Chronic Disease Group Research Articles

Assessing the relevance and implementation of patient-centredness from the patients’ perspective in Germany: results of a Delphi study

ObjectivePatient-centredness (PC) has particularly grown in relevance in health services research as well as in politics and there has been much research on its conceptualisation. However, conceptual work neglected the...

Liver transplantation in Wilson's disease patients, 1996-2017

Introduction: Wilson's disease is a lethal-without-treatment inherited disorder of copper metabolism. Despite the increased focus on the diagnosis and treatment, liver transplantation is needed in a number of cases even nowadays. Aim: To collect and analyze the data of the Hungarian Wilson's disease patients who underwent liver transplantation. Method: Data of 24 Wilson's disease patients who underwent liver transplantation at the Semmelweis University have been analyzed retrospectively. The diagnosis of Wilson's disease was based on the international score system. The diagnosis of acute liver failure corresponded to the King's College criteria. All liver transplantations had been performed at the Department of Transplantation and Surgery of Semmelweis University, in 1996 for the first time. Results: The mean age was 26 years, F/M = 13/11. Twelve patients needed urgent liver transplantation for acute liver failure, and 12 underwent transplantation for decompensated liver cirrhosis. One patient had been retransplanted because of chronic rejection. Three patients with acute on chronic liver failure were transplanted via the Eurotransplant program. The mean time on the waiting list was 3 vs 320 days in acute liver failure and chronic liver disease groups, respectively. The overall 5-year survival was 66%, but it was 80% after 2002 indicating both the learning curve effect and the improvement of vigilance in Hungary. Despite difficulties of the diagnostic process, Wilson's disease was identified in 21/24 patients prior to the transplantation. Conclusion: Liver transplantation is needed in a number of cases of Wilson's disease. The ideal indication and timing of transplantation may improve the survival of the patients. Orv Hetil. 2019; 160(51): 2021-2025.

Diagnostic value of soluble programmed cell death protein-1 in type-1 autoimmune hepatitis in Egyptian children

Programmed cell death protein-1 (PDCD1) is considered a key factor in immune regulation and is expressed mainly on activated T cells. The current study aimed to assess the clinical value of soluble PDCD1/PD1 as a marker for diagnosing type-1 autoimmune hepatitis in children. Sixty children with chronic hepatitis as patients' groups further divided into autoimmune hepatitis group and other chronic liver disease group and 20 healthy children as a control group were enrolled in this study. All children have been studied for clinical profile, biochemical, histological features and serum level of soluble programmed cell death protein-1 by ELISA. There was a significant increase regarding soluble PDCD1/PD1 in the autoimmune hepatitis group than the chronic liver disease group, with the lowest level in the control group. Soluble PDCD1/PD1 level increased with higher fibrosis stage and higher Child Pugh score, also higher in relapsed patients than patients with complete remission in AIH groups. There was a positive correlation between soluble PDCD1/PD1 and PT, IgG, fibrosis stage, HAI, ALT, AST, simplified and revised score system, PELD and MELD among the AIH group. The best cutoff value of PDCD1/PD1 in the prediction of autoimmune hepatitis was 1.73 ng/ml with AUC:0.895 that has a sensitivity of 80%, specificity of 78%. sPDCD1/PD1 level represents a possible promising biomarker of AIH patients who will represent an incomplete response for regular treatment. This finding can be considered as the first step to prove the pivotal role of soluble PDCD1/PD1 in the diagnosis of AIH.

RELATIONSHIP BETWEEN ERYTROCYTE AND PLASMA CONCENTRATION OF MALONDIALDEHYDE IN PATIENTS WITH CORONARY ARTERY DISEASE

Introduction: The oxidative stress contributes for the development of the atherosclerosis and leads to instability of the atheromatous plaque in the vascular wall. The serum biomarkers of lipid peroxidation, such as malondialdehyde, may represent an independent indicator of risk for patients with coronary artery disease (CAD).Aim: To be examined if there is a difference in the erythrocyte and plasma concentrations of thiobarbituric acid (Thiobarbituric acid reactive supplements, TBARS) degradable lipid peroxidation products, expressed through a concentration of malondialdehyde (MDA) between patients with coronary artery disease and healthy blood donors.Material and methods: The examination represents a cross – sectional study involving 300 patients, divided in two groups: patients with an acute coronary artery disease and a chronic (ischemic) heart disease, divided into appropriate subgroups. The specimens processed in the biochemistry laboratory and it was used spectrophotometric test for quantitative determination of malondialdehyde in blood plasma and for an interpretation of the results standard reference values are used. Results: The results indicate statistically significant difference regarding the mean values of malondialdehyde concentration in the patients with and without coronary artery disease. There was no statistically significant difference between those with an acute and with a chronic coronary artery disease, althougt higher concentrations were observed in patients in the acute coronary artery disease than in the patients with the chronic (ischemic) coronary artery disease group. Statistical analysis of the data showed that there was also a statistically significant difference in mean values of malondialdehyde (MDA) concentration between subjects in the acute CAD group: between patients with STEMI and NSTEMI (p = 0.0237) and between patients with APNS and NSTEMI (p = 0.0164), and no statistically significant difference was found between the subjects in the chronic CAD group. Conclusion: The results of the performed research indicate to an increased level of malondialdehyde in the blood plasma at the patients with a coronary artery disease that indicates an existence of a redox imbalance compared with healthy patients. It is necessary, in future, these analyses to be used as a part of the panel of already known and/or new biomarkers with a goal appropriately to act toward the prevention or a certain treatment when curing patients with CAD, especially in patients with acute CAD.

944 Prevalence Rate of Colorectal Cancer in Various Chronic Liver Disease Groups in the United States Between 2014 and 2019: A Population-Based Study

INTRODUCTION: Prior studies have suggested that the risk of colorectal cancer (CRC) may be increased in individuals with cirrhosis and chronic liver disease (CLD). It is well known that a diagnosis of PSC has increased risk of CRC, but there is little date as to whether other causes of CLD have increased CRC risk as well. Some prior studies have been limited by small sample sizes, and to our knowledge no large study has been performed comparing CRC risk between the different causes of chronic liver disease. METHODS: We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to 2019. We identified an aggregated patient cohort of eligible patients with “Diagnosis: Alcoholic liver cirrhosis”, “Diagnosis: Chronic Viral hepatitis”, “Diagnosis: Autoimmune hepatitis”, and “Diagnosis: PBC” followed by a diagnosis of “Primary malignant neoplasm of colon and/or rectum” between May 2014 and May 2019, based on Systematized Nomenclature Of Medicine – Clinical Terms (SNOMED-CT). RESULTS: Of the 36,813,060 individuals active in the database between May 2014 and 2019, we identified 7,350 individuals with PBC with an overall prevalence rate of 20.0 per 100,000 persons; 66,160 individuals with alcoholic cirrhosis (AC) with overall prevalence rate of 180 per 100,000 persons; 186,840 individuals with chronic viral hepatitis (CVH) with overall prevalence rate of 508 per 100,000 persons; and 13,540 individuals with autoimmune hepatitis (AH) with overall prevalence rate of 36.8 per 100,00 persons. In the PBC group, 60 were found to have CRC with overall prevalence rate of 816/100,000, OR 2.1 [95%CI (1.62 to 2.64) P < 0.0001]. In the AC group 400 were found to have CRC with overall prevalence rate of 605/100,000, OR 1.54 [95%CI (1.40 to 1.70) P < 0.0001]. In the CVH group 890 were found to have CRC with overall prevalence of 473/100,000, OR 1.21 [95%CI (1.41 to 1.30) P < 0.0001]. In the AH group 50 were found to have CRC with overall prevalence of 369/100,000, OR 0.94 [95%CI (0.712 to 1.24) P = 0.6647]. CONCLUSION: To our knowledge, this is one of the first large studies to describe the epidemiology of CRC in chronic alcoholic, viral, and autoimmune diseases. We found that the estimated prevalence of CRC to be the highest in the PBC group at 816/100,000 and that CRC in the PBC and AC groups had increased risk compared to non liver disease with ORs of 2.1 and 1.54 respectively.

An observational study of self-reported sedentary behaviour in people with chronic obstructive pulmonary disease and bronchiectasis

BackgroundFew studies have examined sedentary behaviour in chronic respiratory disease. The limited evidence suggests that increased levels of sedentary behaviour are associated with increased mortality. ObjectivesThis study aimed to compare the level of self-reported sedentary behaviour in people with chronic obstructive pulmonary disease (COPD) and bronchiectasis as well as to identify associations between sedentary time with functional performance measures and health-related quality of life in the chronic respiratory disease group. MethodsAn observational study design was used. Participants completed the Sedentary Behaviour Questionnaire from which average sedentary time (hours/day) was determined. Functional performance was measured using the six-minute walk test, the four-metre gait speed test and the five sit-to-stand test. Health-related quality of life was measured using the St George's Respiratory Questionnaire. Sedentary time was compared between groups using an unpaired t-test. Univariate analysis explored relationships amongst variables. ResultsThe convenience sample consisted of 103 people with COPD [52% male; mean±SD age: 73±9 years, FEV1% predicted: 56±23] and 33 people with bronchiectasis [52% male; 74±8 years, FEV1% predicted: 69±25]. Average self-reported sedentary time in COPD was 7.6±2.7 hours/day and in bronchiectasis was 8.0±4.1 hours/day, with no between-group difference (−0.4, 95% CI −1.7, 0.8). No associations were found between sedentary time and any functional performance outcome or with health-related quality of life. ConclusionThere was no difference in the high sedentary time between people with COPD and bronchiectasis. Sedentary behaviour was not associated with functional performance or disease-related health-related quality of life in people with chronic respiratory disease.

Optimizing Utilization Of A Cardiac Rehabilitation Facility For Chronic Disease Prevention.

PURPOSE: Cardiac rehabilitation (CR) involves delivery of structured exercise, education and risk reduction, in a cost-effective manner. Despite its benefits, and clinical practice guideline recommendations, CR programs are grossly underused due to multiple barriers. A large study of 2,67,427 patients showed that CR was used in 13.9% of patients hospitalized for AMI and in 31.0% of those who underwent CABG surgery.To help optimize utilization of resources, at our hospital, we utilised our cardiac rehabilitation facility to include other disease groups such as cancer, respiratory and stable cerebrovascular diseases, since the principles of exercise prescription for these disease groups are similar to CR and require similar infrastructure.The purpose was to utilise a cardiac rehabilitation centre as a chronic disease prevention centre for oncology, and pulmonary patients. To also assess the effects of the comprehensive program on physical fitness levels of these patients using the 6-minute walk test. METHODS: 319 patients, which included those with cardiac disease (185), pulmonary disease (36) and cancer (98) were assessed as part of this study over a period of 3 years. The program comprised aerobic exercises, resistance training, yoga, and disease specific rehabilitation. The aerobic capacity was assessed before and after one month of rehabilitation by means of the 6 Minute Walk Test (6MWT). RESULTS: The 6-minute walk test distance (6MWTD) in the cardiovascular group improved from 331.56 (±99.68) to 413.99 (±104.43) meters, 24.86% increase from baseline (p<0.0001); pulmonary group improved from 313.17 (±100.90) to 339.31 (±116.92) meters, 8.35% increase from baseline (p=0.0002) and oncology group improved from 380.29 (±97.24) to 431.20 (±96.44 meters), 13.39% increase from baseline (p<0.0001). CONCLUSIONS: A comprehensive CR facility can be successfully used to include other chronic disease group patients. It helps to improve overall aerobic capacity as indicated by significant increase in 6-minute walk test distance in cardiac, pulmonary and oncology patients. This can help hospitals deploy their rehabilitation services in an efficient and cost-effective manner.

Relevância diagnóstica dos Gráficos de Recorrência na caracterização de Saúde, Doença ou Morte, em humanos

Gráficos de recorrência (GR) têm sido utilizados para avaliar sistemas dinâmicos complexos, sendo o corpo humano um excelente modelo. Foram analisados ​​os elementos quantitativos e qualitativos do GR na diferenciação de Saúde, Doença e Morte. Séries temporais de batimentos cardíacos normais foram coletadas em recém-nascidos saudáveis ​​(Grupo A1), crianças saudáveis ​​(Grupo A2), adultos jovens saudáveis ​​(Grupo A3), adultos saudáveis ​​de meia-idade (Grupo A4), idosos residentes em casas de repouso (Grupo B), indivíduos com doença renal crônica avançada (Grupo C) e indivíduos com morte encefálica declarada ou em estado de morte iminente (Grupo D). O grupo A3 apresentou a melhor homeostase (menor recorrência). Os grupos A1 e D apresentaram os maiores valores de recorrência. Em termos visuais qualitativos, o Grupo A3 apresentou distribuição mais difusa e uniforme, um indicativo de melhor homeostase e o Grupo D foi totalmente linear, a pior condição. Um padrão parabólico foi claramente evidenciado. Em conclusão, foi possível, utilizando a correlação de apenas duas variáveis ​​(SDNN e TT), diferenciar tanto de modo quantitativo como qualitativo os estados de Saúde, Doença e Morte usando GR.

Lung Transplantation in Hungary From Cardiac Surgeons' Perspective

Thoracic organ transplantation made a fresh start in Hungary with the first double lung transplant in December 2015. This major leap in Hungarian transplantation was preceded by almost 10 years of preparation, new infrastructure development, and structural changes not only at the organizational level but in human resources as well. In the following years, until recently, altogether 47 lung transplants were performed on 24 men and 23 women. The underlying pathologies were as follows: chronic obstructive pulmonary disease, 25; cystic fibrosis, 11; idiopathic pulmonary fibrosis, 7; as well as other diseases, including bronchiectasis, eosinophilic granuloma, lymphangioleiomyomatosis, and primary pulmonary hypertension in 4 cases. The youngest recipient was 13 and the oldest was 65 years old. Overall survival rates at 30 days and at 1 year were 96% and 82%, respectively. No patients were lost in the cystic fibrosis and other diseases group, whereas the 1-year survival rates of the chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis groups were 73% and 71%, respectively. The results show the robustness and viability of the program, although there is still opportunity for further improvement. In this short paper, we summarize the fields of possible further cooperation of thoracic and cardiac teams as well as future challenges facing the new Hungarian lung transplant program.

The evaluation of cardiac functions according to chronic obstructive pulmonary disease groups

Objectives: We aimed to compare right and left ventricular functions by echocardiography (ECHO) according to chronic obstructive pulmonary disease (COPD) groups, and to determine their associations with functional parameters.Methods: Data of patients with COPD who underwent ECHO between 2015 and 2018 were analyzed retrospectively. The results of pulmonary function tests, 6-minute-walking test (6MWT), Modified Medical Research Council (mMRC), COPD assessment test (CAT), and BODE scores were recorded together with ECHO results showing right and left ventricular functions.Results: 126 COPD patients were evaluated. Of these, 37.3% was in group A, 28.6% in group B, 12.7% in group C, and 21.4% in group D. Most common comorbidities were cardiovascular diseases (CVD) and pulmonary hypertension (PH); these were most frequently seen in groups D and B. Regarding ECHO parameters, differences were present among groups in systolic pulmonary arterial pressure (sPAP) and left ventricle end-systolic diameter (LVEF) (p < 0.001 and 0.004, respectively). sPAP was highest in groups D and B whereas LVEF was lowest in group D.Conclusion: Our results suggest that patients’ symptoms in symptomatic COPD groups B and D might be related to increased PAP and concomitant cardiovascular comorbidities. Therefore, a detailed cardiovascular investigation should be performed from early stages in COPD.

High serum IgA/C3 ratio better predicts a diagnosis of IgA nephropathy among primary glomerular nephropathy patients with proteinuria\u2009\u2264\u20091\u2009g/d: an observational cross-sectional study

BackgroundThe serum immunoglobulin A (IgA)/C3 ratio is considered to be an effective predictor of IgA nephropathy (IgAN). This study sought to explore the diagnostic value of the IgA/C3 ratio in IgAN among primary glomerular nephropathy patients in China.MethodsWe recruited 1095 biopsy-diagnosed primary glomerular nephropathy patients, including 757 IgAN patients and 338 non-IgAN patients. Patient demographics, serum immunological indices, and other clinical examinations were measured. IgAN cases were propensity score matched (PSM) to non-IgAN cases on the logit of the propensity score using nearest neighbor matching in a 1:1 fashion, with a caliper of 0.02 with no replacements, according to age, gender, BMI, proteinuria level, and estimated glomerular filtration rate (eGFR).ResultsWe found that in both the full cohort and PSM cohort, the IgA/C3 ratio in the IgAN group was significantly higher than that of the non-IgAN group. The same results were also obtained with stratification by different levels of proteinuria and renal function. In the PSM cohort, there was no difference in IgA/C3 ratio in patients with IgAN between different proteinuria groups and different chronic kidney disease (CKD) groups. The area under the ROC curve (AUROC) of the IgA/C3 ratio in distinguishing IgAN among primary glomerular disease was 0.767 in the full cohort, and 0.734 in the PSM cohort. The highest AUROC of the IgA/C3 ratio was in the ≤1 g/d proteinuria group (0.801 in the full cohort, and 0.803 in the PSM cohort); however, there was no difference between all CKD groups. Meanwhile, the diagnostic accordance rate for the diagnosis of IgAN among all patients with an IgA/C3 ratio > 3.5304 was as high as 92.02% in the full cohort. IgAN was independently correlated with IgA/C3 ratio in the full cohort by multivariate logistic regression analysis.ConclusionsThe present study provides clear evidence that the IgA/C3 ratio is an effective predictor of IgA diagnosis, especially in patients with proteinuria ≤1 g/d. In order to study the effectiveness of this biomarker, and to determine a standardized cut-off value, additional multicenter large-scale studies are needed.

Patient dose evaluation in computed tomography: A French national study based on clinical indications

PurposeA national survey was performed to assess patient dose indicators based on clinical indication and on patient morphology for most common adult computed tomography (CT) examinations in France. MethodsSeventeen groups of clinical indications (GCIs) for diagnostic CT in adult patients were considered based on their frequency and on image quality requirements. Data was collected for 15–30 consecutive examinations performed between 2015 and 2017, per CT scanner and GCI. Distributions of total examination Dose-Length Product (DLP) and Volume CT Dose Index (CTDIvol) were assessed for each GCI as a function of patient gender or patient Body Mass Index (BMI) for head/neck and trunk examinations, respectively. Results6610 examinations were analysed. Median total exam DLP values were higher for men compared to women patients for head and neck examinations: difference ranged from 6% for ear trauma indication (577 vs 543 mGy·cm, p = 0.01) to 35% for brain tumour GCI (1472 vs 1093 mGy·cm, p < 0.01). For trunk examinations, total exam DLP increased consistently with patient’s BMI. For normal-BMI patients, median CTDIvol and DLP differed significantly between different GCIs for single-phase CT of the chest (3 mGy and 112 mGy·cm, respectively, for chronic obstructive pulmonary disease group vs 5.8 mGy and 207 mGy·cm for pulmonary embolism group, p < 0.05) and of the abdomen-pelvis (5.6 mGy and 284 mGy·cm, respectively, in renal colic group vs 9.5 mGy and 463 mGy·cm in occlusive syndrome group, p < 0.05). ConclusionThis study provides morphological- and clinical-based patient dose indicators in CT as a practical tool for clinical practices optimisation.

Evaluation of reticulocyte hemoglobin for assessment of anemia in rheumatological disorders.

The aim of this study was to evaluate the role of reticulocyte hemoglobin (Ret He) estimation in subtyping of anemia and to find the correlation of Ret He with the severity of anemia. Ninety-four patients with rheumatic diseases with anemia were enrolled. Blood samples were taken to determine various parameters. Patients were divided into three groups: iron deficiency anemia, anemia of chronic disease with iron deficiency and anemia of chronic disease depending on the iron status and inflammatory markers. Analysis of variance and Pearson correlation coefficient were used. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating anemia. Statistically significant differences among groups were seen with regard to parameters such as erythrocyte sedimentation rate, C-reactive protein, serum ferritin, total iron binding capacity, transferrin saturation, transferrin receptor protein, soluble transferrin receptor/log ferritin and Ret He. Ret He correlates with the subtype of anemia in patients with rheumatic disorders but it does not correlate with the severity of anemia. Soluble transferrin receptor/log ferritin, Ret He and serum ferritin values were the best parameters to differentiate between various groups. Ret He (pg) values of <24, 24-26.5 and >26.5, while serum ferritin levels (µg/L) of <35, 35-178 and >178 were highly sensitive and specific for iron deficiency anemia, anemia of chronic disease with iron deficiency and anemia of chronic disease groups, respectively. In cost constraints settings, a simple investigation like Ret He alone or with serum ferritin can help us to diagnose and differentiate between the different types of anemia accompanying rheumatological disorders without doing other serum iron studies and expensive tests like transferrin receptor protein which are not readily available.

Acoustic radiation force impulse sonography‐based noninvasive prediction of cirrhosis and esophageal varices

Esophagogastroduodenoscopy (EGD) screening is currently suggested with a practice guideline for all cirrhosis patients, but the true EGD screening rate is low. Our study evaluates noninvasive variables—including liver stiffness (LS), spleen stiffness (SS), and spleen diameter—based on acoustic radiation force impulse (ARFI) sonography for noninvasive prediction of cirrhosis and esophageal varices (EVs). In our study, 118 patients (mean age 57.11 ± 11.23), who were classified into a cirrhosis group and a chronic liver disease group, were compared statistically on their blood data and ARFI sonography. To identify the most effective variable for noninvasive prediction of EVs, the cirrhosis group was further divided into two subgroups by the presence or absence of EVs. EV and non‐EV (NEV) patients were compared statistically using blood data, spleen diameter, LS, and SS. The LS cutoff value for predicting cirrhosis was determined as 1.64 m/s, which carried a sensitivity of 81.2% and a specificity of 93.9%. SS and spleen diameter met a significant difference for EV prediction. Spleen diameter with a cutoff value of 10.69 cm carried a sensitivity of 96.2% and a specificity of 56.3%; SS with a cutoff value of 2.82 m/s carried a sensitivity of 96.2% and a specificity of 50%. In our study, a new cutoff criterion composed of spleen diameter and SS was suggested as a better clinical tool for the screening of EVs.

The Dose per Fraction May be correlated with Late Kidney Toxicity after Total Body Irradiation: a Single Institution Experience

Background: The purpose of the present study was to retrospectively evaluate the subacute or late toxicities in the kidney, lung, and liver after two total body irradiation regimens, 12 Gy in 6 fractions (group A) and 12 Gy in 4 fractions (group B). Methods: Forty-two patients who underwent total body irradiation (group A, n=32; group B, n=10) between June 1997 and June 2013 were included in the present study. The median follow up period was 60 months (range: 3–219 months) for the patients in group A and 143 months (range: 5–220 months) for the patients in group B. We evaluated the renal, pulmonary, and hepatic toxicities using the Common Terminology Criteria for Adverse Events version 4.0. Results: There were 4 cases of chronic kidney disease (group A, n=1; group B, n=3). Although the cumulative incidence of chronic kidney disease differed significantly between the two total body irradiation regimens (p=0.014), the pulmonary and hepatic toxicities did not differ to a statistically significant extent. Conclusion: The present study suggests that a higher dose per fraction caused a higher incidence of chronic kidney disease.

Health Literacy and Medication Literacy in Saudi Arabia: Current Status

Background: Low health literacy and medication literacy can be associated with adverse medication-related events. The objectives of this research were to characterize medication use, describe health information sources, and characterize medication literacy in the KSA population.&#x0D; Methods: A cross-sectional nationwide survey was conducted among Saudi residents aged 18 years or above.&#x0D; Results: A total of 3,557 surveys were available for analysis (men = 1,811 and women = 1,746). Respondents were concentrated in younger categories, and each region was represented by 7% to 8% of respondents by design. Twenty-three percent of respondents (n = 825) reported having at least one chronic disease. A total of 1,882 (53%) of respondents reported ever looking for health information; of those, web pages were the most popular information sources. Among those taking medication for chronic disease, only 61% agreed that they knew how their medication should be monitored, 51% agreed that they knew what to do if they missed a dose, and 50% agreed that they knew their drug's side effects.&#x0D; Conclusion: This study's results suggest that interventions focused on medication literacy and tailored to prevalent chronic disease groups should be explored. Because the most common source of health information is web pages, interventions to improve overall health information literacy, especially pertaining to online medication information, should be studied.

Clinicopathological and prognostic significance of CDH1 hypermethylation in hepatocellular carcinoma: a meta-analysis.

BackgroundThe patients with hepatocellular carcinoma (HCC) have poor prognosis due to being diagnosed at late stage or recurrence following surgery. It’s critical to identify effective biomarkers that can improve overall diagnosis and treatment of HCC.MethodsWe performed a meta-analysis of all relative studies reporting the clinicopathological significance of CDH1 hypermethylation in HCC by using Review Manager 5.2. A comprehensive literature search was performed in EMBASE, PubMed, Web of Science and Google Scholar databases. Kaplan Meier Plotter online database was used for the determination of correlation between CDH1 mRNA expression and overall survival in patients with HCC. Odds Ratios (OR) with 95% corresponding confidence intervals (CIs) were calculated. A total of 12 relevant studies were included in the meta-analysis with 981 patients.ResultsThe positive rate of CDH1 hypermethylation was significantly higher in HCC than in normal liver tissue; and the pooled OR was 4.34 with 95% CI 2.50–7.56, P<0.00001. CDH1 promoter in HCC was more frequently hypermethylated compared to the group of chronic liver disease (CLD); OR was 4.83 with 95% CI 2.67–8.72, P<0.00001. However, the rate of CDH1 promoter hypermethylation was not correlated with different grades as well as stages. High CDH1 mRNA expression was significantly correlated to better overall survival in all 231 HCC patients compared to 133 HCC patients with low level CDH1 mRNA expression; HR was 0.6 with 95% CI 0.42–0.85, P=0.0034.ConclusionIn summary, CDH1 promoter hypermethylation is a risk factor and promising biomarker for HCC carcinogenesis and diagnosis, as well as a predictor of poor prognosis.

Mortality and Exacerbations by Global Initiative for Chronic Obstructive Lung Disease Groups ABCD: 2011 Versus 2017 in the COPDGene® Cohort.

Background: The Global initiative for chronic Obstructive Lung Disease (GOLD) ABCD groupings were recently modified. The GOLD 2011 guidelines defined increased risk as forced expiratory volume in 1 second (FEV1) < 50% predicted or ≥ 2 outpatient or ≥ 1 hospitalized exacerbation in the prior year, whereas the GOLD 2017 guidelines use only exacerbation history. We compared mortality and exacerbation rates in the Genetic Epidemiology of COPD Study cohort (COPDGene®) by 2011 (exacerbation history/FEV1 and dyspnea) versus 2017 (exacerbations and dyspnea) classifications. Methods: Using data from COPDGene®, we tested associations of ABCD groups with all-cause mortality (Cox models, adjusted for age, sex, race and comorbidities) and longitudinal exacerbations (zero-inflated Poisson models). Results: In 4469 individuals (mean age 63.1 years, 44% female), individual distributions in 2011 versus 2017 systems were: A, 32.0% versus 37.0%; B, 17.6% versus 36.3%; C, 9.4% versus 4.4%; D, 41.0% versus 22.3%; (observed agreement 76% [expected 27.8%], Kappa 0.67, p<0.001). Individuals in group D-2011 had 1.1 ± 1.6 exacerbations/year (mean ± standard deviation [SD]) versus 1.4 ± 1.8 for D-2017 (median follow-up 3.7 years). Using group A as reference, for both systems, mortality (median follow-up 6.8 years) was highest in group D (D-2011, [hazard ratio] HR 5.2 [95% confidence interval (CI) 4.2, 6.4]; D-2017, HR 5.5 [4.5, 6.8]), lowest for group C (HR 1.9 [1.4, 2.6] versus HR 1.9 [1.3, 2.8]) and intermediate for group B (HR 2.6 [2.0, 3.4] versus HR 3.4 [2.8, 4.1]). GOLD 2011 had better mortality discrimination (area under the curve [AUC] 0.68) than GOLD 2017 (AUC 0.66, p<0.001 for comparison) but similar exacerbation rate prediction. Conclusions: Relative to the GOLD 2011 consensus statement, discriminate predictive power of the 2017 ABCD classification is similar for exacerbations but lower for survival.

Is hepcidin related with anemia and bone mineral metabolism in children with non-dialysis chronic kidney disease?

Aim:Functional iron deficiency seco ndary to inflammation and increased serum hepcidin lead to erythropoietin-resistant anemia in children with chronic kidney disease. Vitamin D deficiency, parathyroid hormone, and phosphate can also participate in chronic inflammation and anemia. The aim of this study was to evaluate the association between hepcidin, bone mineral metabolism, and anemia in non-dialysis pediatric patients with chronic kidney disease.Material and Methods:Thirty-five patients with stage 2–4 chronic kidney disease and 35 healthy subjects were enrolled in the study. Serum creatinine, blood urea nitrogen, uric acid, C-reactive protein, interleukin-6, hepcidin, complete blood count, ferritin, calcium, phosphorus, parathyroid hormone, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and fibroblast growth factor-23 levels were compared between the groups.Results:Ferritin, C-reactive protein, interleukin-6, blood urea nitrogen, creatinine, uric acid levels, and percentages of reticulocytes were significantly higher than in the controls (p<0.05). The mean serum hepcidin levels in the chronic kidney disease and control groups were 9.6±5.2 (range, 2.15–25.3) and 9.7±4.3 (range, 3.4–22.2) ng/mL and were not significantly different in either group. There were no differences in terms of serum phosphorus, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and fibroblast growth factor-23 levels between the groups (p>0.05). Serum hepcidin levels were not correlated with anemia parameters, serum fibroblast growth factor-23, phosphorus, uric acid, C-reactive protein, parathyroid hormone, and 25-hydroxyvitamin D levels (p>0.05). However, serum hepcidin levels were correlated with 1,25-dihydroxyvitamin D and interleukin-6 levels (p=0.013 and p=0.002, respectively).Conclusion:Serum hepcidin levels may not increase significantly in non-dialysis pediatric patients with chronic kidney disease despite high levels of inflammatory markers such as C-reactive protein and interleukin-6. The increase of serum hepcidin levels may be inhibited by effective treatment of anemia with iron supplementation and erythropoietin, and the treatment of secondary hyperparathyroidism with phosphate binders and the active form of vitamin D, which decrease serum parathyroid hormone and fibroblast growth factor-23 levels, and control inflammation to some extent.

Biological and genetic evaluation of IL-23/IL-17 pathway in ankylosing spondylitis patients.

Ankylosing spondylitis is the most common form of the chronic inflammatory disease group known as spondyloarthritides. Recent discoveries of the CD4+ Th17 cells and IL-23/IL-17 axis have changed the paradigms in many autoimmune diseases. In this study, we aimed to evaluate the importance of IL-23/IL-17 pathway and IL-23 receptor polymorphism in the pathogenesis of ankylosing spondylitis. Blood samples for this study were obtained from 109 ankylosing spondylitis patients and 40 healthy control subjects. Serum levels of TNF-α, IL-6, IL-17, and IL-23 were measured by the ELISA method. The IL-23R gene polymorphisms rs11209026 (Arg381Gln) and rs4131362 (Val362Ile) were performed by the Sanger Sequence method. IL-6 levels were higher in the active and inactive ankylosing spondylitis groups than in the control group. However, levels of IL-17 and IL-23 were lower in the patient group. The frequency of IL-23R gene rs11209026 and rs4131362 polymorphism were 3.7% and 8.3% in the patient, respectively. As a result, dysregulation of the IL-23 / IL-17 pathway, which is caused by reduced levels of IL-17 and IL-23 in systemic circulation in patients with ankylosing spondylitis, may contribute to the pathogenesis of the disease by systemically producing chronic autoimmune inflammation.