Assessment of liver fibrosis in chronic hepatitis C virus(HCV)infection is considered a relevant part of patient care and key for decision making.Although liver biopsy has been considered the gold ...standard for staging liver fibrosis,it is an invasive technique and subject to sampling errors and significant intra-and inter-observer variability.Over the last decade,several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection,with variable performance.Besides the clear advantage of being noninvasive,a more objective interpretation of test results may overcome the mentioned intra-and inter-observer variability of liver biopsy.In addition,these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk.However,in general,these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extrahepatic conditions.These methods are either serum markers(usually combined in a mathematical model)or imaging modalities that can be used separately or combined in algorithms to improve accuracy.In this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C,their advantages,limitations and application in clinical practice.
Natural dietary agents have attracted considerable attention due to their role in promoting health and reducing the risk of diseases including cancer. Ginger, one of the most ancient known spices, ...contains bioactive compounds with several health benefits. 6‐Gingerol constitutes the most pharmacologically active among such compounds. The aim of the present work was to review the literature pertaining to the use of ginger extract and 6‐gingerol against tumorigenic and oxidative and inflammatory processes associated with cancer, along with the underlying mechanisms of action involved in signaling pathways. This will shed some light on the protective or therapeutic role of ginger derivatives in oxidative and inflammatory regulations during metabolic disturbance and on the antiproliferative and anticancer properties. Data collected from experimental (in vitro or in vivo) and clinical studies discussed in this review indicate that ginger extract and 6‐gingerol exert their action through important mediators and pathways of cell signaling, including Bax/Bcl2, p38/MAPK, Nrf2, p65/NF‐κB, TNF‐α, ERK1/2, SAPK/JNK, ROS/NF‐κB/COX‐2, caspases‐3, ‐9, and p53. This suggests that ginger derivatives, in the form of an extract or isolated compounds, exhibit relevant antiproliferative, antitumor, invasive, and anti‐inflammatory activities.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Ataxia-telangiectasia (A-T) is a DNA repair disorder characterized by changes in several organs and systems. Advances in clinical protocols have resulted in increased survival of A-T patients, ...however disease progression is evident, mainly through metabolic and liver changes.
To identify the frequency of significant hepatic fibrosis in A-T patients and to verify the association with metabolic alterations and degree of ataxia.
This is a cross-sectional study that included 25 A-T patients aged 5 to 31 years. Anthropometric data, liver, inflammatory, lipid metabolism and glucose biomarkers (oral glucose tolerance test with insulin curve-OGTT) were collected. The Cooperative Ataxia Rating Scale was applied to assess the degree of ataxia. The following were calculated: Homeostasis Model Assessment-Insulin Resistance, Homeostasis Model Assessment-Adiponectin (HOMA-AD), Matsuda index, aspartate aminotransferase (AST): platelet ratio index, nonalcoholic fatty liver disease fibrosis score and BARD score. Liver ultrasonography and transient liver elastography by FibroScan
were performed.
Significant hepatic fibrosis was observed in 5/25 (20%). Patients in the group with significant hepatic fibrosis were older (p < 0.001), had lower platelet count values (p = 0.027), serum albumin (p = 0.019), HDL-c (p = 0.013) and Matsuda index (p = 0.044); and high values of LDL-c (p = 0.049), AST (p = 0.001), alanine aminotransferase (p = 0.002), gamma-glutamyl transferase (p = 0.001), ferritin (p = 0.001), 120-min glycemia by OGTT (p = 0.049), HOMA-AD (p = 0.016) and degree of ataxia (p = 0.009).
A non-invasive diagnosis of significant hepatic fibrosis was observed in 20% of A-T patients associated with changes in liver enzymes, ferritin, increased HOMA-AD, and the severity of ataxia in comparison with patients without hepatic fibrosis.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Hydrogels are structures that have value for application in the area of tissue engineering because they mimic the extracellular matrix. Naturally obtained polysaccharides, such as chitosan (CH) and ...cashew gum, are materials with the ability to form polymeric networks due to their physicochemical properties. This research aimed to develop a scaffold based on chitosan and phthalated cashew tree gum and test it as a support for the growth of human mesenchymal stem cells. In this study, phthalation in cashew gum (PCG) was performed by using a solvent-free route. PCG-CH scaffold was developed by polyelectrolyte complexation, and its ability to support adherent stem cell growth was evaluated. The scaffold showed a high swelling rate. The pore sizes of the scaffold were analyzed by scanning electron microscopy. Human dental pulp stem cells (hDPSCs) were isolated, expanded, and characterized for their potential to differentiate into mesenchymal lineages and for their immunophenotypic profile. Isolated mesenchymal stem cells presented fibroblastoid morphology, plastic adhesion capacity, and differentiation in osteogenic, adipogenic, and chondrogenic lineages. Mesenchymal stem cells were cultured in scaffolds to assess cell adhesion and growth. The cells seeded on the scaffold showed typical morphology, attachment, and adequate distribution inside the matrix pores. Thus, cells seeded in the scaffold may improve the osteoinductive and osteoconductive properties of these biomaterials.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Most of the ongoing decline in biodiversity, worldwide, is due to human activities, in particular, the expansion of agriculture. In this context, we highlight the need for studies of the taxonomic ...groups that can provide insights into the dynamics of the ecological communities facing anthropogenic impacts. For this, we evaluated the effects of the environmental changes caused by cattle ranching on five phytophysiognomies (Cerrado Savanna, Amazon Forest, Palm Forest, Marshland, and Mangrove) in the state of Maranhão, Brazil. We tested the hypothesis that the species composition, abundance, and richness of the families Calliphoridae, Mesembrinellidae, and Sarcophagidae (Diptera) are affected by ranching in each of the phytophysiognomies. Specimens were collected at 90 sites, including 45 anthropic sites (cattle ranches) and 45 preserved habitats, using traps baited with bovine lung. We collected 15,023 calliphorids (11 species), 10,772 sarcophagids (52 species), and 241 mesembrinellids (one species). The results indicated significant differences between anthropic and preserved habitats in the species composition, abundance, and richness of sarcophagids, in particular in the Amazon Forest, where the highest species richness was recorded in the anthropic environments. In the case of the calliphorids and mesembrinellids, by contrast, significant differences were found in species composition and abundance in only in four of the five phytophysiognomies analyzed (excluding the Cerrado Savanna), while species richness only varied in the palm forest and marshland. In all cases, lower values were recorded in the anthropic environments. These results indicate that the insects of the families Sarcophagidae, Calliphoridae, and Mesembrinellidae respond differentially to the anthropic activity (cattle ranching) and can be used to evaluate this type of anthropogenic impact systematically. In addition, the Amazon Forest was the phytophysiognomy most impacted by this activity in the Brazilian state of Maranhão.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The present study compared patterns of diversity of the families Calliphoridae and Sarcophagidae (Diptera: Oestroidea) among areas of primary and secondary forest, and clearings in the Amazon biome. ...We evaluated the relationship between habitat specialist and generalist species, verifying their potential for use as bioindicator species. The study was conducted in 27 areas that comprise primary and secondary forests and clearings in the municipality of Juruti, Pará, Brazil. We collected 4286 necrophagous flies in the three study environments. The hypothesis of dissimilarity in the diversity among environments was corroborated for the Sarcophagidae and partly upheld for the Calliphoridae. The sarcophagid species
Oxysarcodexia carvalhoi
(Lopes 1946),
Oxysarcodexia fringidea
(Curran and Walley 1934),
Oxysarcodexia thornax
(Walker 1849), and the calliphorids
Chrysomya megacephala
(Fabricius 1794) and
Cochliomyia macellaria
(Fabricius 1775) were all associated with clearing environments. No sarcophagid species were identified as indicators of primary forest. The calliphorids,
Chloroprocta idioidea
(Robineau-Desvoidy 1830) and
Paralucilia adespota
(Dear 1985) were identified as indicators of primary + secondary forest. The occurrence of indicator species and their levels of tolerance varied considerably between the two families. The calliphorids and sarcophagids both included species capable of representing differences in necrophagous fly’s diversity among clearing, primary and secondary forest environments, which increases the understanding of the ecology of the taxa and their potential use for biomonitoring, management, and habitat conservation.
Implications for insects conservation
In general, sarcophagids had a strong relationship with clearings and secondary forest. Some species show intense scavenger behavior and preference for altered environments. This reinforces the importance of the relationship between species and landscapes. In calliphorids, only Chloroprocta idioidea was associated with primary and secondary forest. We also recorded calliphorid species that prefer clearings and secondary forest and are highly tolerant to variation from abiotic factors, with wide niche breadth due to preference for these landscape types. The niche breadth and the tolerance shown by the species are an indication of the potential success of these organisms in response to anthropic processes and changes in landscapes.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background and Aim
FAST score has a good performance for diagnosing the composite of NASH + NAS ≥ 4 + F ≥ 2. However, it has not been evaluated in Latin American individuals with nonalcoholic fatty ...liver disease (NAFLD). We aimed to analyze the performance of the FAST score in a Brazilian NAFLD population.
Methods
Cross-sectional study was held in ≥ 18 years NAFLD patients diagnosed by ultrasonography and submitted to liver biopsy (LB). Liver stiffness (LSM) and CAP measurements were performed with FibroScan®, using M (BMI < 32 kg/m
2
) or XL probes. Area under receiver operating characteristic (AUROC) curves were calculated as well as sensitivity (S), specificity (Spe), positive predictive value (VPP) and negative predictive value (NPV) for the previously established FAST score cut-offs.
Results
Among 287 patients included (75% female; mean age 55 ± 10 years), NASH + NAS ≥ 4 + F ≥ 2 was reported in 30% of LB. For the FAST cut-off of 0.35, the S and NPV to rule out NASH + NAS ≥ 4 + F ≥ 2 were 78.8% and 87.8%, respectively. Regarding the cut-off of 0.67, the Spe and PPV to rule-in NASH + NAS ≥ 4 + F ≥ 2 were 89.1%, 61.8%, respectively. The AUROC of FAST for all included patients was 0.78 (95% CI 0.72–0.84) and for those with ≥ 32 kg/m
2
was 0.81 (95% CI 0.74–0.88).
Conclusion
FAST score has a good performance in a Brazilian NAFLD population, even in patients with higher BMI when the XL probe is adopted. Therefore, FAST can be used as a noninvasive screening tool mainly for excluding the diagnosis of progressive NASH, reducing the number of unnecessary liver biopsies.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Kidney transplant is the treatment of choice for patients with end-stage renal disease and is associated with lower mortality when compared to dialysis methods. Brazil is the country with the second ...largest number of kidney transplants in the world and among these patients it has been observed that liver abnormalities are common. The frequency of liver abnormalities ranges from 20-50% post-transplantation, and have an important impact on the survival and quality of life of these patients. There are scarce data about the frequency, causes and characteristics of these alterations.
To determine the prevalence of the different causes of hepatic abnormalities in kidney transplant recipients, to associate the characteristics of these abnormalities with demographic, epidemiological and clinical variables, to compare the characteristics of hepatic alterations between different etiologies, and to evaluate possible changes in diagnosis over two different periods of time.
Descriptive, cross-sectional observational, epidemiological study was conducted at the outpatient "Hepato-Rim"clinic of Hospital São Paulo (EPM/UNIFESP), a center providing specialized care for patients with hepatic abnormalities and underlying kidney diseases.
Five-hundred eighty-one transplant patients were evaluated. The most prevalent etiologies of liver abnormalities were hepatitis C and B, iron overload, nonalcoholic fatty liver disease (NAFLD), and drug-induced liver injury (DILI). The most common cause - hepatitis C - was analyzed in greater detail. Compared to the other causes, this infection was more frequent in older patients, female patients, and patients with a longer time since transplantation and hemodialysis. Analysis of the two periods showed that patients of period 1 (P1 - 1993 to 2005) were older and were more frequently referred because of positive serology; referral due to aminotransferases abnormalities predominated during period 2 (P2 - 2006 to 2018). The predominant diagnoses were hepatitis C and B during P1 and NAFLD and DILI during P2.
Assessment of the main hepatic alterations in kidney transplant recipients is important because it permits better management of these patients in terms of diagnostic investigation and treatment and contributes to the prevention of complications in this special population.
In 2015 the European Association for the Study of Liver Diseases (EASL) and the Asociación Latinoamericana para el Estudio del Hígado (ALEH) published a guideline for the use of non-invasive markers ...of liver disease. At that time, this guideline focused on the available data regarding ultrasonic-related elastography methods. Since then, much has been published, including new data about XL probe use in transient elastography, magnetic resonance elastography, and non-invasive liver steatosis evaluation. In order to draw evidence-based guidance concerning the use of elastography for non-invasive assessment of fibrosis and steatosis in different chronic liver diseases, the Brazilian Society of Hepatology (SBH) and the Brazilian College of Radiology (CBR) sponsored a single-topic meeting on October 4th, 2019, at São Paulo, Brazil. The aim was to establish specific recommendations regarding the use of imaging-related non-invasive technology to diagnose liver fibrosis and steatosis based on the discussion of evidence-based topics by an organizing committee of experts. It was submitted online to all SBH and CBR members. The present document is the final version of the manuscript that supports the use of this new technology as an alternative to liver biopsy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
New direct‐acting antiviral (DAA) agents are in development or already approved for the treatment of chronic hepatitis C virus (HCV) infection. The effectiveness of these drugs is related to the ...previous existence of resistant variants. Certain clinical conditions can allow changes in immunological characteristics of the host and even modify genetic features of viral populations. The aim of this study was to perform HCV molecular characterization from samples of end‐stage renal disease patients on hemodialysis (ESRD‐HD). Nested PCR and Sanger sequencing were used to obtain genetic information from the NS5B partial region of a cohort composed by 86 treatment‐naïve patients. Genomic sequences from the Los Alamos databank were employed for comparative analysis. Bioinformatics methodologies such as phylogenetic reconstructions, informational entropy, and mutation analysis were used to analyze datasets separated by geographical location, HCV genotype, and renal function status. ESRD‐HD patients presented HCV genotypes 1a (n = 18), 1b (n = 16), 2a (n = 2), 2b (n = 2), and 3a (n = 4). Control subjects were infected with genotypes 1a (n = 11), 1b (n = 21), 2b (n = 4), and 3a (n = 8). Dataset phylogenetic reconstruction separated HCV subtype 1a into two distinct clades. The entropy analysis from the ESRD‐HD group revealed two amino acid positions related to an epitope for cytotoxic T lymphocytes and T helper cells. Genotype 1a was found to be more diverse than subtype 1b. Also, genotype 1a ERSD‐HD patients had a higher mean of amino acids changes in comparison to control group patients. The identification of specific mutations on epitopes and high genetic diversity within the NS5B HCV partial protein in hemodialysis patients can relate to host immunological features and geographical distribution patterns. This genetic diversity can affect directly the new DAA's resistance mechanisms.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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