[Impact of treatment compliance in chronic hepatitis B].

The incidence rate of chronic hepatitis B remains high in China. Antiviral therapy can significantly reduce the risk of progressive liver disease and hepatocellular carcinoma in patients with chronic hepatitis B. However, all current antiviral treatments can only inhibit HBV replication and not completely eliminate the hepatitis B virus, so antiviral therapy for chronic hepatitis B is probably a long-term or even lifelong treatment. Antiviral therapy compliance is essential for achieving long-term clinical benefits and preventing nucleot(s)ide drugs resistance. Herein, we analyzed the relevant factors of antiviral therapy compliance and their impact on CHB treatment and explored feasible programs that can improve compliance with nucleot(s)ide drug treatment by conducting a literature search using PubMed and Scopus with search terms including hepatitis B, compliance, nucleot(s)ide drugs, antiviral therapy, viral suppression, and drug resistance.

[Current concerns and considerations regarding mesenchymal stem cells therapy in perplexing severe liver diseases].

Stem cells are type of cells that have unlimited self-renewal and multi-differentiation potential under specific conditions. Stem cell-based therapeutic techniques can provide new methods for the treatment of perplexing severe liver diseases. Umbilical cord mesenchymal stem cells are currently considered as ideal stem cells due to their low immunogenicity, convenient materials, abundant sources and advantage of no ethical controversy in the clinical treatment of diseases. Presently, there is a large number of basic and clinical application evidence, which suggests that mesenchymal stem cells can significantly improve the condition and outcome of end-stage liver diseases such as liver cirrhosis and liver failure, and its mechanism of action may include hepatocyte-like cells differentiation, immune function regulation, exosome secretion, etc. This paper briefly summarizes the current theories and clinical research status of mesenchymal stem cells application, as well as the therapeutic clinical trial issues and concerns that needs to be resolved during the perplexing severe liver diseases process.

Intrahepatic IFN-alpha expression in liver specimens from HBV-infected patients with different outcomes.

BACKGROUND: Interferon-alpha (IFN-α), an active cytokine, plays an important role in antiviral host responses, including protection against hepatitis B virus (HBV) infection. This study was designed to investigate the correlation between intrahepatic IFN-α expression levels and disease severity using liver biopsy specimens from HBV-infected patients with different outcomes. PATIENTS AND METHODS: Immunohistochemistry (IHC) was performed to detect intrahepatic IFN-α expression in liver biopsy specimens obtained from 69 HBV-infected patients with different outcomes (including 23 cases with chronic hepatitis B [CHB], 18 cases with severe hepatitis B [SHB], and 28 cases with liver cirrhosis [LC]). In situ hybridization (ISH) was carried out to measure the levels of HBV DNA in liver samples. In addition, the liver specimens of 33 healthy liver transplant donors without detectable liver diseases comprised a normal control (NC) group. RESULTS: The intrahepatic expression levels of IFN-α were higher in the HBV-infected patients than the NC group (p = 0.001). Intrahepatic IFN-α expression was also significantly higher in the SHB and CHB groups compared to the NC group (p = 0.001 and p = 0.001, respectively), while the intrahepatic HBV DNA levels of the SHB patients were higher than those of LC patients (p = 0.013). Furthermore, intrahepatic IFN-α expression was positively correlated with serum alanine aminotransferase (ALT) levels in CHB patients; no significant correlations were discovered between intrahepatic IFN-α expression and intrahepatic HBV DNA levels in all other sub-groups. CONCLUSIONS: Intrahepatic IFN-α expression may correlate with liver inflammation after hepatitis B virus infection, and IFN-α may play a vital role in the occurrence of SHB.

Seroprevalence of hepatitis B virus markers in individuals for physical examination in West China Hospital, China.

BACKGROUND: Hepatitis B virus (HBV) is the major cause of chronic hepatitis,cirrhosis, and hepatocellular carcinoma. The global epidemiological scenario of HBV infection has been changing rapidly over the last two decades due to an effective immunization programme initiated by the World Health Organization. The objective of this study is to estimate the prevalence of HBV in apparently adult people who were taken health examination in our Hospital. METHODS: A cross-sectional seroprevalence analysis of hepatitis B virus infection was performed in 12037 adult residents (aged > or =18 years) in Chengdu, who visited Health Examination Center of West China Hospital of Sichuan University for routine medical check-up during the period from March to December 2008. A structured medical form was used to collect data on demographic characteristics and risk factors. ELISA was used to test sera for HBV markers. Descriptive and logistic regression models were used for analysis. RESULTS: A total of 12,037 urban residents were involved. Prevalence of positive HBsAg was 6.1%, lower than the level of national seroepidemiological survey in (7.18%). Among HBsAg negative people, anti-HBs and anti-HBc was 60.2% and 13.6% respectively. There was a maximum between 18 to 29 years of age (61.8%) in anti-HBs positive people. Multivariate conditional logistic regressive analysis showed that, except for blood and vertical transmission, factors of male gender (OR, 1.876; 95% CI, 1.519-2.316; P < 0.001) and alcohol intake (OR, 0.689; 95% CI, 0.571-0.832; P < 0.001) were associated with a higher risk of positive HBsAg. CONCLUSIONS: Among the medical examination people in Chengdu, HBsAg positive rate was lower than the national general population, the epidemiological characteristics of hepatitis B has been changed, because of vacination policies to the newborn; therefore, the necessity to continue to carry on the vaccination program.

Regional body FDG-PET in postoperative recurrent hyperparathyroidism.

PURPOSE: The use of preoperative imaging studies in patients with persistent or recurrent hyperparathyroidism after initial operation is generally accepted to improve the success rate and minimize the morbidity from reoperative surgery. The purpose of this study was to define the performance of FDG-PET for the localization of hyperfunctioning parathyroid tissue prior to reoperation. METHOD: Twenty patients with biochemical evidence of recurrent or persistent hyperparathyroidism following previous neck surgery were investigated. Regional body PET imaging of the neck and upper chest (axial field of view 27.5 cm) was acquired 45 min after 5-10 mCi FDG was given intravenously. RESULTS: Subsequent surgery revealed solitary parathyroid adenomas in 14 patients, seven hyperplastic glands in 2 patients, and parathyroid carcinoma in 1 patients. FDG-PET correctly identified 79% (11/14) of the parathyroid adenomas, 29% (2/7) of the hyperplastic glands, and the parathyroid carcinoma. FDG-PET was negative in 79% (30/38) of the surgically identified normal parathyroid glands. Eight false-positive findings led to a positive predictive value of 64%. CONCLUSION: These preliminary data suggest that regional body FDG-PET is a promising procedure in the evaluation of patients with persistent or recurrent postoperative hyperparathyroidism.

Comparison of FDG-PET and sestamibi-SPECT in primary hyperparathyroidism.

UNLABELLED: Preoperative localization of hyperfunctioning parathyroid tissue in patients with primary hyperparathyroidism has been a longstanding diagnostic challenge. This study directly compared FDG-PET and sestamibi-SPECT for preoperative detection of abnormal parathyroid tissue. METHODS: Twenty-one consecutive patients with primary hyperparathyroidism were studied prospectively before surgical neck exploration. SPECT of the neck and chest was performed at 15 min and 2 hr after intravenous 99mTc-sestamibi. Regional body PET was performed 45 min after intravenous FDG. RESULTS: Surgery revealed 19 solitary parathyroid adenomas, 2 parathyroid adenomas in one patient; and 3 hyperplastic parathyroid glands in one patient, and 51 normal parathyroid glands. The diagnostic sensitivities for detection of parathyroid adenomas of 43% (9 of 21) for dual-phase sestamibi-SPECT and 86% (18 of 21) for FDG-PET were significantly different (p < 0.001). The difference in diagnostic specificities of 78% (40 of 51) for FDG-PET and 90% (46 of 51) for dual-phase sestamibi-SPECT approached statistical significance (p = 0.063). CONCLUSION: This study demonstrates that FDG-PET is more sensitive than sestamibi-SPECT in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism.

Outcome of temporal lobe epilepsy surgery predicted by statistical parametric PET imaging.

UNLABELLED: PET is useful in the presurgical evaluation of temporal lobe epilepsy. The purpose of this retrospective study is to assess the clinical use of statistical parametric imaging in predicting surgical outcome. METHODS: Interictal 18FDG-PET scans in 17 patients with surgically-treated temporal lobe epilepsy (Group A-13 seizure-free, group B = 4 not seizure-free at 6 mo) were transformed into statistical parametric imaging, with each pixel representing a z-score value by using the mean and s.d. of count distribution in each individual patient, for both visual and quantitative analysis. RESULTS: Mean z-scores were significantly more negative in anterolateral (AL) and mesial (M) regions on the operated side than the nonoperated side in group A (AL: p < 0.00005, M: p = 0.0097), but not in group B (AL: p = 0.46, M: p = 0.08). Statistical parametric imaging correctly lateralized 16 out of 17 patients. Only the AL region, however, was significant in predicting surgical outcome (F = 29.03, p < 0.00005). Using a cut-off z-score value of -1.5, statistical parametric imaging correctly classified 92% of temporal lobes from group A and 88% of those from Group B. CONCLUSION: The preliminary results indicate that statistical parametric imaging provides both clinically useful information for lateralization in temporal lobe epilepsy and a reliable predictive indicator of clinical outcome following surgical treatment.

Malignant pheochromocytoma of the anterior mediastinum: PET findings with [18F]FDG and 82Rb.

A case of a malignant pheochromocytoma arising from the anterior mediastinum is presented. We report the use of positron emission tomography with 82Rb and [18F]fluorodeoxyglucose to successfully image this neoplasm.

Primary hyperparathyroidism: preoperative parathyroid imaging with regional body FDG PET.

PURPOSE: To explore the feasibility of use of positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) to localize abnormal parathyroid tissue. MATERIALS AND METHODS: Regional body FDG PET with attenuation correction was performed in 17 adult patients with primary hyperparathyroidism (HPT) prior to surgical neck exploration. The regional body FDG PET results were correlated with surgical and histopathologic findings. RESULTS: Surgical neck exploration revealed 18 parathyroid adenomas in 16 patients and four hyperplastic parathyroid glands in one patient. Regional body FDG PET allowed correct localization of 17 of the 18 parathyroid adenomas (94% sensitivity) and two of the four hyperplastic parathyroid glands (50% sensitivity). Three false-positive FDG PET findings were encountered, including two follicular thyroid adenomas. CONCLUSION: Regional body FDG PET is a promising procedure for preoperative localization of pathologic parathyroid tissue in patients with primary HPT.

Parathyroid adenoma localization by PET FDG.

A patient with primary hyperparathyroidism was examined with positron emission tomography using [18F]-2-fluorodeoxyglucose. The radioactive tracer accumulated in a cervical mass that proved to be a parathyroid adenoma resulting in the correct preoperative localization of the parathyroid tumor.