Primary liver cancer in Cote d'Or (Burgundy). Results of three year's systematic registration in a well defined French population

The registry of digestive tract cancers set up for the department of Cote d'Or (455, 727) was used to study primary liver cancer. The crude annual incidence rate was 10.4 per 100 000 for males, 2.3 per 100 000 for females. Among other cancer registries annual age standardized rates: 7.6 per 100 000 in males, 1.4 per 100 000 in females are in the intermediate range, close to the figure reported in Geneva and higher than incidence rates reported elsewhere in Europe. Most cancers were hepatocullular carcinomas (83%). Significant etiological factors were the sex ratio (5, 4), alcoholic cirrhosis associated with primary liver cancer in 61% of the patients. The one year crude survival rate was 8%.     

“Sicca Complex” in Liver Disease

Sixty-three patients with liver disease were studied for the presence of the components of Sjögren''s syndrome. The “sicca complex” (that is, patients without arthritis) was detected in 42% of patients with active chronic hepatitis, 72% with primary biliary cirrhosis, and 38% with cryptogenic cirrhosis. One patient with active chronic hepatitis and one with primary biliary cirrhosis had rheumatoid arthritis. No evidence of Sjögren''s syndrome was detected in seven patients with alcoholic cirrhosis. It is suggested that the sicca complex and autoimmune liver disease may be part of a systemic disorder in which immunological mechanisms are concerned in the pathogenesis.     

Serum apoproteins A and B and the lecithin: cholesterol acyl transferase activities in liver cirrhosis and hepatic coma patients

Serum apoproteins A and B and LCAT activities were estimated in 80 patients, 46 with posthepatic cirrhosis and 34 with alcoholic cirrhosis. The cirrhosis patients were also divided into compensated, decompensated, and hepatic coma subgroups. Apo-A and LCAT activities were significantly decreased in both cirrhotic groups without any significant difference between posthepatitic and alcoholic cirrhotic groups, while Apo-B was decreased in hepatic coma patients only. The decompensated cirrhosis patients showed lower Apo-A levels than the compensated cirrhosis patients and hepatic coma patients showed still lower levels compared to decompensated subgroup, while no significant decrease was observed in LCAT activities between compensated and decompensated cirrhosis patients. Apo-A level was correlated more significantly with serum albumin level than the LCAT activity. The study confirms that Apo-A level is highly related to the degree of liver injury and also suggests that this decrease may be mainly due to impaired liver synthesis and that the serum levels of Apo-A and Apo-B can be utilized in the differential diagnosis of chronic liver diseases.     

Efficacy and safety of autologous stem cell transplantation for decompensated liver cirrhosis: A retrospective cohort study

AIM To evaluate the long-term efficacy and safety of autologous stem cell transplantation(SCT) for decompensated liver cirrhosis.METHODS Consecutive patients with decompensated liver cirrhosis were included and assigned into the SCT group and non-transplantation(non-SCT) group according to whether they received SCT treatment. Patients werefollowed up for ten years. The long-term survival rate and incidence of hepatocellular carcinoma(HCC) were compared between groups.     

Role of vagal neuropathy in the hyponatraemia of alcoholic cirrhosis.

The hyponatraemia common in decompensated cirrhosis arises in part from secretion of antidiuretic hormone attributed to a decrease in effective blood volume. Baroreceptors send inhibitory impulses to the midbrain and hypothalamus through the vagus and glossopharyngeal nerves. Since vagal neuropathy often occurs in chronic alcoholism, this might theoretically contribute to the inappropriate secretion of antidiuretic hormone, which might in turn induce hyponatraemia. In a prospective study including 34 patients with cirrhosis a high incidence of vagal neuropathy was found in the alcoholics (64%) and a clear cut increase in the incidence of hyponatraemia in patients with evidence of vagal damage and ascites (seven of eight patients (88%); p = 0.02). Results of a retrospective study of 64 patients with cirrhosis and ascitic decompensation showed hyponatraemia in 17 (50%) of 34 alcoholics but in only four (13%) of 30 patients with non-alcoholic disease (p = 0.006). Vagal neuropathy in alcoholic cirrhosis may contribute to the low serum sodium concentrations commonly found in these patients.     

Impaired hepatic removal of interleukin-6 in patients with liver cirrhosis

Systemic concentrations of interleukin-6 (IL-6) are elevated in patients with liver cirrhosis, and impaired hepatic uptake of IL-6 was suggested to contribute to higher levels in these patients. To test this hypothesis IL-6 was measured in portal venous serum (PVS), hepatic venous serum (HVS) and systemic venous serum (SVS) of 41 patients with liver cirrhosis and four patients with normal liver function. IL-6 was higher in PVS than HVS of all blood donors and about 43% of portal vein derived IL-6 was extracted by the healthy liver, and 6.3% by the cirrhotic liver demonstrating markedly impaired removal of IL-6 by the latter. Whereas in patients with CHILD-PUGH stage A IL-6 in HVS was almost 25% lower than in PVS, in patients with CHILD-PUGH stage C IL-6 was similarly abundant in the two blood compartments. Ascites is a common complication in cirrhotic patients and was associated with higher IL-6 levels in all blood compartments without significant differences in hepatic excretion. Hepatic venous pressure gradient did not correlate with the degree of hepatic IL-6 removal excluding hepatic shunting as the principal cause of impaired IL-6 uptake. Furthermore, patients with alcoholic liver cirrhosis had higher IL-6 in all blood compartments than patients with cryptogenic liver cirrhosis. Aetiology of liver cirrhosis did not affect hepatic removal rate indicating higher IL-6 synthesis in patients with alcoholic liver cirrhosis. In summary, the current data provide evidence that impaired hepatic removal of IL-6 is explained by hepatic shunting and liver dysfunction in patients with liver cirrhosis partly explaining higher systemic levels.     

Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse.

OBJECTIVE--To evaluate the outcome of liver transplantation in patients with alcoholic cirrhosis with respect to selection criteria, survival, and evidence suggesting a return to harmful drinking. DESIGN--Nine year retrospective study. SETTING--Cambridge and King''s College Hospital liver transplant programme. SUBJECTS--24 Patients (three women, 21 men) with alcoholic cirrhosis. MAIN OUTCOME MEASURES--Survival, rehabilitation, and clinical and laboratory evidence of a return to harmful drinking after transplantation. RESULTS--15 Patients were selected for transplantation because of repeated admission to hospital for the complications of advanced portal hypertension despite abstinence, and six because they had a hepatocellular carcinoma superimposed on alcoholic cirrhosis. Three patients who were not abstinent received transplants. The one year survival rate was 66%, and of the 18 patients surviving at least three months, 17 had been rehabilitated. In three patients laboratory variables and histological examination of the liver suggested a return to drinking, though they did not admit to taking alcohol. These patients represented the only cases in the series that were not abstinent before transplantation. CONCLUSIONS--The survival and rehabilitation of patients who received transplants for alcoholic cirrhosis compared favourably with those of patients who received transplants for cirrhosis of other aetiology. The criteria for selection for liver transplantation in patients with alcoholic cirrhosis should include recurrent complications related to severe portal hypertension despite maximum medical treatment in addition to a minimum period of six months of abstinence before transplantation.     

Increased incidence of menstrual abnormalities and hysterectomy preceding primary biliary cirrhosis.

A study was performed to assess the incidence of previous hysterectomy and dilatation and curettage among women with primary biliary cirrhosis. In 87 patients with primary biliary cirrhosis hysterectomy or dilatation and curettage had been performed significantly more often than among 100 age matched normal controls and 80 age matched patients with chronic active hepatitis or alcoholic liver disease. Among the 47 patients with primary biliary cirrhosis who had undergone hysterectomy or dilatation and curettage operations had been performed at a mean of 10.7 years and 13.2 years, respectively, before the onset of disease. The main indication for hysterectomy among patients with primary biliary cirrhosis and controls was menorrhagia. These menstrual disorders may be a consequence of high concentrations of oestrogens in patients with primary biliary cirrhosis.     

肝炎肝硬化和酒精性肝硬化的B超表现比较

目的比较肝炎肝硬化和酒精性肝硬化的B超表现,为临床工作提供参考。方法收集2007年1月1日至2008年12月31日入住温州医学院附属第三医院肝硬化患者的B超资料,回顾性分析比较其B超表现特点。结果酒精性肝硬化患者肝脏肿大的比例高于肝炎肝硬化患者,差异有统计学意义(P0.001),但二者肝脏缩小比例差异无统计学意义。酒精性肝硬化患者肝脏表面光滑的比例较高而呈锯齿状的比例较低,与肝炎肝硬化患者比较差异均有统计学意义(P=0.015和P=0.027)。酒精性肝硬化患者肝内明显可见结节的比例低于肝炎肝硬化患者,二者差异有统计学意义(P=0.009)。门静脉宽度比较2组均数差异无统计学意义(P=0.581)。结论与肝炎肝硬化患者比较,酒精性肝硬化患者肝右叶斜径增大的比例较高,表面较光滑而较少出现锯齿状,发现粗大不规则结节的比例较低,而门静脉内径二者无差异。     

2004—2013年深圳市乙型病毒性肝炎流行特征分析

目的了解深圳市乙型病毒性肝炎(乙肝)流行特征,为制定乙肝防控策略提供科学依据。方法用描述性流行病学方法对2004—2013年深圳市乙肝疫情资料进行分析。结果深圳市2004—2013年共报告乙肝病例90 292例,剔除慢性病例71 435例,年均报告发病率为19.72/10万,发病率最高年份2007年为33.29/10万,最低年份2013年为9.32/10万。发病年龄构成中,15岁占1.58%,15~44岁占89.91%,≥45岁占8.52%;以20~30岁为发病高峰期;男性多于女性,男女性别比为3.33∶1(14 503/4 354);工人发病数最多,占总病例数42.3%;市郊发病率高于市区。结论深圳市近6年乙肝发病率呈下降趋势;15岁儿童病例显著减少,表明乙肝疫苗接种成效显著。     

Meningitis in the central Arctic: a 4-year experience.

There were 37 cases of meningitis during a 4-year period among the native and white populations served by the Churchill Health Centre in northern Manitoba, an annual incidence of 128 per 100 000 in the overall population and of 202 per 100 000 among the Inuit. Bacterial meningitis predominated; Neisseria meningitidis and Haemophilus influenzae each accounted for one third of the cases. There were five deaths, and 14 of the survivors had severe sequelae. Therefore, although the doctors and nurses involved in the study had improved access to telecommunication and air transportation services in caring for patients in isolated northern settlements, and despite their efforts to be vigilant for possible cases of meningitis and to begin vigorous treatment early, the incidence, morbidity and mortality of this disease remained relatively high, particularly among the Inuit.     

Autologous Bone Marrow Mononuclear Cell Transplantation in Patients with Decompensated Alcoholic Liver Disease: A Randomized Controlled Trial

Objective

Impaired liver regeneration is associated with a poor outcome in patients with decompensated alcoholic liver disease (ALD). We assessed whether autologous bone marrow mononuclear cell transplantation (BMMCT) improved liver function in decompensated ALD.

Design

58 patients (mean age 54 yrs; mean MELD score 19, all with cirrhosis, 81% with alcoholic steatohepatitis at baseline liver biopsy) were randomized early after hospital admission to standard medical therapy (SMT) alone (n = 30), including steroids in patients with a Maddrey’s score ≥32, or combined with G-CSF injections and autologous BMMCT into the hepatic artery (n = 28). Bone marrow cells were harvested, isolated and reinfused the same day. The primary endpoint was a ≥3 points decrease in the MELD score at 3 months, corresponding to a clinically relevant improvement in liver function. Liver biopsy was repeated at week 4 to assess changes in Ki67+/CK7+ hepatic progenitor cells (HPC) compartment.

Results

Both study groups were comparable at baseline. After 3 months, 2 and 4 patients died in the BMMCT and SMT groups, respectively. Adverse events were equally distributed between groups. Moderate alcohol relapse occurred in 31% of patients. The MELD score improved in parallel in both groups during follow-up with 18 patients (64%) from the BMMCT group and 18 patients (53%) from the SMT group reaching the primary endpoint (p = 0.43 (OR 1.6, CI 0.49–5.4) in an intention to treat analysis. Comparing liver biopsy at 4 weeks to baseline, steatosis improved (p<0.001), and proliferating HPC tended to decrease in both groups (−35 and −33%, respectively).

Conclusion

Autologous BMMCT, compared to SMT is a safe procedure but did not result in an expanded HPC compartment or improved liver function. These data suggest either insufficient regenerative stimulation after BMMCT or resistance to liver regenerative drive in patients with decompensated alcoholic cirrhosis.

Trial Registration

Controlled-Trials.com ISRCTN83972743.     

MR Angiography Follow-Up 10 Years after Cryptogenic Nonperimesencephalic Subarachnoid Hemorrhage

ObjectivesLong-term magnetic resonance angiography (MRA) follow-up studies regarding cryptogenic nonperimesencephalic subarachnoid hemorrhage (nSAH) are scarce. This single-centre study identified all patients with angiographically verified cryptogenic nSAH from 1998 to 2007: The two main objectives were to prospectively assess the incidence of de novo aneurysm with 3.0-MRI years after cryptogenic nSAH in patients without evidence for further hemorrhage, and retrospectively assess patient demographics and outcome.MethodsFrom prospectively maintained report databases all patients with angiographically verified cryptogenic nSAH were identified. 21 of 29 patients received high-resolution 3T-MRI including time-of-flight and contrast-enhanced angiography, 10.2 ± 2.8 years after cryptogenic nSAH. MRA follow-up imaging was compared with initial digital subtraction angiography (DSA) and CT/MRA. Post-hemorrhage images were related to current MRI with reference to persistent lesions resulting from delayed cerebral ischemia (DCI) and post-hemorrhagic siderosis. Patient-based objectives were retrospectively abstracted from clinical databases.Results29 patients were identified with cryptogenic nSAH, 17 (59%) were male. Mean age at time of hemorrhage was 52.9 ± 14.4 years (range 4 – 74 years). 21 persons were available for long-term follow-up. In these, there were 213.5 person years of MRI-follow-up. No de novo aneurysm was detected. Mean modified Rankin Scale (mRS) during discharge was 1.28. Post-hemorrhage radiographic vasospasm was found in three patients (10.3%); DCI-related lesions occurred in one patient (3.4%). Five patients (17.2%) needed temporary external ventricular drainage; long-term CSF shunt dependency was necessary only in one patient (3.4%). Initial DSA retrospectively showed a 2 x 2 mm aneurysm of the right distal ICA in one patient, which remained stable. Post-hemorrhage siderosis was detected 8.1 years after the initial bleeding in one patient (4.8%).ConclusionPatients with cryptogenic nSAH have favourable outcomes and do not exhibit higher risks for de novo aneurysms. Therefore the need for long-term follow up after cryptogenic nSAH is questionable.     

粒细胞集落刺激因子对失代偿期肝硬化患者骨髓干细胞的动员效果及安全性观察

目的观察失代偿期肝硬化患者行自体骨髓干细胞移植前粒细胞集落刺激因子（G-CSF）对骨髓干细胞的动员效果及安全性。方法在51例失代偿期肝硬化患者行自体骨髓干细胞经肝动脉移植术前,连续2 d给予G-CSF 4μg/（kg·d）动员骨髓干细胞。抽取骨髓的当日化验血常规、肝肾功等指标;从患者髂后上棘抽取骨髓150-200 ml,分离收集骨髓单个核细胞并计数,应用流式细胞仪检测CD34＋细胞并计数,观察应用G-CSF期间不良反应的类型和发生率。患者治疗前后比较采用配对t检验进行统计学分析。结果G-CSF皮下注射后,外周血白细胞由术前（3.31±0.96）×10^9/L升至（11.35±1.92）×10^9/L（P〈0.01）,骨髓单个核细胞数（1.91±0.83）×10^9/kg,CD34＋细胞为（2.02±1.29）×10^7/kg;患者皮下注射后,发热率17.6﹪,体温最高38℃,停药后降至正常;腹部胀痛3例,四肢皮肤散发皮疹2例,均未给予特殊处理,2-3 d后恢复正常。结论给予G-CSF皮下注射后提取骨髓干细胞移植治疗失代偿期肝硬化的是一种临床确切有效的、安全的干细胞动员方法。     

Active tuberculosis in Indochinese refugees in British Columbia.

The incidence of active tuberculosis in 8692 Indochinese refugees admitted to British Columbia between 1979 and 1981 was reviewed. In the first 3 months after entry into the province the rate was extremely high--estimated at 1890/100 000 (126 times the provincial average). A large proportion of these cases were of primary or minimal pulmonary tuberculosis. However, although the proportion of cases of minimal pulmonary tuberculosis was twice the provincial average, the proportion of these cases that were confirmed by culture was only one third the provincial average; this suggests some overdiagnosis in this period. In the subsequent 21 months of residence the incidence of active tuberculosis was also high, at 353/100 000, which was more than 20 times the provincial average. The distribution of cases by severity was closer to the provincial distribution in this period, but advanced disease accounted for a far smaller proportion of cases in both periods than it did in 1980 in the entire province.     

The dietary patterns are a modifying risk factor for breast cancer: An ecological study

A comparative study of dietary patterns (DPs) with breast cancer (BC) incidence in different countries has been performed. It was established that in the countries with a high incidence of BC (76 per 100 000 people) the levels of consumption of the “nutrients of animal foods,” “fruits and beverages,” and “alcoholic drinks” are 1.5–2 times higher and that of “cereals and vegetables” is 1.5 times lower than in the countries with a low incidence of BC (35 per 100 000). In Mediterranean countries, where incidence of BC is 51 per 100 000, the levels of consumption of “animal foods” is two times lower than the levels of consumption of “cereals and vegetables.” A method of assessing the impact of DPs on the incidence of BC has been proposed.     

靖西县2007—2011年流行性腮腺炎流行病学分析

目的为了解靖西县流行性腮腺炎的疫情动态,为制定预防控制措施提供依据。方法采用描述流行病学分析方法对靖西县2007—2011年流行性腮腺炎发病情况进行分析。结果 2007—2011年共报告流行性腮腺炎721例,占法定传染病报告数4.03%,占丙类传染病报告数17.82%,报告年均发病率为23.39/10万。2007—2011年发病率呈上升趋势,其中2011年发病率最高达49.32/10万。全年均有发病,以5—7月为发病高峰,占37.86%,5、6、7月发病数分别占13.73%、11.65%、12.48%。全县19个乡镇都有腮腺炎病例发生,以新靖镇发病率居首位达254.52/10万,其次化峒镇的发病率为183.65/10万。发病主要分布0～15岁年龄组,发病人数占89.65%,以4～8岁年龄组发病人数最多,占45.91%。结论靖西县流行性腮腺炎发病率较高,近年发病呈上升趋势,应采取以腮腺炎疫苗接种为重点的综合性预防控制措施,降低学生和托幼机构儿童的发病率。     

Are HLA antigens important in the development of alcohol-induced liver disease?

The prevalences of 10 HLA-A and 16 HLA-B antigens were determined in 50 patients with alcoholic cirrhosis and 120 alcoholic patients without cirrhosis and compared with those in a control group of 550 healthy subjects from the same geographical area. B40 was absent in the patients with cirrhosis but was found in 18 (15%) of the patients without cirrhosis (p = 0.0087). No other association was noted. It is concluded that there is no good evidence to date of an association between HLA antigen state and susceptibility to alcohol-induced cirrhosis.     

Differences between the metabolic profiles of decompensated and compensated cirrhosis patients with Hepatitis B virus infections under high-performance liquid chromatography-mass spectrometry

To improve the grading and staging of liver cirrhosis among patients with HBV infection noninvasively, a high-performance liquid chromatography with mass spectrometry metabolomics method was used to investigate the potential metabolic biomarkers in the serum of patients with different degrees of hepatic cirrhosis. The results demonstrate that lysophosphatidyl choline (LPC) from positive electrospray ionization (ESI) mode, and fatty acids and bile acids from negative ESI mode play important roles in distinguishing decompensated from compensated cirrhosis. A total of 21 differential metabolites were found from the two groups of patients. LPCs, fatty acids, and taurocholic acid (TCA) 3-sulfate decreased in patients with decompensated cirrhosis, whereas other bile acids increased significantly. The levels of TCA 3-sulfate, LPC 16:0, and LPC 18:0 were significantly correlated with the stages of the decompensated cirrhosis, and they may serve as potential biomarkers for the stage assessment of liver cirrhosis in patients with HBV infections.     

Severity of alcohol dependence in patients with alcoholic liver disease.

To determine the severity of dependence on alcohol in patients with alcoholic liver disease the severity of alcohol dependence questionnaire was administered to 193 patients with various types of alcoholic liver disease established histologically, in whom a detailed history of lifetime alcohol consumption was also obtained. Only 34 patients (18%) were classified as being severely dependent compared with 56% of patients without overt liver disease who were attending a neighbouring alcohol treatment unit. There was a significant correlation between the severity of dependence and mean daily alcohol consumption (r = 0.45 and 0.39 for men and women, respectively) but not duration of drinking. Dependence scores tended to be lower in patients with cirrhosis than in those with precirrhotic liver disease, but this difference reached significance only in women. These findings confirm that patients who develop chronic alcoholic liver disease are usually only mildly dependent on alcohol and support the hypothesis that patients who escape florid symptoms of alcohol dependence are at greater risk of developing liver damage because they are able to sustain a continual consumption of alcohol over many years.