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1.
Claudia Palladino Beatriz Esteban-Cartelle Irene Mate-Cano Marta Sánchez-Carrillo Salvador Resino Verónica Briz 《Enfermedades infecciosas y microbiología clínica》2018,36(5):262-267
Resistance-associated substitutions (RASs) to the new HCV NS5A inhibitor elbasvir may limit its efficacy and lead to virological failure in HCV-GT1a-infected patients. There are no data outside clinical trials evaluating their prevalence and impact in grazoprevir/elbasvir in GT1a-infected patients in Spain. A multicentre cross-sectional study of 632 initial patients was conducted. In 13 of these patients, the sample could not be amplified or a consensus sequence by Sanger sequencing could not be performed. Ultimately, 617 HCV-G1a-infected individuals treated at 84 Spanish hospitals from the 17 autonomous communities plus the 2 autonomous cities of Spain were analysed. HCV population sequencing was used to identify RAS to elbasvir and the mutational pattern and drug sensitivity were confirmed by geno2pheno[HCV]. Viruses bearing RASs to elbasvir were present in 6.2% of HCV-G1a infected patients. The most common RASs were the Y93C/H/N and Q30E/H/R (2.4% and 2.3%, respectively). Only 3.4% of the identified RASs to elbasvir conferred reduced susceptibility to elbasvir by geno2pheno[HCV], which exclusively identified the positions Q30H/R (n = 7) and Y93C/H/N (n = 8) as single mutations and Q30H + Y93H (n = 4) and Q30R + Y93H (n = 2) as double mutations as the major RASs to elbasvir. A lower prevalence of RASs to elbasvir was observed in our HCV-G1a Spanish cohort than reported previously in clinical trials evaluating patients from the USA. This information may be essential to guide the implementation of grazoprevir/elbasvir in Spain and to manage G1a-infected patients. 相似文献
2.
José María Moreno-Planas Juan Ramón Larrubia-Marfil Juan José Sánchez-Ruano Julia Morillas-Ariño Roberto Patón-Arenas Rosa María Sáiz-Chumillas Emilia Tébar-Romero Alfredo Lucendo-Villarín Pilar Gancedo-Bringas Mario Solera-Muñoz María del Mar Vicente-Gutiérrez Elisa Martínez-Alfaro 《Enfermedades infecciosas y microbiología clínica》2018,36(5):277-283
Introduction
There are few published studies on predictors of response to treatment with sofosbuvir and simeprevir in HCV patients.Objective
The objective of the study was to analyse possible predictors of response to simeprevir (SMV) and sofosbuvir (SOF) in patients infected with hepatitis C genotypes 1 or 4.Patients and methods
Prospective observational cohort study in 12 hospitals. The primary efficacy endpoint was SVR rate 12 weeks after end of treatment (SVR12).Results
204 patients (62.3% male, mean age 55 years) were included: 186 (91.2%) genotype 1 (60.3% 1 b 25% 1 a) and 18 (8.8%) genotype 4. 132 (64.7%) cirrhotic (87.9% Child A), 33 (16.2%) F3, 31 (15.2%) F2, 8 (3.9%) F0-1. 80.8% MELD < 10. 93 (45.6%) naive. Ribavirin was added in 68 (33.3%). Mean baseline viral load 2,151,549 IU/ml (SD: 2,391,840). Treatment duration 12 weeks in 93.1%. 4 discontinued therapy: suicide, psychotic attack, hyperbilirubinaemia and liver cancer recurrence. 190 (93.1%) achieved SVR12. There were no differences in SVR12 depending on the genotype, treatment duration, ribavirin use, prior therapy, viral load (VL) or baseline platelets. In univariate analysis, undetectable VL at 4 weeks (p = 0.042), absence of cirrhosis (p = 0.021), baseline albumin ≥ 4 g/dl (p = 0.001) and MELD < 10 (p < 0.0001) were associated with higher SVR12. In multivariate analysis, only baseline MELD score <10 patients had higher SVR12 (p < 0.001).Conclusions
The combination of simeprevir and sofosbuvir in patients infected with genotype 1 and 4 hepatitis C is highly effective. It is a safe therapy, especially in patients without ribavirin. This combination was more effective in patients with a MELD score below 10. 相似文献3.
4.
Isabel Galán Úrsula Verdalles Marisol García de Vinuesa Borja Quiroga Marian Goicoechea Ana Pérez Eduardo Verde José Luño 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(4):379-385
Objective
Observational retrospective study with consecutive patients with CKD to assess the degree of accomplishment of the therapeutic objectives in hypertension and dyslipidaemia recommended by JNC 8 and KDIGO-2013 CKD guidelines the impact of their implementation compared with previous guidelines.Results
618 patients were included, mean age 67 ± 15 years, 61.33% male. Mean eGFR was 45.99 ± 18.94 ml/min, with median albumin/creatinine 26 (0-151) mg/g. A total of 87.6% received antihypertensive treatment and 50.2% received statins. According to KDIGO guidelines, 520 patients (84.14%) should receive statins, but only 304 (58.46%) were receiving them. Patients on statin treatment had more diabetes and hypertension, and a greater cardiovascular history and lower levels of total and LDL-cholesterol.A total of 97.7% of patients were under 60 years of age or had eGFR < 60 ml/min/1.73 m2 or were diabetic, so according to the JNC 8 report, they should have a target blood pressure < 140/90 mmHg. A total of 289 patients did (47.85%). According to the JNC 7 report, this group had a tighter target blood pressure < 130/90 mmHg, reducing the number of patients who fulfilled the target: 136 (22.52%). Patients reclassified were older, had a greater cardiovascular history and less DM.Conclusion
The new KDIGO guidelines for dyslipidaemia treatment increase the indication of statin therapy, especially in patients at high cardiovascular risk. The JNC 8 guidelines improve the percentage of patients with controlled blood pressure, especially the elderly and patients with increased cardiovascular risk, in whom the target blood pressure is currently controversial. 相似文献5.
Montserrat Laguno Centeno Beatriz Alvarez Maria Martínez-Rebollar Lorena de la Mora Laura Prieto Elisa de Lazzari Ana González-Cordón Berta Torres Alfonso Cabello Miguel Gorgolas Josep Mallolas 《Gastroenterologia y hepatologia》2021,44(3):191-197
BackgroundAcute hepatitis C virus (AHC) infection is increasingly common among HIV+ men who have sex with men (MSM). Until 2017, the guidelines recommended therapy with pegylated-interferon plus ribavirin with a mild sustained virological response (SVR). This prompted many patients to reject that treatment, at that time, waiting to be treated with better and safer options with new Direct-Acting-Antivirals (DAA).ObjectivesAssess the efficacy and safety of Elbasvir/Grazoprevir to treat recent chronic hepatitis C infection, genotype 1 or 4, in HIV+ MSM patients.MethodsProspective, open-labeled, two center, pilot study. SVR is analyzed for treatment with Elbasvir/Grazoprevir (8 weeks in GT1b or 12 in GT1a or GT4) in patients with a recent chronic HCV infection, defined as HCV infection lasting less than 4 years and mild liver fibrosis (liver stiffness <8 kPa).ResultsForty-eight patients were included (May 2017–March 2018): 2 GT1b, 24 GT1a and 22 GT4. HCV-RNA > 800000 UI in 63% and medium liver stiffness 4.9 kPa. The SVR was 98%, one patient failed due to poor adherence. 67% of patients had adverse effects, but only 16% treatment related. The most frequent side effects were gastrointestinal (19%), related with the central nervous system (18%), respiratory (16%) and systemic symptoms (15%).During one year of follow-up post-therapy, 4 AHC and 18 patients with sexually transmitted diseases (STD) were diagnosed.ConclusionsTreatment with Elbasvir/Grazoprevir in this scenario is highly effective and safe. Patients with risky sexual practices must remain linked to the medical care system to detect new STD and HCV reinfection. 相似文献
6.
Nicola Ryan Luis Nombela-Franco Pilar Jiménez-Quevedo Corina Biagioni Pablo Salinas Andrés Aldazábal Enrico Cerrato Nieves Gonzalo María del Trigo Iván Núñez-Gil Antonio Fernández-Ortiz Carlos Macaya Javier Escaned 《Revista espa?ola de cardiología》2018,71(8):628-637
Introduction and objectives
The predictive value of the SYNTAX score (SS) for clinical outcomes after transcatheter aortic valve implantation (TAVI) is very limited and could potentially be improved by the combination of anatomic and clinical variables, the SS-II. We aimed to evaluate the value of the SS-II in predicting outcomes in patients undergoing TAVI.Methods
A total of 402 patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI were included. Preprocedural TAVI angiograms were reviewed and the SS-I and SS-II were calculated using the SS algorithms. Patients were stratified in 3 groups according to SS-II tertiles. The coprimary endpoints were all-cause death and major adverse cardiovascular events (MACE), a composite of all-cause death, cerebrovascular event, or myocardial infarction at 1 year.Results
Increased SS-II was associated with higher 30-day mortality (P = .036) and major bleeding (P = .015). The 1-year risk of death and MACE was higher among patients in the 3 rd SS-II tertile (HR, 2.60; P = .002 and HR, 2.66; P < .001) and was similar among patients in the 2 nd tertile (HR, 1.27; P = .507 and HR, 1.05; P = .895) compared with patients in the 1 st tertile. The highest SS-II tertile was an independent predictor of long-term mortality (P = .046) and MACE (P = .001).Conclusions
The SS-II seems more suited to predict clinical outcomes in patients undergoing TAVI than the SS-I. Increased SS-II was associated with poorer clinical outcomes at 1 and 4 years post-TAVI, independently of the presence of coronary artery disease.Full English text available from: www.revespcardiol.org/en 相似文献7.
8.
《Gastroenterologia y hepatologia》2022,45(6):419-423
Background & aimsColorectal (CRC) screening programs represent a large volume of procedures that need a follow-up endoscopy. A knowledge-based clinical decision support system (K-CDSS) is a technology which contains clinical rules and associations of compiled data that assist with clinical decision-making tasks. We develop a K-CDSS for management of patients included in CRC screening and surveillance of colorectal polyps.MethodsWe collected information on 48 variables from hospital colonoscopy records. Using DILEMMA Solutions Platform © (https://www.dilemasolution.com) we designed a prototype K-CDSS (PoliCare CDSS), to provide tailored recommendations by combining patients data and current guidelines recommendations. The accuracy of rules was verified using four scenarios (normal colonoscopy, lesions different than polyps, non-advanced adenomas and advanced adenomas). We studied the degree of agreement between the clinical assessments made by expert doctors and nurses equipped with PoliCare CDSS. Two experts confirmed a correlation between guidelines and PoliCare recommendations.Results56 consecutive endoscopy cases from colorectal screening program were included (62.8 years; range 53-71). Colonoscopy results were: absence of colon lesions (n = 7, 12.5%), lesions in the colon that are not polyps (n = 3, 5.4%) and resected colonic polyps (n = 46, 82.1%; 100% R0 resection). Patients with resected polyps presented non-advanced adenoma (n = 21, 45.6%) or advanced lesions (n = 25, 54.4%). There were no differences in erroneous orders with PoliCare CDSS (Kappa value 1.0).ConclusionsPoliCare CDSS can easily be integrated into the workflow for improving the overall efficiency and better adherence to evidence-based guidelines. 相似文献
9.
Maria Pipa-Muñiz Lluis Castells Sonia Pascual Javier Fernández-Castroagudín Iratxe Díez-Miranda Javier Irurzun Roberto Díaz-Beveridge María Senosiaín Juan Arenas Manuel de la Mata Juan Turnes María Isabel Monge-Romero Daniel Pérez-Enguix Javier Bustamante-Schneider Nora Otegui Esther Molina-Pérez José Eduardo Rodríguez-Menéndez Maria Varela 《Gastroenterologia y hepatologia》2017,40(8):515-524
Introduction
The appropriate selection of hepatocellular carcinoma (HCC) patients who are eligible for transarterial chemoembolization (TACE) remains a challenge. The ART score has recently been proposed as a method of identifying patients who are eligible or not for a second TACE procedure.Objective
To assess the validity of the Assessment for Retreatment with TACE (ART) score in a cohort of patients treated with drug-eluting bead TACE (DEB-TACE). Secondary objective: to identify clinical determinants associated with overall survival (OS).Method
A retrospective, multicentre study conducted in Spain in patients with HCC having undergone two or more DEB-TACE procedures between January 2009 and December 2014. The clinical characteristics and OS from the day before the second DEB-TACE of patients with a high ART score (ART ≥ 2.5) and a low ART score (ART 0–1) were compared. Risk factors for mortality were identified using Cox's proportional hazards model.Results
Of the 102 patients included, 51 scored 0–1.5 and 51 scored ≥2.5. Hepatitis C was more frequent in patients scoring ≥2.5. Median OS from the day before the second DEB-TACE was 21 months (95% CI, 15–28) in the group scoring 0–1.5, and 17 months (95% CI, 10–25) in the group scoring ≥2.5 (P = 0.3562). Platelet count and tumour size, but not the ART score, were independent baseline predictors of OS.Conclusions
The ART score is not suitable for guiding DEB-TACE retreatment according to Spanish clinical practice standards. 相似文献10.
Mauricio Restrepo-Escobar Paula Andrea Granda-Carvajal Fabián Jaimes 《Reumatología clinica》2019,15(1):27-33
Objective
To develop a multivariable clinical prediction model for the requirement of aggressive immunosuppression with cytostatics, based on simple clinical record data and lab tests. The model is defined in accordance with the result of the kidney biopsies.Methods
Retrospective study conducted with data from patients 16 years and older, with SLE and nephritis with less than 6 months of evolution. An initial bivariate analysis was conducted to select the variables to be included in a multiple logistic regression model. Goodness of fit was evaluated using a Hosmer–Lemeshow test (H–L) and the discrimination capacity of the model by means of the area under the ROC (AUC) curve.Results
Data from 242 patients was gathered; of these, 18.2% (n = 44) did not need an addition of cytostatics according to the findings of their kidney biopsies. The variables included in the final model were 24-h proteinuria, diastolic blood pressure, creatinine, C3 complement and the interaction of hematuria with leukocyturia in urinary sediment. The model showed excellent discrimination (AUC = 0.929; 95% CI = 0.894–0.963) and adequate calibration (H–L, P = .959).Conclusion
In recent-onset LN patients, the decision to use or not to use intensive immunosuppressive therapy could be performed based on our prediction model as an alternative to kidney biopsies. 相似文献11.
Ángeles Rodríguez-Martínez Alberto Ruano-Ravina María Torres-Durán Iria Vidal-García Virginia Leiro-Fernández Jesús Hernández-Hernández Silvia García-García Mariano Provencio Olalla Castro-Añón Isaura Parente-Lamelas Ihab Abdulkader José Abal-Arca Carmen Montero-Martínez Margarita Amenedo Rosirys Guzmán-Taveras Alberto Fernández-Villar Juan Miguel Barros-Dios 《Archivos de bronconeumología》2017,53(12):675-681
Introduction
Small cell lung cancer (SCLC) is the most aggressive histologic type of lung cancer, and accounts for approximately 10%-15% of all cases. Few studies have analyzed the effect of residential radon. Our aim is to determine the risk factors of SCLC.Methods
We designed a multicenter, hospital-based case-control study with the participation of 11 hospitals in 4 autonomous communities.Results
Results of the first 113 cases have been analyzed, 63 of which included residential radon measurements. Median age at diagnosis was 63 years; 11% of cases were younger than 50 years of age; 22% were women; 57% had extended disease; and 95% were smokers or former smokers. Median residential radon concentration was 128 Bq/m3. Concentrations higher than 400 Bq/m3 were found in 8% of cases. The only remarkable difference by gender was the percentage of never smokers, which was higher in women compared to men (P < .001). Radon concentration was higher in patients with stage IV disease (non-significant difference) and in individuals diagnosed at 63 years of age or older (P = .032).Conclusions
A high percentage of SCLC cases are diagnosed early and there is a predominance of disseminated disease at diagnosis. Residential radon seems to play an important role on the onset of this disease, with some cases having very high indoor radon concentrations. 相似文献12.
Carolina Muñoz-Codoceo Maria Amo Ana Martín Cristina Martín-Arriscado Arroba Lidia Cuevas del Campo Maria Luisa Manzano Raquel Muñoz Gregorio Castellano Inmaculada Fernández 《Gastroenterologia y hepatologia》2021,44(4):269-276
IntroductionThe aim of this study was to investigate the accuracy of liver and spleen stiffness measurement by transient elastography for the prediction of gastroesophageal varices in patients with HCV-associated cirrhosis treated with new direct-acting antiviral agents.Patients and methodsThis cross-sectional observational study included patients with compensated HCV-related cirrhosis and sustained virological response after direct-acting antiviral therapy. Patients underwent liver and spleen stiffness measurement, abdominal ultrasound and oesophago-gastroduodenoscopy. Clinical and laboratory data and non-invasive markers such as the liver stiffness–spleen diameter to platelet ratio score, variceal risk index and platelet count to spleen diameter ratio were analyzed.ResultsNinety-seven consecutive patients were included. Liver stiffness measurement (12.2 vs 16; p = 0.02), spleen stiffness measurement (39.4 vs 46.05; p = 0.04), liver stiffness–spleen diameter to platelet ratio score (1.21 vs 2.02; p = 0.008), platelet count to spleen diameter ratio (1102.19 vs 829.7; p = 0.04) and variceal risk index (?3.4 vs ?1.02; p = 0.01) showed significant differences between patients without/with gastroesophageal varices. The best cut-off value to discard the presence of gastroesophageal varices was 12.3 kPa for liver stiffness measurement and 27 kPa for spleen stiffness measurement. However, diagnostic accuracy was moderate (AUROC: 0.671 and 0.624 respectively). Combining different non-invasive parameters did not significantly improve the overall performance.DiscussionLiver and spleen stiffness measurement showed suboptimal results for non-invasive assessment of gastroesophageal varices in HCV cirrhotic patients treated with direct-acting antiviral agents. Our results suggest that non-invasive methods cannot substitute standard procedures for predicting gastroesophageal varices in this population. 相似文献
13.
Susana Martínez González Arantxa Cano Cortés Luis Alfonso Sota Yoldi José María García García Luz María Alba Álvarez Juan José Palacios Gutiérrez 《Archivos de bronconeumología》2017,53(10):554-560
Introduction and objective
Non-tuberculous mycobacteria (NTM) isolates are becoming more common. The main objective of our study was to establish the number and diversity of NTM species in our region and their distribution according to the source sample, age and gender of the patients, and to analyse clinically significant isolates.Methodology
Prospective study of all NTM isolated in Asturias from 2005 to 2012. Samples were processed following internationally accepted guidelines. Statistical analysis was based on Fisher's exact test for 2 × 2 contingency tables.Results
A total of 3,284 mycobacteria were isolated: 1,499 Mycobacterium tuberculosis complex (MTB) and 1,785 NTM. During the study, NTM isolation rates increased while MTB isolation decreased. NTM were more frequent in men (P < .001). M. gordonae was the most frequently isolated species but did not cause disease in any case. NTM isolates from 212 patients were associated with clinically significant disease (17.1%). M. kansasii and M. avium were most commonly associated with disease. The number of M. kansasii isolates from men was statistically significant (P < .01).Conclusions
In our study, NTM isolates increased by 35%, compared with a 21% decline in cases of MTB. Both isolation of NTM and clinically significant cases were more common in men. Only 17.1% of NTM isolates were associated with disease, most commonly M. avium complex and M. kansasii. 相似文献14.
Jesús Maese Petra Díaz del Campo Daniel Seoane-Mato Mercedes Guerra Juan D. Cañete 《Reumatología clinica》2018,14(2):81-89
Background
Due to the clinical heterogeneity of psoriatic arthritis (PsA), recommendations have been developed by international groups to guide therapeutic decisions of the rheumatologist. The objective of the current systematic review (RS) was to evaluate the evidence of efficacy of disease-modifying antirheumatic drugs (DMARDs) in PsA.Methods
Literature search in Medline, EMBASE, Cochrane Library, from 2008 to 2014. We included RS, randomized clinical trials and observational studies, in patients with PsA and an evaluation of efficiency of conventional DMARDs (methotrexate, sulfasalazine, leflunomide), according to the following outcomes: peripheral and axial symptoms; peripheral radiological damage; enthesitis according to power Doppler ultrasound or magnetic resonance imaging (enthesitis count before and after therapy); dactylitis; uveitis.Results
Title and abstract were used to retrieve 1,662 documents for this review (Medline, n = 433; EMBASE n = 1,132; Cochrane, n = 97), and 48 studies were selected for detailed reading; finally, 8 studies were included.Conclusions
Since the studies included are not robust, and there are arguments to support the effectiveness of methotrexate, the evidence observed with the treatment of DMARDs in PsA is not conclusive 相似文献15.
Rosa Agra Bermejo Alberto Cordero José M. García-Acuña Inés Gómez Otero Alfonso Varela Román Álvaro Martínez Leyre Álvarez Rodríguez Charigan Abou-Jokh Moisés Rodríguez-Mañero Belén Cid Álvarez Ramón López-Palop Pilar Carrillo José R. González-Juanatey 《Revista espa?ola de cardiología》2018,71(10):820-828
Introduction and objectives
Contemporary data on the incidence and prognosis of heart failure (HF) and the influence of left ventricular ejection fraction (LVEF) in the setting of acute coronary syndrome (ACS) are scant. The aim of this study was to examine the relationship between LVEF and HF with long-term prognosis in a cohort of patients with ACS.Methods
This is a retrospective observational study of 6208 patients consecutively admitted for ACS to 2 different Spanish hospitals. Baseline characteristics were examined and a follow-up period was established for registration of death and HF rehospitalization as the primary endpoint.Results
Among the study participants, 5064 had ACS without HF during hospitalization: 290 (5.8%) had LVEF < 40%, 540 (10.6%) LVEF 40% to 49%, and 4234 (83.6%) LVEF ≥ 50%. The remaining 1144 patients developed HF in the acute phase: 395 (34.6%) had LVEF < 40%, 251 (21.9%) LVEF 40% to 49%, and 498 (43.5%) LVEF ≥ 50%. Patients with LVEF 40% to 49% had a demographic and clinical profile with intermediate features between the LVEF < 40% and LVEF ≥ 50% groups. Kaplan-Meier curves showed that mortality and HF readmissions were statistically different depending on LVEF in the non-HF group but not in the HF group. Left ventricular ejection fraction ≥ 50% was an independent prognostic factor in the non-HF group only.Conclusions
In ACS, long-term prognosis is considerably worse in patients who develop HF during hospitalization than in patients without HF, irrespective of LVEF. This parameter is a strong prognostic predictor only in patients without HF.Full English text available from: www.revespcardiol.org/en 相似文献16.
Antonio Guardiola-Arévalo Rafael Gómez Rodríguez Marta Romero Gutiérrez Ana Zaida Gómez Moreno Almudena García Vela Raquel Sánchez Simón Cesar Gómez Hernando Eva María Andrés Esteban 《Gastroenterologia y hepatologia》2018,41(3):153-162
Objectives
To identify glutamic pyruvic transaminase (GPT) and hepatitis B virus DNA (HBV-DNA) cut-off values at diagnosis in patients with hepatitis B virus e antigen-negative chronic infection (HBeAg(–)), which may be predictors of clinical course, prognosis and/or the need for antiviral therapy.Methods
A retrospective and observational cohort study of patients diagnosed with HBeAg(–) chronic infection (2005-2012). A normal GPT cut-off value at diagnosis that predicts abnormal GPT values in the clinical course of the infection, a baseline HBV-DNA cut-off value that predicts an increase in HBV-DNA above 2,000 IU/ml, and GPT and HBV-DNA as predictors of the need for treatment were investigated using ROC curves.Results
126 patients were enrolled (follow-up: 42.1 ± 21.5 months), 93 of which had normal GPT levels at diagnosis. In the ROC curve analysis, 900 IU/ml was found to be the HBV-DNA cut-off value that best predicted this value's increase above 2,000 IU/ml (sensitivity: 90%; specificity: 88%; PPV: 79%; NPV: 100%; diagnostic precision: 89%), while 25 mU/ml was the normal GPT cut-off value at diagnosis that best predicted subsequently elevated GPT levels (sensitivity: 95.4%; specificity: 81.6%; PPV: 67%; NPV: 96%; diagnostic precision: 80.6%). Patients with GPT 26-40 mU/ml at diagnosis presented with more complications or required more treatment than subjects with GPT ≤ 25 mU/ml (P < .05). The combined GPT and HBV-DNA values that elicited the highest treatment need were 38 mU/ml of GPT and 6,000 IU/ml of HBV-DNA (sensitivity: 75%; specificity: 93.4%; PPV: 60%; NPV: 96.6%).Conclusion
HBeAg(–) patients with GPT < 25 mU/ml and HBV-DNA < 900 IU/ml at diagnosis have positive outcomes and may not require such stringent follow-up in the first years after diagnosis. 相似文献17.
Flaviu Bob Adalbert Schiller Romulus Timar Daniel Lighezan Oana Schiller Bogdan Timar Cristiana Georgeta Bujor Mircea Munteanu Florica Gadalean Adelina Mihaescu Iulia Grosu Andreea Hategan Lazar Chisavu Agneta-Maria Pusztai Adrian Covic 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2019,39(3):250-257
Background
Klotho is found in two forms: a transmembrane form and a soluble form (s-Klotho). In order to be excreted, s-Klotho, that is too large to be filtered, will probably reach the proximal convoluted tubule by a transcytosis process. The aim of our study was to show the relationship between the levels of s-Klotho and tubular injury in patients with diabetic kidney disease (DKD), using as tubular injury marker the kidney injury molecule-1 (KIM-1).Methods
Our study included 63 DKD patients (stages 1–5, mean eGFR 65.15 ± 32.45 ml/min) with a mean age 58.13 ± 12 years. In all patients we determined serum levels of: KIM-1 and s-Klotho using ELISA, urinary albumin/creatinine ratio (UACR) and reduction in the estimated glomerular filtration rate (eGFR) per year.Results
We found a strong statistically significant correlation of s-Klotho with the rate of reduction of eGFR/year (r = 0.714, p = 0.0004) and with the tubular injury marker KIM-1 (r = 0.758, p = 0.005) and strong correlations of UACR with the rate of reduction of eGFR/year (r = 0.53, p < 0.01), KIM-1 (r = 0.49, p < 0.05) and s-Klotho (r = 0.52, p < 0.01).Conclusion
Despite previous published data, that shows a decrease of s-Klotho in chronic kidney disease, in our study the rapid annual decline of kidney function but not the level of eGFR was associated with increased s-Klotho. A possible explanation could be a more severe proximal tubule injury that could lead to a reduction of tubular excretion of s-Klotho as suggested by the correlation of s-Klotho levels with the serum levels of KIM-1. 相似文献18.
《Gastroenterologia y hepatologia》2020,43(5):248-255
IntroductionThere is little information on whether direct-acting antiviral (DAA) treatment can improve liver fibrosis or change glucose and lipid profile in patients with chronic hepatitis C (CHC). We aimed to evaluate the impact of sustained virologic response (SVR) on liver stiffness, glucose and lipid levels.Methods445 monoinfected CHC patients started treatment with interferon-free DAA therapy from January 2015 to February 2017. Transient elastography (TE), fibrosis scores, glucose and lipid levels were analyzed at baseline and 48 weeks post-treatment (SVR48).ResultsThe SVR rate was 97.7%. Finally, we evaluated 369 patients who achieved SVR and had reliable TE measurements. Median liver stiffness significantly decreased from 9.3 (IQR 7.3–14.3) kPa at baseline to 6.4 (IQR 4.9–8.9) at SVR48 (p < 0.0001). 54.7% of the cohort presented fibrosis regression. Median FIB4 score regressed from 2.0 (IQR 1.1–3.3) to 1.3 (IQR 0.9–2.0) (p < 0.0001). Median APRI and Forns values significantly decreased from 0.9 (IQR 0.5–1.7) to 0.3 (IQR 0.2–0.4) and from 6.2 (5.0–7.5) to 4.9 (IQR 3.8–5.9) (p < 0.001), respectively. Mean levels of total cholesterol and LDL-C increased from 172 mg/dL and 101.5 mg/dL to 191 mg/dL and 117.5 mg/dL (p < 0.0001), respectively. In the sub-group of patients with pre-diabetes or diabetes, mean glucose levels decreased from 142.7 mg/dL at baseline to 127.2 mg/dL at SVR48 (p < 0.001).DiscussionSVR reduces liver stiffness based on TE and fibrosis scores, in patients treated with DAA. Our results show elevated total cholesterol and LDL-C and decreased glucose levels at SVR48. 相似文献
19.
Paolo Domenico Dallaglio Ignasi Anguera José B. Martínez Ferrer Luisa Pérez Xavier Viñolas Jose Manuel Porres Adolfo Fontenla Javier Alzueta Juan Gabriel Martínez Aníbal Rodríguez Nuria Basterra Xavier Sabaté 《Revista espa?ola de cardiología》2018,71(9):709-717
Introduction and objectives
Fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator are susceptible to antitachycardia pacing (ATP) termination. Some manufacturers allow programming 2 ATP bursts: before charging (BC) and during (DC) charging. The aim of this study was to describe the safety and effectiveness of ATP BC and DC for fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator in daily clinical practice.Methods
Data proceeded from the multicenter UMBRELLA trial, including implantable cardioverter-defibrillator patients followed up by the CareLink monitoring system. Fast ventricular tachycardias in the ventricular fibrillation zone until a cycle length of 200 ms with ATP BC and/or ATP DC were included.Results
We reviewed 542 episodes in 240 patients. Two ATP bursts (BC/DC) were programmed in 291 episodes (53.7%, 87 patients), while 251 episodes (46.3%, 153 patients) had 1 ATP burst only DC. The number of episodes terminated by 1 ATP DC was 139, representing 55.4% effectiveness (generalized estimating equation-adjusted 60.4%). There were 256 episodes terminated by 1 or 2 ATP (BC/DC), representing 88% effectiveness (generalized estimating equation-adjusted 79.3%); the OR for ATP effectiveness BC/DC vs DC was 2.5, 95%CI, 1.5-4.1; P < .001. Shocked episodes were 112 (45%) for ATP DC vs 35 (12%) for ATP BC/DC, representing an absolute reduction of 73%. The mean shocked episode duration was 16 seconds for ATP DC vs 19 seconds for ATP BC/DC (P = .07).Conclusions
The ATP DC in the ventricular fibrillation zone for fast ventricular tachycardia is moderately effective. Adding an ATP burst BC increases the overall effectiveness, reduces the need for shocks, and does not prolong episode duration.Full English text available from: www.revespcardiol.org/en 相似文献20.
Carlos Labata Teresa Oliveras Elisabet Berastegui Xavier Ruyra Bernat Romero Maria-Luisa Camara Maria-Soledad Just Jordi Serra Ferran Rueda Marc Ferrer Cosme García-García Antoni Bayes-Genis 《Revista espa?ola de cardiología》2018,71(8):638-642