Podcasts about Fibrosis

This week's newsmaker, Yukti Choudhury, Director of Clinical Development at HistoIndex, joins Roger Green to discuss FibroSIGHT, a new HistoIndex service that allows clinicians to use HistoIndex's Second Harmonic Generation (SHG) technology and analytics to determine specific CRN fibrosis level for patients with inconclusive NIT results.  One reason FibroSIGHT is worthy of attention: This is the first time an in-depth analysis of clinical trial biopsy results is being placed at the service of clinical treatment. Another reason: Yukti states that demand for this technique could equal 163,000 cases this year, rising to one million by 2028. The interview starts with Yukti sharing information on her own academic and commercial background and how she came to this role. She describes FibroSIGHT, a service that will provide a highly accurate CRN fibrosis level for patients whose NIT results suggest no clear or consistent finding. Yukti provides practical cues on ordering the test and its reimbursement. Roger shares his long-standing respect for SHG and the clarity it produces. He notes the economic benefit of determining whether a patient has F2 fibrosis, which is indicated for pharmacotherapy, vs.F1, which is not indicated. He sees clear benefit in this analysis. Roger goes on to express concern that any option requiring more biopsies will reduce the number of patients treated, particularly if having this tool encourages payers to require a biopsy as a prerequisite to treatment. He asks whether, over time, HistoIndex might be able to develop a companion analytic to improve these estimates without requiring biopsy. 

The timeline of diagnosis, to possible transplant recipient -- to post-transplant can feel like a whirlwind for patients and caregivers. Marion Marin, a lung transplant recipient, joins the show to discuss how that process went for her! She discusses advocating for yourself, waiting for 'the call' -- and the importance of the community around you when physically and emotionally dealing with a diagnosis! It's the 'Pulmonary Fibrosis' podcast! Brought to you the Wescoe Foundation for Pulmonary Fibrosis and the Pennsylvania IPF Support Network! Find this podcast wherever you get your podcasts! Are you interested in helping advance PF research? If so, consider joining a workgroup! Visit wescoe.org or pfpatientengagement.org for more details!See omnystudio.com/listener for privacy information.

Drs Carol H. Wysham and Scott Isaacs discuss incorporating the screening and management of metabolic dysfunction–associated steatotic liver disease in endocrine practice. Relevant disclosures can be found with the episode show notes on Medscape https://www.medscape.com/viewarticle/1002045. The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Type 2 Diabetes Mellitus https://emedicine.medscape.com/article/117853-overview Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review https://pubmed.ncbi.nlm.nih.gov/37700494/ Fibrosis-4 (FIB-4) Calculator https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4 Liver Fibrosis Assessment: MR and US Elastography https://pubmed.ncbi.nlm.nih.gov/34687329/ Using the FIB-4, Automatically Calculated, Followed by the ELF Test in Second Line to Screen Primary Care Patients for Liver Disease https://pubmed.ncbi.nlm.nih.gov/38806580/ American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD) https://pubmed.ncbi.nlm.nih.gov/35569886/ Mediterranean Diet and Nonalcoholic Fatty Liver Disease https://pubmed.ncbi.nlm.nih.gov/29785077/ Drug Treatment for Metabolic Dysfunction-Associated Steatotic Liver Disease: Progress and Direction https://pubmed.ncbi.nlm.nih.gov/39470028/ Current Status of Glucagon-Like Peptide-1 Receptor Agonists in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Clinical Perspective https://pubmed.ncbi.nlm.nih.gov/39801787/ Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK576405/ Update on the Applications and Limitations of Alpha-Fetoprotein for Hepatocellular Carcinoma https://pubmed.ncbi.nlm.nih.gov/35110946/

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826241296412

The EVOLVED trial investigated whether early aortic valve intervention could improve outcomes in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. The randomized, multicenter study of 224 patients found no significant difference in all-cause mortality or unplanned aortic stenosis-related hospitalizations between early intervention and guideline-directed conservative management. However, early intervention was associated with lower rates of NYHA class II-IV symptoms and fewer unplanned hospitalizations. The trial highlights the potential symptomatic benefits of early intervention but underscores the need for further research to assess long-term outcomes.

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in Pharma and Biotech world. Bristol Myers Squibb is seeking to broaden the use of its CAR T cell therapy, Breyanzi, to address marginal zone lymphoma as a strategy to offset losses from exclusivity. In other news, Boehringer Ingelheim has seen promising results in a Phase III trial for its lung fibrosis drug, randomilast, aimed at progressive pulmonary fibrosis. However, Pliant has experienced a stock decline following the halt of its Phase IIb/III study for idiopathic pulmonary fibrosis. Additionally, Vertex has received FDA approval for its non-opioid pain treatment, while AbbVie has secured approval for a new antibiotic. Bain's acquisition of Tanabe for $3.3 billion is also making headlines. Regeneron is currently in a legal battle with Sanofi over the Dupixent pact, and Equillium's itolizumab is undergoing testing against Humira for ulcerative colitis. On the horizon, Acelyrin and Alumis are joining forces to address immune-mediated diseases, while Eisai is seeking subq approval for Leqembi due to sluggish US sales. Job opportunities are available at ATCC, AbbVie, Regeneron Pharmaceuticals, and Dren Bio.

Interview with Katherine A. Hutcheson, PhD, author of Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors: The MANTLE Nonrandomized Clinical Trial. Hosted by Paul C. Bryson, MD, MBA. Related Content: Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors

Interview with Katherine A. Hutcheson, PhD, author of Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors: The MANTLE Nonrandomized Clinical Trial. Hosted by Paul C. Bryson, MD, MBA. Related Content: Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors

EVOLVED: Early Intervention in Patients with Asymptomatic Severe Aortic Stenosis and Left Ventricular Myocardial Fibrosis

In this episode, Naim Alkhouri, Mike Betel, Michelle Long and Jeff McIntyre join Jörn Schattenberg and Roger Green to look back at The Liver Meeting 2024. This conversation reviews the late-breaker presentation on efimosermin, a q4w FGF-21 agent and the "FDA Corner" session. Jörn begins the discussion by highlighting a paper from the later breaker session on efimosfermin alfa, an FGF-21 agent dosed q4w. He notes that after only six doses (24 weeks), efimosfermin alfa demonstrated significant increases in fibrosis regression and lowering NAS score. To Jörn, this result, coupled with others on efruxifermin and pegozafermin, suggest that FGF-21s are likely to play a significant role in MASH therapy once approved. After Roger and Mike note their enthusiasm about the drug class and this study, Jörn mentions a study with 96-week efruxifermin that data demonstrates prolonged efficacy. As he points out, this matters because while studies of an earlier FGF-21 candidate suggested that antibodies might develop in FGF-21 therapy, that does not appear to be an issue here. Mike asks the group why they feel placebo performs so well in clinical trials. Jörn suggests that working with a compassionate clinical care team in dealing with the patient leads to better performance on diet and exercise and, as a result, increased placebo response to what we might find in general community practice.Michelle praises the FDA Corner session, particularly the agency's transparency and willingness to engage industry and academia in finding paths to move away from biopsy. She also notes some of the practical challenges inherent of moving away from biopsy using data from earlier trials with an outmoded histology reader setup. She is optimistic about the scientific community coming together to address these issues. Jeff praises the agency for an "amazing" session. 

In this episode, Naim Alkhouri, Mike Betel, Michelle Long and Jeff McIntyre join Jörn Schattenberg and Roger Green to look back at The Liver Meeting 2024. This conversation reviews the ESSENCE trial, the Phase 3 trial demonstrating that semaglutide regresses fibrosis levels in some MASH patients.  The conversation begins with each panelist sharing a word or short phrase they felt best captured their feelings about TLM2024. Next, panelists review the meeting's most consequential paper, the ESSENCE Trial. Naim starts by describing ESSENCE, a Phase 3 trial with semaglutide demonstrating significant levels of fibrosis regression in non-cirrhotic MASH patients. Jörn adds the hopeful note that NITs performed as well as or better than biopsy in this trial, which he hopes will speed the transition in diagnostic approaches and tools. Jeff and Mike agree that from the patient's perspective, ESSENCE will be seen as a milestone in MASH therapy: the proof that a second drug can succeed in MASH. As the conversation ends, Roger notes that approval of a second agent for a particular disease often leads to dramatic growth in overall drug treatment by changing the pivotal question from whether to treat with a drug to which choice to prescribe. 

rWotD Episode 2792: Myocardial scarring Welcome to Random Wiki of the Day, your journey through Wikipedia’s vast and varied content, one random article at a time.The random article for Wednesday, 25 December 2024 is Myocardial scarring.Myocardial scarring is the accumulation of fibrous tissue resulting after some form of trauma to the cardiac tissue. Fibrosis is the formation of excess tissue in replacement of necrotic or extensively damaged tissue. Fibrosis in the heart is often hard to detect because fibromas, scar tissue or small tumors formed in one cell line, are often formed. Because they are so small, they can be hard to detect by methods such as magnetic resonance imaging. A cell line is a path of fibrosis that follow only a line of cells.This recording reflects the Wikipedia text as of 00:45 UTC on Wednesday, 25 December 2024.For the full current version of the article, see Myocardial scarring on Wikipedia.This podcast uses content from Wikipedia under the Creative Commons Attribution-ShareAlike License.Visit our archives at wikioftheday.com and subscribe to stay updated on new episodes.Follow us on Mastodon at @wikioftheday@masto.ai.Also check out Curmudgeon's Corner, a current events podcast.Until next time, I'm generative Amy.

This week we delve into the world of adult congenital heart disease to review the topic of liver disease in the Fontan patient and specifically, hepatocellular carcinoma (HCC). What is the prevalence of this disease in the Fontan single ventricle adult patient? How effective are scores like the MELD-XI or Fibrosis-4 Index at identification of HCC in the Fontan patient? How should the Fontan adult patient be surveilled for this form of cancer? What evidence is there that earlier identification of HCC is associated with better outcomes? What may prove to be the most important factor in protection of the liver in the Fontan patient? Dr. Yuli Kim, Director of the ACHD program at The University of Pennsylvania shares her deep insights this week into this important topic. DOI: 10.1093/eurheartj/ehad788

Las personas con fibrosis quística son particularmente susceptibles a las infecciones respiratorias, por lo que es importante encontrar tratamientos para estas infecciones. Una revisión Cochrane del Grupo Cochrane de Fibrosis quística y enfermedades genéticas examina la evidencia sobre el uso de antibióticos en personas con esta afección y en este podcast se habla sobre sus hallazgos. Este podcast ha sido traducido por Yasmín García y locutado por Andrea Cervera del Centro Cochrane Iberoamericano.

Las personas con fibrosis quística son particularmente susceptibles a las infecciones respiratorias, por lo que es importante encontrar tratamientos para estas infecciones. Una revisión Cochrane del Grupo Cochrane de Fibrosis quística y enfermedades genéticas examina la evidencia sobre el uso de antibióticos en personas con esta afección y en este podcast se habla sobre sus hallazgos. Este podcast ha sido traducido por Yasmín García y locutado por Andrea Cervera del Centro Cochrane Iberoamericano.

Lynette Chambers, a 9-year PAH (pulmonary arterial hypertension) patient, has also been diagnosed with pulmonary fibrosis (PF). She shares her journey, from struggling with daily activities to being admitted to the hospital with severely low oxygen levels. Lynette discusses the emotional challenges of facing a terminal illness and the difficulty of balancing work and family time. Despite the hard reality, Lynette emphasizes the importance of gratitude, making others feel better, and being the best version of oneself. She finds strength in her family, especially her grandchildren, and strives to create lasting memories and make a positive impact on those around her. Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Engage for a cure: www.phaware.global/donate #phaware Share your story: info@phaware.com Like, Subscribe and Follow us: www.phawarepodcast.com. @phacanada

Silicosis is a lung disease caused by inhaling tiny crystalline particles of silica, or silicon dioxide, often linked to work environments like mining, construction, stonework, and sandblasting. The disease leads to symptoms such as coughing, inflammation, and fibrosis (scarring) and is classified under pneumoconioses, a group of lung conditions caused by inhaling dust. Silicosis can be chronic, developing over more than 10 years of exposure; subacute, occurring in two to five years with heavier exposure; or acute, which can happen within months of intense exposure. Although silicosis is irreversible and has no cure, treatments are available to manage symptoms.

In this week's episode we'll discuss how immune fitness impacts response to teclistamab in relapsed/refractory multiple myeloma; learn more about a new mechanism of resistance to asciminib conferred by the BCR::ABL1 M244V mutation, and discuss the impact of hematopoietic cell transplantation on myocardial fibrosis in young patients with sickle cell disease. Featured Articles:Correlation of immune fitness with response to teclistamab in relapsed/refractory multiple myeloma in MajesTEC-1BCR::ABL1 kinase N-lobe mutants confer moderate to high degrees of resistance to asciminibImpact of hematopoietic cell transplantation on myocardial fibrosis in young patients with sickle cell disease

In the second half of Roger Green's interview with Global Liver Institute Vice President, Liver Programs Jeff McIntyre, Jeff discusses the implications of his key EASL Congress takeaways for GLI and other patient advocacy groups.  To Jeff, this trend makes patient advocates a more valuable player in the clinical trial design process, particularly when coupled with the FDA's increasing focus on diversity in trial populations. This will become particularly important because, today, the major use of incretin agonists like semaglutide and tirzepatide is in anti-obesity, where payers are frequently declining to pay for the drugs. Advocates like GLI will be pivotal in ensuring that patients who need MASLD drugs will still get the drugs they need, particularly at earlier stages of fibrosis. This discrimination may allow patients to receive incretin agonists during the pre-fibrosis stage based on diabetes and anti-obesity medications and reserve the fibrosis drugs for patients with more advanced MASH. The entire scenario of early metabolic, later MASH treatment with different agents is at least 4-5 years in the future. In the meantime, Jeff sees a need to advocate for underserved groups in the population while at the same time laying the foundation for the longer-term case. In this context, the United Nations General Assembly side effect (covered in S5, E22) is an exciting and vital event.

This conversation contains the first half of Roger Green's interview with PharmaNest Founder and CEO Mathieu Petitjean. After Matt tells the audience a little about his background and PhramaNest, the two discuss what Matt considered the key strategic takeaways for PharmaNest from the various EASL Congress presentations, abstracts and discussions. Before answering the question, Matt describes the core services his company offers: "PharmaNest specializes in digital pathology. Four years ago, we put down the hypothesis that the histological phenotype of fibrosis should be quantified in a high-resolution, sophisticated way." He goes on to state their core proposition for MASLD: "The big idea here is that fibrosis equals phenotype." He proceeds to describe his offerings in greater detail before offering the underlying value of computed histology: fibrosis is a continuous variable that is scored in discrete categories under the NASH-CRN model that drives FDA analysis. With this as context, he answers the question by describing three kinds of MASLD clinical trial designs. The first, earliest trials had a single pathologist reading histological slides. The method is not precise, but the drugs were not very good, and none were ultimately approved. The second set of trials relied on more rigorous methods for pathologists to read histology slides, with multiple readers and robust adjudication systems. Also, the drugs in this second set of trials were more efficacious, so that NASH-CRN, while a blunt instrument, could adequately assess efficacy. For the third set of trials, Matt believes non-invasive tests (NITs) are likely to suffice.

In the second half of Roger Green's interview with PharmaNest Founder and CEO Mathieu Petitjean, Matt discusses the implications of his key EASL Congress takeaways for PharmaNest.  Matt starts this discussion with a simple question: Will biopsy-based analyses become part of a surrogate endpoint? As he points out, they are not today, and creating the necessary data might require a significant effort. If not, they are unlikely to remain relevant to the large, Phase 3 trials. Regardless of the answer to this question, Matt believes digital pathology will still be important in pre-clinical work and other efforts to define underlying liver structures and faults better. Also, he notes, digital pathology is valuable in an array of other liver diseases and in non-hepatological markets, notably including pathology. One way or another, he is confident PharmaNest will continue to make contributions to hepatology and grow as a business.

00:00:00 - Surf's Up: Season 5 Episode 24 This week's episode on MASLD lessons from the EASL Congress 2024 includes three separate elements: individual interviews with PharmaNext Founder and CEO Mathieu Petitjean and Global Liver Institute Vice President of Liver Programs Jeff McIntyre,  followed by a discussion with patient advocates Mike Betel of the Fatty Liver Alliance and José Willemse from the Netherlands, now supporting EASL. 00:02:45 - IntroductionRoger explains the episode format, including the two key questions for Mathieu and Jeff: (i) what were their key takeaways from the EASL Congress, and (ii) how have those takeaways changed how they do their jobs or plan for the future? Roger also sets up the Question of the Week discussion that is today's third section. 00:04:04 - Meet Mathieu PetitjeanThis is the SurfingMASH debut for Mathieu Petitjean, Founder and CEO of PharmaNest. He tells the audience a bit about his background and his love of Harleys.00:07:10 - First question to MattMatt begins by describing the core services Pharmest, a digital pathology company, offers MASH drug developers. Then he answers Roger's question by describing three phases in MASLD clinical trial designs. His point is that over time, drugs have gotten better, and histology requirements have become more onerous. At some point in the not-too-distant future, Matt believes non-invasive tests (NITs) are likely to suffice in large Phase 3 trials of the future.00:21:01 - Second question to MattMatt starts the answer with a conditional: if biopsy-based analyses become part of a surrogate endpoint, the role is large and clear. If not, they are unlikely to remain relevant in Phase 3 trials. Regardless of the answer to this question, Matt believes digital pathology will remain important in pre-clinical work and in other continuous liver diseases with less-defined targets. Also, he says, digital pathology is valuable in an array of non-hepatological markets, notably including pathology. 00:29:11 - First question to JeffJeff describes an "overriding sense of optimism" he felt due to the many positive drug trials presented in Milano. This suggests that the MASLD community is developing safe and effective MASH drugs with many different modes of action. This is allowing GLI and other advocates to start to have "more enlightened discussions" about MASLD in the context of the patient's overall metabolic state. All this means that what works in one patient might not in another. This can reshape clinical trials so that the endpoint target might not be change in fibrosis but impact against specific NIT targets. Jeff envisions this line of inquiry as a possible step away from biopsy. 00:39:34 - Second question to JeffConcurrently, FDA is beginning to require greater diversity in clinical trial populations. To Jeff, all this makes patient advocates like GLI more valuable to the clinical trial design process and pivotal in ensuring that metabolic and advanced MASH patients will still get the drugs they need. Starting today, Jeff sees advocates as championing underserved groups in the population while at the same time laying the foundation for the longer-term case. 00:55:20 - Discussing previous "Question of the Week"This is a 15-minute discussion of the Question of the Week we posed at the end of S5 E23. This section will constitute S5 E24.5, which we will post in the next day or two. A more complete summary will appear there. 01:11:23 - Question of the WeekThe Question of the Week is the first question Roger asks Matt and Jeff during this episode.01:12:58 - Business ReportPreviewing Episode 25, with Maru Rinella discussing the recently-published expert recommendations on use of resmetirom, along with comments on office hours the reason we will not have a vault conversation this week.

Episode 172: NAFLD and ObesityFuture Dr. Nguyen explains the pathophysiology of non-alcoholic fatty liver disease and how it relates to obesity. Dr. Arreaza gives information about screening and diagnosis of NAFLD. Written by Ryan Nguyen, MS4, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction/PathophysiologyNonalcoholic fatty liver disease (NAFLD) refers to the buildup of excess fat in liver cells, occurring without the influence of alcohol or drugs. Nonalcoholic steatohepatitis (NASH) represents a more severe form of NAFLD, characterized by inflammation and liver cell injury due to fat accumulation. If left untreated, NASH can progress to liver fibrosis or cirrhosis. Typically, NAFLD/NASH is diagnosed after other liver conditions are ruled out, making it a diagnosis of exclusion.NAFLD -> NASH -> Cirrhosis -> Liver failure. Another term for NAFLD is metabolic dysfunction-associated steatotic liver disease. Fatty liver disease is identified when more than 5% of liver weight consists of fat, whereas, NASH is diagnosed when this fat accumulation is accompanied by inflammation and liver cell injury, sometimes leading to fibrosis. Understanding these distinctions is crucial in recognizing and managing the spectrum of liver conditions associated with obesity and metabolic syndrome.BMI serves as a tool to gauge body fat levels: individuals are categorized as normal weight if their BMI falls between 18.5 and 24.9, overweight if it ranges from 25 to 29.9. Class I obesity is diagnosed with a BMI of 30 to 34.9, class II obesity between 35 and 39.9, and class III obesity when BMI exceeds 40.Obesity puts you at risk of NAFLD, but you can also see NAFLD in non-obese patients, but the prevalence is very low, about 5%. What did you learn about the demographics of NAFLD?NAFLD is most widespread in regions like South Asia, the Middle East, Mexico, Central and South America, with prevalence rates exceeding 30%. In the United States, prevalence varies with approximately 23-27%, notably higher among Asians at 30%, followed by Hispanic individuals at 21%, White individuals at 12.5%, and Black individuals at 11.6%. Across all racial groups, obesity plays a significant role, affecting more than two-thirds of individuals diagnosed with NAFLD. Understanding these demographics underscores the global impact of obesity on NAFLD prevalence.Diagnosis: Screening/Labs/Imaging/ToolsThe American Association for the Study of Liver Diseases does not recommend screening for NAFLD, but if it is discovered an appropriate workup is warranted. AST/ALT RatioLiver health can be assessed by a series of tests aimed at assessing fat accumulation, inflammation, and fibrosis. Initial screening often includes laboratory tests such as measuring the ratio between aspartate transaminase (AST) and alanine transaminase (ALT), where a ratio less than 1 may suggest possible NAFLD, although it is not diagnostic on its own. Normally, AST is slightly more elevated than ALT. So, if the AST/ALT ratio is lower, then means that ALT is higher than AST. FibroSure®.Additionally, you can measure indirect markers of fibrosis with tests such as FibroSure or FibroTest blood tests that combine several biomarkers including age, sex, gamma-glutamyl-transferase (GGT), total bilirubin, alpha-2-macroglobulin, apolipoprotein A1, haptoglobin, and ALT to provide insights into liver health.Some people may be more familiar with FibroSure before Hepatitis C treatment. You can get a fibrosis score (F0-F4), and it is considered significant fibrosis if the score is > or equal to F2. Imaging plays a crucial role in diagnosing NAFLD without the need for invasive procedures like liver biopsy. Vibration-controlled transient elastography (Fibroscan) uses ultrasound to measure liver stiffness, indicating potential fibrosis and inflammation. While noninvasive and portable, it focuses solely on liver ultrasound and may not be universally accessible. MRI with proton density fat fraction (MRI-PDFF) offers a comprehensive assessment of liver fat content, commonly used in clinical and research settings for NAFLD and NASH evaluation.For evaluating hepatic fibrosis in patients with suspected NAFLD, tools like the Fibrosis-4 Index (FIB-4) incorporate age, AST, ALT, and platelet count to estimate the likelihood of liver disease progression. These screening methods collectively aid in diagnosing and monitoring NAFLD, particularly in individuals at risk due to factors like prediabetes, type 2 diabetes, obesity, and abnormal liver enzyme ratios. With the FIB-4 you can get a faster answer than FibroSure because you only need 4 elements: Age, platelet count, AST and ALT. Cirrhosis is less likely if FIB-4 is 3.25. Understanding these diagnostic approaches is essential for early detection and management of NAFLD in clinical practice.Some researchers are invested in diagnosis and treating NAFLD while others recommend against labeling patients with NAFLD. A 2018 Lancet article concluded that the risks of over-diagnosing and overtreating NAFLD exceed the benefits of screening or periodic imaging because of “the low hepatic mortality, high false-positive rate of ultrasonography, selection bias of current studies, and lack of viable treatment.” However, patients who suffer from metabolic syndrome should be counseled about dietary modification and physical activity regardless of their liver condition. NAFLD and obesityFatty liver disease is often caused by multiple insults towards either genetically or environmentally predisposed individuals. Family history of NAFLD and having specific genetic variants are important risk factors for NAFLD. Those with prior health conditions can have increased susceptibility to NAFLD including T2DM leading to insulin resistance, metabolic syndrome, sleep apnea, hepatitis C, and cardiovascular or chronic kidney disease. A sedentary lifestyle and unhealthy nutrition (especially high intake of processed carbohydrates) cause an increase in free fatty acids leading to hepatic fat deposition → ballooning of hepatocytes → leading to hepatocyte injury/death → inflammation with fibroblast recruitment → end result of fibrosis/cirrhosis. Just a quick reminder, NAFLD is defined as fatty liver with >5% hepatic fat and NASH is defined as fatty liver with >5% hepatic fat with inflammation, hepatocyte injury, with or without fibrosis that we can determine through imaging. A leading concern for the development of NAFLD is the consumption of high fructose corn syrup.  High fructose corn syrup (HFCS), commonly found in candy, processed sweets, soda, fruit juices, and other processed foods, is linked to non-alcoholic fatty liver disease (NAFLD). Unlike natural whole fruits, which contain fiber and are generally healthier due to their slower absorption, HFCS lacks fiber and is quickly absorbed, leading to rapid transport to the liver. This process contributes to NAFLD by increasing the hepatic synthesis of lipids and interfering with insulin signaling. To avoid HFCS, individuals are encouraged to consume whole fruits rather than fruit juices and adopt diets rich in whole grains, lean meats, plant-based proteins, fruits, and vegetables, such as the Mediterranean or DASH diets, which are less likely to promote NAFLD, especially in those with healthy body weight.NAFLD treatment.Avoiding alcohol seems very obvious, but we need to mention it. Avoiding heavy alcohol consumption is recommended and complete abstinence is suggested.Weight loss is crucial; even a modest reduction of 3–5% in body weight can alleviate hepatic steatosis, with greater improvements typically seen with 7–10% weight loss, particularly beneficial for addressing histopathological features of NASH, such as fibrosis. We must focus on tailored medical nutrition therapy and regular physical activity. A strategic meal plan is essential, emphasizing achieving a healthy body weight while limiting trans fats and ultra-processed carbohydrates. Options like the Mediterranean diet, which balances lean proteins and restricts processed carbohydrates have shown promise. Dynamic aerobic and resistance exercises play a significant role in managing NAFLD. They help maintain a healthy weight and enhance peripheral insulin sensitivity, reduce circulating free fatty acids and glucose levels, and boost intrahepatic fatty acid oxidation while curbing fatty acid synthesis. These benefits contribute to mitigating liver damage associated with NAFLD, offering therapeutic advantages beyond mere weight reduction.Exercise may not be a great tool for weight loss, but it is a great tool for weight maintenance, liver health, and overall health as well. “Most patients with NAFLD die from vascular causes, but NAFLD puts patients at increased risk of cardiovascular death”. Medications for NAFLD.Regarding pharmacotherapy, while no medications are currently FDA-approved specifically for NAFLD treatment, some options show promise in clinical settings. Vitamin E supplementation at 800 IU (international units) daily has demonstrated biochemical and histological improvements in NASH cases without diabetes or cirrhosis, though long-term use may elevate prostate cancer risks. It is important to make a shared decision with the patient before starting Vitamin E supplementation. Medications like pioglitazone can reduce liver fat and improve NASH, even as they may increase body weight. But our favorite, GLP-1 receptor agonists, such as liraglutide and semaglutide, also show potential in reducing liver fat and improving NASH symptoms, and this is an emerging therapeutic option for managing this condition.If you decide to treat, then you should monitor as part of the treatment. An aminotransferase check is recommended 6 months after starting a weight loss program. If levels do not improve or do not return to normal after 5-7% of weight loss, another cause of elevated transaminases needs to be investigated.You also need to monitor fibrosis in patients with >F2. If fibrosis has been proven by liver biopsy, you can order FibroSure every 3-4 years. Having a fatty liver may be a red flag that your patient has a metabolic problem. If you discover it, start interventions that would benefit not only the liver but the whole metabolic profile of your patient. The Obesity Medicine Association (OMA) issued a Clinical Practice Statement (CPS) regarding NAFLD and obesity stating that patients with obesity are at increased risk for NAFLD and NASH. It recommends that clinicians strive to understand the etiology, diagnosis, and optimal treatment of NAFLD with a goal to prevent NASH in their patients.Regular exercise, even walking 30 minutes a day can show many benefits in curbing fatty accumulation in the liver. Having a proper diet with avoidance of high fructose corn syrup can overall help in reducing NAFLD/NASH. _____________________Conclusion: Now we conclude episode number 172, “NAFLD and Obesity.” Future Dr. Nguyen explained that NAFLD and obesity are closely related and NAFLD can lead to NASH and cirrhosis in some patients. Dr. Arreaza explained that screening may not be recommended by some medical societies, but others are in favor of screening and treating this disease. However, most people agree that NAFLD is a sign of metabolic disease and a good reason to talk about healthy eating and physical activity with our patients. There are no FDA-approved medications to treat NAFLD, but some evidence suggests that Vitamin E can improve it and GLP-1 receptor agonists are a promising option. This week we thank Hector Arreaza and Ryan Nguyen. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Karjoo S, Auriemma A, Fraker T, Edward H. Nonalcoholic fatty liver disease and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. https://doi.org/10.1016/j.obpill.2022.100027.Curry M, Afdhal N. Noninvasive assessment of hepatic fibrosis: Overview of serologic tests and imaging examinations.  https://www.uptodate.com/contents/noninvasive-assessment-of-hepatic-fibrosis-overview-of-serologic-tests-and-imaging-examinationsRoyalty-free music used for this episode: Cool Groove (Alt-Mix) by Videvo, downloaded on Nov 06, 2023, from https://www.videvo.net

00:00:00 - Surf's Up: Season 5 Episode 21 One important session at the EASL Congress 2024 involved the presentation of the new MASLD Clinical Practice Guidelines. CPG co-authors Elisabetta Bugianesi and Frank Tacke join Louise Campbell and Roger Green to share their perspectives on the guidelines' development some key recommendations.  00:09:36 - Revising the guidelines Roger asks the co-authors to describe the process that led to the 2021 decision to revise the guidelines. EASL was the initial driver; EASD and EASO joined the process. They formed a committee of 15 leaders and assembled a Delphi panel of 46 individuals from different stakeholder communities.  Elisabetta describes the "big advantage" of this collaboration: it conveyed the need for a common way to manage co-morbid patients with MASLD. To Frank, this approach strengthened the guidelines by putting the liver in the center of metabolic disease. Louise asks whether the guidelines will increase the profile of liver disease in other specialties. Elisabetta says "it takes time" but says that the nature of cirrhosis and HCC might make this easier.00:19:07 - Adding resmetirom before approvalEarlier, Louise praised the inclusion of resmetirom in the guidelines, Frank notes that this section was added to the guidelines within a month before their release and praises the "very engaged Delphi panel" that reacted and voted quickly.  He proceeds to discuss how the Delphi panel was formed.00:23:24 - Major issues in screening, diagnosing and case-managing patientsElisabetta starts by saying that resmetirom's approval created momentum for screening. She says the approach identifies patients before cirrhosis or HCC in pre-cirrhotic patients. Frank points out "a major breakthrough": these guidelines do not rely on biopsy.  00:28:04 - Non-medical factors Louise lauds the document's the broad range of diets that will make the document valuable around the world . Frank adds that the guidelines have adjusted thresholds  adapted to the ethnic and socioeconomic background of the individual. 00:30:52 - Pharmacological issues in the new CPG Frank starts the pharmacological discussion noting that the CPG drives holistic thinking about the liver in a metabolic context. Elisabetta notes that while no drugs are efficacious for cirrhosis, the document does report that some drugs are safe for these patients, although sometimes with adjusted doses. 00:33:39 - Screening for cirrhosisFrank concurs that the document provides guidance on managing patients with end-stage liver disease and also discusses how to manage cirrhosis and its various complications. Elisabetta says that HCC can be hard to find in a fatty liver. 00:36:36 - Cardiometabolic nursing as a future training and specialtyLouise suggests that these guidelines "pinpoint...a role of the potential future" for nurses who can support the entire cardiometabolic syndrome. This document might drive a curriculum for such a specialization.00:38:48 - What adjustments would you like to see in the healthcare system?The last set of questions begins with Roger asking what kinds of changes the authors would like to see in the healthcare system.  The discussion revolves around a "cardiometabolic" perspective but in terms of nurse training and the care provided in a hepatologist's office. 00:43:18 - Winding downAs the conversation winds down, each panelist offers a final comment or question.00:47:59 - Question of the WeekRoger asks how readily listeners believe the guidelines will be implemented, and which sections will be easiest and hardest to implement. 00:48:32 - Business ReportThe next EASL Congress review episodes, starting office hours, and a vault discussion from 2023's clinical care pathway document. 

Mazen Noureddin and Naim Alkhouri join Jörn Schattenberg and Roger Green to discuss some of the other major drug development stories from the EASL Congress 2024, with special focus on denifenstat, ION-224 and TAK-227, and to review the SPECIAL study on bariatric surgery and cirrhosis. The panelists concur that all three of these agents have potential value in therapy. Naim expresses some concern about how broad denifestat use will be based on its side effect profile. Later in this conversation, Mazen belives that denifenstat has broad potential for use, given that the most prominent side effect, hair thinning, appears transient and readily manageable. He also notes that denifenstat's impressive results were based on Intent to Treat analysis, which is more rigorous.  Naim states his interest in the ION-224 agent based on its mode of action, which is RNA interference. He also discusses SPECIAL, a study he conducted with the bariatric surgery group at Cleveland Clinic. This study, which evaluated patients with cirrhosis at the time of surgery, demonstrated a 72% risk reduction in major adverse liver outcomes over a 10-year period and 80% risk reduction in decompensation. Jörn discusses a study he presented on TAK-227, a TG2 inhibitor originally developed for celiac disease. Early results here are quite promising and, as Aleksander Krag mentioned in S5 E17, demonstrates exciting potential for collaboration with drug developers for other diseases. As the conversation ends, Roger asks Mazen and Jörn what they consider likely to be the biggest MASLD stories at the AASLD Liver Congress in November. Mazen selects the Phase 3 ESSENCE study for semaglutide, while Jörn suggests NITs. 

In this conversation from July 2023, Stephen Harrison, Jörn Schattenberg and Roger Green discuss the implications of presentations on the FGF-21 agent efruxifermin and the dual GLP/glucagon agonists pemvidutide and efinopegdutide. Here is the description Roger wrote for the original conversation:In this session, conversation shifts from resmetirom to Mazen Noureddin's "NASH Monopoly" game and focuses on the value of FGF-21s and glucagon agents. Stephen posits two comments about GLP-1s. First, there is now adequate data suggesting that GLP-1s will not melt away all liver fat and as a result lead to dramatic fibrosis regression. Second, we know from a small sub-cohort of patients in Akero's SYMMETRY trial that patients already on fairly low doses of GLP-1s saw what Stephen describes as an 'incredible' and incremental benefit for the FGF-21 agent, efruxifermin. The group notes that while glucagon dual and treble agents are likely to produce dramatically more robust results in weight loss and liver defatting than GLP-1s alone, they still seem unlikely to 'usurp the need for other types of agents.' From here discussion considers the FGF-21 class. Stephen notes that two drugs, efruxifermin and pegozafermin, have demonstrated significant efficacy against fibrosis. As the conversation concludes, the panelists agree that earlier, more aggressive screening to arrest cirrhosis will become pivotal and will not occur until the right drug becomes available. 

Mazen Noureddin and Naim Alkhouri join Jörn Schattenberg and Roger Green to focus on the role FGF-21s will play in long-term advanced fibrosis treatment: induction or long-term therapy...or might we even think of the class as being able to produce a "MASH cure?" Responding to Naim's comment closing the previous discussion, Mazen questions why we regard FGF-21 agents as induction therapies given that it appears to be as well tolerated as the oral agents and maintains such efficacy over time. In fact, he adds, its sustained efficacy might make it possible for livers to eliminate fibrosis and return to their "normal" state, almost like a "cure." Jörn adds a comment about pegozafermin, another FGF-21 in development. Jörn notes that this agent is a pegylated molecule, which makes it different from efruxifermin. He notes that NITs show sustained enzyme response at 48 weeks. Mazen reiterates his optimism about the FGF-21 class and reminds us that there is a third FGF-21 in development. Roger raises Michael Charlton's question (Season 5 Episode 11) whether an induction therapy strategy for FGF-21s might not work if removing the drug allows the MAS activity to return. On the other hand, he notes, it might take years for fibrosis to return. Mazen agrees that many unanswered questions exist, but reiterates his belief in long-term therapeutic value.  

Mazen Noureddin and Naim Alkhouri join Jörn Schattenberg and Roger Green to discuss the tirzepatide late-breaker at the EASL Congress 2024 and other "Twin-cretins," all of which are GLP-glucagon combinations. "Twin-cretins" is the name Jörn has coined for agents with a GLP-1 agonist plus another incretin effect. Tirzepatide is a GLP/GIP agent, while survodutide and the agents discussed last year, pemvidutide and efinopegdutide, are GLP/gluagons. Naim reviews the results of the tirzepatide late-breaker presentation. As expected, it showed high rates of MASH resolution. Naim does not feel it answered the question whether an incretin-agonist can achieve significant fibrosis regression without a direct liver effect, since it relied on a completer analysis that treated 3 of 10 non-completers as a success (in ITT, that would have been 0 out of 10). Again, glucagon has a direct effect; GIP does not.This takes Naim back to the question of whether a GLP/GOP can have a meaningful effect on fibrosis. He notes that Stephen believed firmly that it could not, but there is a paradox in that bariatric surgery can produce a reduction in fibrosis. Naim notes that conclusive data will arrive later this year, so no one needs to decide now. Mazen praises tirzepatide's effect on weight loss and safety and could prescribe it now, but the completer analysis has not persuaded him to prescribe to regress fibrosis, particularly given the lack of a dose response. He notes that "while I don't want to compare apples to oranges," he is more confident in the glucagon effect found with survodutide, pemvidutide and efinopegdutide. Jörn agrees. Roger asks how prescribing decisions will change in a market where a significant share of US patients will have been prescribed semaglutide or tirzepatide before coming to the hepatologist. Naim comments that many of his MASH patients have been on GLP-1 already.  He notes that since glucagon increases blood sugar, the ratio of GLP-1:glucagon is a key issue and difference between the three GLP/glucagon agents. 

Naim Alkhouri and Mazen Noureddin join Jörn Schattenberg and Roger Green to discuss issues regarding incretin agonists and results from the efruxiermin late-breaker at the EASL Congress 2024. Naim shares his general excitement about glucagon agents in general. He mentions that the efinopegdutide study included a semaglutide cell, which showed further reduction in liver fat vs. the GLP-1 agent. Jörn comments on the high level of tolerability in the survodutide trials. Mazen shares his high hopes for GLP/glucagons and the triple agents. He goes back to review the survodutide data from the NEJM article. Mazen shares the late-breaker data that Vlad Ratziu presented on behalf of Stephen. This is a 96-week, triple biopsy study showing dramatic, sustained fibrosis improvement with a 30% delta for one level and a 21% delta for two levels. Jörn notes that the triple biopsies are demonstrate the durability of the agent against fibrosis. Roger notes this is particularly encouraging because of the previous pegbelfermin data showing loss of efficacy and tachyphylaxis. Naim concurs and adds that if the two-stage drop in fibrosis can be sustained, this would be a "big deal for the field" that might lead prescribers to think about FGF-21 as indication therapy with a "more tolerated" oral later on.   

Are you taking an ACE-Inhibitor for high blood pressure? If so have you experienced a dry cough? It literally can be linked to your medication and we discuss how easily you can get rid of this cough just by talking to your doctor today.Eating the standard American diet puts anyone at risk for developing fatty liver disease. It may sound benign, but for those where fatty liver disease causes chronic inflammation (even if not obese), 12% of those will be in need of a liver transplant, tune in to see how to avoid this complication.Rezdiffra, a new medication that uses the thyroid binding sites inside the liver to defeat fibrosis, could this be the way to defend the liver from years of processed foods?

In this episode of the FitMIND FitBODY podcast, I had the pleasure of chatting with Liz Van Don Dongen. Liz, a dedicated runner and physiotherapist, shares her incredible journey and the profound impact running has had on her life. Growing up in Hobart, Liz was always active, participating in various sports and embracing the joy of movement. Liz's passion for running deepened as she traveled and lived in different parts of the world. She used running as a way to explore new environments, stay fit, and manage stress. Despite being born with cystic fibrosis, Liz has achieved many running goals, demonstrating remarkable resilience and determination. She emphasises the importance of slowing down and appreciating the privilege of being able to run. Liz believes running is a spectrum, from walking to jogging, and encourages everyone to find their own pace and enjoy the process. Throughout our conversation, Liz offers valuable tips for beginners. She advises new runners to take it easy, listen to their bodies, and not to compare themselves to others. Instead, focus on personal progress and the joy of running. Liz also highlights the importance of finding motivation, whether it's through setting small goals, exploring new routes, or simply enjoying the beauty of nature. Liz's story is not just about running; it's about connecting with nature, building meaningful relationships, and staying grounded through physical activity. She shares how running has brought richness to her life, providing a sense of adventure and a way to overcome challenges. Liz's insights are inspiring and relatable, making this episode a must-listen for anyone interested in running or looking for motivation to stay active. Tune in to hear Liz's inspiring journey, her practical tips for beginners, and her thoughts on the importance of a balanced life. Whether you're a seasoned runner or just starting out, this episode is packed with wisdom and encouragement. A couple of Liz's quotes:- “You don't have to be great to start, but you have to start to be great!” ~ Zig Ziglar “Start where you are, use what you have, do what you can” ~ Arthur Ashe Liz's Running tips: 1. Start Slow: Liz emphasises the importance of starting slow. Running doesn't have to be about speed; it can be a mix of walking and jogging as you build up your endurance. 2. Enjoy the Process: She advises enjoying the journey and not setting strict parameters. Move how your body wants to move, whether that's jogging or walking. 3. Listen to Your Body: Pay attention to how your body feels. If your mind wants you to jog but your body says no, then listen to your body and vice versa. 4. No Rules: Liz highlights that there are no strict rules in running. It's important to find your own rhythm and not be constrained by what you think running should look like. 5. Running is a Privilege: She reminds us that running is a privilege and it's important to appreciate that we have bodies capable of carrying us through this activity. 6. Be Consistent: Consistency is key. Regular runs, even short ones, help build endurance and create a routine. 7. Find Motivation: Motivation can come from various sources, like setting small goals, exploring new routes, or enjoying nature. Finding what motivates you is crucial to maintaining a running habit. 8. Set Goals: Having clear, achievable goals helps keep you motivated. It can be anything from completing a certain distance to simply enjoying your run. 9. Embrace Community: Being part of a running community can provide support and encouragement, making the running experience more enjoyable and sustainable. 10. Balance Life and Running: It's important to have a balanced life. Liz emphasises having interests and careers outside of running to stay grounded and resilient. 11. Track Progress: Keeping track of your progress can be motivating. Liz used running as a way to monitor her health and fitness levels.**A couple of BIG favours: 1) please like and review this podcast so more people will discover it :) 2) come on the podcast and talk about your running journey and/or refer someone you'd love me to interview (whether you know them or not :) )  Lets not keep the power of running a secret any more!  Hit me up on Facebook/Instagram (FitMIND FitBODY) or send me an email - Michelle @ FitMINDFitBODY .co  Don't miss an episode of the FitMind FitBODY Podcast. Sign up to our email list and get notified when new episodes are released. https://fitmindfitbody.co/podcast/ 

This conversation re-introduces us to Sober Livers Founder/Visionary Jenn Jones and introduces us to Beth Lehman, Principal Strategic Advisor to Sober Livers and HOPE, a multi-element patient support program for people who have harmed their livers though AUD (Alcohol Use Disorder).As this conversation starts, we meet Beth Lehman, Principal Strategic Advisor for Sober LIvers, who discusses her disease background and personal history and adds one thing we might not know about her otherwise.After we meet Beth, Roger introduces the topic by discussing how the new nomenclature has broadened stakeholders' view of liver disease by incorporating AUD into the vision of steatotic liver disease through ALD and MetALD. In the aftermath of the new nomenclature uptake, Sober LIvers joined forces with the Fatty Liver Foundation and came to SurfingMASH's attention this way.Jenn introduces HOPE, which stands for Healing Others with Peers and Education, an organization that provides peer support for people who have harmed their bodies due to  AUD, while simultaneously advocating for "people to understand the disease better."  Some peers will be living with cirrhosis, while others will be post-transplant. Patients may have other metabolic system issues.  After sharing how hard it was for her to confront her truth, Beth notes that while she has been involved in several different programs, none have had subgroups for people who harmed their bodies through AUD...which is why she believes this group is needed so badly.

This conversation revolves largely around two Big Data presentations Hannes Hagstrom's team is sharing at the EASL Congress. Every other panelist has at least one meaningful comment to make about the future of Big Data in MASLD.Hannes describes two big data studies of his own, "very much Big Data, but it's not omics." One examined 860,000 residents of Stockholm who took a liver test between 2010-2022 seeking to estimate liver and cardiovascular risk. It relied on a tool from Stefano Romeo's group called the Fibrotic Mass Index. The results demonstrated the prediction of liver-related and cardiovascular-related outcomes.The other study relied on the same dataset to build a prediction model for liver-related outcomes in the general population. Instead of relying on a dedicated test like FIB-4, which has false results on both sides, this assimilates five simple parameters (ALT, AST, GGT, ender, age) and proves to be far more accurate at risk assessment than FIB-4. The study team will also present a small, web-based calculator "where people can go to estimate the risk." The tricky part, Hannes notes, is where to set a tolerable risk threshold. Jörn, thinking about the 860,000 sample, asks, "How much data is big enough?" Hannes notes that if the sample is big enough, we need not worry about statistical tests because we have true population-level data. Michelle considers the overarching implications of Hannes's comments: "I think a risk-based view of this disease makes a lot of sense." Aleksander and Roger concur that using a risk-based screening approach is preferable, in large part because it should allow a far larger share of resources to be devoted to those with significant disease. 

A person with rheumatoid arthritis and lupus develops new back pain in her mid-upper left side. It feels like “it's coming from under my ribs,” she says. First, it's diagnosed as arthritis, but interventions don't seem to make a difference. Finally, a year into this unremitting pain, a rheumatologist asks about her breathing and discovers she has developed a complication called pulmonary thrombosis, probably related to her autoimmune diseases. They start treatment and voilà, her back pain is gone. This is a good example of a case in which massage therapy was definitely NOT the best choice.   Resources: Dsouza, K.G. et al. (2023) ‘Management of interstitial lung disease in patients with autoimmune disease-related interstitial lung disease', Multidisciplinary Respiratory Medicine, 18(1), p. 890. Available at: https://doi.org/10.4081/mrm.2023.890.   Fibrosis as an autoimmune disease (no date) CPC - M. Available at: https://www.cpc-munich.de/en/research-projects/fibrosis-as-an-autoimmune-disease/index.html, https://www.cpc-munich.de/en/research-projects/fibrosis-as-an-autoimmune-disease/index.html (Accessed: 3 May 2024).   3. Gole, S. and Bankole, A. (2024) ‘Nintedanib', in StatPearls. Treasure Island (FL): StatPearls Publishing. Available at: http://www.ncbi.nlm.nih.gov/books/NBK585049/ (Accessed: 8 May 2024).   Interstitial Lung Diseases - What Are Interstitial Lung Diseases? | NHLBI, NIH (2022). Available at: https://www.nhlbi.nih.gov/health/interstitial-lung-diseases (Accessed: 8 May 2024).   5. Kašiković Lečić, S. et al. (2022) ‘Management of musculoskeletal pain in patients with idiopathic pulmonary fibrosis: a review', Upsala Journal of Medical Sciences, 127, p. 10.48101/ujms.v127.8739. Available at: https://doi.org/10.48101/ujms.v127.8739.   6. Massage & Bodywork - MAY | JUNE 2021 (no date). Available at: https://www.massageandbodyworkdigital.com/i/1358392-may-june-     Host:   Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.        Sponsors:   Anatomy Trains: www.anatomytrains.com    Elements Massage: www.elementsmassage.com/abmp   Earthlite: www.earthlite.com  

- Today, I have an excerpt from an interview with Dr. David Amron from our Lipedema Worldwide Summit in 2016.- Dr. David Amron is a plastic surgeon specializing in liposuction for lipedema, practicing in Beverly Hills, California.- In this excerpt, Dr. Amron explains the pathophysiology of fibrosis in lipedema.

In this conversation, Sven Francque and William Alazawi join Jörn Schattenberg, Louise Campbell, and Roger Green to review papers co-authored by Sven in 2023 and Jörn in 2020 to discuss what failure has taught us about future MASH drug development.00:00:00 - Surf's Up: Season 5 Episode 12Roger comments briefly on Stephen Harrison's passing and explains why this episode will be more sedate than usual.00:01:45 - IntroductionOpening comments from panelists.00:02:28 - GroundbreakersEach panelist shares one piece of good news from the previous week (NOTE: This was recorded before Stephen's death.)00:05:10 - Sven Francque on the State of the Graveyard in 2023Sven starts by noting how different the world is now than when he co-authored this paper in 2023. He goes on to describe three key issues in successful trials that are as relevant now as when the episode was written.00:10:59 - Efficacy endpoint challengesThe group discusses an array of challenges: that fibrosis regressions is a high bar, that patient heterogeneity presents a dilemma for trial recruitment, and that NAS score presents its own challenges. 00:18:29 - Thinking more broadly about metabolic valuesLouise suggests that in addition to stabilizing MASH, endpoints might look at related metabolic diseases that poor liver health can affect. The group considers whether placebo rates can provide guidance and reconsiders the regression and response rate issues, noting the differences between RCT patients and those in usual clinical practice.  00:28:05 - Lessons from 2020 Graveyard articleRoger asks what we have learned since 2020. Jörn points to improved consistency in reading biopsy results and greater diligence in analyzing pre-clinical data before rushing into larger late-stage trials. 00:31:49 - Implications for metabolic agents on MASH therapies Roger returns to the issue of complex drug effects, noting a recent tirzepatide Phase 3 trial on dual agonist's effect on obstructive sleep apnea. Louise notes that apnea correlates highly with SLD. Louise and Will discuss the importance of educating more physician specialties about liver health. Will discusses a presentation he made to an academic session on MASH at the Diabetes UK conference the previous week and noted that it was well-attended.00:36:05 - Looking aheadRoger asks what insights investors and others might take from this discussion. To Jörn,  (i) we now know how to get a drug approved, and (ii) drugs in development today may be potent enough to overcome issues that challenged earlier agents. Sven adds that in future years, the use of incretin double-agonists and triple-agonists will change the nature of therapy. 00:42:23 - Wrap-up and closing questionLouise asks whether we are thinking broadly enough about older agents in MASH, using a recent study on low-dose aspirin (S5 - E11.) . Jörn and Roger each raise a practical challenge for such a trial.  After a brief digression, Roger asks his closing question: how will having a drug approved affect the conduct of trials going forward. Answers vary and present a complex picture. you'll have to listen to learn00:51:45 - Question of the WeekThe question asks for the greatest hurdle left to overcome that will improve the percent of MASH agents achieving approval and, separately, speed approval times.00:52:14 - Back-end reportThis report includes Roger's usual weekly comment on Ukraine and Israel, followed by a tribute to Stephen Harrison. This episode was recorded the day before Stephen Harrison's untimely passing. His influence on this entire podcast was massive. Three years after he ended his co-hosting stint, there are at least two references to his research, insights, or what we called "Stephenisms" during our first anniversary episode.

Earlier in this episode, the panel discusses different prescribing models for MASH drugs, triggered by Roger Green's question about whether MASH prescribing will resemble an oncology model. This conversation, from the EASL Congress 2023 wrap-up episodes, takes a very different view of the relationship between MASH and oncology.The conversation includes Jörn Schattenberg, Stephen Harrison and Roger Green. The original post has an excellent description:This conversation starts with a discussion about the importance of treating early stage cirrhosis patients. Jörn suggests that with new agents in place we may soon be looking to treat other patient populations such as, for example, those with HCC. In such instances NASH drugs will become adjuvant therapy to improve treatment against the primary disease target. Stephen agrees, noting that we will need a better test to diagnose HCC and, once available, there will be fewer presentations of advanced HCC because we will have treated more of them earlier with better agents and adjuvant therapies. Again, all this will await the approval of NASH and ideally cirrhosis drugs in the future. Roger asks how to identify the 20 to 30% of HCC patients who develop cancer before NASH. Stephen suggests it depends largely on NIT development. From there the panelists each share final thoughts around what the session has yet to cover that is important. Stephen comes up with a new idiom and Jörn speculates a new concept. Listen to the session to find out what they are.

Is brain damage detectable on MRI in patients with Havana Syndrome? Find out about this and more in today's PeerDirect Medical News Podcast.

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This conversation explores the challenges with using the current non-invasive tests (NITs) to diagnose patients with F2/F3 advanced MASH fibrosis. If tests today cannot achieve the requisite level of precision, panelists explore other ways to define patient targets. Roger Green starts by recalling that in a recent episode (Season 5 Episode 2), Jeff McIntyre suggested that in the US, the initial patient population may be as small as a few hundred thousand people. Ian Rowe states that current tools are incapable of placing these patients in a narrow diagnostic or therapeutic window. Jörn Schattenberg takes a "pragmatic" approach to defining the patient he is certain to treat; test results are a small part of his calculus. Naim Alkhouri shifts the discussion to focus on VCTE cutoff points for cirrhosis. The interplay between Naim and Ian suggests that different practices and guidelines carry with them different cutoffs. Jörn expresses gratitude that the can watch the US and learn from that experience. He notes the tension between wanting a cost-effective system and large numbers of patients clamoring for the new medicine. The need to rule some patients out is obvious, the way to do so is challenging. Asking, "What can we do besides scan" or use conventional tests, Naim discusses some newer options, starting with the metabolomics-based MASEF score discussed in Season 4 Episode 39. He also mentions the LiverFast test. Jörn describes factors that can render a test inappropriate for a particular patient. Louise suggests the right test will depend on the specific question the provider is trying to answer.

This conversation focuses more tightly on the specific challenges with the current approaches that use NITs to diagnose and stage advanced MASH fibrosis and explores several newer options and ways of thinking about the challenge.Roger Green notes that recent papers discuss the failure to predict accurately with FIB-4. He asks how we can improve predictive performance. Louise Campbell notes some specific challenges, after which Jörn Schattenberg praises John Dillon's work in automating lab detection algorithms. He also reiterates his view that repeat testing will be pivotal in good test protocols. Ian Rowe rejoins the conversation (from a faulty Internet connection) to comment that our inability to stage patients reliably will lead to government payers like NHS believing that they will need biopsy to stage patients accurately and treat them cost-effectively. Jörn says Germany will work differently and if EMA approves it, it will launch in Germany.Roger asks about new tests on the horizon and specifically whether there is sufficient improvement in diagnosis, staging or treatment. He refers specifically to MASEF and Naim Alkhouri's earlier comments about four scan vendors at his conference. Ian says there are tests that can rise to this task, but they are not produced in sufficient quantity and cost too much to become a first-line option. Naim notes that the most exciting tests are a couple of years away. Ian returns to Jörn's earlier point about the value of sequential testing vs an individual test. Louise suggests that device size will be pivotal for primary care.

Joining us for his second appearance on the show, Dr Jack Auty is a lecturer in the Medical Sciences in the School of Medicine at the University of Tasmania. Jack leads research on the intricate connections between inflammation and disease. With a diverse array of interests, ranging from the impact of microplastics on lung and gut inflammation to the potential use of common anti-inflammatories in treating Alzheimer's disease, Jack's work is at the forefront of medical research.If this is your first introduction to Dr Auty, please take time to listen to his first podcast episode with us here, as it will give you a more detailed background on his fascinating work to date. In this episode we focus in on Jack's work with AdriftLab, where he's been looking at wildlife impacted by microplastic exposure and the ability of plastic to directly induce severe, organ-wide scar tissue formation.In this episode we discuss:Jack's background and previous researchVarious hypotheses which may explain the rise in allergiesThe work of AdriftLab, led by the wonderful Dr Jennifer Lavers‘Plasticosis' – evidence for a new plastic-induced fibrotic diseaseThe types of plastics commonly found in seabirds and the global marine plastic loadPlastics, microplastics and their unique inflammatory potentialHow inflammation impacts the body and how plastic can make its way into cells throughout the bodyPotential implications of these findings for both humans and other wildlifeThe need for an interdisciplinary approach when researching pollution's impact on wildlife and human healthIdentifying laboratory sources of microplastic and nanoplastic contaminationTop tips for reducing plastic exposure in daily lifePlastics as a delivery mechanism for a wide range of toxic chemicalsFuture research projects for Jack and AdriftLabTo view all the links to the websites and documents, visit the show notes on our website. Don't forget to subscribe to this podcast, leave us a review and share this episode with your friends and family.Please support our work and enable us to deliver more content by buying us a coffee.Follow us on Instagram, Facebook, and LinkedIn.

Editor-in-Chief Sue Yom hosts Dr. Lachlan McDowell, a consultant Radiation Oncologist at the Princess Alexandra Hospital and the first author of a new paper this month, "A longitudinal study evaluating sexual health outcomes and prioritization in patients undergoing chemoradiation for human papillomavirus-associated oropharyngeal cancer," Dr. Jie Deng, Professor of Nursing, Senior Fellow at the Leonard Davis Institute of Health Economics, and Faculty Director of the Laboratory of Innovative & Translational Nursing Research at the University of Pennsylvania, and Dr. Barbara Murphy, Professor of Medicine, Hematology and Oncology Division Director, and Director of the Pain and Symptom Management Oncology Services at Vanderbilt University. Drs. Deng and Murphy were the first and last authors on a second paper this month, Longitudinal Pattern of Lymphedema and Fibrosis in Patients with Oral Cavity or Oropharyngeal Cancer: A Prospective Study.

Covid vaccines seem to be causing these clots. Found in corpses --- Send in a voice message: https://podcasters.spotify.com/pod/show/iantrottier/message Support this podcast: https://podcasters.spotify.com/pod/show/iantrottier/support

Commentary by Dr. Valentin Fuster

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Gadolinium-Associated Nephrogenic Systemic Fibrosis⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠from the Renal section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

The year 2024 is now underway. After a busy 2023, we're now looking back at some of the oncology headlines from the new year.  Notably, we have a clinical trial hold for a lung cancer drug, a trial that showed that a CAR-T cell therapy is cost-effective — though far from cheap — for lymphoma treatment, and a novel drug that's showing promise for the treatment of myelofibrosis.  FDA Places Hold on Trial Evaluating TIL Therapy in NSCLC The Food and Drug Administration placed a clinical hold on the ongoing IOV-LUN-202 trial, evaluating LN-145 TIL for patients with non-small cell lung cancer. With the clinical hold, new patients will not be able to enroll on the trial, and those who were previously treated will continue to be monitored.  The FDA placed the hold on the trial after the death of a patient. According to the FDA, the agency has the power to request that a trial be stopped, and then the sponsor — that's the organization or company running the study — can reply via a response letter addressing the concerns. The FDA then has 30 days to respond, and potentially allow for the trial to resume.  Breyanzi Cost Effective As Second-Line R/R DLBCL Treatment Research published in the journal, Blood Advances, found that the CAR-T cell therapy, Breyanzi, was found to be a promising and cost-effective treatment option for patients with relapsed or refractory diffuse large B-cell lymphoma — also known as DLBCL.  The study found that the incremental cost-effective ratio of the drug was just over $99,000 per quality-adjusted life-year from a health care perspective, and just over $68,000 from a societal perspective. Both these numbers are lower than the assumed social willingness to pay up to $100,000 per quality-adjusted life-year gained, as established by the American Society of Hematology.  While Breyanzi was deemed to be cost effective, CAR-T cell therapies are still far from inexpensive. In fact, the drug cost rose by 9% since its initial approval for DLBCL in 2022. In a CURE® Speaking Out® video series, Lee Greenberger, the chief scientific officer of the Leukemia & Lymphoma Society, expressed concern about the price of these drugs.    “Some of that the government is going to have to pay, some insurance is going to have to pay, but some of it the patients are going to have to pay as well. And the price tags are going to be significant. How are we going to manage that? Phase 2 Trial Shows Fibrosis Reduction in Some With Myelofibrosis Also in the blood cancer space, findings from the phase 2a trial found that a novel drug, GB2064, reduced fibrosis in the bone marrow, thereby slowing cancer progression in patients with myelofibrosis who were previously treated with Jakafi.  Myelofibrosis is a disease that affects the body's production of blood cells in the bone marrow. The disease causes scar tissue to grow there — a process called fibrosis. By decreasing the amount of fibrosis that occurs, GB2064 has the potential to improve outcomes. For this patient population. However, we should note that this trial was completed in only a small number of patients — 10, to be exact. Six patients had a decrease of fibrosis after receiving GB2064 for six months.   For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

Commentary by Dr. Valentin Fuster