RESUMEN

Mucinous adenocarcinoma of the colon occasionally develops from the submucosa, depending on the pattern of onset; therefore, in many cases, it is already advanced at the time of diagnosis. This type of cancer is known to have a poor prognosis. We report the case of a 59-year-old woman who presented with abdominal pain on defecation for 1 month. A mass was palpable in the lower part of her abdomen. On computed tomography(CT), an extrinsic mass was seen in the sigmoid colon, and lower gastrointestinal endoscopy findings suggested an invasive tumor originating from another organ outside the intestinal wall. A high level of the tumor marker CEA(40.8 ng/mL)was observed. No findings suggestive of malignancy were present on biopsy examination, Colorectal cancer was suspected, for which a sigmoidectomy was performed. On histopathological examination, though there was little to indicate a primary colon tumor on HE staining, due to strong CDX2 positivity it was suspected to be an intestinal-type adenocarcinoma. The final clinical diagnosis was unclassifiable, poorly differentiated, mucinous adenocarcinoma of the colon. Multiple liver metastases appeared 4 months postoperatively, which were treated with XELOX plus BV and FOLFIRI plus BV. CT evaluation 24 months postoperatively showed a complete response radiographically. This case of mucinous adenocarcinoma of the colon, in which chemotherapy was successful and long-term survival of 5 years and 2 months was achieved postoperatively, is reported together with a discussion of the literature.

Asunto(s)

Adenocarcinoma Mucinoso , Neoplasias Hepáticas , Neoplasias del Colon Sigmoide , Adenocarcinoma Mucinoso/tratamiento farmacológico , Adenocarcinoma Mucinoso/cirugía , Colon Sigmoide , Femenino , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Persona de Mediana Edad , Neoplasias del Colon Sigmoide/tratamiento farmacológico , Neoplasias del Colon Sigmoide/cirugía

RESUMEN

BACKGROUND: Previous clinical studies have shown that the circulating level of endostatin is related to kidney injury. We hypothesized that the impact of HbA1c, fasting, and postprandial plasma glucose on urinary albumin excretion would be related to the serum endostatin level. METHODS: A cross-sectional, community-based population study of 1057 Japanese residents was conducted. Of these subjects, 162 with a fasting plasma glucose value between 5.5 and 6.9 mmol/L and an HbA1c level of <6.5 % received an oral glucose tolerance test, had serum endostatin measured, and had the urinary albumin/creatinine ratio (UACR) calculated. RESULTS: In multivariate analysis, 2-h postprandial plasma glucose (ß = 0.26, P < 0.01) was significantly associated with log-transformed UACR, independently of fasting plasma glucose (ß = 0.14, P = 0.28) and HbA1c (ß = -0.08, P = 0.57). When divided by the median value of endostatin (82.2 ng/mL), 2-h postprandial plasma glucose (ß = 0.38, P = 0.01) remained significantly associated with the log-transformed UACR of the participants below the median, while the fasting plasma glucose (ß = 0.34, P = 0.046) was independently associated with the log-transformed UACR of participants above the median. CONCLUSION: Postprandial plasma glucose was independently associated with the urinary albumin excretion of the residents with prediabetes. Moreover, this relationship was limited to residents with a serum endostatin level below the median.

Asunto(s)

Albuminuria/sangre , Albuminuria/orina , Glucemia/metabolismo , Endostatinas/sangre , Estado Prediabético/sangre , Estado Prediabético/orina , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Ayuno , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Japón , Masculino , Persona de Mediana Edad , Periodo Posprandial

RESUMEN

BACKGROUND: The relation between tongue color and gastroesophageal disease is unclear. This study was done to investigate the associations between tongue color (TC), endoscopic findings, Helicobacter.pylori infection status, and serological atrophic gastritis (SAG). METHODS: The participants were 896 residents of Ishigaki Island, Okinawa, aged 28-86 years. The tongue was photographed, esophagogastroduodenoscopy was done, and serum antibody to H.pylori was measured. SAG was defined as a serum Pepsinogen (PG)Ilevel ≤70 ng/ml and a PGI/IIratio ≤3.0. TC was measured by the device-independent international commission on Illumination 1976 L*a*b* color space standards at four points: (1) edge, (2) posterior, (3) middle, and (4) apex. We also calculated the ratio of the tongue edge to the three other measured points to examine the association between the coating of the tongue and the endoscopic and laboratory findings. RESULTS: Participants were excluded who had two or more endoscopic findings (n = 315) or who had SAG without seropositivity to H.pylori (n = 33). The remaining 548 participants were divided into three groups: SAG and seropositive to H.pylori (n = 67), seropositive to H.pylori alone (n = 56), and without SAG and seronegative for H.pylori (n = 425). We divided 425 residents into a single endoscopic finding positive group (n = 207) and a negative group, which served as a control (n = 218). The most frequent single endoscopic finding was esophageal hernia (n = 110), followed by erosive esophagitis (n = 35) and erosive gastritis (EG) (n = 45). EH was significantly associated with TC (2b*/1b*) (P < 0.05). EG was significantly associated with TC (3a*, 3b*) (P < 0.05). Seropositivity to H.pylori was significantly associated with TC (3 L*, 3 L*/1 L*) (P < 0.05, <0.01), and seropositivity to both H.pylori and SAG was significantly associated with TC (3 L*/1 L*) (P < 0.05). Multivariate analysis extracted TC (3a*, 3b*) as an independent factor associated with a differential diagnosis of EG (Odds ratio (OR) 2.66 P = 0.008, OR 2.17 P = 0.045). CONCLUSIONS: The tongue body color of the middle area reflects acute change of gastric mucosa, such as erosive gastritis. Tongue diagnosis would be a useful, non-invasive screening tool for EG.

Asunto(s)

Gastritis Atrófica/diagnóstico , Infecciones por Helicobacter/diagnóstico , Medicina Kampo , Lengua/química , Adulto , Anciano , Anciano de 80 o más Años , Color , Diagnóstico Diferencial , Endoscopía del Sistema Digestivo , Femenino , Gastritis Atrófica/microbiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/aislamiento & purificación , Helicobacter pylori/fisiología , Humanos , Japón , Masculino , Medicina Kampo/métodos , Persona de Mediana Edad

RESUMEN

Granulomatosis with polyangiitis can be a complication of thyroid disease, not only autoimmune disease but also subacute thyroiditis.

RESUMEN

OBJECTIVE: Diabetes mellitus is a major cause of cardiovascular, kidney, neurologic, and eye diseases, and may be preventable in some cases by lifestyle modification. Screening tests for diabetes mellitus include fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c). Our objective was to evaluate the utility of plasma glycated albumin (GA) in the diagnosis of diabetes mellitus. DESIGN AND METHODS: A cross-sectional, community-based population study of 908 non-diabetic Japanese residents was conducted. Of these subjects, 176 with FPG value between 5.5 and 6.9mmol/l, and an HbA1c level of <6.5% received an oral glucose tolerance test (OGTT). RESULTS: The OGTT results were used for the diagnosis of diabetes mellitus using World Health Organization criteria. Receiver operating characteristic (ROC) analyses demonstrated that optimal threshold values for the diagnosis of diabetes in this population were 15.2% for GA and 5.9% for HbA1c, respectively. Using these cutoff levels, the sensitivity of GA at 62.1% for detecting diabetes was the same as that of HbA1c. However the specificity for GA for detecting diabetes was 61.9%, while for HbA1c it was higher at 66.7%. CONCLUSIONS: Our results indicate that the measurement of glycated albumin may serve as a useful screening test for diabetes in a general Japanese population.

Asunto(s)

Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Albúmina Sérica/análisis , Adulto , Anciano , Antropometría , Pueblo Asiatico , Glucemia/análisis , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Femenino , Prueba de Tolerancia a la Glucosa , Hemoglobina Glucada/análisis , Productos Finales de Glicación Avanzada , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Factores de Riesgo , Adulto Joven , Albúmina Sérica Glicada

RESUMEN

AIM: To investigate the predictors of proximal kidney tubular dysfunction (PKTD) induced by adefovir dipivoxil (ADV) treatment for chronic hepatitis B. METHODS: Seventy-nine patients (age at the evaluation of PKTD: 56.9±10.7 years) with chronic hepatitis B undergoing long-term oral antiviral nucleos(t)ide analogue treatment were consecutively recruited. PKTD was defined by the presence of at least two of the following five abnormalities: phosphate diabetes, nondiabetic glucosuria, metabolic acidosis, ß2-microglobulinuria, or renal hypouricemia. The single-nucleotide polymorphisms (SNPs) in the SLC22A6 gene encoding human organic anion transporter 1 (hOAT1) and ABCC2 encoding multidrug resistance protein 2 (MRP2) were analyzed using the TaqMan Allelic Discrimination Demonstration Kit. RESULTS: Nine (30.0%) of the 30 ADV-treated patients were diagnosed with PKTD, while no patients without ADV developed PKTD (P<0.001). Three patients with ADV were diagnosed with symptomatic osteomalacia. Among the patients who took ADV, those with PKTD were of higher age at initiation, had significantly longer treatment duration, and had a significantly lower body mass index than those without PKTD. The incidence of PKTD dramatically increased after 96 mo from the start of ADV administration. In contrast, the SNPs were not correlated with PKTD. Logistic regression analysis extracted older age at initiation (OR=5.0, 95%CI: 1.1-23.4; P=0.040) and longer treatment duration (OR=3.2, 95%CI: 1.2-8.6; P=0.020) as significant factors associated with PKTD. CONCLUSION: Our results suggest that the tubular function of the kidney of older patients undergoing long-term ADV treatment should be carefully evaluated.

Asunto(s)

Adenina/análogos & derivados , Antivirales/efectos adversos , Hepatitis B Crónica/tratamiento farmacológico , Enfermedades Renales/inducido químicamente , Túbulos Renales Proximales/efectos de los fármacos , Organofosfonatos/efectos adversos , Adenina/efectos adversos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Predisposición Genética a la Enfermedad , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/epidemiología , Humanos , Japón/epidemiología , Enfermedades Renales/diagnóstico , Enfermedades Renales/epidemiología , Enfermedades Renales/genética , Enfermedades Renales/fisiopatología , Túbulos Renales Proximales/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Proteína 2 Asociada a Resistencia a Múltiples Medicamentos , Proteínas Asociadas a Resistencia a Múltiples Medicamentos/genética , Oportunidad Relativa , Proteína 1 de Transporte de Anión Orgánico/genética , Osteomalacia/inducido químicamente , Osteomalacia/epidemiología , Polimorfismo de Nucleótido Simple , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo

RESUMEN

OBJECTIVE: To examine whether or not subclinical atherosclerosis independently predicts the incidence of chronic kidney disease (CKD) in the Japanese general population. METHODS: This study is part of the Kyushu and Okinawa Population Study (KOPS), a survey of vascular events associated with lifestyle-related diseases. Participants who attended both baseline (2004-2007) and follow-up (2009-2012) examinations were eligible. The common carotid intima-media thickness (IMT) was assessed for each participant at baseline. The end point was the incidence of CKD, defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) during the follow-up of participants without CKD at baseline. RESULTS: During the five-year follow-up, 224 of the 1824 participants (12.3%) who developed CKD had higher carotid IMT (0.74 ± 0.22 vs. 0.65 ± 0.14 mm, P < 0.001), higher triglycerides (1.6 ± 0.8 vs. 1.3 ± 0.7 mmol/L, P < 0.001), and lower high density lipoprotein cholesterol (1.5 ± 0.4 vs. 1.6 ± 0.4 mmol/L, P < 0.001) at baseline than those who did not. In logistic regression analysis adjusted for significant covariates, eGFR (Odds ratio [OR] 0.83, 95% confidence interval (CI) 0.80-0.85, P < 0.001), carotid IMT (0.10 mm increase: OR 1.17, 95% CI 1.04-1.33, P = 0.010), and triglycerides (OR 1.35, 95% CI 1.06-1.73, P = 0.015) at baseline were independent predictors for the development of CKD. CONCLUSIONS: Higher carotid IMT and hypertriglyceridemia were independently associated with the development of CKD in the population studied.

Asunto(s)

Pueblo Asiatico , Enfermedades de las Arterias Carótidas/etnología , Hipertrigliceridemia/etnología , Insuficiencia Renal Crónica/etnología , Triglicéridos/sangre , Adulto , Anciano , Enfermedades Asintomáticas , Biomarcadores/sangre , Enfermedades de las Arterias Carótidas/diagnóstico , Grosor Intima-Media Carotídeo , Distribución de Chi-Cuadrado , LDL-Colesterol/sangre , Femenino , Tasa de Filtración Glomerular , Encuestas Epidemiológicas , Humanos , Hipertrigliceridemia/sangre , Hipertrigliceridemia/diagnóstico , Incidencia , Japón/epidemiología , Riñón/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Factores de Riesgo , Factores de Tiempo

RESUMEN

BACKGROUND: Liver fibrosis remains one of the most important predictors of sustained virological response (SVR) in this era of direct-acting antiviral treatment of chronic hepatitis C. We compare non-invasive fibrosis assessment with liver biopsy (METAVIR) in terms of their ability to predict SVR by telaprevir (TVR)-based triple therapy. METHODS: This prospective study consisted of 108 patients with chronic HCV genotype 1 infection who received TVR in combination with pegylated interferon (PEG-IFN)-α2b and ribavirin (RBV). Non-invasive fibrosis data included transient elastography (FibroScan), FIB-4 index and aspartate aminotransferase to platelet ratio index (APRI). RESULTS: SVR was achieved by 84.3% of the patients by intention-to-treat analysis. In contrast to the high SVR rates for treatment-naive patients (87.1%, 27 of 31) and patients who previously relapsed (97.9%, 46 of 47), the SVR rate of prior partial/null responders was significantly lower (60.0%, 18 of 30). The impact of fibrosis on SVR was greater for prior partial/null responders, and fibrosis data, including both METAVIR score and non-invasive fibrosis assessments, were useful for predicting SVR. The METAVIR score (area under the receiver operating characteristic curve [AUROC] 0.91, cutoff ≤F2), FibroScan values (AUROC 0.99, cutoff ≤10.0 kPa), FIB-4 index (AUROC 0.91, cutoff ≤3.5) and APRI (AUROC 0.91, cutoff ≤0.80) were shown to have equal, excellent predictive power. CONCLUSIONS: An alternative to METAVIR score by liver biopsy, non-invasive fibrosis assessments are useful options for predicting SVR by prior partial or null responders in TVR-based triple therapy.

Asunto(s)

Antivirales/uso terapéutico , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Cirrosis Hepática/tratamiento farmacológico , Carga Viral/efectos de los fármacos , Anciano , Área Bajo la Curva , Aspartato Aminotransferasas/sangre , Biomarcadores/análisis , Biopsia , Quimioterapia Combinada , Diagnóstico por Imagen de Elasticidad , Femenino , Hepacivirus/fisiología , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/patología , Humanos , Interferón-alfa/uso terapéutico , Hígado/efectos de los fármacos , Hígado/patología , Hígado/virología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , Oligopéptidos/uso terapéutico , Recuento de Plaquetas , Polietilenglicoles/uso terapéutico , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Curva ROC , Proteínas Recombinantes/uso terapéutico , Ribavirina/uso terapéutico , Resultado del Tratamiento

RESUMEN

OBJECTIVE: The most common screening tests for glucose intolerance are fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c). Because it reflects the current status of hyperglycemia, urinary myo-inositol (UMI) may be useful. We evaluated UMI as a screening tool for glucose intolerance. DESIGN AND METHODS: A cross-sectional, community-based population study of 1057 Japanese residents. 173 with an FPG level between 5.5 and 6.9 mmol/L and an HbA1c under 6.5% had an oral glucose tolerance test. We measured UMI level before (fasting UMI) and 2h after (2h-UMI) glucose ingestion. Δ-UMI was defined as the difference between fasting UMI and 2h-UMI. RESULTS: Δ-UMI, 2h-UMI and HbA1c levels significantly increased as glucose intolerance worsened. Δ-UMI level was significantly positively correlated with 2h-UMI level (r=0.896, p<0.001). Using cutoff levels from receiver operating characteristic (ROC) analyses, the sensitivity of Δ-UMI (82.1%) and 2h-UMI (79.3%) were higher than that of HbA1c (48.3%). The area under the ROC curve values for Δ-UMI (0.903) and 2h-UMI (0.891) were higher than that for HbA1c (0.785). CONCLUSIONS: 2h-UMI is useful as a non-invasive screening of glucose intolerance.

Asunto(s)

Biomarcadores/orina , Intolerancia a la Glucosa/diagnóstico , Inositol/orina , Complejo Vitamínico B/orina , Adulto , Anciano , Glucemia/análisis , Estudios Transversales , Femenino , Intolerancia a la Glucosa/epidemiología , Intolerancia a la Glucosa/orina , Prueba de Tolerancia a la Glucosa , Hemoglobina Glucada/análisis , Humanos , Hiperglucemia/diagnóstico , Hiperglucemia/epidemiología , Hiperglucemia/orina , Japón/epidemiología , Masculino , Persona de Mediana Edad , Curva ROC

RESUMEN

AIM: This epidemiological study was done to generate normal ranges for the cholesterol and triglyceride levels in serum lipoprotein subclasses isolated from healthy adults based on gender and menopausal status. METHODS: Cholesterol and triglyceride levels in 20 lipoprotein subclasses as separated by high performance liquid chromatography were measured in serum obtained from 825 fasting healthy subjects (267 men, 558 women). RESULTS: For serum cholesterol, 13.7% was found in very low density lipoprotein (VLDL) subclasses, 55.6% in low density lipoprotein (LDL) subclasses, and 30.4% in high density lipoprotein (HDL) subclasses. For serum triglycerides, these values were 52.1%, 27.9%, and 17.4%, respectively. Levels of cholesterol in some VLDL subclasses were inversely correlated with the levels of some HDL subclasses, while for triglycerides, elevated levels in any one subclass were generally strongly associated with elevated levels in all other subclasses. Men had significantly higher large VLDL-cholesterol levels than women (P < 0.05), while women had significantly higher small VLDL-cholesterol levels than men (P < 0.001). Women had significantly higher large LDL- and large and medium HDL-cholesterol levels than men (P < 0.001). Men had significantly higher chylomicron (CM), large and medium VLDL-, and small LDL-triglyceride levels than women (P < 0.001). Women had significantly higher very large and large HDL-triglyceride levels than men (P < 0.01). Postmenopausal women had significantly higher CM, all VLDL, and large, medium and small LDL-cholesterol levels, and significantly higher all VLDL, LDL, and HDL-triglyceride levels than premenopausal women (P < 0.001). CONCLUSIONS: Our data document important gender and menopausal status differences in cholesterol and triglyceride subclass levels, as well as significant correlations between values in the various serum lipoprotein subclasses.

Asunto(s)

Colesterol/sangre , Lipoproteínas/sangre , Triglicéridos/sangre , Adulto , Anciano , Cromatografía Líquida de Alta Presión , Femenino , Voluntarios Sanos , Humanos , Japón , Masculino , Menopausia , Persona de Mediana Edad , Tamaño de la Partícula , Valores de Referencia , Factores Sexuales

RESUMEN

Human parvovirus B19 infection occurs by droplet nuclei through the respiratory tract and causes a wide range of diseases. It can be transmitted through blood transfusion from asymptomatic blood donors. This study was done to investigate the parvovirus B19 infection rate of a group of healthy Japanese residents. Of 2,081 blood samples tested, 15 (0.72 %) were positive for parvovirus B19 IgM, 1,412 (67.9 %) for B19 virus IgG, and 4 (0.2 %) for parvovirus B19 DNA. About half of all women of childbearing age were susceptible to parvovirus B19 infection. No relationship was found between the frequency of symptoms and the prevalence of parvovirus B19 IgG and IgM, suggesting that there are asymptomatic carriers in the healthy Japanese population. There is a risk of parvovirus B19 infection by blood transfusion from asymptomatic donors and that pregnant women are at high risk for parvovirus B19 infection.

Asunto(s)

Infecciones por Parvoviridae/epidemiología , Infecciones por Parvoviridae/virología , Parvovirus B19 Humano/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Portador Sano/epidemiología , Portador Sano/virología , ADN Viral/sangre , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven

RESUMEN

The elevated serum undercarboxylated osteocalcin (ucOC) level is related to osteoporosis. In Japan, vitamin K intake is lower, and the incidence of hip fractures noticeably higher in northern Kyushu than in other areas. The study was done to determine the serum ucOC levels in a Japanese population and its association with diet and glucose metabolism. The data of 3,658 healthy adults aged 40-69 (1,373 men and 2,285 women) who lived in northern Kyushu area were analyzed. The data included anthropometric measurements and a self-reported personal interview on daily intake of foods. The serum ucOC level of each participant was measured by electrochemiluminescence immunoassay. Glycohemoglobin A1c (HbA1c), fasting plasma glucose, and serum insulin concentrations were measured. The median serum ucOC level of the women (4.65 ng/mL) was significantly higher than that of the men (3.04 ng/mL) (P = 0.0021). The age-specific ucOC levels of the men decreased significantly with age. In contrast, the ucOC levels of the women aged ≥50 were elevated, but the levels varied markedly within the other age groups. For both men and women, multivariate analysis identified a daily diet rich in vitamin K and HbA1c level as independently having a significant, negative relationship to serum ucOC level. Our study indicates that the serum ucOC decreases with age in men, increases postmenopausally in women, and correlates inversely with dietary consumption of certain foods and with fasting glucose and HbA1c level.

Asunto(s)

Dieta , Estilo de Vida , Osteocalcina/sangre , Adulto , Factores de Edad , Anciano , Pueblo Asiatico , Glucemia , Estudios Transversales , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Japón , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Encuestas y Cuestionarios

RESUMEN

BACKGROUND & AIMS: Early menopause in women with chronic hepatitis C virus (HCV) infection is associated with a low likelihood of a sustained virological response (SVR) in conjunction with their antiviral treatment. This is potentially related to their reduced estrogen secretion. The study was done to determine whether selective estrogen receptor modulator administration might improve the efficacy of the current standard of care (SOC) treatment, pegylated interferon (PegIFN) α2a plus ribavirin (RBV), for postmenopausal women. METHODS: One hundred and twenty-three postmenopausal women with genotype 1b chronic hepatitis C were randomly assigned to one of two treatment groups: raloxifene hydrochloride (RLX) (60 mg/day) plus SOC (PegIFNα2a 180 µg/week and RBV 600-1,000 mg/day) (n=62) or SOC only (n=61). Genotyping was performed of the polymorphism in the interleukin-28B (IL28B) gene region (rs8099917) of DNA collected from each patient. RESULTS: One RLX-treated patient discontinued RLX because of a systemic rash following 2 weeks of treatment. Twenty-four weeks after treatment, the SVR rate was significantly higher for RLX plus SOC patients (61.3%) than for SOC only patients (34.4%) (p=0.0051). Further, the SVR rate was significantly higher for RLX plus SOC patients with IL28B TT (72.5%) than for SOC only patients with IL28B TT (39.2%) (p=0.0014), but no such relationship was observed in patients carrying the minor IL28B allele. CONCLUSIONS: RLX improved the efficacy of SOC in the treatment of postmenopausal women with chronic hepatitis C. RLX shows promise as an adjuvant to the standard antiviral treatment of such patients.

Asunto(s)

Adyuvantes Farmacéuticos/uso terapéutico , Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Posmenopausia , Clorhidrato de Raloxifeno/uso terapéutico , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Anciano , Femenino , Genotipo , Hepatitis C Crónica/virología , Humanos , Interferón-alfa/uso terapéutico , Interferones , Interleucinas/genética , Persona de Mediana Edad , Polietilenglicoles/uso terapéutico , Estudios Prospectivos , ARN Viral/análisis , Proteínas Recombinantes/uso terapéutico , Ribavirina/uso terapéutico

RESUMEN

BACKGROUND & AIMS: Recent studies have suggested that insulin resistance exerts a strong influence on chronic hepatitis C virus (HCV) infection. We analyzed pretreatment factors useful for predicting sustained virological response (SVR), especially interleukin (IL) 28B polymorphism and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). METHODS: This cohort study consisted of 328 chronic hepatitis C patients with HCV genotype 1 who were treated for 48 weeks with pegylated interferon (PegIFN) α-2b and ribavirin (RBV). Genotyping of the polymorphisms in the IL28B gene region (rs8099917) on chromosome 19 was performed on DNA collected from each patient. RESULTS: No significant difference in IL28B genotype distribution was found according to HOMA-IR. Multivariate analysis identified the IL28B TT genotype (OR=5.97, 95% CI 2.15-16.55, p=0.0006) and the baseline HOMA-IR (OR=0.65, 95% CI 0.48-0.87, p=0.0044) as significant, independent pretreatment predictors of SVR. Receiver operating characteristic analyses to determine the optimal threshold values of HOMA-IR for predicting SVR showed that the areas under the curve (AUC) were high for both IL28B TT (AUC=0.774, HOMA-IR cut-off value: 2.45) and IL28B TG/GG genotypes (AUC=0.772, HOMA-IR cut-off value: 1.55). CONCLUSIONS: For HCV genotype 1, both IL28B and baseline HOMA-IR are independent pretreatment predictors of SVR in patients treated with PegIFNα-2b and RBV. Insulin resistance undermines the advantages of IL28B polymorphism to obtain SVR.

Asunto(s)

Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/genética , Resistencia a la Insulina , Interferón-alfa/uso terapéutico , Interleucinas/genética , Polietilenglicoles/uso terapéutico , Ribavirina/uso terapéutico , Anciano , Área Bajo la Curva , Estudios de Cohortes , Intervalos de Confianza , Femenino , Genotipo , Hepacivirus/genética , Homeostasis , Humanos , Interferón alfa-2 , Interferones , Masculino , Persona de Mediana Edad , Modelos Biológicos , Análisis Multivariante , Oportunidad Relativa , Polimorfismo de Nucleótido Simple , Curva ROC , Proteínas Recombinantes/uso terapéutico , Resultado del Tratamiento

RESUMEN

BACKGROUND/AIMS: Helicobacter pylori infection causes gastritis, peptic ulcers and gastric malignancies, and its eradication has been advocated by many groups. We determined the H. pylori carrier status and eradication rates of patients with chronic hepatitis C virus (HCV) infection. METHODS: In total, 76 chronically HCV-infected patients were enrolled for comparison with 228 HCV-noninfected, age- and sex-matched controls. H. pylori infection was confirmed by H. pylori antibody and urea breath testing. RESULTS: The H. pylori infection rate was significantly higher for HCV-infected patients (67 of 76, 88.2%) than for HCV-noninfected controls (158 of 228, 69.3%). Endoscopic findings showed that the rates of gastric ulcers and gastritis were significantly higher for the 67 HCV-infected patients with H. pylori infection (34.3% and 77.6%) than for the 158 HCV-noninfected controls with H. pylori infection (15.2% and 57.6%). Treatment to eradicate H. pylori had a significantly higher success rate for HCV-infected patients (61 of 67, 91.0%) than for HCV-noninfected controls (115 of 158, 72.8%). CONCLUSIONS: The markedly high H. pylori eradication rate observed in this study shows that eradication of H. pylori holds promise for the improvement of the long-term health condition of patients with chronic HCV infection.

RESUMEN

AIM: To evaluate the association between liver stiffness measured by transient elastography (FibroScan) and the efficacy of long-term nucleoside analog (NA) treatment for patients with chronic hepatitis B. METHODS: Study 1: Forty-four chronic HBV patients had liver stiffness measured by FibroScan and underwent liver biopsy. Study 2: Group A: 22 patients started NA treatment at entry and FibroScan was done annually for 3 years. Group B: 23 patients started NA treatment prior to pretreatment FibroScan measurement, and FibroScan was done for from 3 to 5 years after the start of NA treatment. RESULTS: Study 1: The FibroScan values were significantly correlated with fibrosis stage (r = 0.672, P < 0.0001). Optimal cutoff of FibroScan values were 6.1 kPa for ≥ F1, 6.3 kPa for ≥ F2, 8.9 kPa for ≥ F3 and 12.0 kPa for F4. Study 2: For Group A, the baseline median FibroScan value was 8.2 kPa. FibroScan values significantly decreased annually for 3 years after the start of NA treatment (6.4 kPa, 5.8 kPa and 5.3 kPa at years 1, 2 and 3, respectively). For Group B, the FibroScan values did not significantly improve over the 3 years after the start of NA treatment. CONCLUSIONS: Liver stiffness, measured by transient elastography, of chronic hepatitis B patients treated with NA showed a rapid decline in the first 3 years followed by a more steady transition for from 3 to 5 years irrespective of long term virological effect.

RESUMEN

This study was done to evaluate the utility of the Abbott RealTime PCR assay (ART) for the monitoring of chronic hepatitis C patients. The serum samples of 183 patients infected with hepatitis C virus (HCV) genotype 1b who had completed a 48-week period of pegylated interferon (PEG-IFN) alpha-2b plus ribavirin treatment were prospectively analyzed. Serum HCV RNA levels were measured both by ART and by the Roche COBAS Amplicor Monitor test, version2.0 (CAM) at baseline and at weeks 4, 12, 24, 36, and 48 of treatment, and at 24 weeks after the end of treatment (EOT). A significant positive correlation of pretreatment HCV RNA levels was found between ART and CAM (r = 0.595, P < 0.0001). Of the 183 patients, 66 (36.0%) achieved a sustained virological response (SVR). The logarithmic decline of the HCV RNA level from the pretreatment level determined by ART in SVR patients was significantly higher than that in non-SVR patients at all time points tested. The logarithmic decline determined by CAM in SVR patients was significantly higher than that in non-SVR patients only at week 4, but there was no significant difference at other weeks. Of 124 patients who were HCV RNA-negative at EOT by ART, 58 (46.8%) had a relapse of viremia at 24 weeks after EOT, whereas 77 of 143 patients (53.8%) who were HCV RNA-negative at EOT by CAM had a relapse. The relapse rate was lower when determined by ART than by CAM, but not significantly so. ART is more useful than CAM for evaluating the virological response to antiviral treatment for chronic hepatitis C.

Asunto(s)

Antivirales/uso terapéutico , Hepacivirus/genética , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/virología , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Anciano , Femenino , Hepatitis C Crónica/sangre , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Polietilenglicoles/uso terapéutico , ARN Viral/sangre , Proteínas Recombinantes/uso terapéutico , Ribavirina/uso terapéutico , Estadísticas no Paramétricas , Resultado del Tratamiento , Carga Viral/efectos de los fármacos , Carga Viral/métodos

RESUMEN

OBJECTIVES: The current standard of care for chronic hepatitis C patients is a pegylated interferon-α plus ribavirin combination treatment. This study was carried out to determine the relationship between ribavirin concentration in the later stages of treatment and virological relapse. PATIENTS AND METHODS: Serum ribavirin concentration of 183 chronic hepatitis C patients (genotype 1) treated with pegylated interferon-α2b plus ribavirin for 48 weeks was prospectively measured by HPLC at weeks 4, 12, 24, 36 and 48. Patients with undetectable serum hepatitis C virus (HCV) RNA 24 weeks after the end of treatment were designated as having sustained virological response (SVR). Patients with undetectable HCV RNA during the treatment but with virological relapse after the end of treatment were designated relapse. RESULTS: The mean ribavirin concentration at each testing point of patients with SVR (1401, 1725, 1803, 1811 and 1901 ng/mL) was significantly higher than that of relapse patients (998, 704, 607, 643 and 654 ng/mL) at weeks 4, 12, 24, 36 and 48, respectively (all P < 0.001). Multivariate regression analysis for relapse extracted ribavirin concentration at week 36, but not cumulative ribavirin dosage. The cut-off value by receiver operating curve analysis for predicting a relapse was 1503 and 1562 ng/mL at weeks 36 and 48, respectively. CONCLUSIONS: Ribavirin concentration in the later stages of treatment is an important marker of viral relapse.

Asunto(s)

Antivirales/administración & dosificación , Antivirales/farmacocinética , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/administración & dosificación , Polietilenglicoles/administración & dosificación , Ribavirina/administración & dosificación , Ribavirina/farmacocinética , Suero/química , Adulto , Anciano , Cromatografía Líquida de Alta Presión , Femenino , Humanos , Interferón alfa-2 , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , ARN Viral/sangre , Proteínas Recombinantes , Recurrencia , Resultado del Tratamiento , Carga Viral

RESUMEN

Kaposi's sarocoma (KS) is a well-known complication of the acquired immunodeficiency syndrome (AIDS). A 23-year-old man with AIDS complicated by multiple KS seen in January 2008 for anorexia and 10 kg weight loss had a CD4 cell count of 7/microL and a serum HIV RNA level of 29,000 copies/mL. Computed tomography (CT) and endoscopy showed multiple KS lesions in both lungs, the duodenum, small intestine, colon, liver, and both kidneys but not of the skin. Despite the administration of pegylated liposomal doxorubicin (PLD) and highly active antiretroviral therapy, he died in disease progression, unable to complete PLD, KS-related respiratory failure.

Asunto(s)

Terapia Antirretroviral Altamente Activa , Neoplasias Duodenales/secundario , Humanos , Neoplasias Intestinales/secundario , Neoplasias Renales/secundario , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Masculino , Sarcoma de Kaposi/tratamiento farmacológico , Sarcoma de Kaposi/patología , Adulto Joven

RESUMEN

The thickening properties and association behavior of aqueous solutions of HHM-HEC (hydrophobically-hydrophilically modified hydroxyethyl cellulose) with various hydrophobic and hydrophilic substitution degrees were investigated. The HHM-HEC was used as an oil-in-water emulsifier and stable compositional regions were investigated as a function of polymer concentration and substitution degree. The viscosity of aqueous solutions of HHM-HEC increased drastically at lower concentration for HHM-HEC with a higher hydrophobic/hydrophilic substitution ratio. The intensity ratio of the first and third vibrational bands of pyrene (I(1)/I(3)) decreased with the increase of HHM-HEC concentration and the I(1)/I(3) reached a lower plateau at a lower concentration for HHM-HEC with a higher hydrophobic/hydrophilic substitution ratio. The concentration ranges of HHM-HEC solutions which stabilize O/W emulsions differ by the hydrophobic/hydrophilic substitution ratio. However the viscosity ranges of these HHM-HEC solutions were almost the same regardless of the hydrophobic/hydrophilic substitution ratio. At the suitable concentration range for emulsification, HHM-HEC networks have two properties: (1) oil particle retention capacity and (2) laxation which can trap emulsified particles.