, Luca, A, Bruno, R, Fagiuoli, S, Golfieri, R, Torricelli, P, Di Benedetto, F, Belli, L, Banchelli, F, Laffi, G, Marra, F, Villa, E, Schepis F., Vizzutti F., Garcia-Tsao G., Marzocchi G., Rega L., De Maria N., Di Maira T., Gitto S., Caporali C., Colopi S., De Santis M., Arena U., Rampoldi A., Airoldi A., Cannavale A., Fanelli F., Mosconi C., Renzulli M., Agazzi R., Nani R., Quaretti P., Fiorina I., Moramarco L., Miraglia R., Luca A., Bruno R., Fagiuoli S., Golfieri R., Torricelli P., Di Benedetto F., Belli L. S., Banchelli F., Laffi G., Marra F., Villa E., Schepis, F, Vizzutti, F, Garcia-Tsao, G, Marzocchi, G, Rega, L, De Maria, N, Di Maira, T, Gitto, S, Caporali, C, Colopi, S, De Santis, M, Arena, U, Rampoldi, A, Airoldi, A, Cannavale, A, Fanelli, F, Mosconi, C, Renzulli, M, Agazzi, R, Nani, R, Quaretti, P, Fiorina, I, Moramarco, L, Miraglia, R, Luca, A, Bruno, R, Fagiuoli, S, Golfieri, R, Torricelli, P, Di Benedetto, F, Belli, L, Banchelli, F, Laffi, G, Marra, F, Villa, E, Schepis F., Vizzutti F., Garcia-Tsao G., Marzocchi G., Rega L., De Maria N., Di Maira T., Gitto S., Caporali C., Colopi S., De Santis M., Arena U., Rampoldi A., Airoldi A., Cannavale A., Fanelli F., Mosconi C., Renzulli M., Agazzi R., Nani R., Quaretti P., Fiorina I., Moramarco L., Miraglia R., Luca A., Bruno R., Fagiuoli S., Golfieri R., Torricelli P., Di Benedetto F., Belli L. S., Banchelli F., Laffi G., Marra F., and Villa E.

Abstract

Background & Aims: Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time. Methods: We performed a prospective, non-randomized study of 42 unselected patients with cirrhosis who received under-dilated TIPS (7 and 6 mm) and 53 patients who received PTFE-SGs of 8 mm or more (controls) at referral centers in Italy. After completion of this study, dilation to 6 mm became the standard and 47 patients were included in a validation study. All patients were followed for 6 months; Doppler ultrasonography was performed 2 weeks and 3 months after TIPS placement and every 6 months thereafter. Stability of PTFE-SG diameter was evaluated by computed tomography analysis of 226 patients with cirrhosis whose stent grafts increased to 6, 7, 8, 9, or 10 mm. The primary outcomes were incidence of at least 1 episode of PSE grade 2 or higher during follow up, incidence of recurrent variceal hemorrhage or ascites, incidence of shunt dysfunction requiring TIPS recanalization, and reduction in porto-caval pressure gradient. Results: PSE developed in a significantly lower proportion of patients with under-dilated TIPS (27%) than controls (54%) during the first year after the procedure (P =.015), but the proportions of patients with recurrent variceal hemorrhage or ascites did not differ significantly between groups. No TIPS occlusions were observed. These results were confirmed in the validation cohort. In an analysis of self-expansion of stent grafts, during a mean follow-up period of 252 days after placement, none of the PTFE-SGs self-expanded to t

Published
2018

7. Application of LCA modelling in integrated waste management

Author

Christensen, T. H., Damgaard, A., Levis, J., Zhao, Y., Björklund, Anna, Arena, U., Barlaz, M. A., Starostina, V, Boldrin, A., Astrup, T. F., Bisinella, V, Christensen, T. H., Damgaard, A., Levis, J., Zhao, Y., Björklund, Anna, Arena, U., Barlaz, M. A., Starostina, V, Boldrin, A., Astrup, T. F., and Bisinella, V

Abstract

Life cycle assessment (LCA) has been used in waste management for the last two decades and hundreds of journal papers have been published. The use of LCA in waste management has provided a much-improved holistic view of waste management including waste flows and potential environmental impacts. Although much knowledge has been obtained from LCA studies, there is still a need to use LCA models in integrated waste management. This paper describes six areas where LCA is expected to play a role in waste management in the future: 1) understanding an existing waste management system; 2) improving existing waste management systems; 3) comparing alternative technologies/ technology performance; 4) technology development/prospective technologies; 5) policy development/strategic development; and 6) reporting. Illustrative examples are provided for each application area., QC 20201201

Published
2020
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8. Application of LCA modelling in integrated waste management

Author

Christensen, Thomas Højlund, Damgaard, Anders, Levis, J., Zhao, Y., Björklund, A., Arena, U., Barlaz, M. A., Starostina, V., Boldrin, Alessio, Astrup, Thomas Fruergaard, Bisinella, Valentina, Christensen, Thomas Højlund, Damgaard, Anders, Levis, J., Zhao, Y., Björklund, A., Arena, U., Barlaz, M. A., Starostina, V., Boldrin, Alessio, Astrup, Thomas Fruergaard, and Bisinella, Valentina

Abstract

Life cycle assessment (LCA) has been used in waste management for the last two decades and hundreds of journal papers have been published. The use of LCA in waste management has provided a much-improved holistic view of waste management including waste flows and potential environmental impacts. Although much knowledge has been obtained from LCA studies, there is still a need to use LCA models in integrated waste management. This paper describes six areas where LCA is expected to play a role in waste management in the future: 1) understanding an existing waste management system; 2) improving existing waste management systems; 3) comparing alternative technologies/ technology performance; 4) technology development/prospective technologies; 5) policy development/strategic development; and 6) reporting. Illustrative examples are provided for each application area.

Published
2020

11. Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry

Author

Violi, F, Corazza, R, Caldwell, S, Perticone, F, Gatta, A, Angelico, M, Farcomeni, A, Masotti, M, Napoleone, L, Vestri, A, Raparelli, V, Basili, S, Palasciano, G, D'Alitto, F, Palmieri, V, Santovito, D, Di Michele, D, Croce, G, Sacerdoti, D, Brocco, S, Fasolato, S, Cecchetto, L, Bombonato, G, Bertoni, M, Restuccia, R, Andreozzi, P, Liguori, L, Caroleo, B, Perticone, M, Staltari, O, Manfredini, R, De Giorgi, A, Averna, M, Giammanco, A, Granito, A, Pettinari, I, Marinelli, S, Bolondi, L, Falsetti, L, Salvi, A, Durante-Mangoni, E, Cesaro, F, Farinaro, V, Ragone, E, Morana, I, Andriulli, A, Ippolito, A, Iacobellis, A, Niro, G, Merla, A, Raimondo, G, Maimone, S, Cacciola, I, Varvara, D, Drenaggi, D, Staffolani, S, Picardi, A, Vespasiani-Gentilucci, U, Galati, G, Gallo, P, Davi, G, Schiavone, C, Santilli, F, Tana, C, Licata, A, Soresi, M, Bianchi, B, Carderi, I, Pinto, A, Tuttolomondo, A, Ferrari, G, Gresele, P, Fierro, T, Morelli, O, Laffi, G, Romanelli, R, Arena, U, Cristina, S, Gasbarrini, A, Gargovich, M, Zocco, Z, Riccardi, L, Ainora, M, Capeci, W, Martino, M, Lorenzo, N, Cavallo, M, Frugiuele, P, Greco, A, Pietrangelo, A, Ventura, P, Cuoghi, C, Marcacci, M, Serviddio, G, Vendemiale, G, Villani, R, Gargano, R, Vidili, G, Di Cesare, V, Masala, M, Delitala, G, Invernizzi, P, Di Minno, G, Tufano, A, Purrello, F, Privitera, G, Forgione, A, Curigliano, V, Senzolo, M, Rodriguez-Castro, K, Giannelli, G, Serra, C, Neri, S, Pignataro, P, Rizzetto, M, Debernardi, V, Svegliati, B, Bergamaschi, G, Costanzo, F, Angelico, F, Del Ben, M, Polimeni, L, Talerico, G, Proietti, M, Romiti, G, Ruscio, E, Toriello, F, Violi F., Corazza R. G., Caldwell S. H., Perticone F., Gatta A., Angelico M., Farcomeni A., Masotti M., Napoleone L., Vestri A., Raparelli V., Basili S., Palasciano G., D'Alitto F., Palmieri V. O., Santovito D., Di Michele D., Croce G., Sacerdoti D., Brocco S., Fasolato S., Cecchetto L., Bombonato G., Bertoni M., Restuccia R., Andreozzi P., Liguori L. M., Caroleo B., Perticone M., Staltari O., Manfredini R., De Giorgi A., Averna M., Giammanco A., Granito A., Pettinari I., Marinelli S., Bolondi L., Falsetti L., Salvi A., Durante-Mangoni E., Cesaro F., Farinaro V., Ragone E., Morana I., Andriulli A., Ippolito A., Iacobellis A., Niro G., Merla A., Raimondo G., Maimone S., Cacciola I., Varvara D., Drenaggi D., Staffolani S., Picardi A., Vespasiani-Gentilucci U., Galati G., Gallo P., Davi G., Schiavone C., Santilli F., Tana C., Licata A., Soresi M., Bianchi B. G., Carderi I., Pinto A., Tuttolomondo A., Ferrari G., Gresele P., Fierro T., Morelli O., Laffi G., Romanelli R. G., Arena U., Cristina S., Gasbarrini A., Gargovich M., Zocco Z. M., Riccardi L., Ainora M. E., Capeci W., Martino M. G., Lorenzo N., Cavallo M., Frugiuele P., Greco A., Pietrangelo A., Ventura P., Cuoghi C., Marcacci M., Serviddio G., Vendemiale G., Villani R., Gargano R., Vidili G., Di Cesare V., Masala M., Delitala G., Invernizzi P., Di Minno G., Tufano A., Purrello F., Privitera G., Forgione A., Curigliano V., Senzolo M., Rodriguez-Castro K. -I., Giannelli G., Serra C., Neri S., Pignataro P., Rizzetto M., Debernardi V. W., Svegliati B. G., Bergamaschi G., Costanzo F., Angelico F., Del Ben M., Polimeni L., Talerico G., Proietti M., Romiti G. F., Ruscio E., Toriello F., Violi, F, Corazza, R, Caldwell, S, Perticone, F, Gatta, A, Angelico, M, Farcomeni, A, Masotti, M, Napoleone, L, Vestri, A, Raparelli, V, Basili, S, Palasciano, G, D'Alitto, F, Palmieri, V, Santovito, D, Di Michele, D, Croce, G, Sacerdoti, D, Brocco, S, Fasolato, S, Cecchetto, L, Bombonato, G, Bertoni, M, Restuccia, R, Andreozzi, P, Liguori, L, Caroleo, B, Perticone, M, Staltari, O, Manfredini, R, De Giorgi, A, Averna, M, Giammanco, A, Granito, A, Pettinari, I, Marinelli, S, Bolondi, L, Falsetti, L, Salvi, A, Durante-Mangoni, E, Cesaro, F, Farinaro, V, Ragone, E, Morana, I, Andriulli, A, Ippolito, A, Iacobellis, A, Niro, G, Merla, A, Raimondo, G, Maimone, S, Cacciola, I, Varvara, D, Drenaggi, D, Staffolani, S, Picardi, A, Vespasiani-Gentilucci, U, Galati, G, Gallo, P, Davi, G, Schiavone, C, Santilli, F, Tana, C, Licata, A, Soresi, M, Bianchi, B, Carderi, I, Pinto, A, Tuttolomondo, A, Ferrari, G, Gresele, P, Fierro, T, Morelli, O, Laffi, G, Romanelli, R, Arena, U, Cristina, S, Gasbarrini, A, Gargovich, M, Zocco, Z, Riccardi, L, Ainora, M, Capeci, W, Martino, M, Lorenzo, N, Cavallo, M, Frugiuele, P, Greco, A, Pietrangelo, A, Ventura, P, Cuoghi, C, Marcacci, M, Serviddio, G, Vendemiale, G, Villani, R, Gargano, R, Vidili, G, Di Cesare, V, Masala, M, Delitala, G, Invernizzi, P, Di Minno, G, Tufano, A, Purrello, F, Privitera, G, Forgione, A, Curigliano, V, Senzolo, M, Rodriguez-Castro, K, Giannelli, G, Serra, C, Neri, S, Pignataro, P, Rizzetto, M, Debernardi, V, Svegliati, B, Bergamaschi, G, Costanzo, F, Angelico, F, Del Ben, M, Polimeni, L, Talerico, G, Proietti, M, Romiti, G, Ruscio, E, Toriello, F, Violi F., Corazza R. G., Caldwell S. H., Perticone F., Gatta A., Angelico M., Farcomeni A., Masotti M., Napoleone L., Vestri A., Raparelli V., Basili S., Palasciano G., D'Alitto F., Palmieri V. O., Santovito D., Di Michele D., Croce G., Sacerdoti D., Brocco S., Fasolato S., Cecchetto L., Bombonato G., Bertoni M., Restuccia R., Andreozzi P., Liguori L. M., Caroleo B., Perticone M., Staltari O., Manfredini R., De Giorgi A., Averna M., Giammanco A., Granito A., Pettinari I., Marinelli S., Bolondi L., Falsetti L., Salvi A., Durante-Mangoni E., Cesaro F., Farinaro V., Ragone E., Morana I., Andriulli A., Ippolito A., Iacobellis A., Niro G., Merla A., Raimondo G., Maimone S., Cacciola I., Varvara D., Drenaggi D., Staffolani S., Picardi A., Vespasiani-Gentilucci U., Galati G., Gallo P., Davi G., Schiavone C., Santilli F., Tana C., Licata A., Soresi M., Bianchi B. G., Carderi I., Pinto A., Tuttolomondo A., Ferrari G., Gresele P., Fierro T., Morelli O., Laffi G., Romanelli R. G., Arena U., Cristina S., Gasbarrini A., Gargovich M., Zocco Z. M., Riccardi L., Ainora M. E., Capeci W., Martino M. G., Lorenzo N., Cavallo M., Frugiuele P., Greco A., Pietrangelo A., Ventura P., Cuoghi C., Marcacci M., Serviddio G., Vendemiale G., Villani R., Gargano R., Vidili G., Di Cesare V., Masala M., Delitala G., Invernizzi P., Di Minno G., Tufano A., Purrello F., Privitera G., Forgione A., Curigliano V., Senzolo M., Rodriguez-Castro K. -I., Giannelli G., Serra C., Neri S., Pignataro P., Rizzetto M., Debernardi V. W., Svegliati B. G., Bergamaschi G., Costanzo F., Angelico F., Del Ben M., Polimeni L., Talerico G., Proietti M., Romiti G. F., Ruscio E., and Toriello F.

Abstract

Portal vein thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the portal area to evaluate the prevalence and incidence of portal vein thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected portal vein thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the portal vein thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous portal vein thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with portal vein thrombosis. Portal vein thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with portal vein thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.

Published
2016

12. Thank you: A journal is as good as its reviewers (Editorial)

Author

Arena, U., Barlaz, M., He, P., D'Adamo, I., Astals, S., Bogner, J. E., Bolyard, S. C., de Brito, J. M. C. L., Calabrò, P. S., Canu, P., Chroni, C., Clarke, B., Corvellec, H., Costa, G., Gent, M. R., Izquierdo, A. G., Koziel, J. A., Lapa, N., Leckner, B., Lombardi, Lidia, Materazzi, M., Oonk, H., Pivnenko, K., Reddy, K. R., van der Sloot, H., Sundqvist, J. -O., Tatàno, F., Townsend, T., Turner, D., Vehlow, J., Wang, T., Wang, Y., White, J., Zeng, Y., and Zurbrügg, C.

Published
2018

13. Portal Vein Thrombosis Relevance on Liver Cirrhosis: Italian Venous Thrombotic Events Registry

Author

Violi F., Corazza R. G., Caldwell S. H., Perticone F., Gatta A., Angelico M., Farcomeni A., Masotti M., Napoleone L., Vestri A., Raparelli V., Basili S., Palasciano G., D'Alitto F., Palmieri V. O., Santovito D., Di Michele D., Croce G., Sacerdoti D., Brocco S., Fasolato S., Cecchetto L., Bombonato G., Bertoni M., Restuccia R., Andreozzi P., Liguori L. M., Caroleo B., Perticone M., Staltari O., Manfredini R., De Giorgi A., Averna M., Giammanco A., Granito A., Pettinari I., Marinelli S., Bolondi L., Falsetti L., Salvi A., Durante-Mangoni E., Cesaro F., Farinaro V., Ragone E., Morana I., Andriulli A., Ippolito A., Iacobellis A., Niro G., Merla A., Raimondo G., Maimone S., Cacciola I., Varvara D., Drenaggi D., Staffolani S., Picardi A., Vespasiani-Gentilucci U., Galati G., Gallo P., Davi G., Schiavone C., Santilli F., Tana C., Licata A., Soresi M., Bianchi B. G., Carderi I., Pinto A., Tuttolomondo A., Ferrari G., Gresele P., Fierro T., Morelli O., Laffi G., Romanelli R. G., Arena U., Cristina S., Gasbarrini A., Gargovich M., Zocco Z. M., Riccardi L., Ainora M. E., Capeci W., Martino M. G., Lorenzo N., Cavallo M., Frugiuele P., Greco A., Pietrangelo A., Ventura P., Cuoghi C., Marcacci M., Serviddio G., Vendemiale G., Villani R., Gargano R., Vidili G., Di Cesare V., Masala M., Delitala G., Invernizzi P., Di Minno G., Tufano A., Purrello F., Privitera G., Forgione A., Curigliano V., Senzolo M., Rodriguez-Castro K. -I., Giannelli G., Serra C., Neri S., Pignataro P., Rizzetto M., Debernardi V. W., Svegliati B. G., Bergamaschi G., Costanzo F., Angelico F., Del Ben M., Polimeni L., Talerico G., Proietti M., Romiti G. F., Ruscio E., Toriello F., Violi, F., Corazza, R. G., Caldwell, S. H., Perticone, F., Gatta, A., Angelico, M., Farcomeni, A., Masotti, M., Napoleone, L., Vestri, A., Raparelli, V., Basili, S., Palasciano, G., D'Alitto, F., Palmieri, V. O., Santovito, D., Croce, G., Sacerdoti, D., Brocco, S., Fasolato, S., Cecchetto, L., Bombonato, G., Restuccia, R., Andreozzi, P., Liguori, L. M., Perticone, M., Staltari, O., Manfredini, R., De Giorgi, A., Averna, M., Giammanco, A., Granito, A., Marinelli, S., Bolondi, L., Falsetti, L., Salvi, A., Durante-Mangoni, E., Cesaro, F., Farinaro, V., Ragone, E., Morana, I., Andriulli, A., Ippolito, A., Iacobellis, A., Niro, G., Merla, A., Raimondo, G., Maimone, S., Cacciola, I., Varvara, D., Drenaggi, D., Staffolani, S., Picardi, A., Vespasiani-Gentilucci, U., Galati, G., Gallo, P., Davi, G., Schiavone, C., Santilli, F., Tana, C., Licata, A., Soresi, M., Bianchi, B. G., Carderi, I., Pinto, A., Tuttolomondo, A., Ferrari, G., Gresele, P., Fierro, T., Morelli, O., Laffi, G., Romanelli, R. G., Arena, U., Cristina, S., Gasbarrini, A., Gargovich, M., Zocco, Z. M., Riccardi, L., Ainora, M. E., Capeci, W., Martino, M. G., Lorenzo, N., Cavallo, M., Frugiuele, P., Greco, A., Pietrangelo, A., Ventura, P., Cuoghi, C., Marcacci, M., Serviddio, G., Vendemiale, G., Villani, R., Gargano, R., Vidili, G., Di Cesare, V., Masala, M., Delitala, G., Invernizzi, P., Di Minno, G., Tufano, A., Purrello, F., Privitera, G., Forgione, A., Curigliano, V., Senzolo, M., Rodriguez-Castro, K. -I., Giannelli, G., Serra, C., Neri, S., Pignataro, P., Rizzetto, M., Debernardi, V. W., Svegliati, B. G., Bergamaschi, G., Costanzo, F., Angelico, F., Del Ben, M., Polimeni, L., Talerico, G., Proietti, M., Romiti, G. F., Ruscio, E., Toriello, F., Violi, F, Corazza, R, Caldwell, S, Perticone, F, Gatta, A, Angelico, M, Farcomeni, A, Masotti, M, Napoleone, L, Vestri, A, Raparelli, V, Basili, S, Palasciano, G, D'Alitto, F, Palmieri, V, Santovito, D, Di Michele, D, Croce, G, Sacerdoti, D, Brocco, S, Fasolato, S, Cecchetto, L, Bombonato, G, Bertoni, M, Restuccia, R, Andreozzi, P, Liguori, L, Caroleo, B, Perticone, M, Staltari, O, Manfredini, R, De Giorgi, A, Averna, M, Giammanco, A, Granito, A, Pettinari, I, Marinelli, S, Bolondi, L, Falsetti, L, Salvi, A, Durante-Mangoni, E, Cesaro, F, Farinaro, V, Ragone, E, Morana, I, Andriulli, A, Ippolito, A, Iacobellis, A, Niro, G, Merla, A, Raimondo, G, Maimone, S, Cacciola, I, Varvara, D, Drenaggi, D, Staffolani, S, Picardi, A, Vespasiani-Gentilucci, U, Galati, G, Gallo, P, Davi, G, Schiavone, C, Santilli, F, Tana, C, Licata, A, Soresi, M, Bianchi, B, Carderi, I, Pinto, A, Tuttolomondo, A, Ferrari, G, Gresele, P, Fierro, T, Morelli, O, Laffi, G, Romanelli, R, Arena, U, Cristina, S, Gasbarrini, A, Gargovich, M, Zocco, Z, Riccardi, L, Ainora, M, Capeci, W, Martino, M, Lorenzo, N, Cavallo, M, Frugiuele, P, Greco, A, Pietrangelo, A, Ventura, P, Cuoghi, C, Marcacci, M, Serviddio, G, Vendemiale, G, Villani, R, Gargano, R, Vidili, G, Di Cesare, V, Masala, M, Delitala, G, Invernizzi, P, Di Minno, G, Tufano, A, Purrello, F, Privitera, G, Forgione, A, Curigliano, V, Senzolo, M, Rodriguez-Castro, K, Giannelli, G, Serra, C, Neri, S, Pignataro, P, Rizzetto, M, Debernardi, V, Svegliati, B, Bergamaschi, G, Costanzo, F, Angelico, F, Del Ben, M, Polimeni, L, Talerico, G, Proietti, M, Romiti, G, Ruscio, E, Toriello, F, Violi F., Corazza R.G., Caldwell S.H., Perticone F., Gatta A., Angelico M., Farcomeni A., Masotti M., Napoleone L., Vestri A., Raparelli V., Basili S., Palasciano G., D'Alitto F., Palmieri V.O., Santovito D., Di Michele D., Croce G., Sacerdoti D., Brocco S., Fasolato S., Cecchetto L., Bombonato G., Bertoni M., Restuccia R., Andreozzi P., Liguori L.M., Caroleo B., Perticone M., Staltari O., Manfredini R., De Giorgi A., Averna M., Giammanco A., Granito A., Pettinari I., Marinelli S., Bolondi L., Falsetti L., Salvi A., Durante-Mangoni E., Cesaro F., Farinaro V., Ragone E., Morana I., Andriulli A., Ippolito A., Iacobellis A., Niro G., Merla A., Raimondo G., Maimone S., Cacciola I., Varvara D., Drenaggi D., Staffolani S., Picardi A., Vespasiani-Gentilucci U., Galati G., Gallo P., Davi G., Schiavone C., Santilli F., Tana C., Licata A., Soresi M., Bianchi B.G., Carderi I., Pinto A., Tuttolomondo A., Ferrari G., Gresele P., Fierro T., Morelli O., Laffi G., Romanelli R.G., Arena U., Cristina S., Gasbarrini A., Gargovich M., Zocco Z.M., Riccardi L., Ainora M.E., Capeci W., Martino M.G., Lorenzo N., Cavallo M., Frugiuele P., Greco A., Pietrangelo A., Ventura P., Cuoghi C., Marcacci M., Serviddio G., Vendemiale G., Villani R., Gargano R., Vidili G., Di Cesare V., Masala M., Delitala G., Invernizzi P., Di Minno G., Tufano A., Purrello F., Privitera G., Forgione A., Curigliano V., Senzolo M., Rodriguez-Castro K.-I., Giannelli G., Serra C., Neri S., Pignataro P., Rizzetto M., Debernardi V.W., Svegliati B.G., Bergamaschi G., Costanzo F., Angelico F., Del Ben M., Polimeni L., Talerico G., Proietti M., Romiti G.F., Ruscio E., and Toriello F.

Subjects
Registrie, Liver Cirrhosis, Male, Cirrhosis, Hepatocellular carcinoma, 030204 cardiovascular system & hematology, Gastroenterology, 0302 clinical medicine, Esophageal varices, Prevalence, Medicine, Prospective Studies, Registries, Prospective cohort study, Multivariate Analysi, Venous Thrombosis, Portal Vein, Anticoagulants, Liver failure, Splanchnic venous thrombosis, Emergency Medicine, Internal Medicine, Middle Aged, Portal vein thrombosis, Venous thrombosis, Splanchnic venous thrombosis , Anticoagulants , Liver failure , Hepatocellular carcinoma , Esophageal varices, Italy, Liver, Female, 030211 gastroenterology & hepatology, medicine.symptom, Settore SECS-S/01 - Statistica, Human, medicine.medical_specialty, Liver Cirrhosi, Socio-culturale, Asymptomatic, 03 medical and health sciences, Anticoagulants, Esophageal varices, Hepatocellular carcinoma, Liver failure, Splanchnic venous thrombosis, Internal medicine, Humans, Aged, Hepatology, Esophageal varice, business.industry, Anticoagulant, Splanchnic venous thrombosi, medicine.disease, Surgery, Prospective Studie, Splanchnic venous thrombosis, Anticoagulants, Liver failure, Hepatocellular carcinoma, Esophageal varices, Multivariate Analysis, Upper gastrointestinal bleeding, Complication, business
Abstract

Portal vein thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the portal area to evaluate the prevalence and incidence of portal vein thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68% men; 64±12years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44%) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20%. The prevalence of ultrasound-detected portal vein thrombosis was 17% (n=126); it was asymptomatic in 43% of the cases. Notably, more than half of the portal vein thrombosis patients (n=81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous portal vein thrombosis (p&nbsp

Published
2016

15. Interferon-free therapy in hepatitis C virus mixed cryoglobulinaemia: a prospective, controlled, clinical and quality of life analysis

Author

Gragnani, L., primary, Cerretelli, G., additional, Lorini, S., additional, Steidl, C., additional, Giovannelli, A., additional, Monti, M., additional, Petraccia, L., additional, Sadalla, S., additional, Urraro, T., additional, Caini, P., additional, Xheka, A., additional, Simone, A., additional, Arena, U., additional, Matucci-Cerinic, M., additional, Vergani, D., additional, Laffi, G., additional, and Zignego, A. L., additional

Published
2018
Full Text
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17. Bonifica dei Terreni Contaminati. Osservazioni critiche, linee guida e proposte normative

Author

Aggazzotti, Gabriella, Andretta, Alfonso, Benezzoli, Umberto, Bonifazi, Giuseppe, Butti, Luciano, Cappucci, Sergio, Davini, Andrea, Nauta, Stefano Di, Ferrante, Margherita, Finotelli, Fabrizio, Longo, Oronzo Antonio, Miano, Teodoro, Moretto, Carlo Giovanni, Orrico, Bruno, Pedron, Roberto, Peres, Federico, Pivato, Alberto, Quercia, Francesca, Racciatti, Rocco Virginio, Braschi, Ilaria, Bonifica dei terreni contaminati, in: Aggazzotti, G., Ajmone Marsan, F., Andretta, A., Andrisani, A. G., Angeloni, A., Arcella, C., Ardissone, E., Arena, U., Argese, E., Balestreri, A., Bavestrelli, A., Benezzoli, U., Bergamini, M., Bonifazi, G., Braschi, I., Bratti, A., Brutti, R., Butti, L., Canè, G., Cappucci, S., Castellano, G., Cervelli, M., Cianciullo, A., Cossu, R., Davini, A., Davit, J. P., Davoli, E., Dei Svaldi, M., Del Frate, A. A., Di Nauta, S., Di Sante, M., Dotti, M., Evangelista, R., Faleschini, F., Farina, R., Ferrante, M., Finotelli, F., Fogal, E., Forni, A., Forni, F., Furnari, S., Gnocchi, A., Gosso, E., Grisolia, M., Guerini, A., Lagorio, M., Lattanzi, P., Lavagnolo, M. C., Leombruni, A., Longo, O. A., Malagoli, M., Marotta, A., Massara, R., Massarini, P., Mastrantonio, M., Mazzieri, F., Miano, T., Misano, V., Monfroni, I., Morello, L., Moretto, C. G., Orrico, B., Parma, M., Pasqualini, E., Pedron, R., Peres, F., Petruzzelli, D., Petruzzelli, G. A., Piccolo, A., Pingitore, D., Pintore, M., Piscitelli, M., Pivato, A., Potenza, F., Potenza, G., Preda, G., Quercia, F., Racciati, R. V., Ranieri, G., Ranieri, M., Recchia, L., Ricci, R., Righini, L., Russo, P., Scalco, R., Schiavone, C., Spagni, A., Tasselli, L., Tonello, P., Tresso, G., Trevisi, V. M., Ursino, N., Vecchio, A., and Vinci, L.

Published
2015

18. Liver stiffness, a non-invasive marker of liver disease: a core study group report

Author

Bonino, F, Arena, U, Brunetto, Mr, Coco, B, Fraquelli, M, Oliveri, F, Pinzani, M, Prati, D, Rigamonti, C, Vizzuti, F, Collaborators: Balocco M, Liver Stiffness Study Group 'Elastica' of the Italian Association for the Study of the Liver., Forni, G, Bottelli, R, Bruno, R, Filice, C, Bruno, S, Cammà, C, Craxì, A, Colletta, C, Colombatto, P, Colombo, M, Fatuzzo, F, Larocca, L, Montineri, A, Festi, D, Colecchia, A, Grasso, A, Maida, I, Mazzotta, F, Marino, N, Blanc, P, Puoti, M, Quartini, M, Sacchini, D, Vinelli, F., Craxi, A, Bonino, F, Arena, U, Brunetto, MR, Coco, B, Fraquelli, M, Oliveri, F, Pinzani, M, Prati, D, Rigamonti, C, Vizzuti, F, and Liver Stiffness Study Group 'Elastica' of the Italian Association for the Study of the Liver

Subjects
Pharmacology, Liver Cirrhosis, medicine.medical_specialty, Core (anatomy), business.industry, Non invasive, Hepatitis B, medicine.disease, Gastroenterology, Clinical Practice, liver stiffness, Liver disease, Infectious Diseases, Liver, Liver stiffness, Internal medicine, medicine, Elasticity Imaging Techniques, Pharmacology (medical), Transient elastography, business, Liver pathology, Biomarkers
Abstract

The ability to evaluate liver stiffness non-invasively in clinical practice by measuring transient elastography using FibroScan® has resulted in considerable interest and enthusiasm. A core study group, organized by the Italian Association for the Study of the Liver, has assessed the usefulness of FibroScan® in the diagnosis and management of liver disease in clinical practice. The group concluded that FibroScan® is a valuable, non-invasive technique and have developed a consensus report form for registering transient elastography results. In this article, we report the findings of the study group.

Published
2010

19. Effect of potassium canrenoate, an anti-aldosterone agent, on incidence of ascites and variceal progression in cirrhosis

Author

Bolondi, L., Piscaglia, F., Gatta, Angelo, Salerno, F., Bernardi, M., Ascione, A., Ferraù, O., Sacerdoti, David, Visentin, S., Trevisani, F., Mazzanti, R., Donati, G., Arena, U., Gentilini, P., on behalf of the DOC, Bolognesi, Massimo, Bolondi L., Piscaglia F., Gatta A., Salerno F., Bernardi M., Ascione A., Ferrau O., Sacerdoti D., Visentin S., Trevisani F., Mazzanti R., Donati G., Arena U., Gentilini P., and DOC (Decrease of Complications in cirrhosis) Study Group.

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis, Placebo, Esophageal and Gastric Varices, Kidney Function Tests, Gastroenterology, symbols.namesake, Esophageal varices, Double-Blind Method, Internal medicine, Ascites, medicine, Humans, Fisher's exact test, Aged, Mineralocorticoid Receptor Antagonists, Hepatology, business.industry, Incidence, Middle Aged, medicine.disease, Potassium canrenoate, symbols, Disease Progression, Portal hypertension, Female, medicine.symptom, Canrenoic Acid, business, Varices, medicine.drug
Abstract

Because aldosterone-dependent sodium and water retention contribute to portal hypertension, the safety and effect of an antialdosteronic drug (Kcanrenoate) have been evaluated on the occurrence of de novo appearance of ascites and the development of esophageal varices or the progression of small varices.Inclusion criteria were as follows: Child-Pugh A viral pre-ascitic cirrhosis, with either F1 esophageal varices or no varices, but endoscopic and/or ultrasound evidence of portal hypertension. Thirteen Italian Liver Units prospectively enrolled 120 patients randomized to receive double-blind either Kcanrenoate (100 mg/day; 66 patients) or placebo (54 patients). Endoscopy and sonography were performed at entry and at 52 weeks unless the patient developed ascites earlier, whereas laboratory examinations were performed at entry and every 3 months thereafter. An intention-to-treat analysis was performed, with each end point assessed by the Fisher exact test; the cumulative risk for the appearance of any end point was analyzed by the adjusted log-rank test (Tarone-Ware), with censoring for drop-outs.The progression of variceal status or appearance of ascites, analyzed independently, was not significantly more frequent on placebo (24.1% and 9.2%, respectively) than on Kcanrenoate (12.1% and 1.5%, respectively), whereas the cumulative occurrence of end points was decreased on Kcanrenoate (17.6% vs 38.3% with placebo; P.05, Tarone-Ware test). The incidence of adverse events was negligible and did not differ between groups.This preliminary study shows that 100 mg/day of Kcanrenoate is well tolerated and does not reduce the individual incidence of ascites and/or the appearance or progression of esophageal varices in preascitc cirrhosis, but may decrease their 1-year cumulative occurrence.

Published
2006

21. Non-invasive assessment of fibrosis in non-alcoholic fatty liver disease

Author

Vizzutti, F, Arena, U, Nobili, V, Tarquini, R, Trappoliere, M, Laffi, G, Marra, F, and Pinzani, M.

Subjects
Adult, Liver Cirrhosis, Adolescent, Biopsy, Reproducibility of Results, Biomarkers, Child, Elasticity Imaging Techniques, Fatty Liver, Humans, Predictive Value of Tests, Risk Assessment, Risk Factors, Severity of Illness Index
Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Western countries, and its prevalence is increasing worldwide. It currently affects approximately 30% of adults and 10% of children and adolescents. The resulting increase in the number of patients with NAFLD is expected to translate into increased numbers of patients with liver cirrhosis, and hepatocellular carcinoma. In this context, it is particularly important to identify patients at risk for progressive chronic liver disease. Currently, liver biopsy is the gold standard to diagnose non-alcoholic steatohepatitis (NASH) and to establish the presence and stage of fibrosis. Due to the remarkable increase in the prevalence of NAFLD and the concomitant efforts in developing novel therapies for patients with NASH, non-invasive, simple, reproducible, and reliable non-invasive methodologies are needed. This paper provides a concise overview of the role of non-invasive diagnostic tools for the determination of presence and extent of fibrosis in NAFLD patients, with particular emphasis on the methods currently available in clinical practice.

Published
2009

23. Discrete particle simulation of the homogeneous fluidization of Geldart A particles

Author

Ye, M., Hoef, van der, M.A., Kuipers, J.A.M., Arena, U., Energy Technology, Multi-scale Modelling of Multi-phase Flows, and Multiphase Reactors (SMR)

Subjects
Condensed Matter::Soft Condensed Matter
Abstract

The homogeneous fluidization of Geldart A particles has been studied with a 2D soft-sphere discrete particle model. We find that the homogeneous fluidization regime represents a quasi-equilibrium state where the force balance exists at the macroscopic-level, but not at the level of individual particles. The velocity fluctuation of particles is an exponential function of the squared superficial gas velocity in the homogeneous fluidization regime, not a linear function as found by Cody et al.

Published
2004

25. Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C.

Author

Universitat de Barcelona, Arena, U., Vizzutti, F., Abraldes, Juan G., Corti, G., Stasi, C., Moscarella, S., Milani, S., Lorefice, E., Petrarca, A., Romanelli, R.G., Laffi, G., Bosch i Genover, Jaume, Marra, F., Pinzani, M., Universitat de Barcelona, Arena, U., Vizzutti, F., Abraldes, Juan G., Corti, G., Stasi, C., Moscarella, S., Milani, S., Lorefice, E., Petrarca, A., Romanelli, R.G., Laffi, G., Bosch i Genover, Jaume, Marra, F., and Pinzani, M.

Published
2011

32. Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Author

Francesco Giuseppe Foschi, Gianpaolo Vidili, Andrea Mega, Antonio Gasbarrini, Marco Zoli, Edoardo G. Giannini, Rodolfo Sacco, Alessandro Vitale, Francesco Tovoli, Giacomo Laffi, Maria Di Marco, Giovanni Raimondo, Gianluca Svegliati-Baroni, Claudia Campani, Francesco Azzaroli, Fabio Farinati, Umberto Arena, Fabio Marra, Gabriele Dragoni, Alberto Masotto, Franco Trevisani, Maurizia Rossana Brunetto, Giuseppe Cabibbo, Elisabetta Biasini, Gian Ludovico Rapaccini, Eugenio Caturelli, Gerardo Nardone, Maria Guarino, Umberto Cillo, Campani, C., Vitale, A., Dragoni, G., Arena, U., Laffi, G., Cillo, U., Giannini, E. G., Tovoli, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Mega, A., Guarino, M., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Biasini, E., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Brunetto, M. R., Farinati, F., Trevisani, F., Marra, F., Campani C., Vitale A., Dragoni G., Arena U., Laffi G., Cillo U., Giannini E.G., Tovoli F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Sacco R., Cabibbo G., Mega A., Guarino M., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Biasini E., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Brunetto M.R., Farinati F., Trevisani F., and Marra F.

Subjects
ALBI grade, Barcelona Clinic Liver Cancer, Cancer of the Liver Italian Program, ITALICA staging system, MESIAH, medicine.medical_specialty, lcsh:RC254-282, Gastroenterology, Internal medicine, Medicine, In patient, Radiologic Response, Settore MED/12 - Gastroenterologia, Original Paper, Hepatology, business.industry, Proportional hazards model, Confounding, Hazard ratio, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Oncology, Hepatocellular carcinoma, Akaike information criterion, business, Liver cancer
Abstract

Introduction: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. Results: The median OS of the enrolled patients was 41 months. According to LRT χ2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10–1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. Conclusion: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.

Published
2021

33. Platelet count does not predict bleeding in cirrhotic patients: Results from the PRO-LIVER Study

Author

Basili, S. a, Raparelli, V. b., Napoleone, L. b., Talerico, G. a., Corazza, G. R. c., Perticone, F. d., Sacerdoti, D. e., Andriulli, A. f., Licata, A. g., Pietrangelo, A., Picardi, A. i., Raimondo, G. j., Violi, F., Palasciano, G., D’Alitto, F., Palmieri, V. O., Santovito, D., Michele, Di, Croce, D., Brocco, G., Fasolato, S., Cecchetto, S., Bombonato, L., Bertoni, G., Restuccia, M., Andreozzi, T., Liguori, P., Caroleo, M. L., Perticone, B., Staltari, M., Manfredini, O., Giorgi, De, Averna, A., Giammanco, M., Granito, A., Pettinari, A., Marinelli, I., Bolondi, S., Falsetti, L., Salvi, L., Durante-Mangoni, A., Cesaro, E., Farinaro, F., Ragone, V., Morana, E., Ippolito, I., Iacobellis, A., Niro, A., Merla, G., Maimone, A., Cacciola, S., Varvara, I., Drenaggi, D., Staffolani, D., Vespasiani-Gentilucci, S., Galati, U., Gallo, G., Davì, P., Schiavone, G., Santilli, C., Tana, F., Soresi, C., Bianchi, Giovanni, Carderi, B., Pinto, I., Tuttolomondo, A., Ferrari, A., Gresele, G., Fierro, P., Morelli, T., Laffi, O., Romanelli, G., Arena, R. G., Stasi, U., Gasbarrini, A., Garcovich, M., Zocco, M. A., Riccardi, L., Ainora, M. E., Capeci, W., Martino, Giuseppe, Nobili, P., Cavallo, L., Frugiuele, M., Greco, P., Ventura, P., Cuoghi, C., Marcacci, M., Serviddio, G., Vendemiale, G., Villani, R., Gargano, R., Vidili, G., Cesare, Di, Masala, V., Delitala, M., Invernizzi, G., Vincenzo, P., Minno, Di, Tufano, G., Purrello, A., Privitera, F., Forgione, G., Curigliano, A., Senzolo, V., Rodríguez-Castro, M., Giannelli, K. I., Serra, G., Neri, C., Pignataro, S., Rizzetto, P., Debernardi, M., Svegliati, V. W., Bergamaschi, B. G., Masotti, G., Costanzo, M., Antonio, F., Angelico, F., Del, Ben, Polimeni, M., Proietti, L., Cangemi, M., Romiti, R., Toriello, G. F., Sperduti, F., Santangelo, N., Visioli, G., Todisco, G., Vestri, Anna, Farcomeni, R., Corrao, A., Gobbi, S., Corradini, E., Costantino, G., Tripepi, G., Angelico, M., Bolondi, L., D’Amico, G., Franchis, De, Gatta, R., Tassone, A., Anzaldi, E. J., Barone, M., Bazzini, M., Bianchi, C., Boari, P. I., Bracco, B., Buonauro, C., Buttà, A., Buzzetti, E., Calabria, S., Caradio, F., Carleo, P., Carrabba, Maria, Castorani, D., Cecchetto, L., Cicco, L., Cimini, S., Colombo, C., B. M., Vuono, De, Denegri, S., Del, Corso, Giosia, Di, Donnarumma, P., Giorgini, E., Grassi, P., Grembiale, D., Hijazi, A., Iamele, D., Lorusso, L., Marchese, G., Marra, Alberto, Masala, M., Miceli, M., Montebianco, G., Murgia, A. L., Naccarato, G., Padula, P., Pattoneri, D., Perego, P., Pesce, F., Petramala, P., Piano, L., Pinto, S., Pinna, D., Pignataro, M., Pretti, F. S., Pucci, V., Salinaro, G., Salzano, F., Santarossa, A., Scarpini, C., Scicali, F., Sirico, R., Suppressa, D., Talia, P., Torres, M., Traversa, D., Vazzana, M., Vecchio, Claudia, Vettore, R., Vitale, E., Basili, S., Raparelli, V., Napoleone, L., Talerico, G., Corazza, G.R., Perticone, F., Sacerdoti, D., Andriulli, A., Licata, A., Pietrangelo, A., Picardi, A., Raimondo, G., Violi, F., Palasciano, Giuseppe, D’Alitto, Felicia, Palmieri, Vincenzo Ostilio, Santovito, Daniela, Di Michele, Dario, Croce, Giuseppe, Brocco, Silvia, Fasolato, Silvano, Cecchetto, Lara, Bombonato, Giancarlo, Bertoni, Michele, Restuccia, Tea, Andreozzi, Paola, Liguori, Maria Livia, Caroleo, Benedetto, Perticone, Maria, Staltari, Orietta, Manfredini, Roberto, De Giorgi, Alfredo, Averna, Maurizio, Giammanco, Antonina, Granito, Alessandro, Pettinari, Irene, Marinelli, Sara, Bolondi, Luigi, Falsetti, Lorenzo, Salvi, Aldo, Durante-Mangoni, Emanuele, Cesaro, Flavio, Farinaro, Vincenza, Ragone, Enrico, Morana, Ignazio, Ippolito, Antonio, Iacobellis, Angelo, Niro, Grazia, Merla, Antonio, Maimone, Sergio, Cacciola, Irene, Varvara, Doriana, Drenaggi, Davide, Staffolani, Silvia, Vespasiani-Gentilucci, Umberto, Galati, Giovanni, Gallo, Paolo, Davì, Giovanni, Schiavone, Cosima, Santilli, Francesca, Tana, Claudio, Soresi, Maurizio, Bianchi Giovanni, Battista, Carderi, Isabella, Pinto, Antonio, Tuttolomondo, Antonino, Ferrari, Giovanni, Gresele, Paolo, Fierro, Tiziana, Morelli, Olivia, Laffi, Giacomo, Romanelli, Roberto Giulio, Arena, Umberto, Stasi, Cristina, Gasbarrini, Antonio, Garcovich, Matteo, Zocco, Maria Assunta, Riccardi, Laura, Ainora, Maria Elena, Capeci, William, Martino Giuseppe, Pio, Nobili, Lorenzo, Cavallo, Maurizio, Frugiuele, Pierluigi, Greco, Antonio, Ventura, Paolo, Cuoghi, Chiara, Marcacci, Matteo, Serviddio, Gaetano, Vendemiale, Gianluigi, Villani, Rosanna, Gargano, Ruggiero, Vidili, Gianpaolo, Di Cesare, Valentina, Masala, Maristella, Delitala, Giuseppe, Invernizzi, Pietro, Vincenzo, Ronca, Di Minno, Giovanni, Tufano, Antonella, Purrello, Francesco, Privitera, Graziella, Forgione, Alessandra, Curigliano, Valentina, Senzolo, Marco, Rodríguez-Castro, Kryssia Isabel, Giannelli, Gianluigi, Serra, Carla, Neri, Sergio, Pignataro, Pietro, Rizzetto, Mario, Debernardi, Venon Wilma, Svegliati, Baroni Gianluca, Bergamaschi, Gaetano, Masotti, Michela, Costanzo, Filippo, Antonio, Figliomeni, Angelico, Francesco, Del Ben, Maria, Polimeni, Licia, Proietti, Marco, Cangemi, Roberto, Romiti Giulio, Francesco, Toriello, Filippo, Sperduti, Nicolò, Santangelo, Giuseppe, Visioli, Giacomo, Todisco, Tommaso, Vestri Anna, Rita, Farcomeni, Alessio, Corrao, Salvatore, Gobbi, Paolo, Corradini, Elena, Costantino, Giorgio, Tripepi, Giovanni, Angelico, Mario, D’Amico, Gennaro, De Franchis, Roberto, Gatta, Angelo, Tassone, Eliezer Joseph, Anzaldi, Massimiliano, Barone, Milena, Bazzini, Cristina, Bianchi, Paola Ilaria, Boari, Benedetta, Bracco, Christian, Buonauro, Agostino, Buttà, Carmelo, Buzzetti, Elena, Calabria, Stefano, Caradio, Federica, Carleo, Pietro, Carrabba Maria, Domenica, Castorani, Luigi, Cicco, Sebastiano, Cimini, Claudia, Colombo, Barbara Maria, De Vuono, Stefano, Denegri, Andrea, Del Corso, Lisette, Di Giosia, Paolo, Donnarumma, Emilia, Giorgini, Paolo, Grassi, Davide, Grembiale, Alessandro, Hijazi, Daniel, Iamele, Luigi, Lorusso, Giusi, Marchese, Alessandra, Marra Alberto, Maria, Miceli, Giuseppe, Montebianco, Abenavoli Ludovico, Murgia, Giuseppe, Naccarato, Paola, Padula, Donatella, Pattoneri, Paolo, Perego, Francesca, Pesce, Paola, Petramala, Luigi, Piano, Salvatore, Pinto, Daniela, Pinna, Miriam, Pignataro, Francesca Serena, Pretti, Vincenzo, Pucci, Giacomo, Salinaro, Francesco, Salzano, Andrea, Santarossa, Claudia, Scarpini, Francesca, Scicali, Roberto, Sirico, Domenico, Suppressa, Patrizia, Talia, Michela, Torres, Daniele, Traversa, Matteo, Vazzana, Natale, Vecchio Claudia, Rita, Vettore, Elia, Vitale, Francesco, Basili, S, Raparelli, V, Napoleone, L, Talerico, G, Corazza, G, Perticone, F, Sacerdoti, D, Andriulli, A, Licata, A, Pietrangelo, A, Picardi, A, Raimondo, G, Violi, F, Palasciano, G, D'Alitto, F, Palmieri, V, Santovito, D, Di Michele, D, Croce, G, Brocco, S, Fasolato, S, Cecchetto, L, Bombonato, G, Bertoni, M, Restuccia, T, Andreozzi, P, Liguori, M, Caroleo, B, Perticone, M, Staltari, O, Manfredini, R, De Giorgi, A, Averna, M, Giammanco, A, Granito, A, Pettinari, I, Marinelli, S, Bolondi, L, Falsetti, L, Salvi, A, Durante-Mangoni, E, Cesaro, F, Farinaro, V, Ragone, E, Morana, I, Ippolito, A, Iacobellis, A, Niro, G, Merla, A, Maimone, S, Cacciola, I, Varvara, D, Drenaggi, D, Staffolani, S, Vespasiani-Gentilucci, U, Galati, G, Gallo, P, Davi, G, Schiavone, C, Santilli, F, Tana, C, Soresi, M, Bianchi Giovanni, B, Carderi, I, Pinto, A, Tuttolomondo, A, Ferrari, G, Gresele, P, Fierro, T, Morelli, O, Laffi, G, Romanelli, R, Arena, U, Stasi, C, Gasbarrini, A, Garcovich, M, Zocco, M, Riccardi, L, Ainora, M, Capeci, W, Martino Giuseppe, P, Nobili, L, Cavallo, M, Frugiuele, P, Greco, A, Ventura, P, Cuoghi, C, Marcacci, M, Serviddio, G, Vendemiale, G, Villani, R, Gargano, R, Vidili, G, Di Cesare, V, Masala, M, Delitala, G, Invernizzi, P, Vincenzo, R, Di Minno, G, Tufano, A, Purrello, F, Privitera, G, Forgione, A, Curigliano, V, Senzolo, M, Rodriguez-Castro, K, Giannelli, G, Serra, C, Neri, S, Pignataro, P, Rizzetto, M, Debernardi, V, Svegliati, B, Bergamaschi, G, Masotti, M, Costanzo, F, Antonio, F, Angelico, F, Del Ben, M, Polimeni, L, Proietti, M, Cangemi, R, Romiti, G, Toriello, F, Sperduti, N, Santangelo, G, Visioli, G, Todisco, T, Vestri Anna, R, Farcomeni, A, Corrao, S, Gobbi, P, Corradini, E, Costantino, G, Tripepi, G, Angelico, M, D'Amico, G, De Franchis, R, Gatta, A, Tassone, E, Anzaldi, M, Barone, M, Bazzini, C, Bianchi, P, Boari, B, Bracco, C, Buonauro, A, Butta, C, Buzzetti, E, Calabria, S, Caradio, F, Carleo, P, Carrabba Maria, D, Castorani, L, Cicco, S, Cimini, C, Colombo, B, De Vuono, S, Denegri, A, Del Corso, L, Di Giosia, P, Donnarumma, E, Giorgini, P, Grassi, D, Grembiale, A, Hijazi, D, Iamele, L, Lorusso, G, Marchese, A, Marra, A, Miceli, G, Montebianco, A, Murgia, G, Naccarato, P, Padula, D, Pattoneri, P, Perego, F, Pesce, P, Petramala, L, Piano, S, Pinto, D, Pinna, M, Pignataro, F, Pretti, V, Pucci, G, Salinaro, F, Salzano, A, Santarossa, C, Scarpini, F, Scicali, R, Sirico, D, Suppressa, P, Talia, M, Torres, D, Traversa, M, Vazzana, N, Vecchio Claudia, R, Vettore, E, Vitale, F, S Basili, V Raparelli, L Napoleone, G Talerico, G Corazza, F Perticone, D Sacerdoti, A Andriulli, A Licata, A Pietrangelo, A Picardi, G Raimondo, F Violi, MD on behalf of PRO-LIVER Collaborator, Palasciano Giuseppe, D’Alitto Felicia, Palmieri Vincenzo Ostilio, Santovito Daniela, Di Michele Dario, Croce Giuseppe, Brocco Silvia, Fasolato Silvano, Cecchetto Lara, Bombonato Giancarlo, Bertoni Michele, Restuccia Tea, Andreozzi Paola, Liguori Maria Livia, Caroleo Benedetto, Perticone Maria, Staltari Orietta, Manfredini Roberto, De Giorgi Alfredo, Averna Maurizio, Giammanco Antonina, Granito Alessandro, Pettinari Irene, Marinelli Sara, Bolondi Luigi, Falsetti Lorenzo, Salvi Aldo, Durante-Mangoni Emanuele, Cesaro Flavio, Farinaro Vincenza, Ragone Enrico, Morana Ignazio, Ippolito Antonio, Iacobellis Angelo, Niro Grazia, Merla Antonio, Maimone Sergio, Cacciola Irene, Varvara Doriana, Drenaggi Davide, Staffolani Silvia, Vespasiani-Gentilucci Umberto, Galati Giovanni, Gallo Paolo, Davi Giovanni, Schiavone Cosima, Santilli Francesca, Tana Claudio, Soresi Maurizio, Bianchi Giovanni Battista, Carderi Isabella, Pinto Antonio, Tuttolomondo Antonino, Ferrari Giovanni, Gresele Paolo, Fierro Tiziana, Morelli Olivia, Laffi Giacomo, Romanelli Roberto Giulio, Arena Umberto, Stasi Cristina, Gasbarrini Antonio, Garcovich Matteo, Zocco Maria Assunta, Riccardi Laura, Ainora Maria Elena, Capeci William, Martino Giuseppe Pio, Nobili Lorenzo, Cavallo Maurizio, Frugiuele Pierluigi, Greco Antonio, Ventura Paolo, Cuoghi Chiara, Marcacci Matteo, Serviddio Gaetano, Vendemiale Gianluigi, Villani Rosanna, Gargano Ruggiero, Vidili Gianpaolo, Di Cesare Valentina, Masala Maristella, Delitala Giuseppe, Invernizzi Pietro, Vincenzo Ronca, Di Minno Giovanni, Tufano Antonella, Purrello Francesco, Privitera Graziella, Forgione Alessandra, Curigliano Valentina, Senzolo Marco, Rodríguez-Castro Kryssia Isabel, Giannelli Gianluigi, Serra Carla, Neri Sergio, Pignataro Pietro, Rizzetto Mario, Debernardi Venon Wilma, Svegliati Baroni Gianluca, Bergamaschi Gaetano, Masotti Michela, Costanzo Filippo, Antonio Figliomeni, Angelico Francesco, Del Ben Maria, Polimeni Licia, Proietti Marco, Cangemi Roberto, Romiti Giulio Francesco, Toriello Filippo, Sperduti Nicolò, Santangelo Giuseppe, Visioli Giacomo, Todisco Tommaso, Vestri Anna Rita, Farcomeni Alessio, Corrao Salvatore, Gobbi Paolo, Corradini Elena, Costantino Giorgio, Tripepi Giovanni, Angelico Mario, D’Amico Gennaro, de Franchis Roberto, Gatta Angelo, Tassone Eliezer Joseph, Anzaldi Massimiliano, Barone Milena, Bazzini Cristina, Bianchi Paola Ilaria, Boari Benedetta, Bracco Christian, Buonauro Agostino, Buttà Carmelo, Buzzetti Elena, Calabria Stefano, Caradio Federica, Carleo Pietro, Carrabba Maria Domenica, Castorani Luigi, Cicco Sebastiano, Cimini Claudia, Colombo Barbara Maria, De Vuono Stefano, Denegri Andrea, Del Corso Lisette, Di Giosia Paolo, Donnarumma Emilia, Giorgini Paolo, Grassi Davide, Grembiale Alessandro, Hijazi Daniel, Iamele Luigi, Lorusso Giusi, Marchese Alessandra, Marra Alberto Maria, Miceli Giuseppe, Montebianco Abenavoli Ludovico, Murgia Giuseppe, Naccarato Paola, Padula Donatella, Pattoneri Paolo, Perego Francesca, Pesce Paola, Petramala Luigi, Piano Salvatore, Pinto Daniela, Pinna Miriam, Pignataro Francesca Serena, Pretti Vincenzo, Pucci Giacomo, Salinaro Francesco, Salzano Andrea, Santarossa Claudia, Scarpini Francesca, Scicali Roberto, Sirico Domenico, Suppressa Patrizia, Talia Michela, Torres Daniele, Traversa Matteo, Vazzana Natale, Vecchio Claudia Rita, Vettore Elia, Vitale Francesco, Corazza, G. R., Guidacci, Raimondo, Palasciano, G., D'Alitto, F., Palmieri, V. O., Santovito, D., Di Michele, D., Croce, G., Brocco, S., Fasolato, S., Cecchetto, L., Bombonato, G., Bertoni, M., Restuccia, T., Andreozzi, P., Liguori, M. L., Caroleo, B., Perticone, M., Staltari, O., Manfredini, R., De Giorgi, A., Averna, M., Giammanco, A., Granito, A., Pettinari, I., Marinelli, S., Bolondi, L., Falsetti, L., Salvi, A., Durante-Mangoni, E., Cesaro, F., Farinaro, V., Ragone, E., Morana, I., Ippolito, A., Iacobellis, A., Niro, G., Merla, A., Maimone, S., Cacciola, I., Varvara, D., Drenaggi, D., Staffolani, S., Vespasiani-Gentilucci, U., Galati, G., Gallo, P., Davi, G., Schiavone, C., Santilli, F., Tana, C., Soresi, M., Bianchi Giovanni, B., Carderi, I., Pinto, A., Tuttolomondo, A., Ferrari, G., Gresele, P., Fierro, T., Morelli, O., Laffi, G., Romanelli, R. G., Arena, U., Stasi, C., Gasbarrini, A., Garcovich, M., Zocco, M. A., Riccardi, L., Ainora, M. E., Capeci, W., Martino Giuseppe, P., Nobili, L., Cavallo, M., Frugiuele, P., Greco, A., Ventura, P., Cuoghi, C., Marcacci, M., Serviddio, G., Vendemiale, G., Villani, R., Gargano, R., Vidili, G., Di Cesare, V., Masala, M., Delitala, G., Invernizzi, P., Vincenzo, R., Di Minno, G., Tufano, A., Purrello, F., Privitera, G., Forgione, A., Curigliano, V., Senzolo, M., Rodriguez-Castro, K. I., Giannelli, G., Serra, C., Neri, S., Pignataro, P., Rizzetto, M., Debernardi, V. W., Svegliati, B. G., Bergamaschi, G., Masotti, M., Costanzo, F., Antonio, F., Angelico, F., Del Ben, M., Polimeni, L., Proietti, M., Cangemi, R., Romiti, G. F., Toriello, F., Sperduti, N., Santangelo, G., Visioli, G., Todisco, T., Vestri Anna, R., Farcomeni, A., Corrao, S., Gobbi, P., Corradini, E., Costantino, G., Tripepi, G., Angelico, M., D'Amico, G., De Franchis, R., Gatta, A., Tassone, E. J., Anzaldi, M., Barone, M., Bazzini, C., Bianchi, P. I., Boari, B., Bracco, C., Buonauro, A., Butta, C., Buzzetti, E., Calabria, S., Caradio, F., Carleo, P., Carrabba Maria, D., Castorani, L., Cicco, S., Cimini, C., Colombo, B. M., De Vuono, S., Denegri, A., Del Corso, L., Di Giosia, P., Donnarumma, E., Giorgini, P., Grassi, D., Grembiale, A., Hijazi, D., Iamele, L., Lorusso, G., Marchese, A., Marra, A. M., Miceli, G., Montebianco, A. L., Murgia, G., Naccarato, P., Padula, D., Pattoneri, P., Perego, F., Pesce, P., Petramala, L., Piano, S., Pinto, D., Pinna, M., Pignataro, F. S., Pretti, V., Pucci, G., Salinaro, F., Salzano, A., Santarossa, C., Scarpini, F., Scicali, R., Sirico, D., Suppressa, P., Talia, M., Torres, D., Traversa, M., Vazzana, N., Vecchio Claudia, R., Vettore, E., and Vitale, F.

Subjects
Liver Cirrhosis, Male, Settore MED/09 - Medicina Interna, 030204 cardiovascular system & hematology, Gastroenterology, Severity of Illness Index, cjirrhosis, ACTIVATION, 0302 clinical medicine, Risk Factors, Medicine, Platelet, Prospective Studies, Prospective cohort study, RISK, Aged, 80 and over, medicine.diagnostic_test, PRO-LIVER, Platelet, cirrhosis, gastrointestinal bleeding, ASSOCIATION, Middle Aged, Prognosis, Italy, 030211 gastroenterology & hepatology, Female, Gastrointestinal Hemorrhage, Human, Adult, Platelets, medicine.medical_specialty, Prognosi, Liver Cirrhosi, MEDLINE, COAGULATION, gastrointestinal bleeding, Socio-culturale, Hemorrhage, Hepatology, Follow-Up Studie, 03 medical and health sciences, Text mining, Internal medicine, Severity of illness, ENDOTOXEMIA, Pro-Liver Study, Humans, HEMOSTASIS, International Normalized Ratio, Aged, Proportional Hazards Models, Prothrombin time, Cirrhosi, Platelet Count, Bleeding, Liver Cirrhosis, business.industry, Proportional hazards model, Platelet Count, Risk Factor, cirrhosis, bleeding, Thrombocytopenia, Prospective Studie, THROMBOSIS, Platelets, cjirrhosis, bleeding, PRO-LIVER, Proportional Hazards Model, Prothrombin Time, business, DECOMPENSATED CIRRHOSIS, Follow-Up Studies
Abstract

OBJECTIVES: Thrombocytopenia is a hallmark for patients with cirrhosis and it is perceived as a risk factor for bleeding events. However, the relationship between platelet count and bleeding is still unclear. METHODS: We investigated the relationship between platelet count and major or clinical relevant nonmajor bleedings during a follow-up of ∼4 years. RESULTS: A total of 280 cirrhotic patients with different degrees of liver disease (67% males; age 64±37 years; 47% Child–Pugh B and C) were followed up for a median of 1,129 (interquartile range: 800–1,498) days yielding 953.12 patient-year of observation. The annual rate of any significant bleeding was 5.45%/year (3.57%/year and 1.89%/year for major and minor bleeding, respectively). Fifty-two (18.6%) patients experienced a major (n=34) or minor (n=18) bleeding event, predominantly from gastrointestinal origin. Platelet counts progressively decreased with the worsening of liver disease and were similar in patients with or without major or minor bleeding: a platelet count ≤50×103/μl was detected in 3 (6%) patients with and in 20 (9%) patients without any bleeding event. Conversely, prothrombin time-international normalized ratio was slightly higher in patients with overall or major bleeding. On Cox proportional hazard analysis, only a previous gastrointestinal bleeding (hazard ratio (HR): 1.96; 95% confidence interval: 1.11–3.47; P=0.020) and encephalopathy (HR: 2.05; 95% confidence interval: 1.16–3.62; P=0.013) independently predicted overall bleeding events. CONCLUSIONS: Platelet count does not predict unprovoked major or minor bleeding in cirrhotic patients.

Published
2018

34. How to enhance the environmental sustainability of WEEE plastics management: An LCA study

Author

Giovanni Francesco Cardamone, Filomena Ardolino, Umberto Arena, Ardolino, F., Cardamone, G. F., and Arena, U.

Subjects
020209 energy, WEEE plastics, 02 engineering and technology, Catalytic pyrolysis, 010501 environmental sciences, Brominated flame retardants, Combustion, 01 natural sciences, Electronic Waste, Electronic equipment, 12. Responsible consumption, Life cycle assessment, Dissolution/precipitation, 11. Sustainability, 0202 electrical engineering, electronic engineering, information engineering, Recycling, Waste Management and Disposal, Life-cycle assessment, WEEE plastics, Life cycle assessment, Dissolution/precipitation, Pyrolysis, Plastic upgrading, Brominated flame retardants, Flame Retardants, 0105 earth and related environmental sciences, Waste management, Global warming, 1. No poverty, Dissolution precipitation, 13. Climate action, Sustainability, Plastic upgrading, Environmental science, Electronics, Plastics, Pyrolysis
Abstract

A new management scheme of plastics from waste of electrical and electronic equipment (WEEE), which includes novel treatments of sorting, dissolution/precipitation, extrusion, catalytic pyrolysis, and plastic upgrading, is proposed. Its environmental performances are quantified by an attributional Life Cycle Assessment and compared with those of European currently adopted schemes, which include conventional mechanical recycling and thermal treatments as well as improper options of dumping and open burning, largely applied to WEEE plastics exported to developing countries. The proposed innovative scheme greatly enhances the environmental sustainability of WEEE plastics management, by increasing the annual amounts of polymers sent to recycling (from 390 kt/y up to 530 kt/y), decreasing residues to be sent to combustion (from 360 kt/y up to 60 kt/y), and reducing the potential impacts of all the midpoint categories under analysis (up to 580% for that of Global Warming). These results are mainly related to the adoption of a dissolution/precipitation process, which allows recovering target polymers such as ABS, HIPS and PC, with improvements in terms of Global Warming, Non-Carcinogens, and Carcinogens equal to 246%, 69% and 35%, even when the stages of polymer upgrading and catalytic pyrolysis are not included in the analysis. The sensitivity analysis shows that advantages of the new approach substantially disappear if the awful contributions of exportation outside Europe are taken into account. This clearly indicates that the first step to enhance the sustainability of WEEE plastics management is a strong limitation of improper treatments applied to exported wastes. A new management scheme of plastics from waste of electrical and electronic equipment (WEEE), which includes novel treatments of sorting, dissolution/precipitation, extrusion, catalytic pyrolysis, and plastic upgrading, is proposed. Its environmental performances are quantified by an attributional Life Cycle Assessment and compared with those of European currently adopted schemes, which include conventional mechanical recycling and thermal treatments as well as improper options of dumping and open burning, largely applied to WEEE plastics exported to developing countries. The proposed innovative scheme greatly enhances the environmental sustainability of WEEE plastics management, by increasing the annual amounts of polymers sent to recycling (from 390 kt/y up to 530 kt/y), decreasing residues to be sent to combustion (from 360 kt/y up to 60 kt/y), and reducing the potential impacts of all the midpoint categories under analysis (up to 580% for that of Global Warming). These results are mainly related to the adoption of a dissolution/precipitation process, which allows recovering target polymers such as ABS, HIPS and PC, with improvements in terms of Global Warming, Non-Carcinogens, and Carcinogens equal to 246%, 69% and 35%, even when the stages of polymer upgrading and catalytic pyrolysis are not included in the analysis. The sensitivity analysis shows that advantages of the new approach substantially disappear if the awful contributions of exportation outside Europe are taken into account. This clearly indicates that the first step to enhance the sustainability of WEEE plastics management is a strong limitation of improper treatments applied to exported wastes.

Published
2021

35. Application of LCA modelling in integrated waste management

Author

Anna Björklund, Vlada Starostina, Valentina Bisinella, Morton A. Barlaz, Alessio Boldrin, James W. Levis, Thomas Højlund Christensen, Umberto Arena, Thomas Fruergaard Astrup, Anders Damgaard, Yan Zhao, Christensen, T. H., Damgaard, A., Levis, J., Zhao, Y., Björklund, A., Arena, U., Barlaz, M. A., Starostina, V., Boldrin, A., Astrup, T. F., and Bisinella, V.

Subjects
Engineering, Policy development, 020209 energy, 02 engineering and technology, Environment, 010501 environmental sciences, Technology development, 01 natural sciences, Modelling, Waste management system, Waste Management, 0202 electrical engineering, electronic engineering, information engineering, SDG 7 - Affordable and Clean Energy, Prospective Studies, Policy Making, Waste management, Waste Management and Disposal, Life-cycle assessment, LCA, Waste management, Modelling, 0105 earth and related environmental sciences, business.industry, LCA, Refuse Disposal, SDG 12 - Responsible Consumption and Production, business, Strategic development
Abstract

Life cycle assessment (LCA) has been used in waste management for the last two decades and hundreds of journal papers have been published. The use of LCA in waste management has provided a much-improved holistic view of waste management including waste flows and potential environmental impacts. Although much knowledge has been obtained from LCA studies, there is still a need to use LCA models in integrated waste management. This paper describes six areas where LCA is expected to play a role in waste management in the future: 1) understanding an existing waste management system; 2) improving existing waste management systems; 3) comparing alternative technologies/ technology performance; 4) technology development/prospective technologies; 5) policy development/strategic development; and 6) reporting. Illustrative examples are provided for each application area.

Published
2020

36. Transjugular Intrahepatic Portosystemic Shunt does not affect the efficacy and safety of direct-acting antivirals in patients with advanced cirrhosis: A real-life, case-control study

Author

Pietro Andreone, Silvia Aspite, Claudia Campani, Francesco Vizzutti, Fabio Marra, Pasquale Apolito, Sinan Sadalla, Filippo Schepis, A. Scuteri, Laura Turco, Stefano Gitto, Fabio Conti, Giacomo Laffi, Federica Lombardo, Umberto Arena, Giovanni Vitale, Erica Villa, Fabrizio Fanelli, W. Debernardi-Venon, Gitto S., Vizzutti F., Schepis F., Turco L., Aspite S., Vitale G., Arena U., Villa E., Laffi G., Debernardi-Venon W., Fanelli F., Andreone P., Marra F., Apolito P., Campani C., Sadalla S., Lombardo F., Conti F., and Scuteri A.

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis complication, medicine.medical_treatment, Kaplan-Meier Estimate, Antiviral therapy, Advanced liver disease, Cirrhosis complications, Portal hypertension, Hepatology, Gastroenterology, Logistic regression, Antiviral Agents, Severity of Illness Index, End Stage Liver Disease, 03 medical and health sciences, Liver disease, Postoperative Complications, 0302 clinical medicine, Internal medicine, Hypertension, Portal, medicine, Humans, Adverse effect, Aged, Univariate analysis, business.industry, Case-control study, Middle Aged, medicine.disease, Hepatitis C, Logistic Models, Treatment Outcome, Italy, Case-Control Studies, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Portasystemic Shunt, Transjugular Intrahepatic, business, Transjugular intrahepatic portosystemic shunt
Abstract

Background Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a well-established treatment for complications of portal hypertension. Aims To analyze the impact of TIPS on virologic response and safety profile in patients treated with direct-acting antivirals (DAAs). Methods We analyzed data from HCV-positive cirrhotic patients treated with DAAs. Twenty-one patients with previous TIPS placement were compared with 42 matched subjects without TIPS. Logistic regression was used to identify predictors of hepatic function worsening and adverse events. Results No differences were found between the two groups in particular regarding sustained virologic response (92.5 and 97.6% in TIPS vs no-TIPS, p = 0.559). Model for End-stage Liver Disease (MELD) of both TIPS and no-TIPS groups declined from baseline to week 24 of follow-up (from 12.5 ± 3.5 to 10.8 ± 3.4 and from 11.1 ± 3.5 to 10.3 ± 3.4, p = 0.044 and 0.025). There were no differences in adverse event rates. At univariate analysis, age was associated with MELD increase from baseline to week 24 (OR 1.111, 95% CI 1.019-1.211, p = 0.017), and patients with higher baseline MELD developed serious adverse events more frequently (OR 0.815, 95% CI 0.658–1.010, p = 0.062). Patients with or without TIPS did not show differences in transplant-free survival. Conclusion TIPS placement does not affect virologic response and clinical outcome of patients receiving DAAs.

Published
2019

37. Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease

Author

Sebastian Mueller, Paul Calès, Omar Elshaarawy, Jérôme Boursier, Emmanuel Tsochatzis, Aleksander Krag, Umberto Arena, Victor de Ledinghen, Margarita Papatheodoridi, Maja Thiele, Massimo Pinzani, Laurent Castera, Edgar Brodkin, George V. Papatheodoridis, Fabio Marra, Georgios Markakis, Jean Baptiste Hiriart, Monica Lupsor-Platon, Audrey Payancé, Vincenza Calvaruso, Fabrizio Bronte, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Università degli Studi di Firenze = University of Florence [Firenze] (UNIFI), Papatheodoridi M., Hiriart J.B., Lupsor-Platon M., Bronte F., Boursier J., Elshaarawy O., Marra F., Thiele M., Markakis G., Payance A., Brodkin E., Castera L., Papatheodoridis G., Krag A., Arena U., Mueller S., Cales P., Calvaruso V., de Ledinghen V., Pinzani M., and Tsochatzis E.A.

Subjects
0301 basic medicine, Alcoholic liver disease, medicine.medical_specialty, Cirrhosis, [SDV]Life Sciences [q-bio], Chronic liver disease, Asymptomatic, Gastroenterology, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, NAFLD, medicine, Viral hepatitis, 10. No inequality, Portal hypertension, ComputingMilieux_MISCELLANEOUS, Cirrhosi, Hepatology, medicine.diagnostic_test, business.industry, Fatty liver, medicine.disease, 3. Good health, 030104 developmental biology, Fibroscan, Liver biopsy, FIB-4, 030211 gastroenterology & hepatology, medicine.symptom, Transient elastography, business
Abstract

Background: The Baveno VI consensus proposed a dual liver stiffness (LS) by transient elastography threshold of 15 kPa for excluding and diagnosing compensated advanced chronic liver disease (cACLD) in the absence of other clinical signs. Herein, we aimed to validate these criteria in a real-world multicentre study. Methods: We included 5,648 patients (mean age 51 ± 13 years, 53% males) from 10 European liver centres who had a liver biopsy and LS measurement within 6 months. We included patients with chronic hepatitis C (n = 2,913, 52%), non-alcoholic fatty liver disease (NAFLD, n = 1,073, 19%), alcohol-related liver disease (ALD, n = 946, 17%) or chronic hepatitis B (n = 716, 13%). cACLD was defined as fibrosis stage ≥F3. Results: Overall, 3,606 (66%) and 987 (18%) patients had LS 15 kPa, respectively, while cACLD was histologically confirmed in 1,772 (31%) patients. The cut-offs of 15 kPa showed 75% sensitivity and 96% specificity to exclude and diagnose cACLD, respectively. Examining the ROC curve, a more optimal dual cut-off at 12 kPa, with 91% sensitivity and 92% specificity for excluding and diagnosing cACLD (AUC 0.87; 95% CI 0.86–0.88; p 15 kPa dual cut-offs, we found that the 12 kPa dual cut-offs have better diagnostic accuracy in cACLD. Lay summary: The term compensated advanced chronic liver disease (cACLD) was introduced in 2015 to describe the spectrum of advanced fibrosis and cirrhosis in asymptomatic patients. It was also suggested that cACLD could be diagnosed or ruled out based on specific liver stiffness values, which can be non-invasively measured by transient elastography. Herein, we assessed the suggested cut-off values and identified alternative values that offered better overall accuracy for diagnosing or ruling out cACLD.

Published
2021

38. Serial combination of non-invasive tools improves the diagnostic accuracy of severe liver fibrosis in patients with NAFLD

Author

Salvatore Petta, Jean-Baptiste Hiriart, Wassil Merrouche, Antonio Craxì, J. Vergniol, Fabio Marra, Anthony W.H. Chan, Vincent Wai-Sun Wong, V. de Ledinghen, Umberto Arena, Brigitte Le-Bail, Grace Lai-Hung Wong, Calogero Cammà, Hung Chan, V. Di Marco, Petta, S., Wong, V., Camma', C., Hiriart, J., Wong, G., Vergniol, J., Chan, A., DI MARCO, V., Merrouche, W., Chan, H., Marra, F., Le-Bail, B., Arena, U., Craxi, A., and de Ledinghen, V.

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Liver fibrosis, Diagnostic accuracy, Sensitivity and Specificity, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Liver stiffness, Fibrosis, Internal medicine, Histological diagnosis, Nonalcoholic fatty liver disease, medicine, Humans, Pharmacology (medical), In patient, Aged, Hepatology, business.industry, Non invasive, Middle Aged, medicine.disease, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, business, Algorithms
Abstract

SummaryBackground The accuracy of available non-invasive tools for staging severe fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is still limited. Aim To assess the diagnostic performance of paired or serial combination of non-invasive tools in NAFLD patients. Methods We analysed data from 741 patients with a histological diagnosis of NAFLD. The GGT/PLT, APRI, AST/ALT, BARD, FIB-4, and NAFLD Fibrosis Score (NFS) scores were calculated according to published algorithms. Liver stiffness measurement (LSM) was performed by FibroScan. Results LSM, NFS and FIB-4 were the best non-invasive tools for staging F3-F4 fibrosis (AUC 0.863, 0.774, and 0.792, respectively), with LSM having the highest sensitivity (90%), and the highest NPV (94%), and NFS and FIB-4 the highest specificity (97% and 93%, respectively), and the highest PPV (73% and 79%, respectively). The paired combination of LSM or NFS with FIB-4 strongly reduced the likelihood of wrongly classified patients (ranging from 2.7% to 2.6%), at the price of a high uncertainty area (ranging from 54.1% to 58.2%), and of a low overall accuracy (ranging from 43% to 39.1%). The serial combination with the second test used in patients in the grey area of the first test and in those with high LSM values (>9.6 KPa) or low NFS or FIB-4 values (

Published
2017

39. Hot char-catalytic reforming of volatiles from MSW pyrolysis

Author

Na Wang, Dezhen Chen, Pinjing He, Umberto Arena, Wang, N., Chen, D., Arena, U., and He, P.

Subjects
020209 energy, Volatile, 02 engineering and technology, 010501 environmental sciences, Management, Monitoring, Policy and Law, 01 natural sciences, Hot char, chemistry.chemical_compound, Catalytic reforming, Pyrolysis oil, MSW pyrolysi, Reforming, 0202 electrical engineering, electronic engineering, information engineering, Char, Sulfur dioxide, 0105 earth and related environmental sciences, Synga, Waste management, Mechanical Engineering, Building and Construction, Syngas to gasoline plus, General Energy, chemistry, Chemical engineering, Heat of combustion, Pyrolysis, Syngas
Abstract

Volatile products obtained from pyrolysis of municipal solid waste (MSW), including syngas and pyrolysis oil, were forced to contact the hot char from the same pyrolysis process at 500-600 degrees C in a fixed bed reactor to be reformed. The yields and properties of syngas, char and pyrolysis liquid Were investigated; and the energy re-distribution among the products due to char reforming was quantified. The preliminary investigation at lab scale showed that hot char-catalytic reforming of the volatiles leads to an increase in the dry syngas yield from 0.25 to 0.37 N m(3) kg(-1) msw at 550 degrees C. Accordingly, the carbon conversion ratio into syngas increases from 29.6% to 35.0%; and the MSW chemical energy transferred into syngas increased from 41.8% to 47.4%. The yield of pyrolysis liquid products, including pyrolysis oil and water, decreased from 27.3 to 16.5 wt%, and the molecular weight of the oil becoming lighter. Approximately 60% of the water vapour contained in the volatiles converted into syngas. After reforming, the concentrations of SO2 and HCN in the syngas decreases, while those of NO and NO2 increase. The char concentrations of N, H, C and alkali metal species decreased and its higher heating value decreased too. (C) 2017 Elsevier Ltd. All rights reserved.

Published
2017

40. Biogas-to-biomethane upgrading: A comparative review and assessment in a life cycle perspective

Author

Filomena Ardolino, Francesco Parrillo, Giovanni Francesco Cardamone, Umberto Arena, Ardolino, F., Cardamone, G. F., Parrillo, F., and Arena, U.

Subjects
Municipal solid waste, Renewable Energy, Sustainability and the Environment, 020209 energy, media_common.quotation_subject, Material flow analysis, Environmental engineering, Life cycle assessment Life cycle costing Biogas upgrading Membrane separation Water scrubbing Chemical absorption Pressure swing adsorption, 02 engineering and technology, Pressure swing adsorption, Anaerobic digestion, Biogas, 0202 electrical engineering, electronic engineering, information engineering, Environmental science, media_common.cataloged_instance, Quality (business), European union, Life-cycle assessment, media_common
Abstract

The study reviews and compares the most utilised techniques to obtain high quality biomethane by upgrading biogas from anaerobic digestion of the organic fraction of municipal solid waste. Environmental and economic aspects of membrane separation, water scrubbing, chemical absorption with amine solvent, and pressure swing adsorption have been quantified in a life cycle perspective. An attributional environmental Life Cycle Assessment has been implemented with the support of a Material Flow Analysis and in combination with a complementary environmental Life Cycle Costing. The analyses are based on data largely obtained from Italian existing plants but they can be generalised to the whole European Union, as demonstrated by a companion sensitivity analysis. The comparative assessment of the results indicates all the examined options as fully sustainable, also identifying the “win-win” situations. In particular, the membrane separation technique appears to have the best performances, even though in some cases with limited differences. With reference to base case scenarios, this technique shows better results for the respiratory inorganics potential (up to 34%, i.e. up to 328 kgPM2.5eq/y), global warming potential (up to 7%, i.e. up to 344 tCO2eq/y), and non-renewable energy potential (up to 12%, i.e. up to 6400 GJprimary/y) as well as for life cycle costs (up to 3.4%, i.e. about 60 k€/y). The performances of the examined techniques appear anyway dependent on site-specific conditions (such as the injection pressure in the gas grid or the existence/amount of local economic incentives) and commercial strategies for the market of interest.

Published
2021

41. Removal of naphthalene by activated carbons from hot gas

Author

Ernesto Salzano, Francesco Parrillo, F. Di Gregorio, F. Cammarota, Umberto Arena, Di Gregorio, F., Parrillo, F., Salzano, E., Cammarota, F., Arena, Umberto, and Arena, U.

Subjects
020209 energy, General Chemical Engineering, 02 engineering and technology, Industrial and Manufacturing Engineering, law.invention, chemistry.chemical_compound, Adsorption, Fuel gas, law, 0202 electrical engineering, electronic engineering, information engineering, medicine, Environmental Chemistry, Organic chemistry, Filtration, Naphthalene, Waste-to-energy, Syngas cleaning, Tar, General Chemistry, Porosimetry, Biomass-to-energy, chemistry, Chemical engineering, Carbon dioxide, Gasification, Activated carbon, medicine.drug
Abstract

The gasification of biomass and waste is a potentially high efficiency process for energy generation. However, the appropriate cleaning of the produced fuel gas is a major issue, in particular for tar removal. This study investigates the performance of three new-generation activated carbons, which are able to adsorb a wide spectrum of tars at high temperature, from 750°C up to 900°C. For this purpose, a laboratory scale hot gas filtration apparatus was designed and set-up. Experimental tests were carried out with naphthalene as the reference tar compound. The selected activated carbons were tested under different conditions of temperature, test duration and naphthalene concentration. The procedure allows evaluating the contributions of adsorption and cracking phenomena on the overall tar removal efficiency. Complete naphthalene removal was obtained with two of the selected activated carbons, at 850 °C and 900 °C, respectively. Simultaneously, a partial reforming of adsorbed naphthalene was observed, and molecular hydrogen was detected in the gas phase. Results were correlated to the differences in porosimetry and chemical surface of the selected activated carbons, as well as to those highlighted by Scanning Electronic Microscopy and X-ray analyses. Finally, a procedure for activated carbon regeneration by carbon dioxide is reported, together with results from preliminary tests. The gasification of biomass and waste is a potentially high efficiency process for energy generation. However, the appropriate cleaning of the produced fuel gas is a major issue, in particular for tar removal. This study investigates the performance of three new-generation activated carbons, which are able to adsorb a wide spectrum of tars at high temperature, from 750 degrees C up to 900 degrees C. For this purpose, a laboratory-scale hot gas filtration apparatus was designed and set-up. Experimental tests were carried out with naphthalene as the reference tar compound. The selected activated carbons were tested under different conditions of temperature, test duration and naphthalene concentration. The procedure allows evaluating the contributions of adsorption and cracking phenomena on the overall tar removal efficiency. Complete naphthalene removal was obtained with two of the selected activated carbons, at 850 degrees C and 900 degrees C respectively. Simultaneously, a partial reforming of adsorbed naphthalene was observed, and molecular hydrogen was detected in the gas phase. Results were correlated to the differences in porosimetry and chemical surface of the selected activated carbons, as well as to those highlighted by Scanning Electronic Microscopy and X-ray analyses. Finally, a procedure for activated carbon regeneration by carbon dioxide is reported, together with results from preliminary tests. (C) 2016 Elsevier B.V. All rights reserved.

Published
2016

42. Improved noninvasive prediction of liver fibrosis by liver stiffness measurement in patients with nonalcoholic fatty liver disease accounting for controlled attenuation parameter values

Author

Julien Vergniol, Henry Lik-Yuen Chan, Fabio Marra, Anthony W.H. Chan, Salvatore Petta, Grace Lai-Hung Wong, Victor de Ledinghen, Umberto Arena, Jean-Baptiste Hiriart, Vito Di Marco, Calogero Cammà, Wassil Merrouche, Marco Barbara, Antonio Craxì, Brigitte Le-Bail, Vincent Wai-Sun Wong, Petta, S., Wong, V., Camma', C., Hiriart, J., Wong, G., Marra, F., Vergniol, J., Chan, A., DI MARCO, V., Merrouche, W., Chan, H., Barbara, M., Le-Bail, B., Arena, U., Craxi, A., and de Ledinghen, V.

Subjects
Liver Cirrhosis, Adult, Male, medicine.medical_specialty, Liver Cirrhosi, Predictive Value of Test, Sex Factor, Biology, Gastroenterology, Risk Assessment, Sensitivity and Specificity, Cohort Studies, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Elasticity Imaging Technique, Predictive Value of Tests, Liver stiffness, Fibrosis, Non-alcoholic Fatty Liver Disease, Internal medicine, Nonalcoholic fatty liver disease, Biopsy, medicine, Humans, In patient, Age Factor, Multivariate Analysi, Aged, Analysis of Variance, medicine.diagnostic_test, Hepatology, Biopsy, Needle, Age Factors, Middle Aged, medicine.disease, Immunohistochemistry, Quality Improvement, ROC Curve, 030220 oncology & carcinogenesis, Predictive value of tests, Multivariate Analysis, Elasticity Imaging Techniques, 030211 gastroenterology & hepatology, Female, Steatosis, Cohort Studie, Human
Abstract

Background and aims: Liver stiffness measurement (LSM) frequently overestimates the severity of liver fibrosis In Nonalcoholic Fatty Liver Disease (NAFLD). Controlled Attenuation Parameter (CAP) is a new parameter provided by the same machine used for LSM, and associated with both steatosis and BMI, the two factors mostly affecting LSM peformance in NAFLD. We aimed to determine wheter prediction of liver fibrosis by LSM in NAFLD patients is affected by CAP values. Methods: Patients (n=324) were assessed by clinical and histological (Kleiner score) features. LSM and CAP were performed using the M probe. CAP values were grouped by tertiles (lower from 132 to 298, middle from 299 to 338, higher form 339 to 400 dB/m). Results: Among patients with F0-F2 fibrosis, mean LSM values- expressed in kPa- increased according to CAP tertiles (6.8 vs. 8.6 vs. 9.4; p=0.001), and along this line the AUC of LSM for the diagnosis of F3-F4 fibrosis was progressively reduced from lower to middle and further to higher CAP tertiles (0.915, 0.848-0.982; 0.830, 0.753-0.908; 0.806, 0.723-0.890). As a consequence, in subjects with F0-F2 fibrosis, the rates of false-positive LSM results for F3-F4 fibrosis increased according to CAP tertiles (7.2% in lower vs. 16.6% in middle vs. 18.1% in higher). Consistent with this, a decisional flow-chart for prediciting fibrosis was suggested by combining both LSM and CAP values. Conclusions: In patients with NAFLD, CAP values should always be taken into account in order to avoid overestimations of liver fibrosis assessed by TE. This article is protected by copyright. All rights reserved.

Published
2017

43. Under-dilated TIPS Associate With Efficacy and Reduced Encephalopathy in a Prospective, Non-randomized Study of Patients With Cirrhosis

Author

Tommaso Di Maira, Stefano Fagiuoli, Rita Golfieri, Umberto Arena, Fabio Marra, Stefano Gitto, Stefano Colopi, Alessandro Cannavale, Filippo Schepis, Pietro Torricelli, Luca S. Belli, Pietro Quaretti, Giacomo Laffi, Angelo Luca, Cristian Caporali, Roberto Agazzi, Roberto Miraglia, Federico Banchelli, Nicola De Maria, Guido Marzocchi, Ilaria Fiorina, Roberto Nani, Antonio Rampoldi, Erica Villa, Mario De Santis, Raffaele Bruno, Lorenzo Paolo Moramarco, Guadalupe Garcia-Tsao, Aldo Airoldi, Francesco Vizzutti, Fabrizio Fanelli, L. Rega, Matteo Renzulli, Cristina Mosconi, Fabrizio Di Benedetto, Schepis, F, Vizzutti, F, Garcia-Tsao, G, Marzocchi, G, Rega, L, De Maria, N, Di Maira, T, Gitto, S, Caporali, C, Colopi, S, De Santis, M, Arena, U, Rampoldi, A, Airoldi, A, Cannavale, A, Fanelli, F, Mosconi, C, Renzulli, M, Agazzi, R, Nani, R, Quaretti, P, Fiorina, I, Moramarco, L, Miraglia, R, Luca, A, Bruno, R, Fagiuoli, S, Golfieri, R, Torricelli, P, Di Benedetto, F, Belli, L, Banchelli, F, Laffi, G, Marra, F, Villa, E, Schepis, Filippo, Vizzutti, Francesco, Garcia-Tsao, Guadalupe, Marzocchi, Guido, Rega, Luigi, De Maria, Nicola, Di Maira, Tommaso, Gitto, Stefano, Caporali, Cristian, Colopi, Stefano, De Santis, Mario, Arena, Umberto, Rampoldi, Antonio, Airoldi, Aldo, Cannavale, Alessandro, Fanelli, Fabrizio, Mosconi, Cristina, Renzulli, Matteo, Agazzi, Roberto, Nani, Roberto, Quaretti, Pietro, Fiorina, Ilaria, Moramarco, Lorenzo, Miraglia, Roberto, Luca, Angelo, Bruno, Raffaele, Fagiuoli, Stefano, Golfieri, Rita, Torricelli, Pietro, Di Benedetto, Fabrizio, Belli, Luca Saverio, Banchelli, Federico, Laffi, Giacomo, Marra, Fabio, and Villa, Erica

Subjects
Male, medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Liver, liver, portal hypertensive bleeding, portal hypertensive complications, treatment, vascular disease, Hemodynamics, Inferior vena cava, 03 medical and health sciences, 0302 clinical medicine, Model for End-Stage Liver Disease, Vascular Disease, Ascites, medicine, Humans, Prospective Studies, Aged, Hepatology, Vascular disease, business.industry, Incidence, Gastroenterology, Stent, Middle Aged, medicine.disease, Fibrosis, Surgery, Treatment, Treatment Outcome, Italy, Portal Hypertensive Bleeding, medicine.vein, Hepatic Encephalopathy, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Portasystemic Shunt, Transjugular Intrahepatic, medicine.symptom, business, Transjugular intrahepatic portosystemic shunt
Abstract

Background & Aims: Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time. Methods: We performed a prospective, non-randomized study of 42 unselected patients with cirrhosis who received under-dilated TIPS (7 and 6 mm) and 53 patients who received PTFE-SGs of 8 mm or more (controls) at referral centers in Italy. After completion of this study, dilation to 6 mm became the standard and 47 patients were included in a validation study. All patients were followed for 6 months; Doppler ultrasonography was performed 2 weeks and 3 months after TIPS placement and every 6 months thereafter. Stability of PTFE-SG diameter was evaluated by computed tomography analysis of 226 patients with cirrhosis whose stent grafts increased to 6, 7, 8, 9, or 10 mm. The primary outcomes were incidence of at least 1 episode of PSE grade 2 or higher during follow up, incidence of recurrent variceal hemorrhage or ascites, incidence of shunt dysfunction requiring TIPS recanalization, and reduction in porto-caval pressure gradient. Results: PSE developed in a significantly lower proportion of patients with under-dilated TIPS (27%) than controls (54%) during the first year after the procedure (P =.015), but the proportions of patients with recurrent variceal hemorrhage or ascites did not differ significantly between groups. No TIPS occlusions were observed. These results were confirmed in the validation cohort. In an analysis of self-expansion of stent grafts, during a mean follow-up period of 252 days after placement, none of the PTFE-SGs self-expanded to the nominal diameter in hemodynamically relevant sites (such as portal and hepatic vein vascular walls). Conclusions: In prospective, non-randomized study of patients with cirrhosis, we found under-dilation of PTFE-SGs during TIPS placement to be feasible, associated with lower rates of PSE, and effective.

Published
2018

44. Mixing of a lateral gas stream in a two-dimensional riser of a circulating fluidized bed

Author

Antonio Marzocchella, Umberto Arena, Marzocchella, Antonio, Arena, U., Marzocchella, A., and Arena, Umberto

Subjects
Secondary air, Gas-solids mixing, Chemistry, General Chemical Engineering, Mixing (process engineering), Thermodynamics, Gas solid, circulating fluidized bed, Flow field, CFB, gas mixing, Fluidized bed combustion, two dimensional, Geomorphology
Abstract

A cold model of a circulating fluidized bed having a two-dimensional riser, with a 12 × 120 mm section and a 6.4 m height, was equipped with a device to inject a lateral gas stream along the riser. The apparatus was operated under conditions ranging from those characteristic of combustors to those of gas-conversion processes. Flow structures in the interaction region between the rising gas—solids suspension and the lateral gas stream were studied by means of a motion analysis system. Three main configurations were identified. The ratio between the momentum of the lateral gas stream and that of the rising suspension was found to be the parameter able to discriminate among the three configurations. A satisfactory agreement was found with mixing data obtained using a cylindrical riser. On a installe sur un modele froid de lit fluidise circulant muni d'une colonne montante bidimensionnelle (section de 12 × 120 mm et hauteur de 6, 4 m) un dispositif pour injecter un courant de gaz lateral le long de la colonne montante. On a fait fonctionner l'appareil dans des conditions se situant entre les conditions operatoires habituelles des combusteurs et celles des precedes de conversion de gaz. Les structures d'ecoulement dans la region d'interaction entre la suspension montante de gaz—solides et le courant le gaz lateral ont ete etudiees a l'aide d'un systeme d'analyse du deplacement. Trois configurations principales ont ete determinees. On a trouve que le rapport entre le moment du courant de gaz lateral et celui de la suspension dans la colonne montante etait le parametre capable de differencier les trois configurations. Un accord satisfaisant a ete trouve avec les donnees de melange obtenues au moyen d'une colonne montante cylindrique.

Published
1996

45. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis

Author

Umberto Arena, Maria Letizia Bacchi Reggiani, Laura Turco, Lucia Montrone, Massimo Pinzani, Davide Festi, Eleonora Scaioli, Ramona Schiumerini, Giuseppe Mazzella, L. Marzi, Giovanni Casazza, Anna Rita Di Biase, Agostino Colli, Antonio Colecchia, Colecchia A, Montrone L, Scaioli E, Bacchi Reggiani ML, Colli A, Casazza G, Schiumerini R, Turco L, Di Biase AR, Mazzella G, Marzi L, Arena U, Pinzani M, and Festi D.

Subjects
Liver Cirrhosis, Male, Cirrhosis, Biopsy, Portal venous pressure, Severity of Illness Index, Gastroenterology, Endoscopy, Gastrointestinal, Liver disease, Esophageal varices, BOOTSTRAPPING, Splenomegaly, Diagnosis, Prognostic Factor, Liver Disease, controlled clinical trial, diagnostic test accuracy study, esophagogastroduodenoscopy, esophagus varices, liver stiffness, adult, FEMALE, Aged, 80 and over, medicine.diagnostic_test, Hepatitis C, Middle Aged, Prognosis, Portal Pressure, Italy, Liver, Liver biopsy, Elasticity Imaging Techniques, Portal hypertension, esophagus varice, Diagnosi, medicine.medical_specialty, Esophageal and Gastric Varices, Sensitivity and Specificity, Predictive Value of Tests, Internal medicine, Hypertension, Portal, medicine, Humans, Aged, Chi-Square Distribution, Hepatology, Platelet Count, business.industry, liver stiffne, Blood Pressure Determination, medicine.disease, Linear Models, business, Transient elastography, Spleen
Abstract

Background & Aims The hepatic vein pressure gradient (HVPG) is the standard used to determine the degree of portal hypertension (PH) and an important prognostic factor for patients with cirrhosis; HVPG values correlate with the presence of esophageal varices (EV). However, HVPG can only be accurately determined at specialized centers; noninvasive methods are needed to predict HVPG values and the presence of EV. We compared the diagnostic performance of spleen stiffness (SS) measurement by transient elastography with that of liver stiffness (LS) and of other recently proposed noninvasive tests. Methods We measured SS and LS in 100 consecutive patients with hepatitis C virus–induced cirrhosis. Patients were also assessed by FibroScan, HVPG, esophagogastroduodenoscopy, and liver biopsy. We also analyzed LS–spleen diameter to platelet ratio score and platelet count to spleen diameter. Results SS and LS were more accurate than other noninvasive parameters in identifying patients with EV and different degrees of PH. A linear model that included SS and LS accurately predicted HVPG values ( R 2 = 0.85). The results were internally validated using bootstrap analysis. Conclusions Measurement of SS can be used for noninvasive assessment and monitoring of PH and to detect EV in patients with hepatitis C virus–induced cirrhosis.

Published
2012

46. Quick and easy assessment of sarcopenia in cirrhosis: Can ultrasound be the solution?

Author

Campani F, Li Cavoli TV, Arena U, Marra F, Lynch EN, and Campani C

Subjects
Humans, Tomography, X-Ray Computed methods, Prognosis, Liver Neoplasms diagnostic imaging, Liver Neoplasms complications, Muscle, Skeletal diagnostic imaging, Sarcopenia diagnostic imaging, Sarcopenia etiology, Sarcopenia diagnosis, Ultrasonography methods, Liver Cirrhosis complications, Liver Cirrhosis diagnostic imaging, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular complications
Abstract

Cirrhosis is frequently associated with sarcopenia, with reported rates of over 80% in patients with decompensated alcohol-related liver disease. Sarcopenia negatively impacts the prognosis of cirrhotic patients and affects the response to treatment of patients with hepatocellular carcinoma (HCC). For these reasons, identifying an easy-to-perform method to assess sarcopenia in is a key element in the optimization of care in this patient population. Assessment of muscle mass by computed tomography is considered the standard of care for the diagnosis of sarcopenia, but exposure to radiation and high costs limit its application in this setting, especially for repeated assessments. We believe that ultrasound, a cheap and harmless technique also used for HCC screening in cirrhotic patients, could have an expanding role in the diagnosis and follow-up of sarcopenia in these patients., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Published
2024
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47. NAIF: A novel artificial intelligence-based tool for accurate diagnosis of stage F3/F4 liver fibrosis in the general adult population, validated with three external datasets.

Author

Hassoun S, Bruckmann C, Ciardullo S, Perseghin G, Marra F, Curto A, Arena U, Broccolo F, and Di Gaudio F

Subjects
Adult, Humans, Nutrition Surveys, Platelet Count, Artificial Intelligence, Liver Cirrhosis diagnosis, Liver Cirrhosis pathology
Abstract

Objective: The purpose of this study was to determine the effectiveness of a new AI-based tool called NAIF (NAFLD-AI-Fibrosis) in identifying individuals from the general population with advanced liver fibrosis (stage F3/F4). We compared NAIF's performance to two existing risk score calculators, aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (Fib4)., Methods: To set up the algorithm for diagnosing severe liver fibrosis (defined as Fibroscan® values E ≥ 9.7 KPa), we used 19 blood biochemistry parameters and two demographic parameters in a group of 5,962 individuals from the NHANES population (2017-2020 pre-pandemic, public database). We then assessed the algorithm's performance by comparing its accuracy, precision, sensitivity, specificity, and F1 score values to those of APRI and Fib4 scoring systems., Results: In a kept-out sub dataset of the NHANES population, NAIF achieved a predictive precision of 72 %, a sensitivity of 61 %, and a specificity of 77 % in correctly identifying adults (aged 18-79 years) with severe liver fibrosis. Additionally, NAIF performed well when tested with two external datasets of Italian patients with a Fibroscan® score E ≥ 9.7 kPa, and with an external dataset of patients with diagnosis of severe liver fibrosis through biopsy., Conclusions: The results of our study suggest that NAIF, using routinely available parameters, outperforms in sensitivity existing scoring methods (Fib4 and APRI) in diagnosing severe liver fibrosis, even when tested with external validation datasets. NAIF uses routinely available parameters, making it a promising tool for identifying individuals with advanced liver fibrosis from the general population. Word count abstract: 236., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2024
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48. Evaluating the best treatment for multifocal hepatocellular carcinoma: A propensity score-matched analysis.

Author

Risaliti M, Bartolini I, Campani C, Arena U, Xodo C, Adotti V, Rosi M, Taddei A, Muiesan P, Amedei A, Batignani G, and Marra F

Subjects
Hepatectomy adverse effects, Humans, Propensity Score, Retrospective Studies, Severity of Illness Index, Treatment Outcome, alpha-Fetoproteins, Carcinoma, Hepatocellular pathology, Chemoembolization, Therapeutic adverse effects, Chemoembolization, Therapeutic methods, End Stage Liver Disease surgery, Liver Neoplasms pathology
Abstract

Background: Hepatocellular carcinoma (HCC) is a common tumour often diagnosed with a multifocal presentation. Patients with multifocal HCC represent a heterogeneous group. Although Trans-Arterial ChemoEmbolization (TACE) is the most frequently employed treatment for these patients, previous data suggested that liver resection (LR) could be a safe and effective procedure., Aim: To compare LR and TACE in patients with multifocal HCC in terms of procedure-related morbidity and oncologic outcomes., Methods: All patients with multifocal HCC who underwent LR or TACE as the first procedure between May 2011 and March 2021 were enrolled. The decision to perform surgery or TACE was made after a multidisciplinary team evaluation. Only patients in Child-Pugh class A or B7 and stage B (according to the Barcelona Clinic Liver Cancer staging system, without severe portal hypertension, vascular invasion, or extrahepatic spread) were included in the final analysis. Propensity score matching was used to adjust the baseline differences between patients undergoing LR and the TACE group [number and diameter of lesions, presence of cirrhosis, alpha-fetoprotein (AFP) levels, and Model for End-Stage Liver Disease score]. The Kaplan-Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). The outcomes of LR and TACE were compared using the log-rank test., Results: After matching, 30 patients were eligible for the final analysis, 15 in each group. Morbidity rates were 42.9% and 40% for LR and TACE, respectively ( P = 0.876). Median OS was not different in the LR and TACE groups (53 mo vs 18 mo, P = 0.312), while DFS was significantly longer with LR (19 mo vs 0 mo, P = 0.0001). Subgroup analysis showed that patients in the Italian Liver Cancer (ITA.LI.CA) B2 stage, with AFP levels lower than 400 ng/mL, less than 3 lesions, and lesions bigger than 41 mm, benefited more from LR in terms of DFS. Patients classified as ITA.LI.CA B3, with AFP levels higher than 400 ng/mL and with more than 3 lesions, appeared to receive more benefit from TACE in terms of OS., Conclusion: In a small cohort of patients with multifocal HCC, LR confers longer DFS compared with TACE, with similar OS and post-procedural morbidity., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Published
2022
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49. Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization.

Author

Campani C, Vitale A, Dragoni G, Arena U, Laffi G, Cillo U, Giannini EG, Tovoli F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Sacco R, Cabibbo G, Mega A, Guarino M, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Biasini E, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Brunetto MR, Farinati F, Trevisani F, and Marra F

Abstract

Introduction: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC)., Methods: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016., Results: The median OS of the enrolled patients was 41 months. According to LRT χ 2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10-1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model., Conclusion: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction., Competing Interests: The authors report the following conflicts of interest related to the present work: Francesco Tovoli: consultant for Bayer and LaForce Guerbet. Fabio Marra: consultant for Bayer, Ipsen, and Eisai and received travel support from Bayer., (Copyright © 2021 by S. Karger AG, Basel.)

Published
2021
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50. Under-dilated TIPS Associate With Efficacy and Reduced Encephalopathy in a Prospective, Non-randomized Study of Patients With Cirrhosis.

Author

Schepis F, Vizzutti F, Garcia-Tsao G, Marzocchi G, Rega L, De Maria N, Di Maira T, Gitto S, Caporali C, Colopi S, De Santis M, Arena U, Rampoldi A, Airoldi A, Cannavale A, Fanelli F, Mosconi C, Renzulli M, Agazzi R, Nani R, Quaretti P, Fiorina I, Moramarco L, Miraglia R, Luca A, Bruno R, Fagiuoli S, Golfieri R, Torricelli P, Di Benedetto F, Belli LS, Banchelli F, Laffi G, Marra F, and Villa E

Subjects
Aged, Fibrosis surgery, Humans, Incidence, Italy epidemiology, Male, Middle Aged, Prospective Studies, Treatment Outcome, Fibrosis complications, Hepatic Encephalopathy epidemiology, Hepatic Encephalopathy prevention & control, Portasystemic Shunt, Transjugular Intrahepatic adverse effects, Portasystemic Shunt, Transjugular Intrahepatic methods
Abstract

Background & Aims: Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time., Methods: We performed a prospective, non-randomized study of 42 unselected patients with cirrhosis who received under-dilated TIPS (7 and 6 mm) and 53 patients who received PTFE-SGs of 8 mm or more (controls) at referral centers in Italy. After completion of this study, dilation to 6 mm became the standard and 47 patients were included in a validation study. All patients were followed for 6 months; Doppler ultrasonography was performed 2 weeks and 3 months after TIPS placement and every 6 months thereafter. Stability of PTFE-SG diameter was evaluated by computed tomography analysis of 226 patients with cirrhosis whose stent grafts increased to 6, 7, 8, 9, or 10 mm. The primary outcomes were incidence of at least 1 episode of PSE grade 2 or higher during follow up, incidence of recurrent variceal hemorrhage or ascites, incidence of shunt dysfunction requiring TIPS recanalization, and reduction in porto-caval pressure gradient., Results: PSE developed in a significantly lower proportion of patients with under-dilated TIPS (27%) than controls (54%) during the first year after the procedure (P = .015), but the proportions of patients with recurrent variceal hemorrhage or ascites did not differ significantly between groups. No TIPS occlusions were observed. These results were confirmed in the validation cohort. In an analysis of self-expansion of stent grafts, during a mean follow-up period of 252 days after placement, none of the PTFE-SGs self-expanded to the nominal diameter in hemodynamically relevant sites (such as portal and hepatic vein vascular walls)., Conclusions: In prospective, non-randomized study of patients with cirrhosis, we found under-dilation of PTFE-SGs during TIPS placement to be feasible, associated with lower rates of PSE, and effective., (Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Published
2018
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