The relationship between attachment needs, earned secure therapeutic attachment and outcome in adult psychotherapy.

OBJECTIVE: The aim of this study was to investigate a sequence of associations between clients' pretreatment attachment style, the development of individuated-secure attachment to the therapist (i.e., therapeutic attachment), and the experience of increased comfort with emotional closeness (growing engagement) or independence (growing autonomy) in therapy. Moreover, the study explored whether clients' experience of growing engagement or growing autonomy was associated with a change in interpersonal problems at the end of therapy. METHOD: Three hundred thirty adult clients (mean age 40.2, 75% female) were seen by 44 therapists in individual psychotherapy. The associations between pretreatment attachment insecurity measured on the Experiences in Close Relationships scale, repeated measures of therapeutic attachment measured on the Client Attachment to Therapist Scale, repeated measures of a growing engagement or growing autonomy measured on the Therapeutic Distance Scale, and pre-post measures of interpersonal problems measured on the Inventory for Interpersonal Problems were analyzed using multilevel modeling. Two types of therapeutic attachment were estimated, one controlling for anxious attachment characteristics and one for avoidant. RESULTS: Significant associations between higher levels of therapeutic attachment controlled for avoidant attachment characteristics and lower levels of growing autonomy in therapy were found. Moreover, higher levels of growing engagement in therapy and higher levels of therapeutic attachment controlled for anxious attachment characteristics were associated with a decrease in interpersonal problems at the end of therapy. CONCLUSIONS: Distinct types of therapeutic attachment may exert different influences on the process and outcome of therapy. Furthermore, therapists' attunement to clients' specific attachment needs in therapy may enhance interpersonal outcomes of treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Therapists' Perceptions of Individual Patient Characteristics that May Be Hindering to Group CBT for Anxiety and Depression.

Objective: Individual patient characteristics are important in trying to understand why people respond differently to group CBT. Only a few studies have explored therapists' perceptions of within-patient attributes that may be hindering in group CBT in a mental health setting. Method: We explored the perception of individual patient characteristics and related obstacles in 12 psychotherapists in Danish Mental Health Services through semi-structured interviews. The interviews were analyzed using a descriptive qualitative framework. Results: The results revealed four distinct themes that the therapists pointed to as important for the outcome of a 14-week group CBT intervention for social phobia, panic disorder, agoraphobia and major depressive disorder. The four themes were Complexity & severity, External circumstances, Attitudes & coping and Cognitive ability & reflection level. The therapists explained how they perceived higher complexity and severity in the patients as an obstacle, they highlighted that a calm and stable outside environment aided therapeutic change, whilst stressors were hindering. They perceived active coping mechanisms, positive attitudes and high readiness to change as positive factors, whilst dependent and hostile coping mechanisms and negative attitudes were seen as obstacles. Finally, the therapists pointed to cognitive abilities and reflection level, explaining how it could be difficult to obtain good outcomes for patients who's cognitive abilities were debilitated due to psychopathological factors or for patients with a generally low reflection level. Conclusions: The results indicated that the therapists experience group CBT as an intervention that requires certain prerequisites of the patients, and that the four themes should be considered when deciding on treatment options for any given patient. The clinical utility and theoretical implications of the results are discussed.

A clinical case of tuberculosis with transient constrictive pericarditis and perimyocarditis.

Tuberculous pericarditis is a rare diagnosis seen among as few as 1% of tuberculosis (TB) patients in developed countries. We present a case of a 60-year-old male suffering from a transient constrictive pericarditis and subclinical involvement of the myocardium in a clinical case of tuberculous pericarditis with corresponding improvement after the initiation of anti-tuberculous treatment. We suggest monitoring of myocardial function using global longitudinal strain by myocardial speckle tracking strain analysis as supplement to routine left ventricular ejection fraction to assess clinical improvement in patients at risk of developing constrictive pericarditis. LEARNING POINTS: Tuberculous pericarditis is rare and a diagnostic challenge in low-incidence countries.Patients with tuberculosis and involvement of the heart are at high risk of developing constrictive pericarditis.Novel imaging techniques, such as estimation of global longitudinal strain using myocardial speckle tracking analysis, may be useful in assessing cardiac involvement in tuberculosis patients.

Pre-treatment microbial Prevotella-to-Bacteroides ratio, determines body fat loss success during a 6-month randomized controlled diet intervention.

This corrects the article DOI: 10.1038/ijo.2017.220.

Toxicity and efficacy of lomustine and bevacizumab in recurrent glioblastoma patients.

The combination of lomustine and bevacizumab is a commonly used salvage treatment for recurrent glioblastoma (GBM). We investigated the toxicity and efficacy of lomustine plus bevacizumab (lom-bev) in a community-based patient cohort and made a comparison to another frequently used combination therapy consisting of irinotecan plus bevacizumab (iri-bev). Seventy patients with recurrent GBM were treated with lomustine 90 mg/m2 every 6 weeks and bevacizumab 10 mg/kg every 2 weeks. Toxicity was registered and compared to the toxicity observed in 219 recurrent GBM patients who had previously been treated with irinotecan 125 mg/m2 and bevacizumab 10 mg/kg every 2 weeks. The response rate was 37.1% for lom-bev and 30.1% for iri-bev. Median progression-free survival (PFS) was 23 weeks for lom-bev and 21 weeks for iri-bev (p = 0.9). Overall survival (OS) was 37 weeks for lom-bev and 32 weeks for iri-bev (p = 0.5). Lom-bev caused a significantly higher frequency of thrombocytopenia (11.4% grade 3-4) compared to iri-bev (3.5% grade 3-4). Iri-bev patients had more gastrointestinal toxicity with regard to nausea, vomiting, diarrhea, constipation and stomatitis. Within the limitations of the study lom-bev is a well-tolerated treatment for recurrent GBM, although hematological toxicity may be a dose limiting factor. No significant differences between lom-bev and iri-bev were observed with regard to PFS or OS. The differences in toxicity profiles between lom-bev and iri-bev could guide treatment decision in recurrent GBM therapy as efficacy is equal and no predictive factors for efficacy exist.

Pre-treatment microbial Prevotella-to-Bacteroides ratio, determines body fat loss success during a 6-month randomized controlled diet intervention.

On the basis of the abundance of specific bacterial genera, the human gut microbiota can be divided into two relatively stable groups that might have a role in personalized nutrition. We studied these simplified enterotypes as prognostic markers for successful body fat loss on two different diets. A total of 62 participants with increased waist circumference were randomly assigned to receive an ad libitum New Nordic Diet (NND) high in fiber/whole grain or an Average Danish Diet for 26 weeks. Participants were grouped into two discrete enterotypes by their relative abundance of Prevotella spp. divided by Bacteroides spp. (P/B ratio) obtained by quantitative PCR analysis. Modifications of dietary effects of pre-treatment P/B group were examined by linear mixed models. Among individuals with high P/B the NND resulted in a 3.15 kg (95% confidence interval (CI): 1.55; 4.76, P<0.001) larger body fat loss compared with ADD, whereas no differences was observed among individuals with low P/B (0.88 kg (95% CI: -0.61; 2.37, P=0.25)). Consequently, a 2.27 kg (95% CI: 0.09; 4.45, P=0.041) difference in responsiveness to the diets were found between the two groups. In summary, subjects with high P/B ratio appeared more susceptible to lose body fat on diets high in fiber and whole grain than subjects with a low P/B ratio.

Clopidogrel-Paclitaxel Drug-Drug Interaction: A Pharmacoepidemiologic Study.

Paclitaxel is mainly eliminated by CYP2C8 in the liver. CYP2C8 is strongly inhibited by the clopidogrel metabolite acyl-ß-D-glucuronide. To determine if this interaction has clinical relevance, we identified 48 patients treated with clopidogrel and paclitaxel using databases and a prescription register. Peripheral sensory neuropathy was retrospectively evaluated from medical charts and compared to that of 88 age- and sex-matched controls treated with paclitaxel and low-dose aspirin. By a cumulative dose of 1,500 mg paclitaxel, 35% of the patients had developed severe neuropathy. The overall hazard ratio between clopidogrel use and severe paclitaxel neuropathy was 1.7 (95% confidence interval, 0.9-3.0). Among those receiving a high-dose paclitaxel regimen, the hazard ratio was 2.3 (95% confidence interval, 1.1-4.5). Our study indicates that clopidogrel is associated with a clinically relevant increased risk of neuropathy in patients treated with high-dose paclitaxel.

Habitual dietary phosphorus intake and urinary excretion in chronic kidney disease patients: a 3-day observational study.

Hyperphosphatemia in chronic kidney disease (CKD) is associated with vascular calcification, cardiovascular morbidity and mortality. The aim of this study was to estimate the daily dietary phosphorus intake compared with recommendations in CKD patients and to evaluate the reproducibility of the 24-h urinary phosphorus excretion. Twenty CKD patients stage 3-4 from the outpatient clinic, collected 24-h urine and kept dietary records for 3 consecutive days. The mean daily phosphorus intake was 1367±499, 1642±815 and 1426±706 mg/day, respectively (P=0.57). The mean urinary phosphorus excretion was 914±465, 954±414 and 994±479 mg/day, respectively (P=0.21). In this population of CKD patients stage 3-4 the daily phosphorus intake was above the recommended. Twenty-four-hour urinary phosphorus excretion was reproducible and the data indicate that a single 24-h urine collection is sufficient to estimate the individual phosphorus excretion.

Myocardial oedema in acute myocarditis detected by echocardiographic 2D myocardial deformation analysis.

AIMS: The clinical diagnosis of acute myocarditis is based on symptoms, electrocardiography, elevated myocardial necrosis biomarkers, and echocardiography. Often, conventional echocardiography reveals no obvious changes in global cardiac function and therefore has limited diagnostic value. Myocardial deformation imaging by echocardiography is an evolving method used to characterize quantitatively longitudinal systolic function, which may be affected in acute myocarditis. The aim of our study was to assess the utility of echocardiographic deformation imaging of the left ventricle in patients with diagnosed acute myocarditis in whom cardiovascular magnetic resonance (CMR) evaluation was performed. METHODS AND RESULTS: We included 28 consecutive patients (mean age 32 ± 13 years) with CMR-verified diagnosis of acute myocarditis according to the Lake Louise criteria. Cardiac function was evaluated by a comprehensive assessment of left ventricular (LV) function, including 2D speckle-tracking echocardiography. We found no significant correlation between the peak values of cardiac enzymes and the amount of myocardial oedema assessed by CMR (troponin: r= 0.3; P = 0.05 and CK-MB: r = 0.1; P = 0.3). We found a larger amount of myocardial oedema in the basal part of the left ventricle [American Heart Association (AHA) segments 1-6] in inferolateral and inferior segments, compared with the anterior, anterolateral, anteroseptal, and inferoseptal segments. In the mid LV segments (AHA segments 7-12), this was more pronounced in the anterior, anterolateral, and inferolateral segments. Among conventional echocardiographic parameters, LV function was not found to correlate with the amount of myocardial oedema of the left ventricle. In contrast, we found the wall motion score index to be significantly correlated with the amount of myocardial oedema, but this correlation was only present in patients with an extensive amount of oedema (>11% of the total left ventricle). Global longitudinal systolic myocardial strain correlated significantly with the amount of oedema (r = 0.65; P < 0.001). We found that both the epicardial longitudinal and the endocardial longitudinal systolic strains were significantly correlated with oedema (r = 0.55; P = 0.003 and r = 0.54; P < 0.001). CONCLUSION: In patients with acute myocarditis, 2D speckle-tracking echocardiography was a useful tool in the diagnostic process of acute myocarditis. Global longitudinal strain adds important information that can support clinical and conventional echocardiographic evaluation, especially in patients with preserved LV ejection fraction in relation to the diagnosis and degree of myocardial dysfunction.

Histone deacetylase 3 inhibition improves glycaemia and insulin secretion in obese diabetic rats.

Failure of pancreatic ß cells to compensate for insulin resistance is a prerequisite for the development of type 2 diabetes. Sustained elevated circulating levels of free fatty acids and glucose contribute to ß-cell failure. Selective inhibition of histone deacetylase (HDAC)-3 protects pancreatic ß cells against inflammatory and metabolic insults in vitro. In the present study, we tested the ability of a selective HDAC3 inhibitor, BRD3308, to reduce hyperglycaemia and increase insulin secretion in a rat model of type 2 diabetes. At diabetes onset, an ambulatory hyperglycaemic clamp was performed. HDAC3 inhibition improved hyperglycaemia over the study period without affecting weight gain. At the end of the hyperglycaemic clamp, circulating insulin levels were significantly higher in BRD3308-treated rats. Pancreatic insulin staining and contents were also significantly higher. These findings highlight HDAC3 as a key therapeutic target for ß-cell protection in type 2 diabetes.

TL1A regulates TCRγδ+ intraepithelial lymphocytes and gut microbial composition.

TL1A is a proinflammatory cytokine, which is prevalent in the gut. High TL1A concentrations are present in patients with inflammatory bowel disease (IBD) and in IBD mouse models. However, the role of TL1A during steady-state conditions is relatively unknown. Here, we used TL1A knockout (KO) mice to analyse the impact of TL1A on the intestinal immune system and gut microbiota. The TL1A KO mice showed reduced amounts of small intestinal intraepithelial TCRγδ(+) and CD8(+) T cells, and reduced expression of the activating receptor NKG2D. Moreover, the TL1A KO mice had significantly reduced body weight and visceral adipose tissue deposits, as well as lower levels of leptin and CXCL1, compared with wild-type mice. Analysis of the gut microbial composition of TL1A KO mice revealed a reduction of caecal Clostridial cluster IV, a change in the Firmicutes/Bacteroidetes ratio in caecum and less Lactobacillus spp. in the mucosal ileum. Our results show that TL1A deficiency impacts on the gut microbial composition and the mucosal immune system, especially the intraepithelial TCRγδ(+) T-cell subset, and that TL1A is involved in the establishment of adipose tissue. This research contributes to a broader understanding of TL1A inhibition, which is increasingly considered for treatment of IBD.

Calcium-dependent behavioural responses to acute copper exposure in Oncorhynchus mykiss.

Using rainbow trout Oncorhynchus mykiss, the present study demonstrated that: (1) calcium (Ca) increased the range of copper (Cu) concentrations that O. mykiss avoided; (2) Ca conserved the maintenance of pre-exposure swimming activity during inescapable acute (10 min) Cu exposure. Data showed that when presented with a choice of Cu-contaminated water (ranging from 0 to 454 µg Cu l⁻¹ ) and uncontaminated water in a choice tank, O. mykiss acclimated and tested at low Ca concentration (3 mg Ca l⁻¹ avoided the 10 µg Cu l⁻¹ only. By contrast, O. mykiss acclimated and tested at high Ca concentration (158 mg Ca l⁻¹) avoided all the Cu concentrations ≥37 µg⁻¹. The Cu avoidance was connected with increased spontaneous swimming speed in the Cu-contaminated water. When subjected to inescapable Cu exposure (35 µg Cu l⁻¹), O. mykiss acclimated and tested at low Ca concentration reduced their spontaneous swimming speed, whereas no response was observed in O. mykiss acclimated and tested at high Ca concentration. Collectively, the data support the conclusion that in O. mykiss the behavioural responses to acute Cu exposure are Ca-dependent.

Immune responses to hair dyes containing toluene-2,5-diamine.

BACKGROUND: Toluene-2,5-diamine (PTD) is the most frequently used dye in oxidative hair dyes on the Scandinavian market. However, little is known about immune responses to PTD-containing oxidative hair dyes. OBJECTIVES: To study immune responses induced by PTD-containing hair dyes in mice. METHODS: Immune responses against two different permanent hair dye products containing 1·60% (w/w) and 0·48% (w/w) PTD within the colour gel, and various concentrations of pure PTD were studied. The local inflammatory response was measured by ear swelling and cell infiltration, and T- and B-cell infiltration and proliferation was determined in the draining lymph nodes. RESULTS: Concentration-dependent immune responses were seen to PTD both in the skin and draining lymph nodes. The hair dye containing 1·60% PTD induced strong local inflammation and caused T- and B-cell infiltration and proliferation as well as an increased number of regulatory T cells in the draining lymph nodes. In contrast, the hair dye containing 0·48% PTD induced skin inflammation but only minor responses in the draining lymph nodes. CONCLUSIONS: Consumer-available PTD-containing permanent hair dyes can be potent immune activators inducing both pro- and anti-inflammatory responses. The outcome of the response is dependent on allergen dose, amount of additional allergens and exposure regime.

Pilot study of minimally invasive cast adhesive copings for early restoration of hypomineralised first permanent molars with post-eruptive breakdown.

BACKGROUND: Severely hypomineralised first permanent molars (FPMs) in children with molar incisor hypomineralisation (MIH) often require comprehensive restorative treatment. Different types of treatment have been described in the literature, including conservative treatment and use of various types of crowns. AIM: To describe a gentle and minimally invasive method for restoration of severely hypomineralised FPMs and to perform an initial, practice-based evaluation of the outcome for up to a 10-year follow-up period. METHODS: Thirty-three children (mean age 12.1 years, SD 2.6) were treated with 57 minimally invasive cast adhesive gold copings (CAC). Sedation, local analgesia using a computer-controlled injection device, and behaviour management techniques were used to secure gentle care of the child. In cases with need for treatment of several teeth, the teeth not under treatment were covered by splints. The preparation border was placed in sound enamel, allowing 1/2-2 mm space to secure sufficient strength of the final restoration, which was cemented with dual composite cement. Follow-up examinations were performed by the dentists referring the children. RESULTS: All the children referred for treatment could be treated using this procedure, and of the 57 CAC, 56 (98.2 %) were still functioning after a mean observation period of 38.6 months (SD 28.9). CONCLUSION: In addition to existing types of treatment, minimally invasive CAC seems to be a feasible and useful method for restoration of FPMs with demarcated opacities and post-eruptive surface loss in children with MIH.

Glucose metabolism is altered after loss of L cells and α-cells but not influenced by loss of K cells.

The enteroendocrine K and L cells are responsible for secretion of glucose-dependent insulinotropic polypeptide (GIP) and glucagon like-peptide 1 (GLP-1), whereas pancreatic α-cells are responsible for secretion of glucagon. In rodents and humans, dysregulation of the secretion of GIP, GLP-1, and glucagon is associated with impaired regulation of metabolism. This study evaluates the consequences of acute removal of Gip- or Gcg-expressing cells on glucose metabolism. Generation of the two diphtheria toxin receptor cellular knockout mice, TgN(GIP.DTR) and TgN(GCG.DTR), allowed us to study effects of acute ablation of K and L cells and α-cells. Diphtheria toxin administration reduced the expression of Gip and content of GIP in the proximal jejunum in TgN(GIP.DTR) and expression of Gcg and content of proglucagon-derived peptides in both proximal jejunum and terminal ileum as well as content of glucagon in pancreas in TgN(GCG.DTR) compared with wild-type mice. GIP response to oral glucose was attenuated following K cell loss, but oral and intraperitoneal glucose tolerances were unaffected. Intraperitoneal glucose tolerance was impaired following combined L cell and α-cell loss and normal following α-cell loss. Oral glucose tolerance was improved following L cell and α-cell loss and supernormal following α-cell loss. We present two mouse models that allow studies of the effects of K cell or L cell and α-cell loss as well as isolated α-cell loss. Our findings show that intraperitoneal glucose tolerance is dependent on an intact L cell mass and underscore the diabetogenic effects of α-cell signaling. Furthermore, the results suggest that K cells are less involved in acute regulation of mouse glucose metabolism than L cells and α-cells.

Periapical and endodontic status of permanent teeth in patients with hypophosphatemic rickets.

Hypophosphatemic rickets (HR) is a rare hereditary disease in which dental problems in terms of spontaneous periapical infections are frequently reported. Most previous reports have been based on a small number of HR patients and have been published before the disease could be confirmed genetically. The aim of the present study was to describe the periapical and endodontic status of permanent teeth in patients with genetically and/or biochemically confirmed HR. The patients were recruited from a medical study on HR patients. The patients underwent a dental examination including a digital panoramic radiograph, which was scored for endodontically affected teeth (i.e. teeth with periapical radiolucencies and/or endodontically treated teeth). A total of 52 patients (age range: 5·7-74·5 years; 17 males and 35 females) were included. HR patients were characterised by a high number of endodontically affected teeth (mean: 4·2; s.d.: 5·0). The number of affected teeth rose significantly with age (P < 0·01), and no statistically significant gender difference was found. The relative distribution of endodontically affected teeth in the three tooth groups (incisors and canines, premolars, and molars) varied according to age. In the youngest age group, only incisors and canines were affected, while the relative proportion of affected premolars and molars increased with age. Endodontically affected teeth are common in HR patients, and the number of affected teeth increased significantly with age. Hence, the need for endodontic treatment among HR patients is comprehensive.

Behaviour of rainbow trout Oncorhynchus mykiss presented with a choice of normoxia and stepwise progressive hypoxia.

The objective of this study was to identify behavioural adjustments leading to avoidance of hypoxia. Using the oxygen-sensitive species rainbow trout Oncorhynchus mykiss as a model, individual fish were recorded while moving freely between two sides of a test arena: one with normoxia and one with stepwise progressive hypoxia [80-30% dissolved oxygen (DO) air saturation]. The results demonstrated a gradual decrease in the total time spent in hypoxia starting at 80% DO air saturation. At this DO level, the avoidance of hypoxia could not be attributed to changes in spontaneous swimming speed, neither in normoxia nor in hypoxia. Reducing the DO level to 60% air saturation resulted in decreased spontaneous swimming speed in normoxia, yet the number of trips to the hypoxic side of the test arena remained unchanged. Moreover, data revealed increased average residence time per trip in normoxia at DO levels ≤60% air saturation and decreased average residence time per trip in hypoxia at DO levels ≤50% air saturation. Finally, the spontaneous swimming speed in hypoxia increased at DO levels ≤40% air saturation and the number of trips to hypoxia decreased at the 30% DO air saturation level. Thus, avoidance of the deepest hypoxia was connected with a reduced number of trips to hypoxia as well as decreased and increased spontaneous swimming speed in normoxia and hypoxia, respectively. Collectively, the data support the conclusions that the mechanistic basis for avoidance of hypoxia may (1) not involve changes in swimming speed during mild hypoxia and (2) depend on the severity of hypoxia.

Short communication: Effects of dietary nitrogen concentration on messenger RNA expression and protein abundance of urea transporter-B and aquaporins in ruminal papillae from lactating Holstein cows.

To test the hypothesis that dietary N concentrations affect gut epithelial urea transport by modifying the expression of urea transporter B (UT-B) and aquaporins (AQP), the mRNA expression and protein abundance of UT-B and AQP3, AQP7, AQP8, and AQP10 were investigated in ruminal papillae from 9 lactating dairy cows. Ruminal papillae were harvested from cows fed low N (12.9% crude protein) and high N (17.1% crude protein) diets in a crossover design with 21-d periods. The mRNA expression was determined by real-time reverse transcription-PCR and protein abundance by immunoblotting. The mRNA expression of UT-B was not affected by dietary treatment, whereas mRNA expression of AQP3, 7, and 10 were greater in the high N compared with the low N fed cows. Using peptide-derived rabbit antibodies to cow AQP3, 7, and 8, immunoblotting revealed bands of approximately 27, 27, and 24 kDa in ruminal papillae, respectively. A peptide-derived chicken antibody to cow UT-B detected a band of approximately 30 to 32 kDa in ruminal papillae. The abundance of UT-B and AQP3 and 7 were not affected by dietary treatment. In contrast, the abundance of AQP8 was greater in high N compared with low N diets. In conclusion, AQP3, 7, and 8 were found to be expressed in bovine rumen papillae. None of the investigated transcripts or proteins correlated to the increased rumen epithelial urea permeability observed with low dietary N concentration.

Haptocorrin as marker of disease progression in fibrolamellar hepatocellular carcinoma.

AIMS: No valid markers are routinely available to follow disease progression in patients with fibrolamellar hepatocellular carcinoma (FLHCC). We report data suggesting that the vitamin B12 binding protein haptocorrin (HC) may prove a suitable marker. METHODS: We monitored a 15-year-old boy diagnosed to have FLHCC by measuring the common markers alanine aminotransaminase, alkaline phosphatase, lactate dehydrogenase, and bilirubin, as well as vitamin B12 (B12), and the forms of the B12 binding proteins. Tumour biopsies were examined immunohistologically. DNA and RNA were extracted from tumour and normal tissue and examined for content of HC DNA and mRNA. RESULTS: The only markers indicative of disease progression were HC and (B12), levels of which were markedly elevated to 84 (11) nmol/L at the time of diagnosis and returned to values within the reference interval (0.43 (0.33) nmol/L) after an apparently radical removal of the tumour. The disappearance rate of HC followed a biphasic curve, the unsaturated protein displaying a half-life of 2.8 days and B12 and saturated HC one of 13 days. Before each diagnosed relapse, an increased concentration of HC was observed. We found a strong immunoreaction against HC in tumour tissue and a high mRNA expression of HC supporting the notion that HC was tumour derived. CONCLUSIONS: Plasma HC proved to be a useful tumour marker in a patient with FLHCC, and we suggest the use of this protein as a marker of disease progression in these patients.