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Background & Aims: Chronic liver diseases (CLDs) are major health problems that require complex and costly treatments. Liver-specific clinical outcome indicators (COIs) able to assist both clinicians and administrators in improving the value of care are presently lacking. The Value-Based Medicine in Hepatology (VBMH) study aims to fill this gap, devising and testing a set of COIs for CLD, that could be easily collected during clinical practice. Here we report the COIs generated and recorded for patients with HBV or HCV infection at different stages of the disease. Methods/Results: In the first phase of VBMH study, COIs were identified, based on current international guidelines and literature, using a modified Delphi method and a RAND 9-point appropriateness scale. In the second phase, COIs were tested in an observational, longitudinal, prospective, multicentre study based in Lombardy, Italy. Eighteen COIs were identified for HBV and HCV patients. Patients with CLD secondary to HBV (547) or HCV (1391) were enrolled over an 18-month period and followed for a median of 4 years. The estimation of the proposed COIs was feasible in the real-word clinical practice and COI values compared well with literature data. Further, the COIs were able to capture the impact of new effective treatments like direct-acting antivirals (DAAs) in the clinical practice. Conclusions: The COIs efficiently measured clinical outcomes at different stages of CLDs. While specific clinical practice settings and related healthcare systems may modify their implementation, these indicators will represent an important component of the tools for a value-based approach in hepatology and will positively affect care delivery.

Background and aim: Liver transplantation (LT) is a validated treatment for hepatocellular carcinoma (HCC). HCC recurrence occurred between 8 and 20% of patients and lung is the most frequent site. Pulmonary metastases resection (PMR) prolongs survival, however in LT-setting the impact on survival is unclear. To give new lights on this issue, we report the experience of three Italian LT Centers. Methods: All consecutive HCC transplanted patients in three Italian LT Centers, who developed pulmonary metastasis from HCC (PM-HCC), as first metastasis, from 2008 to 2018, were included whenever treated with PMR. Results: Twenty-five patients were enrolled (median age 58 yrs, 84% male, 3% cirrhotics). HCC recurred after 34 months (9–306) since LT and PMR was performed after 2.4 months (0–43.1). A total of 28 PMR (19 single resections; 9 multiple resections; 16 right; 2 left) have been performed on 24 patients while in one case percutaneous microwave ablation (MWA) was preferred. Four patients have been re-operated due to pulmonary HCC-recurrence after surgery. The majority of surgical resection type was wedge resection (26, 89%). Surgical access was: video-assisted thoracic surgery (VATS) in 17 cases (59%); thoracotomy in 11 (38%); MWA in 1 (3%). The 48% of nodule was in right lower lobe. Perioperative in-hospital mortality and 30 days mortality were nil; median surgical time 90 min (50–365); median post-operative overall stay 5 days (2–11). Post-operative ICU treatment was necessary in 1 case (3%) for 3 days; blood transfusions in 2 cases (7%). Overall, 5 complications (2 bleeding; 1 AKI; 1 major cardiac; 1 wound dehiscence) occurred, with an overall complications rate of 23%. Eight (32%) patients died during a follow-up after HCC recurrence of 32 months (7–213): 7 for HCC progression, 1 for severe liver failure due to chronic rejection. The 1 and 5 year cumulative probability of OS from recurrence were 100 and 43% (95%CI 12–74), respectively, with a median OS of 51 month

Stock nurseries of rootstock cultivars, in the EU, account for 7,466 ha, according to the “Comité international des pépiniéristes viticoles” (2012) while 6,052 ha are devoted to stock nurseries of V. vinifera cultivars. The main rootstock producing countries are Spain, France and Italy, which represent 87% of the total area, while about 60% of total area for stock nurseries of V. vinifera cultivars are located in Italy and France. In 2012, the production of grafted cuttings in the EU was about 546 million, whilst nursery cuttings were about 10 million. The rootstock cultivars grown in the three main producing countries are 41; 110 Richter (1,940 ha), SO 4 (774 ha), 1103 Paulsen (765 ha), 140 Ruggeri (511 ha), Kober 5BB (391 ha), 41B (300 ha), 161.49 Couderc (290 ha), 3309 Couderc (241 ha), Fercal (188 ha), 420A (130 ha), 101.14 Mgt (102 ha), Gravesac (89 ha), 775 Paulsen (42 ha) and 779 Paulsen (37 ha). In Italy, five rootstock cultivars account for 82,5% of total rooted cuttings and grafts produced, as follows: 1103 Paulsen (22%), Kober 5BB (24%), SO 4 (22%), 110 Richter (9.5%), 420A (7%). The remaining production is split among 27 other rootstock cultivars. The rootstock cultivars grown in Italy are 36 and the most important are: 1103 Paulsen (499 ha), Kober 5BB (351 ha), SO 4 (305 ha), 110 Richter (188 ha), 140 Ruggeri (176 ha), 420A (101 ha) that account for 88% of total area. The remaining area is planted with 30 cultivars. Under EU legislation, production and marketing of propagating material of rootstock standard category is no longer allowed.

By the means of the data of the decennial censuses of agriculture it was commented the evolution of the Italian viticulture from 1970 to 2010 either as for the national and regional acreage and as for the changes of the surfaces occupied by the wine producing varieties. It continues to rely mainly on native varieties and on some quality effective foreign varieties. Italian viticulture is in general reducing its acreage but there is an increase of the surface cultivated with varieties for production of PDO wines at the expenses of varieties for production of non PDO or less appreciated wines.

La Direttiva Comunitaria 68/193/CEE istituisce il Registro Nazionale delle Varietà di Vite di cui il materiale di propagazione è sottoposto a controllo ufficiale e certificazione. In Italia la normativa nazionale ha assegnato al Consiglio per la Ricerca e la sperimentazione in Agricoltura – Centro di ricerca per la viticoltura (CRA-VIT) la conservazione e l’aggiornamento del Registro. Al fine di rendere le informazioni contenute nel Registro maggiormente accessibili agli utenti, il CRA-VIT, all’interno delle attività di controllo e certificazione del materiale di propagazione della vite, ha sviluppato un’applicazione online che il Ministero delle Politiche Agricole Alimentari e Forestali ha inserito nel suo sito web. Ad oggi sono incluse: i) 530 descrizioni relative a varietà di uva da vino, da tavola e varietà di portinnesti riprese dalle pubblicazioni scientifiche o dai fascicoli presentati per la richiesta di iscrizione delle varietà nel Registro; ii)818 schede di descrizione di cloni riguardanti le loro caratteristiche principali, specialmente quelle relative al vino prodotto; iii) 8323 fotografie delle diverse parti della vite. Fusto, foglia e grappolo sono mostrati in differenti momenti della stagione vegetativa e ciò costituisce un utile supporto alle descrizioni; iv) dati di produzione di barbatelle radicate di tutte le varietà dal 1989 ad oggi; v) lista dei Vini DOP e IGP relativi alle varietà interessate e classificazione delle varietà per ciascuna regione. Inoltre il Registro include un ampio range di informazioni circa l’utilizzo delle varietà nella produzione di vino e, attraverso le immagini relative alla produzione del materiale di propagazione, la loro importanza in termini di coltivazione. La possibilità di disporre di descrizioni relative alle principali caratteristiche dei cloni e alla loro produzione coadiuvano il viticoltore nel momento della scelta del materiale. Il registro Nazionale nella sua forma online è di semplice utilizzo e

The purpose was to assess the cost-effectiveness of sorafenib in the treatment of hepatocellular carcinoma (HCC) patients incorporating current prices and the results of the recent published field practice SOraFenib Italian Assessment (SOFIA) study. We created a Markov Decision Model to evaluate, in a hypothetical cohort of Caucasian male patients, aged 67 years with Barcelona Clinic Liver Cancer (BCLC) C HCC, or BCLC B HCC who were unfit or failed to respond to locoregional therapies, well compensated cirrhosis, and with performance status 0-1 according to Eastern Cooperative Oncology Group (ECOG), the cost-effectiveness of the following strategies: (1) full or dose-adjusted sorafenib for BCLC B and C patients together; (2) full or dose-adjusted sorafenib for BCLC B patients; (3) full or dose-adjusted sorafenib for BCLC C patients. Outcomes include quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER). In the base-case analysis dose-adjusted sorafenib was the most effective of the evaluated strategies. For dose-adjusted sorafenib, QALY was 0.44 for BCLC B and C patients together, 0.44 for BCLC C patients, and 0.38 for BCLC B patients. The ICER of dose-adjusted sorafenib compared with BSC was €34,534 per QALY gained for BCLC B and C patients together, €27,916 per QALY gained for BCLC C patients, and €54,881 per QALY gained for BCLC B patients. Results were sensitive to BSC survival rate, and sorafenib treatment duration.

In recent years, a worsening outcome of hepatitis C virus (HCV)-positive recipients and a faster progression of recurrent disease to overt cirrhosis have been reported. Our aims were to 1) assess patient survival and development of severe recurrent disease (Ishak fibrosis score > 3) in different transplant years; and 2) model the effects of pre- and post-liver transplantation (LT) variables on the severity of recurrent disease. A multicenter retrospective analysis was conducted on 502 consecutive HCV-positive transplant recipients between January 1990 and December 2002. Protocol liver biopsies were obtained at 1, 3, 5, 7, and 10 yr post-LT ir almost 90% of the patients. All 502 patients were included in the overall survival analysis, while only the 354 patients with a follow-up longer than 1 yr were considered for the analysis of predictors of disease progression. The overall Kaplan-Meier survival rates were 78.7%, 66.3%, and 58.6%, at 12, 60, and 120 months, respectively, and a trend for a better patient survival over the years emerged from all 3 centers. The cumulative probability of developing HCV-related recurrent severe fibrosis (Ishak score 4-6) in the cohort of 354 patients who survived at least 1 yr remained unchanged over the years. Multivariate analysis indicated that older donors (P = 0.0001) and female gender of recipient (P = 0.02) were the 2 major risk factors for the development of severe recurrent disease, while the adoption of antilymphocytic preparations was associated with a less aggressive course (P = 0.03). Two of these prognostic factors, donor age and recipient gender, are easily available before LT and their combination showed an important synergy, such that a female recipient not only had a much higher probability of severe recurrent disease than a male recipient but her risk increased with the increasing age of the donor, reaching almost 100% when the age of the donor was 60 or older. In conclusion, a trend for a better patient survival

Background & Aims: This study extends our previously reported observations that various immunological factors are associated with the occurrence of histologically proven recurrent hepatitis C. The two specific issues investigated were to confirm the associations of MHC alleles and donor/recipient mismatch with the occurrence of recurrent hepatitis C in an independent cohort of newly transplanted patients and to look for immunologic and nonimmunologic variables affecting the severity of the recurrent disease. Methods: Two separate cohorts of consecutive patients were studied: a look-back cohort (LC) of 120 patients and a cohort for studying the disease progression (CSDP) of 190 patients. Protocol liver biopsies were obtained at least 1, 3, 5, 7, and 10 years after liver transplantation (LT). Results: A fully mismatched donor/recipient pair at the DRB1 locus was confirmed to be associated with both the recurrence of histologic hepatitis in the LC (59% vs 23%, P = .0002) and its progression beyond stage 3 in the CSPD (71.4% vs 39.3%, P = .0003). Relevant immunologic and nonimmunologic variables were included into a multivariate Cox proportional model and three variables, namely, donor age, full HLA-DRB1 donor-recipient mismatch, and HLA B14, resulted in independent risk factors for the development of severe fibrosis. Conclusion: This study provides evidence that DRB1 donor-recipient mismatch affects both the occurrence and progression of recurrent hepatitis C disease. This information is clinically relevant as it may help to better allocate organs and to recognize patients at risk for progression so that specific interventions can be implemented. © 2006 by the American Gastroenterological Association Institute