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BACKGROUND AND AIMS: The Swiss Autoimmune Hepatitis Cohort Study is a nationwide registry, initiated in 2017, that collects retrospective and prospective clinical data and biological samples from patients of all ages with autoimmune hepatitis treated at Swiss hepatology centres. Here, we report the analysis of the first 5 years of registry data. RESULTS: A total of 291 patients with autoimmune hepatitis have been enrolled, 30 of whom were diagnosed before 18 years of age and composed the paediatric cohort. Paediatric cohort: median age at diagnosis 12.5 years (range 1–17, interquartile range (IQR) 8–15), 16 (53%) girls, 6 (32%) with type 2 autoimmune hepatitis, 8 (27%) with autoimmune sclerosing cholangitis, 1 with primary biliary cholangitis variant syndrome, 4 (15%) with inflammatory bowel disease and 10 (41%) with advanced liver fibrosis at diagnosis. Adult cohort: median age at diagnosis 54 years (range 42–64, IQR 18–81), 185 (71%) women, 51 (20%) with primary biliary cholangitis variant syndrome, 22 (8%) with primary sclerosing cholangitis variant syndrome, 9 (4%) with inflammatory bowel disease and 66 (32%) with advanced liver fibrosis at diagnosis. The median follow-up time for the entire cohort was 5.2 years (IQR 3–9.3 years). Treatment in children: 29 (97%) children were initially treated with corticosteroids, 28 of whom received combination treatment with azathioprine. Budesonide was used in four children, all in combination with azathioprine. Mycophenolate mofetil was used in five children, all of whom had previously received corticosteroids and thiopurine. Treatment in adults (data available for 228 patients): 219 (96%) were treated with corticosteroids, mostly in combination with azathioprine. Predniso(lo)ne was the corticosteroid used in three-quarters of patients; the other patients received budesonide. A total of 78 (33%) patients received mycophenolate mofetil, 62 of whom had previously been treated with azathioprine. Complete biochemical response was achieved in 13 of 19 (68%) children and 137 of 182 (75%) adults with available follow-up data. All children were alive at the last follow-up, and none had undergone liver transplantation. Five (2%) adults underwent liver transplantation, two of whom had a fulminant presentation. Four (2%) adults with autoimmune hepatitis died (two from liver-associated causes). CONCLUSION: Patients with autoimmune hepatitis in Switzerland had clinical features similar to those in other cohorts. The proportion of patients diagnosed with primary biliary cholangitis variant syndrome was higher than expected. Autoimmune hepatitis was managed according to guidelines, except for the use of budesonide in a small proportion of paediatric patients. The outcomes were excellent, but the findings must be confirmed over a longer follow-up period.

BACKGROUND AND AIMS: Chronic hepatitis B infection (defined as sustained detection of hepatitis B virus [HBV] surface antigen [HBsAg] protein in serum) is a leading cause of cirrhosis, hepatocellular carcinoma and liver-related deaths. A situation analysis carried out by the Swiss Federal Office of Public Health estimated the HBsAg prevalence in Switzerland to be 0.53% (95% CI: 0.32–0.89%) in 2015 (~44,000 cases). A lower prevalence of chronic HBV in the younger generation and the adoption of universal coverage in the first year of life are expected to decrease the burden of HBV; however, a number of people in key populations (including migrants) remain undiagnosed and untreated, and infected individuals remain at risk of progressing to cirrhosis, hepatocellular carcinoma and death. Our primary objective was to examine the current and estimate the future disease burden of HBV in Switzerland and the impact of migration. The secondary objective was to estimate the impact of changing future treatment numbers. METHODS: A modelling study was performed using an existing, validated model (PRoGReSs Model) applied to the Swiss context. Model inputs were selected through a literature search and expert consensus. Population data from the Federal Statistical Office were used alongside prevalence data from the Polaris Observatory to estimate the number of HBV infections among people born abroad. The PRoGReSs Model was populated with and calibrated to the available data and what-if scenarios were developed to explore the impact of intervention on the future burden of disease. A Monte Carlo simulation was used to estimate 95% uncertainty intervals (95% UIs). RESULTS: In 2020, there were an estimated 50,100 (95% UI: 47,500–55,000) HBsAg+ cases among people born abroad. Among people born in Switzerland, there were approximately 62,700 (UI: 58,900–68,400) total HBV infections (0.72% [UI: 0.68–0.79%] prevalence). Prevalence among infants and children under the age of 5 were both

Abstract Transjugular intrahepatic portosystemic shunt (TIPS) reduces portal hypertension in patients with liver cirrhosis. The exact cardiac consequences of subsequent increase of central blood volume are unknown. Cardiovascular magnetic resonance (CMR) imaging is the method of choice for quantifying cardiac volumes and ventricular function. The aim of this study was to investigate effects of TIPS on the heart using CMR, laboratory, and imaging cardiac biomarkers. 34 consecutive patients with liver cirrhosis were evaluated for TIPS. Comprehensive CMR with native T1 mapping, transthoracic echocardiography, and laboratory biomarkers were assessed before and after TIPS insertion. Follow-up (FU) CMR was obtained in 16 patients (47%) 207 (170–245) days after TIPS. From baseline (BL) to FU, a significant increase of all indexed cardiac chamber volumes was observed (all P

Until recently, sorafenib was the only systemic treatment available for patients with advanced hepatocellular carcinoma (HCC) since its approval in 2007. In the IMbrave150 trial, atezolizumab plus bevacizumab, as first-line therapy, demonstrated improvement in overall survival (OS) and progression-free survival (PFS) in patients with unresectable HCC compared with sorafenib. Based on these results, this combination is recommended as a standard of care for treatment-naïve patients with advanced HCC and Child-Pugh A cirrhosis. Earlier, we presented a review of systemic treatments for advanced HCC.^1^ Here, we reported the case of a 61-year-old patient with excellent response to the treatment with atezolizumab plus bevacizumab, despite a serious complication.

Background Asplenia or functional hyposplenism are risk factors for severe infections, and vaccinations against encapsulated bacteria are advised. There are only limited data regarding the spleen function of cirrhotic patients. Methods We evaluated spleen function in patients with liver cirrhosis, who were prospectively enrolled in this study. Spleen function was evaluated by the measurement of pitted erythrocytes. Functional hyposplenism was defined as a percentage of PE of >15%. Results 117 patients, mean age 58.4 years and 61.5% (n = 72) male with liver cirrhosis were included. Functional hyposplenism was diagnosed in 28/117 patients (23.9%). Pitted erythrocytes correlated with albumin (p = 0.024), bilirubin (pConclusion A quarter of patients with liver cirrhosis and almost 50% of patients with Child C cirrhosis have functional hyposplenism. Functional hyposplenism is associated with poor liver function and the degree of portal hypertension, which is characterized by higher liver stiffness measurements in transient elastography.

Multiple factors are involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), but the exact immunological mechanisms that cause inflammation and fibrosis of the liver remain enigmatic. In this current study, cellular samples of a cohort of NAFLD patients (peripheral blood mononuclear cells (PBMC): n = 27, liver samples: n = 15) and healthy individuals (PBMC: n = 26, liver samples: n = 3) were analyzed using 16-color flow cytometry, and the frequency and phenotype of 23 immune cell subtypes was assessed. PBMC of NAFLD patients showed decreased frequencies of total CD3+, CD8+ T cells, CD56dim NK cells and MAIT cells, but elevated frequencies of CD4+ T cells and Th2 cells compared to healthy controls. Intrahepatic lymphocytes (IHL) of NAFLD patients showed decreased frequencies of total T cells, total CD8+ T cells, Vd2+γδ T cells, and CD56bright NK cells, but elevated frequencies of Vδ2-γδ T cells and CD56dim NK cells compared to healthy controls. The activating receptor NKG2D was significantly less frequently expressed among iNKT cells, total NK cells and CD56dim NK cells of PBMC of NAFLD patients compared to healthy controls. More strikingly, hepatic fibrosis as measured by fibroscan elastography negatively correlated with the intrahepatic frequency of total NK cells (r2 = 0,3737, p = 0,02). Hepatic steatosis as measured by controlled attenuation parameter (CAP) value negatively correlated with the frequency of circulating NKG2D+ iNKT cells (r2 = 0,3365, p = 0,0047). Our data provide an overview of the circulating and intrahepatic immune cell composition of NAFLD patients, and point towards a potential role of NK cells and iNKT cells for the regulation of hepatic fibrosis and steatosis in NAFLD.

This article aimed to analyze the profile of traffic accidents in the municipality of Toledo/PR in the period from 2005 to 2016, in order to identify the adverse economic and social consequences. To this end, the methodology used part of the qualitative approach using structured data from competent institutions (SYSBM and IPEA), which brings the amount of traffic accidents and deaths resulting from such accidents, as well as the estimated costs for each situation, among them loss of production, damage to property and medical/hospital costs. It was noted that the financial costs can be measured, but the social reflexes involving the pain and suffering of the relatives and friends of the victims of traffic accidents are incalculable. It was also found that the victims usually stay away from work, which may lead to the constant impoverishment, impacting negatively on his own life and society in general.

This study presents an analysis of how the institutional, organizational and economic environments can influence the social integration of foreign workers in rondonense community. For this, we applied the Prospective Structural Analysis, a method in the form of matrix analysis of relations between the constituent variables of the system studied and those that belong to their explanatory context. The results suggest that there is a strong influence of the institutional and economic environment regarding immigration policies between countries and social integration of immigrants in the host community. There is also an unstable environment displayed by a large number of variables which arise, while also dependent and highly influential. The variable with the most influence, in view of the research group, is the pace of work adopted by agribusinesses. Thus, the institutional environment must be improved and begin the process of improvement, either in the field of migration policies and the development of actions that provides the best quality of life for immigrants and the local community, thus creating an environment of high convergence integration between the local community and the immigrant community. So that significant changes may occur it is necessary, among other things, that the coordination system is driven by institutional bodies represented by the government, with the support of agribusinesses that these immigrants work, developing levers of mutual cooperation between government, industry and immigrants.

Abstract This paper examines the quality of life of organic and conventional soybean farmers in Brazil. We analyzed self-reported symptoms associated with exposure to pesticides and measured life satisfaction levels of the farmers. We applied three models to analyze the data according to the dependent variable distribution - dichotomy, Poisson, and ordinal. Questionnaires were applied to 62 and 139 organic and conventional soybean farmers, respectively. We found that the probability of organic farmers to report symptoms related to pesticides exposure was 59% lower than conventional farmers; and organic farmers had a 68% higher odds ratio for life satisfaction compared to conventional farmers. We conclude that organic soybean production has improved the quality of life for agricultural workers, while also enhancing the sustainability of rural areas.

Aim: To identify predictive factors associated with long-term patient and graft survival (> 15 years) in liver transplant recipients., Methods: Medical charts of all de novo adult liver transplant recipients ( n = 140) who were transplanted in Hamburg between 1997 and 1999 were retrospectively reviewed. In total, 155 transplantations were identified in this time period (15 re-transplantations). Twenty-six orthotopic liver transplant (OLT) recipients were early lost to follow-up due to moving to other places within 1 year after transplantation. All remaining 114 patients were included in the analysis. The following recipient factors were analysed: Age, sex, underlying liver disease, pre-OLT body mass index (BMI), and levels of alanine aminotransferase (ALT), bilirubin, creatinine and gamma-glutamyltransferase (gamma-GT), as well as warm and cold ischemia times. Furthermore, the following donor factors were assessed: Age, BMI, cold ischemia time and warm ischemia time. All surviving patients were followed until December 2014. We divided patients into groups according to their underlying diagnosis: (1) hepatocellular carcinoma ( n = 5, 4%); (2) alcohol toxic liver disease ( n = 25, 22.0%); (3) primary sclerosing cholangitis ( n = 6, 5%); (4) autoimmune liver diseases ( n = 7, 6%); (5) hepatitis C virus cirrhosis ( n = 15, 13%); (6) hepatitis B virus cirrhosis ( n = 21, 19%); and (7) other ( n = 35, 31%). The group "other" included rare diagnoses, such as acute liver failure, unknown liver failure, stenosis and thrombosis of the arteria hepatica, polycystic liver disease, Morbus Osler and Caroli disease., Results: The majority of patients were male ( n = 70, 61%). Age and BMI at the time point of transplantation ranged from 16 years to 69 years (median: 53 years) and from 15 kg/m 2 to 33 kg/m 2 (median: 24), respectively. Sixty-six OLT recipients (58%) experienced a follow-up of 15 years after transplantation. Recipient's age ( P = 0.009) and BMI ( P = 0.029) were identified as risk factors for death by χ 2 -test. Kaplan-Meier analysis confirmed BMI or age above the median as predictors of decreased long-term survival ( P = 0.008 and P = 0.020). Hepatitis B as underlying disease showed a trend for improved long-term survival ( P = 0.049, χ 2 -test, P = 0.055; Kaplan-Meier analysis, Log rank). Pre-transplant bilirubin, creatinine, ALT and gamma-GT levels were not associated with survival in these patients of the pre-era of the model of end stage liver disease., Conclusion: The recipients' age and BMI were predictors of long-term survival after OLT, as well as hepatitis B as underlying disease. In contrast, donors' age and BMI were not associated with decreased survival. These findings indicate that recipient factors especially have a high impact on long-term outcome after liver transplantation., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.