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Hepatitis C virus and metabolic disorder interactions towards liver damage and atherosclerosis

World Journal of Gastroenterology 2014年第11期20卷 2825-2838页

作者： Umberto Vespasiani-Gentilucci Paolo Gallo antonio de vincentis Giovanni Galati antonio Picardi Internal Medicine and Hepatology Unit University Campus Bio-Medico of Rome00128 RomeItaly

Hepatitis C virus (HCV) is one of the main causes of liver disease worldwide, and alterations of glucose metabolism have reached pandemic proportions in western countries. However, the frequent coexistence between these two conditions is more than simply coincidental, since HCV can induce insulin resistance through several mechanisms. Indeed, the virus interferes with insulin signaling both directly and indirectly, inducing the production of pro-inflammatory cytokines. Furthermore, the entire viral life cycle has strict interconnections with lipid metabolism, and HCV is responsible for a “viral” steatosis which is frequently superimposed to a “metabolic” one. Several evidences suggest that HCV-induced metabolic disorders contribute both to the evolution of liver fibrosis and, likely, to the progression of the other disorders which are typically associated with altered metabolism, in particular atherosclerosis. In the present review, we will examine in depth the links between HCV infection and insulin resistance, liver steatosis and diabetes, and analyze the impact of these interactions on the progression of liver fibrosis and atherosclerosis. Special attention will be focused on the highly debated topic of the relationship between HCV infection and cardiovascular disease. The available clinical literature on this item will be broadly reviewed and all the mechanisms possibly implied will be discussed.

关键词： Hepatitis C virus Metabolism Insulin resistance Diabetes mellitus Steatosis Fibrosis Atherosclerosis Cardiovascular risk

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Exhaled breath analysis in hepatology: State-of-the-art and perspectives

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World Journal of Gastroenterology 2019年第30期25卷 4043-4050页

作者： antonio de vincentis Umberto Vespasiani-Gentilucci Anna Sabatini Raffaele Antonelli-Incalzi antonio Picardi Unit of Clinical Medicine and Hepatology Unit of GeriatricsDepartment of MedicineCampus Bio-Medico University HospitalRome 00128Italy Unit of Electronics for sensor systems Department of EngineeringUniversity Campus Bio-Medico of RomeRome 00128Italy

Liver disease is characterized by breath exhalation of peculiar volatile organic compounds(VOCs).Thanks to the availability of sensitive technologies for breath analysis,this empiric approach has recently gained increasing attention in the context of hepatology,following the good results obtained in other fields of *** the first studies that led to the identification of selected VOCs for pathophysiological purposes,subsequent research has progressively turned towards the comprehensive assessment of exhaled breath for potential clinical *** VOC patterns were found to discriminate subjects with liver cirrhosis,to rate disease severity,and,eventually,to forecast adverse clinical outcomes even beyond existing *** results suggest that breath analysis could be useful also for detecting and staging hepatic encephalopathy and for predicting steatohepatitis in patients with nonalcoholic fatty liver ***,clinical translation is still hampered by a number of methodological limitations,including the lack of standardization and the consequent poor comparability between studies and the absence of external validation of obtained *** the low-cost and easy execution at bedside of the new technologies(e-nose),larger and well-structured studies are expected in order to provide the adequate level of evidence to support VOC analysis in clinical practice.

关键词： Exhaled breath analysis Electronic nose Gas chromatography Breath print Liver cirrhosis Nonalcoholic fatty liver disease Hepatic encephalopathy

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Hepatitis C treatment in the elderly:New possibilities and controversies towards interferon-free regimens

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World Journal of Gastroenterology 2015年第24期21卷 7412-7426页

作者： Umberto Vespasiani-Gentilucci Giovanni Galati Paolo Gallo antonio de vincentis Elisabetta Riva antonio Picardi Internal Medicine and Hepatology Unit University Campus Bio-Medico Virology Unit University Campus Bio-Medico

Due to the progressive aging of the hepatitis C virus(HCV) population which have acquired the infection during its maximum spread after the Second World War, the management of the elderly HCV-infected patient is emerging as a hot topic. Unfortunately, although it is recognized that the progression of HCV-related liver disease gets faster with aging, and that even extrahepatic manifestations of HCV infection are probably worse in the elderly, till now, treatment attempts in this population have been significantly limited by the wellknown contraindications and side effects of interferon(IFN). The arrival of several new anti-HCV drugs, and the possibility to combine them in safe and effective anti-viral regimens, is relighting the hope of a cure for many elderly patients who had been cut out of IFN-based treatments. However, although these new regimens will be certainly more manageable, it should be underscored that IFN-free doesn't mean free from any contraindication or side-effect. Moreover, one issue which promises to become central is that of the possible interactions between antiviral therapy and the multiple drugs frequently assumed by elderly patients because of comorbidities. In this review, we will revise the epidemiology pointing to HCV as an infection of the elderly, the evidences that HCV harms the health of the aged patient more than that of the young one, and the available experiences of HCV treatment in the elderly with the "old" IFN-based regimens and with the newer drugs. We will conclude that the availability of IFNfree regimens should prompt us to change our mind and consider a significantly larger number of possible candidates among elderly patients, who would take significant advantage from viral eradication. Rather than the anagraphic age, drug-drug interactions and, mainly in case of economic restrictions, an evaluation of life expectancy dependent on liver disease with respect to that dependent on comorbidities, are likely to be the key issues g

关键词： Hepatitis C virus Elderly Interferon Ribavirin Telaprevir Boceprevir Sofosbuvir Simeprevir Daclatasvir Side effects Drug-drug interactions

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