Differential role of circulating endothelial progenitor cells in cirrhotic patients with or without hepatocellular carcinoma.

BACKGROUND AND AIMS: Circulating endothelial progenitor cells have a negative prognostic impact in patients with hepatocellular carcinoma, but may play a different role in portal hypertension according to preclinical data. Here, we address this issue for the first time in cirrhotic patients+/-hepatocellular carcinoma. METHODS: Portal hypertension in cirrhotic and hepatocellular carcinoma patients was determined by hepatic venous pressure gradient. Blood cells staining positive for CD34/KDR/AC133 using flow cytometry were characterised as endothelial progenitor cells. Vascular endothelial growth factor levels were determined by ELISA. RESULTS: Endothelial progenitor cells levels in peripheral blood were elevated in cirrhotic (n=23) (mean: 0.12+/-0.06% S.D.) and in hepatocellular carcinoma patients (n=24) (0.14+/-0.09% S.D.) relative to healthy controls (H-group, n=15) (0.06+/-0.04% S.D.) (P=0.056 and P=0.02, respectively). There were higher vascular endothelial growth factor levels in hepatocellular carcinoma patients compared to cirrhotics (P=0.047) and HC (P=0.037). Notably, hepatic venous pressure gradient was positively correlated with vascular endothelial growth factor (r=0.5, P=0.046) but negatively with endothelial progenitor cells levels (r=-0.51, P=0.02) in cirrhotics, but not hepatocellular carcinoma patients. CONCLUSION: Circulating endothelial progenitor cells are increased in patients with portal hypertension+/-hepatocellular carcinoma. The negative correlation of endothelial progenitor cells with hepatic venous pressure gradient suggests a protective role of endothelial progenitor cells in liver cirrhosis whilst vascular endothelial growth factor is associated with high hepatic venous pressure gradient. In contrast, increased endothelial progenitor cells in hepatocellular carcinoma rather reflect tumour specific endothelial progenitor cells mobilisation.

Aetiology of cirrhosis of the liver has an impact on survival predicted by the Model of End-stage Liver Disease score.

BACKGROUND: Originally, aetiology of liver disease has been incorporated into the computation of the Model of End-stage Liver Disease (MELD) score. Clinical observations prompted us to hypothesize that patients with viral and alcoholic cirrhosis may differ in predicted survival rates. Until now, no large representative studies evaluated the impact of aetiology on long-term survival predicted by the Child-Pugh and MELD scores. MATERIALS AND METHODS: Four hundred and ninety-three patients who underwent transjugular intrahepatic portosystemic shunt implantation in Vienna, Austria, and Palermo, Italy, were included in this retrospective study. The main analyses were a logistic regression model and a Cox proportional hazards regression model calculating the interaction of the aetiology with the scores. RESULTS: Both groups had similar survival rates (median 1377 and 1721 days for viral and alcoholic cirrhosis, respectively; P = 0.58), but patients with viral cirrhosis had significantly lower MELD scores (P = 0.002). In the Cox analysis, aetiology had a significant impact on the prediction of overall survival by MELD score. For 3-month survival, MELD score was adequately predictive for both groups. For 1-year survival, aetiology had a significant impact on survival, indicating that patients with identical scores but different aetiologies differed in survival rates. When stratifying patients into high- and low-risk patients (MELD < 16 vs. MELD >or= 16), aetiology of cirrhosis had no impact on the predictive value for low-risk patients; high-risk-patients (MELD >or= 16) with viral cirrhosis had significantly lower survival rates than patients with alcoholic cirrhosis and identical scores. With regard to Child-Pugh Score, no significant differences between the two patient groups and in the prediction of 3-month and 1-year survival could be observed. CONCLUSIONS: Our study suggests that aetiology of cirrhosis has an impact on 1-year survival predicted by the MELD score. This becomes more apparent in patients with advanced stage of liver disease (MELD >or= 16). Since MELD score is used for ranking patients for liver transplantation and waiting times are regularly longer than 3 months, our observations suggest that with increasing time on the waiting list and severity of disease, patients with viral cirrhosis may have a disadvantage in the current allocation policy.

[Effect of combustion devices on the quality of indoor air]. / Einfluss von Feuerstätten auf die Beschaffenheit der Innenraumluft.

Combustion devices and the equipment conducting their effluent gases such as ducts and chimneys are factors which might have an unreasonable or even dangerous impact on the quality of air inside buildings. There is a danger of flue gases entering the indoor environment during the heating process (a) if the air-circulation associated with the operation of a combustion device is disturbed or even interrupted, (b) if the air stream - as far as flue gases are involved - flows under elevated pressure, and (c) if the combustion device and the flue gas conducting equipment are not leak-proof. These three cases and their influence on indoor air quality are extensively discussed. In the German Combustion Device Code from 1980 care is taken to minimize the pollutant concentrations in rooms with combustion devices by setting special requirements for the room in which the device is located, and by prescribing the standardization of the technical characteristics of chimneys and combustion devices.