AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care system.METHODS This study used a cross-sectional co...AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care system.METHODS This study used a cross-sectional cohort design.We evaluated chronic viral hepatitis patients with HBV referred to the outpatient services of 16 hospital units.Information in the case report forms included main demographic data,blood chemistry data,viral hepatitis markers,instrumental evaluations,and eligibility for treatment or ongoing therapy and liver transplantation.RESULTS Of 4015 chronic viral hepatitis patients,1096(27.3%)were HBV infected.The case report form was correctly completed for only 833 patients(64%males,36%females;mean age 50.1±15.4).Of these HBV-infected patients,73%were Caucasian,21%Asian,4%Central African,1%North African and 1%American.Stratifying patients by age and nationality,we found that 21.7%of HBV-infected patients were aged<34 years(only 2.8%were Italian).The most represented routes of transmission were nosocomial/dental procedures(23%),mother-to-child(17%)and sexual transmission(12%).The most represented HBV genotypes were D(72%)and A(14%).Of the patients,24.7%of patients were HBe Ag positive,and 75.3%were HBe Ag negative.Of the HBV patients 7%were anti-HDV positive.In the whole cohort,26.9%were cirrhotic(35.8%aged<45 years),and 47%were eligible for or currently undergoing treatment,of whom 41.9%were cirrhotic.CONCLUSION Only 27.3%of chronic viral hepatitis patients were HBV infected.Our results provide evidence of HBV infection in people aged<34 years,especially in the foreign population not protected by vaccination.In our cohort of patients,liver cirrhosis was also found in young adults.展开更多
AIM: To investigate in greater detail the efficacy and safety of sorafenib for the treatment of hepatocellular carcinoma (HCC) in patients with established cirrhosis.
Wilson’s disease(WD)is a rare inherited disorder of human copper metabolism,with an estimated prevalence of 1:30000-1:50000 and a broad spectrum of hepatic and neuropsychiatric manifestations.In healthy individuals,t...Wilson’s disease(WD)is a rare inherited disorder of human copper metabolism,with an estimated prevalence of 1:30000-1:50000 and a broad spectrum of hepatic and neuropsychiatric manifestations.In healthy individuals,the bile is the main route of elimination of copper.In WD patients,copper accumulates in the liver,it is released into the bloodstream,and is excreted in urine.Copper can also be accumulated in the brain,kidneys,heart,and osseous matter and causes damage due to direct toxicity or oxidative stress.Hepatic WD is commonly but not exclusively diagnosed in childhood or young adulthood.Adherent,non-cirrhotic WD patients seem to have a normal life expectancy.Nevertheless,chronic management of patients with Wilson’s disease is challenging,as available biochemical tests have many limitations and do not allow a clear identification of non-compliance,overtreatment,or treatment goals.To provide optimal care,clinicians should have a complete understanding of these limitations and counterbalance them with a thorough clinical assessment.The aim of this review is to provide clinicians with practical tools and suggestions which may answer doubts that can arise during chronic management of patients with hepatic WD.In particular,it summarises current knowledge on Wilson’s disease clinical and biochemical monitoring and treatment.It also analyses available evidence on pregnancy and the role of low-copper diet in WD.Future research should focus on trying to provide new copper metabolism tests which could help to guide treatment adjustments.展开更多
Fatigue is considered one of the most frequent and debilitating symptoms in primary biliary cholangitis(PBC),affecting over 50%of PBC patients.One in five patients with PBC suffer from severe fatigue,which significant...Fatigue is considered one of the most frequent and debilitating symptoms in primary biliary cholangitis(PBC),affecting over 50%of PBC patients.One in five patients with PBC suffer from severe fatigue,which significantly impairs quality of life.Fatigue is made up of a central and a peripheral component,whose pathophysiology is still greatly unresolved.Central fatigue is characterised by a lack of self-motivation and can manifest both in physical and mental activities(lack of intention).Peripheral fatigue includes neuromuscular dysfunction and muscle weakness(lack of ability).Peripheral fatigue could be explained by an excessive deviation from aerobic to anaerobic metabolism leading to excessive lactic acid accumulation and therefore accelerated decline in muscle function and prolonged recovery time.As opposed to itching,and with the exception of endstage liver disease,fatigue is not related to disease progression.The objective of this review is to outline current understanding regarding the pathophysiology of fatigue,the role of comorbidities and contributing factors,the main tools for fatigue assessment,the failed therapeutic options,and future treatment perspectives for this disabling symptom.Since fatigue is an extremely common and debilitating symptom and there is still no licensed therapy for fatigue in PBC patients,further research is warranted to understand its causative mechanisms and to find an effective treatment.展开更多
文摘AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care system.METHODS This study used a cross-sectional cohort design.We evaluated chronic viral hepatitis patients with HBV referred to the outpatient services of 16 hospital units.Information in the case report forms included main demographic data,blood chemistry data,viral hepatitis markers,instrumental evaluations,and eligibility for treatment or ongoing therapy and liver transplantation.RESULTS Of 4015 chronic viral hepatitis patients,1096(27.3%)were HBV infected.The case report form was correctly completed for only 833 patients(64%males,36%females;mean age 50.1±15.4).Of these HBV-infected patients,73%were Caucasian,21%Asian,4%Central African,1%North African and 1%American.Stratifying patients by age and nationality,we found that 21.7%of HBV-infected patients were aged<34 years(only 2.8%were Italian).The most represented routes of transmission were nosocomial/dental procedures(23%),mother-to-child(17%)and sexual transmission(12%).The most represented HBV genotypes were D(72%)and A(14%).Of the patients,24.7%of patients were HBe Ag positive,and 75.3%were HBe Ag negative.Of the HBV patients 7%were anti-HDV positive.In the whole cohort,26.9%were cirrhotic(35.8%aged<45 years),and 47%were eligible for or currently undergoing treatment,of whom 41.9%were cirrhotic.CONCLUSION Only 27.3%of chronic viral hepatitis patients were HBV infected.Our results provide evidence of HBV infection in people aged<34 years,especially in the foreign population not protected by vaccination.In our cohort of patients,liver cirrhosis was also found in young adults.
基金Supported by Grants from Associazione Italiana per la Ricerca sul Cancro(AIRC)and Istituto Toscano Tumori(ITT)to Marra F
文摘AIM: To investigate in greater detail the efficacy and safety of sorafenib for the treatment of hepatocellular carcinoma (HCC) in patients with established cirrhosis.
文摘Wilson’s disease(WD)is a rare inherited disorder of human copper metabolism,with an estimated prevalence of 1:30000-1:50000 and a broad spectrum of hepatic and neuropsychiatric manifestations.In healthy individuals,the bile is the main route of elimination of copper.In WD patients,copper accumulates in the liver,it is released into the bloodstream,and is excreted in urine.Copper can also be accumulated in the brain,kidneys,heart,and osseous matter and causes damage due to direct toxicity or oxidative stress.Hepatic WD is commonly but not exclusively diagnosed in childhood or young adulthood.Adherent,non-cirrhotic WD patients seem to have a normal life expectancy.Nevertheless,chronic management of patients with Wilson’s disease is challenging,as available biochemical tests have many limitations and do not allow a clear identification of non-compliance,overtreatment,or treatment goals.To provide optimal care,clinicians should have a complete understanding of these limitations and counterbalance them with a thorough clinical assessment.The aim of this review is to provide clinicians with practical tools and suggestions which may answer doubts that can arise during chronic management of patients with hepatic WD.In particular,it summarises current knowledge on Wilson’s disease clinical and biochemical monitoring and treatment.It also analyses available evidence on pregnancy and the role of low-copper diet in WD.Future research should focus on trying to provide new copper metabolism tests which could help to guide treatment adjustments.
文摘Fatigue is considered one of the most frequent and debilitating symptoms in primary biliary cholangitis(PBC),affecting over 50%of PBC patients.One in five patients with PBC suffer from severe fatigue,which significantly impairs quality of life.Fatigue is made up of a central and a peripheral component,whose pathophysiology is still greatly unresolved.Central fatigue is characterised by a lack of self-motivation and can manifest both in physical and mental activities(lack of intention).Peripheral fatigue includes neuromuscular dysfunction and muscle weakness(lack of ability).Peripheral fatigue could be explained by an excessive deviation from aerobic to anaerobic metabolism leading to excessive lactic acid accumulation and therefore accelerated decline in muscle function and prolonged recovery time.As opposed to itching,and with the exception of endstage liver disease,fatigue is not related to disease progression.The objective of this review is to outline current understanding regarding the pathophysiology of fatigue,the role of comorbidities and contributing factors,the main tools for fatigue assessment,the failed therapeutic options,and future treatment perspectives for this disabling symptom.Since fatigue is an extremely common and debilitating symptom and there is still no licensed therapy for fatigue in PBC patients,further research is warranted to understand its causative mechanisms and to find an effective treatment.
