Comparison between hepatocellular carcinoma prognostic scores:A 10-year single-center experience and brief review of the current literature

BACKGROUND Hepatocellular carcinoma(HCC)represents the most common primitive liver malignancy.A relevant concern involves the lack of agreement on staging systems,prognostic scores,and treatment allocation algorithms.AIM To compare the survival rates among already developed prognostic scores.METHODS We retrospectively evaluated 140 patients with HCC diagnosed between February 2006 and November 2017.Patients were categorized according to 15 prognostic scoring systems and estimated median survivals were compared with those available from the current medical literature.RESULTS The median overall survival of the cohort of patients was 35(17;67)mo,and it was statistically different in relation to treatment choice,ultrasound surveillance,and serum alpha-fetoprotein.The Italian Liver Cancer(ITA.LI.CA)tumor staging system performed best in predicting survival according to stage allocation among all 15 evaluated prognostic scores.Using the ITA.LI.CA prognostic system,28.6%,40.7%,22.1%,and 8.6%of patients fell within stages 0-1,2-3,4-5 and>5 respectively.The median survival was 57.9 mo for stages 0-1,43 mo for stages 2-3,21.7 mo for stages 4-5,and 10.4 mo for stage>5.The 1-,3-,and 5-year survival rates were respectively 95%,65%,and 20%,for stages 0-1;94.7%,43.9%and 26.3%for stages 2-3;71%,25.8%and 16.1%for stages 4-5;and 50%,16.7%and 8.3%for stage>5.At the same time,although statistically significant in prognostic stratification,the most commonly used Barcelona Clinic Liver Cancer system showed one of the most relevant differences in median survival,especially for stages A and C,when compared to the medical literature.In fact,10.7%,59.3%,27.1%,1.4%,and 0%of patients were stratified into stages 0,A,B,C,and D respectively.The median survival was>81.1 mo for stage 0,44.9 mo for stage A,21.3 mo for stage B,and 3.1 mo for stage C.The 1-,3-,and 5-year survival rates were respectively 86.7%,60%,and 46.7%for stage 0;91.6%,50.6%,and 20.5%for stage A;73.7%,23.7%and 13.2%for stage B;and 2%,0%and 0%for stage C.CONCLUSION Survival analysis shows excellent prognostic ability of the ITA.LI.CA scoring system compared to other staging systems.

Large earthquakes along slow converging plate margins:Calabrian Arc paleoseismicity based on the submarine turbidite record

The Calabrian Arc subduction-rollback system hosts seismogenic faults capable of generating earthquakes exceeding magnitude 7.Since earthquakes are the result of long-term geodynamic processes,documenting seismic activity during a sufficiently long time interval is of fundamental importance for hazard scenarios.Instrumental and historical data provide critical information on seismogenesis,but they cover time periods shorter than the recurrence times of large earthquakes,especially in areas with low deformation rates such as Calabria.If onshore paleoseismological studies are fundamental to compile earthquake catalogs,they are sometime affected by the relatively poor continuity of sedimentation in the subaerial environment.In this study we applied the paleoseismological approach to the submarine environment to reconstruct the record of high-energy sedimentary events triggered by seismic activity.We analyzed three gravity cores collected in disconnected sedimentary basins to reconstruct resedimentation processes during the Holocene,integrating inland information for a better assessment of tectonic activity and seismogenesis.Multiproxy analyses of the sedimentary record constrained by radiometric dating allowed reconstructing event stratigraphy and linking resedimented deposits to specific earthquakes.Onshore and offshore data allow to identify large-magnitude earthquakes in the central Calabrian Arc subduction system during the Holocene,with inferred epicenters located either along normal faults onshore and/or related to the slab dynamics.The turbidite record reveals 20 major events during the last 10 ka,with sources including crustal faults in Calabria(i.e.Lakes,Rossano and Cittanova faults).Analyses of sediment samples and high-resolution seismic reflection images allowed identification of different types of resedimented deposits during the last 30–50 ka.The basin-wide occurrence of three megaturbidites/homogenites suggests they are related to megatsunamis sourced by far field earthquakes along the Hellenic Arc.Megaturbidites with a more limited spatial extent are interpreted as subduction-type events in the Calabrian Arc,while thinner seismo-turbidites record the activity of crustal structures including faults onshore.Results suggest a recurrence time of 2–3 ka for major Calabrian Arc events that needs to be considered for a reliable hazard assessment in the Mediterranean region.

Dual stimuli-responsive polyurethane-based hydrogels as smart drug delivery carriers for the advanced treatment of chronic skin wounds

The design of multi-stimuli-responsive vehicles for the controlled and localized release of drugs is a challenging issue increasingly catching the attention of many research groups working on the advanced treatment of hard-to-close wounds.In this work,a thermo-and pH-responsive hydrogel(P-CHP407)was prepared from an ad hoc synthesized amphiphilic poly(ether urethane)(CHP407)exposing a significant amount of-COOH groups(8.8±0.9 nmol/g_(polymer)).The exposure of acid moieties in P-CHP407 hydrogel led to slightly lower initial gelation temperature(12.1◦C vs.14.6◦C,respectively)and gelation rate than CHP407 hydrogel,as rheologically assessed.Nanoscale hydrogel characterization by Low Field NMR(LF-NMR)spectroscopy suggested that the presence of carboxylic groups in P-CHP407 caused the formation of bigger micelles with a thicker hydrated shell than CHP407 hydrogels,as further proved by Dynamic Light Scattering analyses.In addition,P-CHP407 hydrogel showed improved capability to change its internal pH compared to CHP407 one when incubated with an alkaline buffer(pH 8)(e.g.,pH_(change_5min)=3.76 and 1.32,respectively).Moreover,LF-NMR characterization suggested a stronger alkaline-pH-induced interaction of water molecules with micelles exposing-COOH groups.Lastly,the hydrogels were found biocompatible according to ISO 10993 and able to load and release Ibuprofen:delivery kinetics of Ibuprofen was enhanced by P-CHP407 hydrogels at alkaline pH,suggesting their potential use as smart delivery systems in the treatment of chronic infected wounds.

Extremotolerant fungi from alpine rock lichens and their phylogenetic relationships

Fungi other than the lichen mycobiont frequently co-occur within lichen thalli and on the same rock in harsh environments.In these situations dark-pigmented mycelial structures are commonly observed on lichen thalli,where they persist under the same stressful conditions as their hosts.Here we used a comprehensive sampling of lichen-associated fungi from an alpine habitat to assess their phylogenetic relationships with fungi previously known from other niches.The multilocus phylogenetic analyses suggest that most of the 248 isolates belong to the Chaetothyriomycetes and Dothideomycetes,while a minor fraction represents Sordariomycetes and Leotiomycetes.As many lichens also were infected by phenotypically distinct lichenicolous fungi of diverse lineages,it remains difficult to assess whether the culture isolates represent these fungi or are from additional cryptic,extremotolerant fungi within the thalli.Some of these strains represent yet undescribed lineages within Chaethothyriomycetes and Dothideomycetes,whereas other strains belong to genera of fungi,that are known as lichen colonizers,plant and human pathogens,rock-inhabiting fungi,parasites and saprotrophs.The symbiotic structures of the lichen thalli appear to be a shared habitat of phylogenetically diverse stress-tolerant fungi,which potentially benefit from the lichen niche in otherwise hostile habitats.