Purpose To evaluate the diagnostic accuracy of shear-wave elastography (SWE) in identifying different degrees of fibrosis in a cohort of consecutive children and adolescents with nonalcoholic ...steatohepatitis (NASH). Materials and Methods Consecutive pediatric patients scheduled to undergo liver biopsy were studied with an ultrasonography-based SWE system. Elastography was performed in 68 of 69 patients with biopsy-proved NASH (37 boys and 31 girls; mean age, 12.6 years ± 2.48; age range, 8-17 years). The correlations among laboratory findings, liver stiffness, and fibrosis score were analyzed, and the area under the receiver operating characteristic curve (AUC) was used to assess the presence of any fibrosis (score ≥F1) or significant fibrosis (score ≥F2). Findings from histologic examination were used as the standard of reference. Results SWE showed a very high correlation with liver fibrosis (P < .001) at univariate and multivariate analyses. The AUCs for the association of any and significant fibrosis were 0.92 (95% confidence interval CI: 0.86, 0.98) and 0.97 (95% CI: 0.95, 0.99), respectively. The intraclass correlation coefficient for absolute agreement was 0.95 (95% CI: 0.90, 0.97). Conclusion SWE is an accurate and reproducible noninvasive technique that efficiently depicts the presence of significant liver fibrosis and, less accurately, mild liver fibrosis in pediatric patients with nonalcoholic fatty liver disease. Larger clinical prospective studies are warranted to confirm SWE accuracy and establish threshold values for fibrosis grading in comparison or in combination with other noninvasive methods.
RSNA, 2016.
Background
No available and easy to administer cognitive test has been evaluated for the prediction of mortality in prevalent patients on chronic hemodialysis. The aim of the present study was to ...determine if the Mini‐Mental State Examination (MMSE) was predictor of mortality in patients on chronic hemodialysis.
Methods
One hundred twenty‐seven prevalent patients on chronic hemodialysis were studied. All patients underwent assessment of cognitive function through the MMSE. The MMSE was administered during a midweek hemodialysis session, avoiding the beginning and the end of each treatment to minimize the effects of fluctuations in uremic syndrome or blood pressure in accordance with a previous study. An MMSE score ≤23 was used as indicative of cognitive impairment. Demographic, clinical, and laboratory parameters were recorded for each patient.
Results
Mean (SD) MMSE was 23.2 ± 4.1. Median MMSE was 24 (min–max: 2–30). MMSE was ≤23 in 72 patients and >23 in 55. With data updated in March 2021, after a mean follow‐up of 58.8 ± 41 months (range: 2–156 months), 75 patients died, and 17 were transplanted. None was lost to follow‐up or was transferred to another unit. Dead participants, as compared with alive ones, were significantly older, had a higher Charlson Index score, had lower Activities daily living and Instrumental activities daily living, and had a lower MMSE score and lower serum albumin levels. Kaplan–Meier analysis showed that survival was significantly lower in patients with MMSE ≤23 than in those with MMSE >23 (log‐rank χ2: 8.825, p = 0.003). According to Cox regression analysis, mortality was associated with age and inversely associated with MMSE.
Conclusion
We show that the MMSE predicts mortality in prevalent patients on chronic hemodialysis.
•IL-1β, IL-6 and TNF-α seem not to be involved in the onset of PDF or TIRD.•Predialysis IL-10 levels correlate positively but counterintuitively with PDF severity.•PDF significantly correlates with ...TIRD.
The aetiology of postdialysis fatigue (PDF), an intermittent but debilitating fatigue occurring after haemodialysis (HD) treatment, is still unclear. In other inflammatory diseases, increasing evidence points toward the involvement of the immune system in the onset of fatigue symptoms. Altered serum levels of inflammatory cytokines have also been shown in HD patients. Therefore, we investigated whether pre- and postdialysis serum levels of pro- and anti-inflammatory cytokines (i.e. IL-1β, IL-6, TNF-α and IL-10) or their intradialytic changes (if any) were related to PDF or the time HD patients reported needing to recover from HD treatment (TIRD).
Serum levels of IL-1β, IL-6, TNF-α and IL-10 were measured immediately before and after HD in 45 patients using commercially available kits on an ELLA™ automated immunoassay system. The presence and severity of PDF as well as TIRD duration were assessed by self-report measures.
Seventy-four percent of patients reported PDF, with a median PDF severity index of 3.30 IQR: 3.00–4.30 on a scale from 1 to 5. Median TIRD was 120 min IQR: 60–480. PDF severity correlated strongly with TIRD, rs = 0.85, p < 0.001. Only predialysis levels of IL-10 significantly and positively correlated with PDF severity (rs = 0.43, p = 0.003).
Findings of the present study do not support the involvement of the immune system in the onset of PDF or the time patients needed to recover from HD treatment. A positive, but counterintuitive relationship was found between predialysis levels of anti-inflammatory IL-10 and PDF severity, which warrants further research.
Abstract
Context
British Thyroid Association (BTA), American Thyroid Association (ATA), and American Association of Clinical Endocrinologists (AACE/ACE/AME) recommend for thyroid nodules an ...ultrasound (US)-based stratification of risk of malignancy. Aim of our study was to assess the diagnostic accuracy of US classification systems and their reliability for indication to fine-needle aspiration (FNA).
Design
Prospective study on 987 thyroid nodules consecutively referred for FNA. US images were independently reviewed by four experts for assignment of malignancy risk. Cytologically benign nodules had confirmation with a second FNA, whereas Bethesda class IV, V, and VI nodules were operated upon. Class III nodules had surgery or follow-up on the basis of clinical, immunocytochemical, and US features.
Results
BTA: Malignancy rate was 2.8% in benign, 10.0% in indeterminate, 51.3% in suspicion, and 80.9% in malignant US class. Sensitivity was 0.74, specificity was 0.92, and accuracy was 0.89. ATA: Malignancy rate was 0.0% in benign, 2.2% in very low suspicion, 3.0% in low suspicion, 5.8% in intermediate, and 55.0% in high suspicion US class. Sensitivity was 0.81, specificity was 0.87, and accuracy was 0.86. AACE/ACE/AME: Malignancy rate was 1.1% in low-risk, 4.4% in intermediate-risk, and 54.9% in high-risk US class. Sensitivity was 0.82, specificity was 0.87, and accuracy was 0.86. K correlation coefficient was 78.9%, 76.9%, and 82.0% for BTA, ATA, and AACE/ACE/AME classifications.
Conclusions
Classification systems had elevated predictive value of malignancy in high-risk classes. ATA and AACE/ACE/AME systems were effective for ruling out indication to FNA in low-US-risk nodules. A similar diagnostic accuracy and a substantial interobserver agreement was provided by the three- and the five-category classifications.
ATA, AACE/ACE/AME and BTA US classifications demonstrated high predictive value for malignancy in their high-risk classes and ruled out effectively the indication to FNA in their low-risk US classes.
Background This systematic review with meta-analysis was carried out to study the relationship between workplace violence and sleep problems. Methods The PRISMA statement was used to conduct a ...systematic search of the literature on PubMed/MEDLINE, Scopus, Sociological abstract, DOAJ, Web of Science and Google Scholar databases. Of the original number of 749 studies, 34 were included in the systematic review and 7 in the meta-analysis. Results A total of 119,361 participants from fifteen different countries took part in these studies which were published between 1999 and 2019. Significant heterogeneity was observed among the studies (I2 = 96%). In a random-effects meta-analysis model, pooled odds ratio (OR) analysis revealed that there was a direct relationship between occupational exposure to violence and sleep problems (OR 2.55; 95% CI: 1.77–3.66). According to the GRADE guidelines, the quality of evidence of the association was low. Conclusions The findings of this study demonstrate that occupational exposure to physical, verbal or sexual violence is associated with sleep problems. Further research on the relationship between violence and sleep is needed so that appropriate measures can be taken to prevent violence and improve sleep hygiene in the workplace. Trial registration number PROSPERO International prospective register of systematic reviews (CRD42019124903) February 9, 2019.
Introduction
The present cross‐sectional study aimed to compare the prevalence, the characteristics of post‐dialysis fatigue and the length of recovery time after hemodialysis in prevalent end‐stage ...renal disease patients (ESRD) receiving bicarbonate hemodialysis (HD) or hemodiafiltration (HDF).
Methods
Patients were suffering from post‐dialysis fatigue if they spontaneously offered this complaint when asked the open‐ended question: “Do you feel fatigued after dialysis?”. Moreover, each patient was invited to rate the intensity, duration, and frequency of post‐dialysis fatigue from 1 to 5. In order to assess RECOVERY TIME AFTER DIALYSIS, patients were invited to answer to the following single open‐ended question: “How long does it take you to recover from a dialysis session?”
Findings
We included 335 patients: 252 received HD and 83 received HDF. Post‐dialysis fatigue was present in 204 patients (60.9%). Prevalence of post‐dialysis fatigue did not differ significantly between patients on HD (62.3%) and on HDF (56.6%; p = 0.430). Median recovery time after dialysis was 180 min 180–240 and did not differ significantly between the two subgroups (180 min 130–240 and 240 min 120–332 p = 0.671, respectively). Median post‐dialysis fatigue intensity, duration, and frequency were 3 1–5, 3 1–5, and 4 1–5 and did not differ significantly between patients on HD and on HDF. At the multivariate analysis, age, ADL and hemoglobin levels were the independent predictors of the HDF treatment.
Discussion
Prevalence and characteristics of post‐dialysis fatigue do not differ significantly between patients receiving bicarbonate HD or HDF.
Introduction
This study explores the link between fatigue and apathy in patients on chronic hemodialysis (HD).
Methods
One hundred thirty‐nine chronic HD patients underwent the assessment of fatigue, ...apathy, depression, and their functional status, with the fatigue severity scale (FSS), the Apathy Evaluation Scale (AES), the beck depression inventory (BDI), the activity of daily living (ADL), and instrumental activity of daily living (IADL).
Results
Patients with high FSS had a significantly lower ADL and IADL score, higher BDI, Charlson Comorbidity Index, and AES score, and lower serum levels of creatinine, compared to low FSS patients. FSS was highly correlated with the AES, as well as with the BDI and the AES correlates with the BDI. At multiple regression analyses, only apathy and IADL were independent predictor variables of fatigue in HD population.
Conclusion
Future longitudinal studies could determine if apathy is a causative factor for fatigue manifestation and development in HD patients.
Bilirubin‐IX‐α (BR) is an endogenous molecule with a strong antioxidant feature due to its ability to scavenge free radicals. In this paper, we demonstrated that BR, at concentrations close to those ...found within the cell (0.1–2.5 μM), acted as a denitrosylating agent and increased the release of nitric oxide from S‐nitrosoglutathione (GSNO) and S‐nitrosocysteine (SNOC) (2.5 μM). The complexation of BR with saturating concentrations of human serum albumin (HSA, 2.5 μM) did not further increase nitric oxide release from GSNO and SNOC. At concentrations similar to those reached in plasma (5–20 μM), BR denitrosylated S‐nitroso‐HSA (2.5 μM), the main circulating S‐nitrosothiol, and this effect was potentiated by the complexation of BR with saturating HSA (20 μM). Furthermore, the product(s) of the reaction between nitric oxide and BR were identified. Ultraviolet and mass spectrometry analysis revealed that nitric oxide binds to BR forming a N‐nitroso derivative (BR–nitric oxide) with extinction coefficients of 1.393 mM−1cm−1 and 2.254 mM−1cm−1 in methanol and NaOH, respectively. The formation of BR–nitric oxide did not occur only in a reconstituted system, but was confirmed in rat fibroblasts exposed to pro‐oxidant stimuli. These results provided novel insights on the antioxidant characteristic of BR through its interaction with nitric oxide, a gaseous neurotransmitter with a well‐known dual effect, namely neuroprotective under physiological conditions or neurotoxic if produced in excess, and proposed BR–nitric oxide as a new biomarker of oxidative/nitrosative stress.
Purpose
To assess the efficacy, safety, and pain benefits of imaging-guided laser ablation (IGLA) in patients with radioiodine-refractory (RR) bone metastases from differentiated thyroid carcinoma ...(DTC).
Patients and methods
The institutional medical records of patients with bone metastases from DTC treated with laser ablation (LA) were reviewed retrospectively. Local response, complications, and effects on pain relief were investigated.
Results
Six osteolytic lesions in five patients (one male, four females; mean age 65.4 ± 5.1 years, range 58–72) were treated with IGLA. All lesions were osteolytic and all have had previous treatments with high-dose radioiodine therapy followed by external radiotherapy (EBRT). All patients assumed opioid analgesics for severe pain. Overall, the lesions (mean size 5.8 ± 3.2 cm; median 5.0 cm, range 3.0–12.0 cm) underwent nine IGLA sessions (mean 1.8 ± 0.4 sessions; median 2.0 sessions, range 1–2). In four (80%) out five lesions, cross-sectional imaging showed a nearly complete response (CR) while the largest lesion was ablated by 80%. Pain changes were assessed with the Brief Pain Inventory-Short Form, that was administered before IGLA and during a 6-month follow-up. Patients experienced significant reduction in worst pain, average pain, and pain interference. Following IGLA, the average daily opioid requirement rapidly and progressively decreased. Treatments were well-tolerated and no major complications occurred.
Conclusions
IGLA is an effective and safe debulking procedure and provides significant pain relief in patients suffering from DTC bone metastases that are not responsive to standard treatments. So, IGLA could be considered as part of a multimodality management of advanced thyroid cancer with RR metastatic skeletal involvement.
The aim of this study was to analyse the cytocompatibility of Surefil One (SuO) with respect to the release of monomers from the material. The following reference materials were chosen: SDR Flow Plus ...(SDR, Dentsply Sirona, Konstanz, Germany), One Q Bond (Q, Dentalica, Milan, Italy), and Ketac (K, 3M-ESPE, USA). Fifteen dentin discs (2 mm thickness and diameter) were obtained from 15 third molars and were used in this study. After dentin disc permeability measurement, murine fibroblasts were grown, and the pulp surface of the dentinal disc was placed in direct contact with the cells immersed in DMEM. The experimental materials were positioned on the occlusal side of each dentinal disc until a uniform thickness of 2 mm was obtained. Then, the discs were inserted into an artificial pulp chamber for 24 hours to assess the cytocompatibility. Afterwards, the moles of monomers leached from the specimens in DMEM were determined using HPLC. Statistical analysis was performed using ANOVA (p<0.05). Under the experimental conditions, the toxic effect induced by all tested materials was slight or absent. Diurethane dimethacrylate and acrylic acid were not found in the culture media. It is concluded that all materials have good cytocompatibility consistent with the nondeterminability of the monomers released after polymerization.
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