Evaluation of spleen stiffness by 2D shear wave elastography for ruling out high risk varices in patients with chronic advanced liver disease. A systematic review and meta-analysis.

OBJECTIVES: To systematically review the accuracy of spleen stiffness measurement (SSM) by 2D- Shear Wave Elastography (2D-SWE) in predicting high risk for bleeding varices (HRV) in cirrhotic patients. METHODS: PubMed, Embase, Web of Science, Medline, Cochrane, and Google Scholar databases were searched up to 31/05/2023 for all human studies using 2D-SWE to estimate SSM and endoscopy to detect HRV. Meta-analysis was performed using a generalized linear mixed model. Publication bias was evaluated using the funnel plot asymmetry test. The Area Under the Summarized Receiver Operating Characteristic curve (AUSROC) was estimated using the "mada" package. RESULTS: A total of 13 studies and 1970 patients were included. Of them, 27.8 % had HRV. The pooled sensitivity and polled specificity of SSM in detecting HRV were 90 % (95 %CI:87-92 %) and 68 % (95 %CI:58-77 %), respectively, with an AUSROC at 0.86 (95 %CI:0.82-0.90). The median cutoff value of SSM in detecting HRV was 34.2 kPa. In studies including exclusively HBV cirrhotic patients, SSM's polled sensitivity and specificity in predicting HRV was 88 % (95 %CI:82-92 %) and 73 % (95 %CI:68-78 %), respectively. The AUSROC was 0.84 (95 %CI:0.81-0.87). The number of repeated measurements per patient (<5 or ≥ 5) did not affect the method's capability. Using Aixplorer to evaluate SSM had a higher sensitivity in ruling out HRV than other 2D-SWE devices. CONCLUSIONS: Our meta-analysis supports that SSM by 2D-SWE has a good diagnostic performance for ruling out HRV in cirrhosis.

Distance Learning in Nursing Education during the COVID-19 Pandemic: Psychosocial Impact for the Greek Nursing Students-A Qualitative Approach.

(1) Background: The COVID-19 pandemic posed a major threat to global health and on the educational field. The purpose of this study is to identify and illustrate the psychosocial adaptation of nursing students to the sudden and exclusive application of distance learning during the COVID-19 pandemic; (2) Methods: A qualitative interview research has been designed. Two focus groups of seven members each and six individual interviews were conducted in a sample of undergraduate nursing students in Greece from 3 March 2021, to 9 April 2021.; (3) Results: A qualitative thematic analysis of the data identified six themes: 1. Challenges; 2. Concerns; 3. Social changes; 4. Negative Emotions; 5. Evaluation; and 6. Teaching strategies.; (4) Conclusions: During its implementation, it identified gaps and weaknesses in the entire academic community. The study of the psychosocial adaptation of the academic community is considered crucial, as it can highlight the individual difficulties in distance learning and contribute to the improvement of the methods of its the improvement of its methods.

Spleen stiffness can predict liver decompensation and survival in patients with cirrhosis.

BACKGROUND AND AIM: Liver stiffness measurement (LSM) has been predicting liver decompensation and survival in cirrhotics. The aim of our study was to investigate if spleen stiffness measurement (SSM) by 2D shear-wave elastography could predict better the probability of decompensation and mortality, compared with LSM and other parameters. METHODS: Consecutive cirrhotic patients were recruited between 1/2017 and 12/2021. LSM and SSM were performed at baseline and epidemiological, clinical, and laboratory data were collected. Clinical events were recorded every 3 months. RESULTS: Totally, 177 patients were followed for a mean period of 31 ± 18 months. In Cox regression analysis, only SSM was independently associated with the probability of decompensation (HR: 1.063, 95% CI: 1.009-1.120; P = 0.021), offering an AUROC of 0.710 (P = 0.003) for predicting 1-year liver decompensation (NPV: 81.1% for the cut-off point of 37 kPa). The occurrence of death/liver transplantation was independently associated only with higher SSM (HR: 1.043; 95% CI:1.003-1.084; P = 0.034). The AUROC of SSM for predicting 1-year death/liver transplantation was 0.72 (P = 0.006) (NPV: 95% for the cut-off of 38.8 kPa). The performance of SSM to predict the 1-year death/liver transplantation increased in high-risk patients (CTP: B/C plus MELD >10 plus LSM > 20 kPa), giving an AUROC of 0.80 (P < 0.001). Only 1/26 high-risk patients with SSM < 38.8 kPa died during the first year of follow-up (NPV: 96.4%). CONCLUSIONS: SSM was the only factor independently associated with the probability of decompensation and occurrence of death, showing better diagnostic accuracy for the prediction of 1-year decompensation or death compared with LSM and MELD score.

Comparing 2D-shear wave to transient elastography for the evaluation of liver fibrosis in nonalcoholic fatty liver disease.

BACKGROUND AND AIM: The aim of this study is to evaluate the performance of 2D-shear wave elastography (2D-SWE) in patients with nonalcoholic fatty liver disease (NAFLD) and compare it to transient elastography. METHODS: Over 6 months, 552 patients with NAFLD underwent liver stiffness measurement (LSM) by both 2D-SWE and transient elastography with controlled attenuation parameter (CAP) at the same visit. RESULTS: LSM was not feasible by transient elastography (M/XL probe) in 18 (3.3%) and by 2D-SWE in 26 (4.7%) patients. The median LSM of transient elastography was 5.5 (2.8-75) kPa and of 2D-SWE 6.2 (3.7-46.2) kPa. LSMs by transient elastography and 2D-SWE were correlated regardless of the obesity status (r, 0.774; P < 0.001; r, 0.774; P < 0.001; r, 0.75; P < 0.001 in BMI <25, 25-30 and ≥30 kg/m2 respectively), or the degree of liver steatosis (r = 0.63; P < 0.001 and r = 0.743; P < 0.001 in mild and moderate/severe steatosis, respectively). According to transient elastography, 88 (15.9%) patients were classified with at least severe fibrosis (≥F3) and 55 (10%) with cirrhosis. By using the 2D-SWE, 85 (15.4%) patients had at least severe fibrosis and 52 (9.4%) cirrhosis. The correlation between the two methods was strong in patients with at least severe fibrosis (r, 0.84; P < 0.001) or cirrhosis (r, 0.658; P < 0.001). When transient elastography was used as reference, 2D-SWE showed an excellent accuracy of 98.8 and 99.8% in diagnosing severe fibrosis and cirrhosis, respectively. CONCLUSIONS: In NAFLD, 2D-SWE and transient elastography have comparable feasibility and clinical applicability providing LSMs with strong correlation, even in overweight/obese patients, independently of the severity of liver steatosis and fibrosis. Thus, either of the two methods can be effectively used for the assessment of fibrosis in this setting.

Epidemiology and treatment of hepatitis E in the liver transplantation setting: A literature review.

Hepatitis E virus (HEV) is a common cause of acute hepatitis in developing countries, but it can also take a chronic course especially in immunocompromised patients. Its epidemiology after liver transplantation (LT) is hard to assess and treatment options are still explored. Between 2009 and 2020, literature reporting HEV prevalence and treatment in LT recipients was searched and a synthesis was attempted. Sixteen studies reported HEV prevalence in consecutive LT patients: HEV RNA positivity ranged between 0%-1.4% and 0%-7.7% for Western and Eastern cohorts, respectively. In studies published between 2009-2014 and 2015-2020, HEV RNA positivity ranged between 0.35%-1.3% (all European) and 0%-7.7% (European: 0%-1.4%), respectively. Five studies evaluated HEV prevalence in LT recipients with abnormal liver enzymes: HEV RNA positivity was 2.9% in studies published between 2009 and 2014 and from 3.5% to 20% in studies published between 2015 and 2020. Twenty-seven studies reported HEV treatment in LT recipients: sustained virologic response was achieved in 15% by immunosuppression reduction alone and in 83% of cases by ribavirin regiments. Chronic HEV infection is affecting LT recipients, mostly those with abnormal liver enzymes and in Eastern countries. HEV diagnoses should be based on PCR techniques. Successful treatment can be achieved with ribavirin in most cases.

The changing epidemiology of hepatocellular carcinoma in Greece.

BACKGROUND: Hepatocellular carcinoma (HCC) is the sixth most common cancer globally, and is attributable mainly to viral hepatitis, alcohol and nonalcoholic fatty liver disease. METHODS: Three hundred Greek patients diagnosed with HCC between 2000 and 2019 were retrospectively evaluated for patient and HCC characteristics. Patients were classified as before 2011 (A) or after 2011 (B) and HCC risk factors were compared with historic Greek cohorts. RESULTS: The median age was 64 years and 86% were male; 45% had chronic hepatitis B virus (HBV) infection, 26% chronic hepatitis C virus (HCV) infection, and 30% non-viral liver diseases (nvLD). No change was observed among liver diseases between periods A and B. However, there was a trend towards a decrease in virally and an increase in non-virally induced HCC (P=0.075). Patients in period B (vs. A) were more likely to be diagnosed with fewer (<3, P=0.006) and smaller (<3 cm, P=0.005) nodules. Compared with 1558 Greek HCC patients from 1974-2000, there was a decrease in HBV and an increase in HCV and nvLD-related HCCs (P<0.001). CONCLUSIONS: In Greece, after 2000, there was a decrease in the proportion of HBV and an increase in the proportion of HCV and nvLD-related HCC, while over the last 2 decades there has been a trend towards a decrease in virally and an increase in non-virally induced HCC. Since 2011, HCC is being diagnosed at an earlier stage, possibly reflecting improved surveillance strategies.

Dementia Family Carers' Quality of Life and Their Perceptions About Care-receivers' Dementia Symptoms: The Role of Resilience.

Aim: The study examined (a) the relationship between caregivers' (CG) quality of life (QoL) and their reports about care receivers' dementia symptoms and (b) whether CG's resilience would be a mediator in this relationship. Method: This was a cross-sectional study based on a purposeful sampling. Face-to-face structured interviews were conducted with 118 CGs (79% females, mean age = 59, SD = 12). CGs provided assessment of their QoL and resilience, and proxy assessments of people with dementia (PwD) symptoms (cognitive functioning, functional activity and behavioural problems (BP)). Results: The BP were the only perceived dementia symptoms associated with the CGs' QoL. CGs' resilience fully mediated the relationship between perceived BP and CGs' QoL. Implications: Tailored training programs designed to improve CGs' QoL should focus on strengthening their personal resources, such as skills to manage the behaviour problems exhibited by PwD and their resilience to adapt to self-perceived behaviour problems common to dementia.

Epidemiology of nonalcoholic fatty liver disease in Europe: a systematic review and meta-analysis.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the developed countries. The aim of this study was to evaluate the NAFLD prevalence in European adults and children/adolescents of the general population and specific subgroups. METHOD: Search for all articles published between 01/1990-06/2019 reporting NAFLD prevalence from European countries. RESULTS: Nineteen studies with adults and 9 with children/adolescents were included. Pooled NAFLD prevalence in adults was 26.9%, being higher in studies using ultrasonography (27.2%) or fatty liver index (FLI) (30.1%) than liver biochemical tests (19.1%) and without differences between Mediterranean and non-Mediterranean countries or publication periods. Pooled NAFLD prevalence was higher in men than women (32.8% vs. 19.6%) and in patients with than those without metabolic syndrome (75.3% vs. 17.9%) or any of its components (always P<0.01). Ultrasound and FLI performed equally in estimating NAFLD prevalence in most subgroups. A higher prevalence was reported using FLI in obese and in diabetic patients, whereas a higher prevalence was observed with ultrasound in non-obese patients and in individuals without metabolic syndrome. NAFLD prevalence was 2.7% in unselected and 31.6% in obese/overweight children/adolescents. CONCLUSIONS: NAFLD prevalence exceeds 25% in European adults, being higher in those with metabolic syndrome component(s)-related comorbidities. It remains low in unselected NAFLD population, but increased in overweight/obese European children/adolescents, particularly from Mediterranean countries.

Assessing the risk of obstructive sleep apnoea-hypopnoea syndrome in elderly home care patients with chronic multimorbidity: a cross-sectional screening study.

Obstructive sleep apnoea-hypopnea syndrome (OSAHS) and multimorbidity are common in elderly patients, but a potential link between the two conditions remains unclear. This study aimed to assess the prevalence of OSAHS, chronic multimorbidity and their relation in older adults in primary care settings. A screening study was performed in a cross-section of 490 elderly adults (mean age 77.5 years, 51 % male) receiving home care services in Thessaly, central Greece. The Berlin Questionnaire was employed to assess the likelihood for OSAHS and the Epworth Sleepiness Scale to assess daytime sleepiness. Multimorbidity was defined as a documented history of at least two chronic diseases. The prevalence of high risk for OSAHS, excessive daytime sleepiness and multimorbidity was 33.5, 11.6 and 63.9 %, respectively. None of the study subjects had a confirmed diagnosis for OSAHS prior to this study. A marked dose-response association between a high pre-test likelihood for OSAHS and multimorbidity was noted in patients with two [adjusted odds ratio (OR) 3.13; 95 % confidence interval (CI) 1.85-5.30) and three or more (adjusted OR 4.22; 95 % CI 2.55-6.96) chronic morbidities, independently of age, sex and smoking status. This association persisted across different levels for OSAHS risk in the Berlin questionnaire, was insensitive to varying definitions of multimorbidity and more pronounced in patients with excessive daytime sleepiness. These findings point out that primary care physicians who care for elderly patients who present with several, common and burdensome, chronic diseases should expect to find this multimorbidity often coinciding with undetected, and therefore untreated, OSAHS. Thus it is crucial to consider OSAHS as an important co-morbidity in older adults and systematically screen for OSAHS in primary care practice.

Multiple rescue factors within a Wolbachia strain.

Wolbachia-induced cytoplasmic incompatibility (CI) is expressed when infected males are crossed with either uninfected females or females infected with Wolbachia of different CI specificity. In diploid insects, CI results in embryonic mortality, apparently due to the the loss of the paternal set of chromosomes, usually during the first mitotic division. The molecular basis of CI has not been determined yet; however, several lines of evidence suggest that Wolbachia exhibits two distinct sex-dependent functions: in males, Wolbachia somehow "imprints" the paternal chromosomes during spermatogenesis (mod function), whereas in females, the presence of the same Wolbachia strain(s) is able to restore embryonic viability (resc function). On the basis of the ability of Wolbachia to induce the modification and/or rescue functions in a given host, each bacterial strain can be classified as belonging in one of the four following categories: mod(+) resc(+), mod(-) resc(+), mod(-) resc(-), and mod(+) resc(-). A so-called "suicide" mod(+) resc(-) strain has not been found in nature yet. Here, a combination of embryonic cytoplasmic injections and introgression experiments was used to transfer nine evolutionary, distantly related Wolbachia strains (wYak, wTei, wSan, wRi, wMel, wHa, wAu, wNo, and wMa) into the same host background, that of Drosophila simulans (STCP strain), a highly permissive host for CI expression. We initially characterized the modification and rescue properties of the Wolbachia strains wYak, wTei, and wSan, naturally present in the yakuba complex, upon their transfer into D. simulans. Confocal microscopy and multilocus sequencing typing (MLST) analysis were also employed for the evaluation of the CI properties. We also tested the compatibility relationships of wYak, wTei, and wSan with all other Wolbachia infections. So far, the cytoplasmic incompatibility properties of different Wolbachia variants are explained assuming a single pair of modification and rescue factors specific to each variant. This study shows that a given Wolbachia variant can possess multiple rescue determinants corresponding to different CI systems. In addition, our results: (a) suggest that wTei appears to behave in D. simulans as a suicide mod(+) resc(-) strain, (b) unravel unique CI properties, and (c) provide a framework to understand the diversity and the evolution of new CI-compatibility types.

Methane and carbon dioxide emission in a two-phase olive oil mill sludge windrow pile during composting.

The aim of this work was to make some preliminary evaluations on CO(2) and CH(4) emissions during composting of two-phase olive oil mill sludge (OOMS). OOMS, olive tree leaves (OTL) and shredded olive tree branches (OTB) were used as feedstock for Pile I and Pile II with a 1:1:1 and 1:1:2v/v ratio, respectively. Each pile was originally 1.2m high, 2.0m wide and approximately 15.0m long. Four 500 ml volume glass funnels were inverted and introduced in each pile, two in the core (buried 50-60 cm from the surface) and two near the surface under a thin 10-15 cm layer of the mixture. Thin (0.5 cm diameter) plastic, 80 cm long tubes were connected to the funnels. A mobile gas analyser (GA2000) was used to measure the composition (by volume) of O2, CO2 and CH4 on a daily basis. The funnels were removed prior to each turning and reinserted afterwards. From each pair of funnels (core and surface) of both piles, one was kept closed between samplings. Two way ANOVA was used to test differences between piles and among the tubes. Post hoc Tukey tests were also used to further investigate these differences. There was a significant difference (at p<0.001) in the two piles for all three gases. The average concentrations of O2, CO2 and CH4 in Pile I, from all four funnels was 16.86%, 3.89% and 0.25%, respectively, where for Pile II the average values were 18.07%, 2.38% and 0.04%, respectively. The presence of OOMS in larger amounts in Pile I (resulting in more intense decomposing phenomena), and the larger particle size of OTB in Pile II (resulting in increasing porosity) are the probable causes of these significant differences. Samples from open funnels presented lower, but not significantly lower, O2 composition (higher for CO2 and CH4) in comparison with closed funnels in both depths and both piles. Not significant were also the different mean gas compositions between core and surface funnels in the same pile.