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2.
Zhonghua Yi Xue Za Zhi ; 99(40): 3132-3138, 2019 Oct 29.
Artigo em Chinês | MEDLINE | ID: mdl-31694103

RESUMO

Objective: To investigate the correlation between serum bilirubin and cardiovascular autonomic neuropathy (CAN) in type 2 diabetes mellitus patients. Methods: A total of 369 patients with type 2 diabetes mellitus who were hospitalized at the Department of Endocrinology, Nanjing Jinling Hospital from April 2017 to October 2018 were enrolled, including 226 males and 143 females, with an average age of (54.6±12.1) years. According to cardiovascular reflex tests (CARTs), all the patients were divided into Non CAN group(149 patients without CAN) and CAN group (220 patients complicated with CAN). The difference of serum bilirubin levels between the two groups was compared. The differences of CARTs and the incidence of CAN were compared by tertiles of serum bilirubin levels. The binary logistic regression was used to analyze the risk factors for diabetic cardiovascular autonomic neuropathy. Results: The serum total bilirubin [(9.28±2.74) µmol/L vs (11.08±2.98) µmol/L, P<0.001], direct bilirubin [(3.17±1.20) µmol/L vs (3.71±1.24) µmol/L, P<0.001] and indirect bilirubin levels [(6.11±1.89) µmol/L vs (7.37±2.10) µmol/L, P<0.001] in CAN group were significantly lower than that in Non CAN group. With the increase of serum bilirubin, the incidence of CAN decreased (P<0.01). Multivariate Logistic regression analysis showed that serum total bilirubin (OR=0.819, 95%CI: 0.744-0.901, P<0.001), direct bilirubin (OR=0.739, 95%CI: 0.601-0.908, P=0.004) and indirect bilirubin (OR=0.749, 95%CI: 0.653-0.860, P<0.001) were inversely correlated with the incidence of CAN. Conclusions: Within the physiological range, lower level of serum bilirubin is inversely correlated with the incidence of CAN. It is noteworthy to screen diabetic cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus who had a lower serum bilirubin level.


Assuntos
Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Adulto , Idoso , Bilirrubina , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Fatores de Risco
3.
Medicine (Baltimore) ; 98(39): e17305, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574858

RESUMO

Until now, the recognition of sodium taurocholate cotransporting polypeptide (NTCP) deficiency has been mainly based on sporadic case reports. It was previously believed to be mildly symptomatic and resulting in mild liver dysfunction. However, to our knowledge, there have been no reports about the histopathologic and ultrastructural pathologic characteristics of the disease. The aim of the study was to analyze the clinical, histopathologic and ultrastructural pathologic characteristics of NTCP deficiency in 13 pediatric patients.From August 2012 to October 2018, this retrospective study conducted in the Department of Pediatrics of Tongji Hospital, China analyzed the data of 13 NTCP deficient patients with an SLC10A1 gene mutation. Except for NTCP deficiency, no other liver diseases were present in the patients, which was determined by both a genetic testing panel for jaundice and by reviewing medical records. The laboratory results, imaging, histopathologic, and ultrastructural pathologic information were recorded for analysis.The serum level of total bile acid was high in all 13 patients. All patients had adequate growth and development. Eight of the patients (8/13) presented with visible jaundice and 12 (12/13) were found to have hyperbilirubinemia. A needle liver biopsy was performed in 11 cases, which revealed slightly chronic inflammation in all 11 patients. One of the patients (1/13) was found to be suffering from gallstones.The data showed that although NTCP deficiency was often asymptomatic, some of the patients showed obvious clinical expressions, such as jaundice. Among the 13 pediatric patients with NTCP deficiency, both the biochemical and histopathologic features were similar to those of mild hepatocellular jaundice. In addition, it was determined that the clinical features in the patient with gallstones may have been caused by NTCP deficiency.


Assuntos
Ácidos e Sais Biliares/sangue , Icterícia , Hepatopatias , Fígado , Transportadores de Ânions Orgânicos Dependentes de Sódio , Simportadores , Desenvolvimento Infantil , Pré-Escolar , China/epidemiologia , Testes Genéticos/métodos , Humanos , Biópsia Guiada por Imagem/métodos , Lactente , Icterícia/diagnóstico , Icterícia/etiologia , Fígado/metabolismo , Fígado/patologia , Hepatopatias/diagnóstico , Hepatopatias/genética , Hepatopatias/fisiopatologia , Hepatopatias/terapia , Testes de Função Hepática/métodos , Glicoproteínas de Membrana/metabolismo , Mutação , Transportadores de Ânions Orgânicos Dependentes de Sódio/deficiência , Transportadores de Ânions Orgânicos Dependentes de Sódio/genética , Pediatria/métodos , Estudos Retrospectivos , Simportadores/deficiência , Simportadores/genética
4.
N Engl J Med ; 381(14): 1333-1346, 2019 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-31577875

RESUMO

BACKGROUND: The safety, efficacy, and appropriate timing of isoniazid therapy to prevent tuberculosis in pregnant women with human immunodeficiency virus (HIV) infection who are receiving antiretroviral therapy are unknown. METHODS: In this multicenter, double-blind, placebo-controlled, noninferiority trial, we randomly assigned pregnant women with HIV infection to receive isoniazid preventive therapy for 28 weeks, initiated either during pregnancy (immediate group) or at week 12 after delivery (deferred group). Mothers and infants were followed through week 48 after delivery. The primary outcome was a composite of treatment-related maternal adverse events of grade 3 or higher or permanent discontinuation of the trial regimen because of toxic effects. The noninferiority margin was an upper boundary of the 95% confidence interval for the between-group difference in the rate of the primary outcome of less than 5 events per 100 person-years. RESULTS: A total of 956 women were enrolled. A primary outcome event occurred in 72 of 477 women (15.1%) in the immediate group and in 73 of 479 (15.2%) in the deferred group (incidence rate, 15.03 and 14.93 events per 100 person-years, respectively; rate difference, 0.10; 95% confidence interval [CI], -4.77 to 4.98, which met the criterion for noninferiority). Two women in the immediate group and 4 women in the deferred group died (incidence rate, 0.40 and 0.78 per 100 person-years, respectively; rate difference, -0.39; 95% CI, -1.33 to 0.56); all deaths occurred during the postpartum period, and 4 were from liver failure (2 of the women who died from liver failure had received isoniazid [1 in each group]). Tuberculosis developed in 6 women (3 in each group); the incidence rate was 0.60 per 100 person-years in the immediate group and 0.59 per 100 person-years in the deferred group (rate difference, 0.01; 95% CI, -0.94 to 0.96). There was a higher incidence in the immediate group than in the deferred group of an event included in the composite adverse pregnancy outcome (stillbirth or spontaneous abortion, low birth weight in an infant, preterm delivery, or congenital anomalies in an infant) (23.6% vs. 17.0%; difference, 6.7 percentage points; 95% CI, 0.8 to 11.9). CONCLUSIONS: The risks associated with initiation of isoniazid preventive therapy during pregnancy appeared to be greater than those associated with initiation of therapy during the postpartum period. (Funded by the National Institutes of Health; IMPAACT P1078 TB APPRISE ClinicalTrials.gov number, NCT01494038.).


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Isoniazida/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Resultado da Gravidez , Tuberculose/prevenção & controle , Adolescente , Adulto , Antituberculosos/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Isoniazida/efeitos adversos , Testes de Função Hepática , Período Pós-Parto , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Adulto Jovem
5.
Medicine (Baltimore) ; 98(43): e17664, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651893

RESUMO

RATIONALE: Atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD), atherosclerotic stroke and peripheral vascular disease, has become the most deadly chronic noncommunicable disease throughout the world in recent decades, while plaque regression could reduce the occurrence of ASCVD. Traditional Chinese Medicine (TCM) has been widely used for prevention and treatment of these diseases. In the perspective of TCM, phlegm and blood stasis are considered to be leading pathogenesis for CHD. Hence, activating blood circulation and dissipating phlegm, which is of great benefit to regress plaque, have been regarded as general principles in treatment. PATIENT CONCERNS: A 36-year-old man presented with a 3-month history of intermittent exertional chest pain. Coronary angiography revealed 60% stenosis of the proximal left anterior descending coronary artery. Liver function showed: alanine transaminase (ALT):627U/L, aspartate transaminase (AST):243U/L. DIAGNOSES: CHD and hepatitis B with severe liver dysfunction. INTERVENTIONS: The patient should have been treated with high-intensity statin therapy. Actually, due to severe liver dysfunction, Huazhirougan granule instead of statins was administered. In addition, he was treated with TCM according to syndrome differentiation for two and a half years. OUTCOMES: The chest pain disappeared and other symptoms alleviated as well after treatment. Coronary computed tomographic angiography revealed no stenosis in the proximal left anterior descending coronary artery. ALT and AST level returned to normal (ALT:45U/L,AST:24U/L). LESSONS: For patients with CHD and severe hepatic dysfunction, antilipidemic drugs such as statins are not recommended. This case suggested that TCM might fill a gap in lipid-lowering therapy. Thus, we could see that statins were not the only drug for plaque regression and the effect of TCM in treating coronary artery disease cannot be ignored.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/tratamento farmacológico , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Medicina Tradicional Chinesa , Adulto , Diagnóstico Diferencial , Humanos , Testes de Função Hepática , Masculino
6.
JAMA ; 322(10): 936-945, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503307

RESUMO

Importance: Methotrexate and mycophenolate mofetil are commonly used immunomodulatory therapies for achieving corticosteroid-sparing control of noninfectious uveitis, but there is uncertainty about which drug is more effective. Objective: To compare the effect of methotrexate and mycophenolate for achieving corticosteroid-sparing control of noninfectious intermediate uveitis, posterior uveitis, and panuveitis. Design, Setting, and Participants: The First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial screened 265 adults with noninfectious uveitis requiring corticosteroid-sparing immunosuppressive therapy from 9 referral eye centers in India, the United States, Australia, Saudi Arabia, and Mexico between August 22, 2013, and August 16, 2017. Follow-up ended on August 20, 2018. Interventions: Patients were randomized to receive oral methotrexate, 25 mg weekly (n = 107), or oral mycophenolate mofetil, 3 g daily (n = 109). Main Outcomes and Measures: The primary outcome was treatment success at 6 months, which was defined as having control of inflammation in both eyes, no more than 7.5 mg prednisone daily and less than or equal to 2 drops of prednisolone acetate 1%, and no treatment failure due to safety or intolerability. Patients underwent follow-up to 12 months while receiving the same treatment or switched to the other antimetabolite, depending on their 6-month outcome. Results: Among 216 patients who were randomized (median age, 38 years; 135 (62.5%) women), 194 (89.8%) completed follow-up through 6 months. Treatment success occurred in 64 (66.7%) patients in the methotrexate group vs 56 (57.1%) in the mycophenolate group (difference, 9.5% [95% CI, -5.3% to 21.8%]; odds ratio [OR], 1.50 [95% CI, 0.81 to 2.81]; P = .20). Among patients with posterior uveitis or panuveitis, treatment success was achieved in 58 (74.4%) in the methotrexate group vs 42 (55.3%) in the mycophenolate group (difference, 19.1% [95% CI, 3.6% to 30.6%]; OR, 2.35 [95% CI, 1.16 to 4.90]; P = .02); whereas among patients with intermediate uveitis treatment success occurred in 6 (33.3%) in the methotrexate group vs 14 (63.6%) in the mycophenolate group (difference, -30.3% [95% CI, -51.6% to 1.1%]; OR, 0.29 [95% CI, 0.08 to 1.05]; P = .07; P for interaction = .004). Elevated liver enzymes were the most common nonserious laboratory adverse event, occurring in 14 patients (13.0%) in the methotrexate group and 8 patients (7.4%) in the mycophenolate group. Conclusions and Relevance: Among adults with noninfectious uveitis, the use of mycophenolate mofetil compared with methotrexate as first-line corticosteroid-sparing treatment did not result in superior control of inflammation. Further research is needed to determine if either drug is more effective based on the anatomical subtype of uveitis. Trial Registration: ClinicalTrials.gov Identifier: NCT01829295.


Assuntos
Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Ácido Micofenólico/uso terapêutico , Uveíte/tratamento farmacológico , Adulto , Anti-Inflamatórios/administração & dosagem , Quimioterapia Combinada , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Testes de Função Hepática , Masculino , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/efeitos adversos , Prednisolona/administração & dosagem
7.
Med Klin Intensivmed Notfmed ; 114(7): 665-676, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31538212

RESUMO

Cardiogenic shock is a life-threatening condition that is frequently associated with acute hepatic dysfunction. Due to low cardiac output resulting in end-organ hypoperfusion and hypoxia, different types of liver dysfunction can develop, such as hypoxic hepatitis or acute liver failure. A very serious and late sequela is the secondary sclerosing cholangitis in critically patients. Clinical management of acute hepatic dysfunction involves the stabilization of cardiac output to improve hepatic perfusion and the optimization of liver oxygenation. However, despite maximum efforts in supportive treatment, the outcome of patients with cardiogenic shock and concomitant hepatic dysfunction remains poor.


Assuntos
Hipóxia/complicações , Falência Hepática Aguda/diagnóstico , Fígado/patologia , Choque Cardiogênico , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/etiologia , Estado Terminal , Humanos , Hipóxia/etiologia , Falência Hepática Aguda/etiologia , Testes de Função Hepática , Choque Cardiogênico/complicações
8.
Zhonghua Yi Xue Za Zhi ; 99(28): 2203-2207, 2019 Jul 23.
Artigo em Chinês | MEDLINE | ID: mdl-31434393

RESUMO

Objective: To investigate the association of low serum indirect bilirubin (IBIL) level with all-cause mortality in maintenance hemodialysis (MHD) patients. Methods: A multicenter retrospective cohort study was conducted in seven hemodialysis centers of Guizhou province. The adult outpatients who underwent hemodialysis for more than 3 months were included between June 2015 and June 2016. Demographics, baseline clinical and laboratory test results were collected. Patients were divided into 4 groups according to their baseline serum IBIL levels (interquartile range), and followed up until June 30, 2018. Kaplan-Meier method was used to compare the survival rate of each group. Cox regression model was used to analyze the association of IBIL with all-cause mortality. Results: A total of 885 hemodialysis dialysis patients with baseline IBIL data were enrolled in this study, with age of (55.4±16.2) years old, among whom 57.9% (512/885) were male. Median IBIL was 4.8 µmol/L and interquartile range was 3.3-7.0 µmol/L. The comparison between IBIL quartile groups showed that the differences in proportion of diabetics, hemoglobin, serum albumin, platelet, serum calcium, alanine aminotransferase (ALT), uric acid and urea nitrogen were statistically significant (all P<0.05). After a median follow-up of 24 months, 210 patients died, and 96 cases became lost to follow-up. Kaplan-Meier curves showed higher all-cause mortality in patients with IBIL≤3.3 µmol/L (Q1 group) (65/219, P=0.015). After adjusting for age, gender, comorbidities, and biochemical indicators, taking baseline IBIL Q2 level (IBIL 3.4~4.8 µmol/L) as a reference, the hazard ratio for all-cause death in patients with IBIL≤3.3 µmol/L was 1.661 (95%CI: 1.114-2.476, P=0.013). Kaplan-Meier survival curve showed that there was no significant difference in mortality between the quartile groups according to total bilirubin (TBIL) or direct bilirubin (DBIL) (P=0.167, 0.156). Conclusion: Baseline low serum IBIL in maintenance hemodialysis patients is associated with all-cause mortality.


Assuntos
Diálise Renal , Adulto , Idoso , Bilirrubina , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ácido Úrico
9.
Medicine (Baltimore) ; 98(35): e16972, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464942

RESUMO

Single nuclear polymorphism (SNP) of programmed cell death 1 (PD-1) was reported associated with hepatitis B virus (HBV) infection, but the SNP sites studied were limited. Whether the combination of 2 or more SNP sites could better represent the relationship between PD-1 SNP and HBV infection was not studied.Eight hundred ninety-eight HBV-infected patients (222 asymptomatic carriers [AsC], 276 chronic hepatitis B, 105 acute-on-chronic liver failure, and 295 liver cirrhosis) and 364 health controls of South China were enrolled in this study. Four PD-1 SNPs (rs10204525, rs2227982, rs41386349, and rs36084323) were selected and detected by TaqMan probe. The frequency of allele, genotype, and combination of different SNPs were compared between different groups.For allele frequency analysis, G allele of rs10204525 was protective factor (odds ratio (OR) = 0.823, 95% confidence interval (CI) = 0.679-0.997, P = .046) and T allele of rs2227982 was predisposing factor (OR = 1.231, 95% CI = 1.036-1.463, P = .018) in HBV infection. When analyzed in genotype frequency, the genotype GG of rs10204525 and CC of rs2227982 were protective factor of HBV infection. Combination of rs10204525 GG and rs2227982 CC was potent protective factor of HBV infection (OR = 0.552, 95% CI = 0.356-0.857, P = .007) and was also associated with lower HBV load (OR = 0.201, 95% CI = 0.056-0.728, P = .008) in AsC. The 4 SNP sites were not associated with progression of HBV-related liver disease.Rs10204525 and rs2227982 of PD-1 associate with HBV infection and combination of the 2 SNP sites can better predict host susceptibility in HBV infection.


Assuntos
Hepatite B/genética , Receptor de Morte Celular Programada 1/genética , Fatores Etários , Alelos , Estudos de Casos e Controles , China/epidemiologia , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Testes de Função Hepática , Masculino , Polimorfismo de Nucleotídeo Único , Estudos Retrospectivos , Fatores Sexuais
10.
Medicine (Baltimore) ; 98(30): e16150, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348228

RESUMO

We evaluated the post-treatment overall survival (OS) of elderly hepatocellular carcinoma (HCC) patients.The archived records of 10,578 HCC patients registered at the Korean Central Cancer Registry from 2008 through 2014 were retrospectively analyzed. In this registry, we selected Barcelona Clinic Liver Cancer (BCLC) 0, A, or B staged HCC patients (n = 4744) treated by surgical resection (SR), local ablation therapy (LAT), or locoregional therapy (LRT). OSs in nonelderly (<70 years) and elderly (≥70 years) patients were compared after propensity score matching (PSM).In BCLC 0-A staged HCC, the cumulative OS rates of elderly patients were poorer than those of nonelderly patients after PSM (P < .001), but not in those with BCLC stage B (P > .05). In BCLC 0-A staged elderly patients, OS after SR was significantly better than after LAT (P = .005) or LRT (P < .001). In BCLC B staged elderly patients, SR achieved better OS than LRT (P = .006). Multivariable analysis showed that LAT (hazard ratio [HR] 1.52, P = .048) or LRT (HR, 2.01, P < .001) as compared with SR, and large (>3 cm) tumor size (HR1.49, P = .018) were poor predictors of OS for elderly patients with BCLC stage 0-A, and that LRT (HR, 2.64, P = .042) was a poor predictor for those with BCLC stage B.SR provided a better OS rate than LAT or LRT in elderly HCC patients with BCLC stage 0-A, than LRT in those with BCLC stage B. SR should be considered the first therapeutic option even in elderly HCC patients with these stages.


Assuntos
Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Ablação por Cateter/estatística & dados numéricos , Quimioembolização Terapêutica/estatística & dados numéricos , Comorbidade , Feminino , Comportamentos Relacionados com a Saúde , Hepatectomia/estatística & dados numéricos , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Testes de Função Hepática , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Estadiamento de Neoplasias , Pontuação de Propensão , Sistema de Registros , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Análise de Sobrevida , Carga Tumoral
11.
Medicine (Baltimore) ; 98(30): e16369, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348238

RESUMO

Previous studies have demonstrated a positive relationship between liver cancer and diabetes mellitus. However, elevated fasting blood glucose (FBG) itself may be a risk factor for the development of hepatocellular carcinoma (HCC) rather than diabetes, and during the follow-up period, death is an event that may occur before the occurrence of HCC, which should be dealt with competing risk models. Our study aims to investigate the relationship between FBG and new-onset HCC by using competing risk regression models.We prospectively studied the relationship between FBG concentrations and risk of HCC in a cohort of 93,447 participants who were free of prior HCC, and whose demographic characteristics and biochemical parameters were recorded. Cox proportional hazards regression models and competing risk regression models were used to evaluate the association between FBG concentrations and risk of incident HCC.A total of 302 participants were diagnosed with HCC among 93,447 subjects during 810,499 person-years of follow-up. The multivariable hazard ratios (HRs) [95% confidence interval (95% CI)] for the association of FBG and log(FBG) with HCC were 1.07 (1.01∼1.12), 1.84 (1.23∼2.74) in an analysis adjusted for other potential variables. In the multivariable adjusted analysis, participants who were in 4.82 mmol/L≤FBG≤5.49 mmol/L group and FBG >5.49 mmol/L group would have increased the risk of HCC by 47% and 69%, respectively. In a cause-specific hazard model (CS model), the multivariable HRs (95% CI) for the association of FBG with HCC were 1.46 (1.09∼1.98), 1.69 (1.27∼2.27) in the multivariable adjusted analysis. Similar results were also observed in sub-distribution hazard function model (SD model) with corresponding multivariate HRs (95% CI) of 1.46 (1.09∼2.00), 1.69 (1.25∼2.27) in 4.82 mmol/L≤FBG≤5.49 mmol/L group and FBG >5.49 mmol/L group, respectively.Higher FBG concentrations itself were positively associated with new-onset HCC in the Cox proportional hazards regression models and competing risk models. FBG concentrations can be used as a scientific and important way to identify individuals with a higher risk of HCC and control of FBG concentrations might serve as a possible way to decrease the risk of HCC among Chinese population.Trial registration: ChiCTR-TNRC-11001489. Registered August 24, 2011 (retrospectively registered).


Assuntos
Glicemia/análise , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/epidemiologia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/epidemiologia , Fatores Etários , Idoso , Índice de Massa Corporal , Carcinoma Hepatocelular/diagnóstico , Comorbidade , Jejum/sangue , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Testes de Função Hepática , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais
12.
J Assoc Physicians India ; 67(3): 51-54, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31304707

RESUMO

Aims and Objectives: To evaluate the Thyroid functions in patients with cirrhosis of liver and to assess the severity of liver dysfunction in relation with interpretation of thyroid functions. Material and Methods: The present study was undertaken at Maharana Bhupal Govt. Hospital, attached to R.N.T. Medical College, Udaipur (Raj.). Study included total 50 patients admitted at Maharana Bhupal Govt. Hospital, attached to R.N.T. Medical College Udaipur (Raj.) with clinical, biochemical, and radiological evidence of cirrhosis of liver. All patients were subjected to medical examination as per the fixed Performa. Observations and Conclusion: Prevalence of subclinical hypothyroidism with cirrhosis was 62%. 31 out of 50 patients had subclinical hypothyroidism. The study showed that prevalence of hypothyroidism in cirrhosis patients increases as the severity of cirrhosis increases and findings were statistically significant (p value 0.00).This study found association between serum T3 and severity of liver disease. As the severity of cirrhosis increases which is indicated by Child Pugh A to C, serum level of T3 reduces and findings were statistically significant (p value 0.00).All 50 patients of cirrhosis had their serum T4 level within normal limit and it does not change with severity of liver disease. This study found association between serum FT4 and severity of liver disease. As the severity of cirrhosis increases which is indicated by Child Pugh A to C, serum level of FT4 fall in low-normal or below normal value and findings were statistically significant (p value 0.00). This study found association between serum FT3 and severity of liver disease. As the severity of cirrhosis increases which is indicated by Child Pugh A to C, serum level of FT3 reduces. All patients of Child Pugh C had low FT3 level and the findings were statistically significant (p value 0.00). This study showed that serum bilirubin, prothombin time, INR, TSH level increases and serum albumin level, T3, FT3, and FT4 level reduces as the severity of cirrhosis increases.According to this study all cirrhotic patients should undergo thyroid function evaluation as these patients are definitely associated with development of hypothyroidism. There is significant inverse correlation between serum level of T3, FT3, and FT4 with severity of cirrhosis. These parameters can be used as markers to indicate the severity of cirrhosis.


Assuntos
Cirrose Hepática/epidemiologia , Hepatopatias , Testes de Função Tireóidea , Criança , Humanos , Testes de Função Hepática
13.
Int J Infect Dis ; 86: 191-196, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31310884

RESUMO

OBJECTIVE: In July 2018, recurrent hepatitis E cases were reported from a factory in Qingdao City, China. The aim of this study was to identify additional cases, and help prevent future incidents by identifying possible risk factors for infection. METHODS: Participants were asked to provide blood samples for hepatitis E virus (HEV) IgM and IgG antibodies screening, as well as liver function test. A questionnaire that assessed demographics, potential risk factors, and clinical symptoms was completed by participants. HEV RNA genotyping was performed using a nested Reverse Transcriptional Polymerase Chain Reaction (RT-PCR) method. Adjusted Poisson regression model for participant characteristics and risk factors was constructed for multivariate analysis. RESULTS: Overall, 41(14.5%, 41/283) participants had recent acute infection (21 of these were symptomatic). The result of multivariate analysis demonstrated a significant association of acute HEV infection with consumption of pig liver within the past two months (Relative Risk 2.61, 95% confidence interval (CI) 1.10-6.17, p=0.0294). Sequencing of HEV RNA from seventeen acute cases indicated three HEV isolates of genotype 4 induced this outbreak. CONCLUSIONS: This was probably a common-source foodborne hepatitis E outbreak, related to the consumption of undercooked pig liver.


Assuntos
Surtos de Doenças , Hepatite E/epidemiologia , Instalações Industriais e de Manufatura , Exposição Ocupacional , Adulto , Animais , China/epidemiologia , Feminino , Contaminação de Alimentos , Anticorpos Anti-Hepatite/sangue , Hepatite E/etiologia , Vírus da Hepatite E/imunologia , Humanos , Testes de Função Hepática , Masculino , Carne , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Suínos , Adulto Jovem
14.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(5): 469-476, 2019 May 28.
Artigo em Chinês | MEDLINE | ID: mdl-31303608

RESUMO

OBJECTIVE: To explore the feasibility and clinical value of CT-based arterial enhancement fraction (AEF) for evaluating liver function in liver cirrhosis patients.
 Methods: Fifty-two patients with liver cirrhosis (Child-Pugh A, B, and C group included 13, 20, and 19 patients, respectively) and 17 patients without liver diseases as control were prospectively enrolled, respectively. All individuals underwent three-phase hepatic CT, and the color mapping of AEF were obtained in CT kinetics software, as well as the corresponding parameters, i.e., hepatic AEF (HAEF) and the ratio of HAEF to spleen AEF (H/S). The AEF parameters were compared among different groups, and the area under the receiver operating characteristic curve (AUROC) was calculated. The Spearman correlation analysis was performed between the AEF parameters and model for end-stage liver disease (MELD) score in liver cirrhosis patients.
 Results: The interobserver agreement of HAEF and H/S were perfect, and the intraclass correlation coefficient (ICC) were 0.918 (95% CI 0.871 to 0.949), 0.946 (95% CI 0.915 to 0.966), respectively. The HAEF and H/S among those groups were significant different (both P<0.001), and they elevated with the increase of Child-Pugh classification in liver cirrhosis patients (all P<0.05, except the H/S between Child-Pugh A and B). In all patients with liver cirrhosis, the AUROC of HAEF and H/S were 0.933 and 0.821 for Child-Pugh A, and were 0.925 and 0.915 for Child-Pugh C, respectively. The HAEF and H/S of patients with liver cirrhosis were significantly correlated with the MELD score (HAEF: r=0.752, P<0.001; H/S: r=0.676, P<0.001).
 Conclusion: CT-based AEF parameters including HAEF and H/S are closely associated with the severity and prognosis of patients with liver cirrhosis, which have the potential to estimate the liver function in liver cirrhosis patients quantitatively and effectively.


Assuntos
Cirrose Hepática , Humanos , Cirrose Hepática/diagnóstico por imagem , Testes de Função Hepática , Tomografia Computadorizada por Raios X
15.
Expert Opin Drug Saf ; 18(8): 753-758, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31177863

RESUMO

Objectives: Z-Drugs (ZDs) have been developed to limit benzodiazepines (BZDs) abuse for sleep disorders. Data on the liver toxicity of zolpidem (ZLM) are lacking or anecdotal. The authors evaluated the presence of drug-induced liver injury (DILI) among a cohort of high-dose ZLM abusers. Methods: Retrospective study analyzing clinical records of 1112 consecutive patients admitted for BZDs detoxification from 2003 to 2018. Inclusion criteria: age >18 y.o.; ZLM abuse/dependence; high-dose ZDs abuse. Exclusion criteria: missing lab data; lack of informed consent. Main outcome was the presence of DILI measured as elevation of ALT/AST levels >250 U/l. Results: A total of 107 patients met the eligibility criteria. Liver enzymes alterations were present in 9.3% (95% CI 4.6-16.5%); one patient (0.9%, 95% CI 0.0-2.8%) showed DILI criteria. BMI significantly influenced transaminases levels. No correlations between duration nor doses of ZLM abuse and transaminases levels were found. Conclusion: The present study shows a very low prevalence of DILI among high-dose ZLM abusers. The prevalence of hypertransaminasemia was in line with general population. On one hand ZLM has a substantially safe liver profile but on the other hand ZLM abuse and dependence, especially at very high doses, represents an emerging problem.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Medicamentos Indutores do Sono/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/complicações , Zolpidem/administração & dosagem , Adulto , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medicamentos Indutores do Sono/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Zolpidem/efeitos adversos
16.
Neurología (Barc., Ed. impr.) ; 34(5): 300-308, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180846

RESUMO

Introducción: La acetona cianohidrina (ACH) es una sustancia tóxica resultante de la hidrólisis enzimática de linamarina, contenido en las raíces de yuca (Manihot esculenta Crantz); su consumo a largo plazo se asocia con 2 trastornos neurológicos: konzo y la neuropatía atáxica tropical. Estudios anteriores han evaluado las alteraciones conductuales después del consumo de esta sustancia, pero los efectos tóxicos sobre los procesos fisiológicos se desconocen. Método: Se asignaron 32 ratas Wistar macho a 4 grupos experimentales (n = 8): un grupo vehículo (solución salina 0,3 ml/rata, ip) y 3 grupos con ACH (PubChem CID: 6406) a concentraciones de 10, 15 y 20 mM, durante 28 días, cada 24 h. Se evaluó la actividad motora espontánea en campo abierto y la coordinación motora en pruebas de rotarod y nado a 0, 7, 14, 21 y 28 días de tratamiento. Al final de las pruebas conductuales (día 28) se tomaron muestras de sangre por punción transcardiaca para evaluar la función renal y hepática. Resultados: La ACH promovió alteraciones en la actividad locomotora y promovió tanto el nado lateral como la conducta de giro en la prueba de nado los días 21 y 28 del tratamiento. La ACH incrementó los parámetros de la función renal y hepática de una manera dependiente de la concentración, excepto la glucosa y la bilirrubina total. Conclusión: Estos datos indican que el contenido de este compuesto tóxico contenido en las raíces de yuca podría ser potencialmente peligroso bajo el consumo a largo plazo en sujetos vulnerables


Introduction: Acetone cyanohydrin (ACH) is a toxic substance present in cassava roots (Manihot esculenta Crantz) which results from enzymatic hydrolysis of linamarin. Long-term consumption is associated with 2 neurological disorders: konzo and tropical ataxic neuropathy. Previous studies have evaluated behavioural alterations linked to ACH consumption, but the toxic effects of this substance on physiological processes remain unknown. Method: 32 male Wistar rats were assigned to 4 experimental groups (n = 8 per group): a vehicle group (0.3 mL saline solution, IP) and 3 ACH groups (PubChem CID: 6406) dosed at 10, 15, and 20 mM/24h for 28 days. We evaluated spontaneous motor activity with the open field test and motor coordination with the rotarod and forced swimming tests at 0, 7, 14, 21, and 28 days of treatment. At the end of the assessment period (day 28), blood samples were collected by transcardiac puncture to evaluate kidney and liver function. Results: ACH caused alterations in locomotor activity and promoted both lateral swimming and spinning in the forced swimming test at 21 and 28 days of treatment. Furthermore, it led to an increase in the levels of the parameters of kidney and liver function in a concentration-dependent manner, except for glucose and total bilirubin. Conclusion: Our results suggest that long-term consumption of this toxic compound present in cassava roots may be potentially dangerous for vulnerable subjects


Assuntos
Animais , Ratos , Atividade Motora/efeitos dos fármacos , Fígado/efeitos dos fármacos , Rim/efeitos dos fármacos , Neurotoxinas/isolamento & purificação , Acetona/efeitos adversos , Manihot/efeitos adversos , Ratos Wistar , Extratos Vegetais/farmacocinética , Modelos Animais de Doenças , Testes de Função Renal/estatística & dados numéricos , Testes de Função Hepática/estatística & dados numéricos , Testes de Toxicidade Aguda/métodos
17.
Ticks Tick Borne Dis ; 10(5): 997-1002, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31151923

RESUMO

Crimean-Congo Hemorrhagic Fever (CCHF) is an acute viral hemorrhagic disease. In this study, an evaluation was made of the potential use of iron metabolism and liver function biomarkers to estimate the bleeding status in CCHF patients. This prospective study was conducted in Cumhuriyet University, Turkey. Only patients with confirmed CCHF were enrolled in the study. The study subjects comprised 40 CCHF patients and 37 healthy control subjects. Serum iron, unsaturated iron binding capacity (UIBC), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were determined using the colorimetric method. Serum ferritin levels were measured using the electrochemiluminescent method. The serum ferritin (p = 0.037), AST (p = 0.0002), ALT (p = 0.002), LDH (p = 0.0005) and aPTT (p = 0.001) values were higher in patients with bleeding than in patients without bleeding. Receiving operating characteristic analyses were applied for the area under the curve (AUC) values for ferritin, aPTT, and AST to discriminate the bleeding status in patients, an these were determined as 0.717, 0.819, and 0.882, respectively. A cut-off value of 149 U/L for AST was obtained to discriminate the bleeding condition in CCHF patients. Higher ferritin (p < 0.0001) levels were determined in patients compared to the control group. The iron (p = 0.180) and UIBC (p = 0.0017) values were lower in patients than in the control group. Cytokine storm due to an increase in ferritin levels may contribute to the increased inflammation and coagulation abnormalities in CCHF patients. It was concluded that routine screening of the AST level would be helpful to estimate the bleeding status in addition to screening liver damage in CCHF patients.


Assuntos
Hemorragia/diagnóstico , Vírus da Febre Hemorrágica da Crimeia-Congo/fisiologia , Febre Hemorrágica da Crimeia/diagnóstico , Ferro/sangue , Testes de Função Hepática , Adulto , Idoso , Biomarcadores/sangue , Biomarcadores/metabolismo , Estudos de Casos e Controles , Feminino , Hemorragia/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Turquia , Adulto Jovem
18.
BMC Cancer ; 19(1): 550, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174503

RESUMO

BACKGROUND: To evaluate the value of a three dimension (3D)visualization operative planning system in ultrasound-guided percutaneous microwave ablation (US-PMWA) for large hepatic hemangiomas (LHHs). METHODS: Fifty-eight patients with LHHs were divided into 3D and 2D groups. The therapeutic efficacy was assessed by contrast-enhanced imaging during follow-up. Hepatic and renal function were examined. The complete ablation, tumor volume shrinkage, and complication rates were analyzed. RESULTS: The ablation time and energy of the 3D group were lower than those of the 2D group (1152.0 ± 403.9 s vs. 1379.7 ± 375.8 s and 87,407.2.9 ± 50,387.0 J vs. 117,775.8 ± 46,245.6 J, P = 0.031 and 0.021, respectively). The 3D group had a higher complete ablation rate than the 2D group (97.7 ± 2.4% vs. 94.5 ± 3.7%, P < 0.001). The incidence of hemoglobinuria after ablation in the 3D group was lower than that in the 2D group (32.0% vs. 57.6%, P = 0.047). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and creatinine (Cre) after ablation in the 3D group were lower than those in the 2D group (126.7 ± 56.4 U/L vs. 210.9 ± 96.2 U/L, P < 0.001; 141.0 ± 60.8 U/L vs. 211.4 ± 90.0 U/L, P = 0.001; 57.3 ± 17.6 U/L vs. 80.8 ± 41.9 U/L, P = 0.010; and 66.6 ± 16.6 mmol/L vs. 84.5 ± 39.6 mmol/L, P = 0.037, respectively). There were no significant differences in antenna insertion and the volume reduction rate between the groups. One patient developed acute kidney injury shortly after ablation in the 2D group and recovered after hemodialysis. No other severe complications occurred during the follow-up period. CONCLUSIONS: The 3D visualization operative planning system has a relatively high clinical application value in providing scientific, reasonable, quantifiable, and individualized therapy for LHHs by US-PMWA.


Assuntos
Técnicas de Ablação , Hemangioma/diagnóstico , Hemangioma/terapia , Imagem Tridimensional , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Cirurgia Assistida por Computador , Ultrassonografia , Adulto , Feminino , Humanos , Testes de Função Renal , Testes de Função Hepática , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Ultrassonografia/métodos
19.
Medicine (Baltimore) ; 98(23): e15929, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169712

RESUMO

BACKGROUND: Laparoscopic left hemihepatectomy (LLH) has been widely accepted as a minimally invasive alternative to open liver surgery. We assessed the benefits and drawbacks of LLH compared with open left hemihepatectomy (OLH) using meta-analysis. METHODS: Relevant literature was retrieved using PubMed, Embase, Cochrane, and Ovid Medline databases. Multiple parameters of efficacy and safety were compared between the treatment groups. Results are expressed as odds ratio (OD) or mean difference (MD) with 95% confidence interval (95% CI) for fixed- and random-effects models. RESULTS: The meta-analysis included 13 trials involving 1163 patients. Compared with OLH, LLH significantly reduced intraoperative blood loss (MD, -91.01; 95% CI, -139.12 to -42.89; P = .0002), transfusion requirement (OR, 0.24; 95% CI, 0.11-0.54; P = .0004), time to oral intake (MD, -0.80; 95% CI, -1.27 to -0.33; P = .0008), and hospital stay (MD, -3.94; 95% CI, -4.85 to -3.03; P < .0001). However, operative time; complications rate; and postoperative alanine transferase, albumin, and total bilirubin levels did not differ significantly between the 2 surgical groups (P > .05). For hepatolithiasis treatment, there were no significant differences in operative time, residual stones, stone recurrence, and complications rate between the groups (P > .05), but LLH resulted in lower incisional infection rate (OR, 0.44; 95% CI, 0.22-0.89; P = .02) than OLH. The LLH group demonstrated higher bile leakage rate (OR, 1.79; 95% CI, 1.14-2.81; P = .01) and incurred greater hospital costs (MD, 618.56; 95% CI, 154.47-1082.64; P = .009). CONCLUSIONS: LLH has multiple advantages over OLH and should thus be considered as the first choice for left hemihepatectomy.


Assuntos
Hepatectomia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Hepatopatias/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Fígado/cirurgia , Hepatopatias/sangue , Testes de Função Hepática , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Resultado do Tratamento
20.
Gastroenterology ; 157(3): 705-719.e18, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31121167

RESUMO

BACKGROUND & AIMS: Alpha-1 antitrypsin deficiency (AATD) is among the most common genetic disorders. Severe AATD is caused by a homozygous mutation in the SERPINA1 gene that encodes the Glu342Lys substitution (called the Pi*Z mutation, Pi*ZZ genotype). Pi*ZZ carriers may develop lung and liver diseases. Mutation-associated lung disorders have been well studied, but less is known about the effects in liver. We assessed the liver disease burden and associated features in adults with this form of AATD. METHODS: We collected data from 554 Pi*ZZ adults (403 in an exploratory cohort, 151 in a confirmatory cohort), in 9 European countries, with AATD who were homozygous for the Pi*Z mutation, and 234 adults without the Pi*Z mutation (controls), all without pre-existing liver disease. We collected data on demographic parameters, comorbidities, lung- and liver-related health, and blood samples for laboratory analysis. Liver fibrosis was assessed non-invasively via the serum tests Aspartate Aminotransferase to Platelet Ratio Index and HepaScore and via transient elastography. Liver steatosis was determined via transient elastography-based controlled attenuation parameter. We performed histologic analyses of livers from transgenic mice that overexpress the AATD-associated Pi*Z variant. RESULTS: Serum levels of liver enzymes were significantly higher in Pi*ZZ carriers vs controls. Based on non-invasive tests for liver fibrosis, significant fibrosis was suspected in 20%-36% of Pi*ZZ carriers, whereas signs of advanced fibrosis were 9- to 20-fold more common in Pi*ZZ carriers compared to non-carriers. Male sex; age older than 50 years; increased levels of alanine aminotransferase, aspartate aminotransferase, or γ-glutamyl transferase; and low numbers of platelets were associated with higher liver fibrosis burden. We did not find evidence for a relationship between lung function and liver fibrosis. Controlled attenuation parameter ≥280 dB/m, suggesting severe steatosis, was detected in 39% of Pi*ZZ carriers vs 31% of controls. Carriers of Pi*ZZ had lower serum concentrations of triglyceride and low- and very-low-density lipoprotein cholesterol than controls, suggesting impaired hepatic secretion of lipid. Livers from Pi*Z-overexpressing mice had steatosis and down-regulation of genes involved in lipid secretion. CONCLUSIONS: In studies of AATD adults with the Pi*ZZ mutation, and of Pi*Z-overexpressing mice, we found evidence of liver steatosis and impaired lipid secretion. We identified factors associated with significant liver fibrosis in patients, which could facilitate hepatologic assessment and counseling of individuals who carry the Pi*ZZ mutation. ClinicalTrials.gov Number NCT02929940.


Assuntos
Fígado Gorduroso/etiologia , Metabolismo dos Lipídeos , Cirrose Hepática/etiologia , Fígado/metabolismo , Mutação , Deficiência de alfa 1-Antitripsina/complicações , alfa 1-Antitripsina/genética , Adulto , Fatores Etários , Idoso , Animais , Estudos de Casos e Controles , Técnicas de Imagem por Elasticidade , Europa (Continente) , Fígado Gorduroso/sangue , Fígado Gorduroso/diagnóstico , Feminino , Predisposição Genética para Doença , Homozigoto , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Testes de Função Hepática , Masculino , Camundongos Transgênicos , Pessoa de Meia-Idade , Fenótipo , Fatores de Risco , Fatores Sexuais , Deficiência de alfa 1-Antitripsina/diagnóstico , Deficiência de alfa 1-Antitripsina/enzimologia , Deficiência de alfa 1-Antitripsina/genética
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