Long-term changes in serum cholesterol level does not influence the progression of coronary calcification

BackgroundA number of reports controversially describe the influence of cholesterol level and lipid-lowering treatment (LLT) on the progression of coronary calcium (CC). We tested the hypothesis that long-term changes in serum cholesterol (CL) would affect the progression of CC.MethodsThe study population comprised 510 patients with stable angina pectoris, mean age of 63 ± 9 years. At baseline 372 patients received statin and/or fibrate (LLT group) while 138 patients did not (No-LLT at baseline group). Spiral CT every 24 months was used to track the progression of CC over a median 5.6 year follow-up.ResultsCL decreased during follow-up in both groups, but more pronouncedly in patients with LLT. The changes in total calcium score (TCS) were similar in both groups (p = 0.3). Changes in CL during follow-up were not associated with CC: TCS increased by 501 ± 63 from baseline in the 1st (upper) quartile, and by 350 ± 44, 403 ± 41 and 480 ± 56 in the 2nd, 3rd, and 4th quartiles of CL longitudinal changes (p = 0.2), respectively. Baseline TCS and its changes were not correlated with baseline CL and its changes. New calcified lesions were diagnosed in 132 (28.2%) out of the 467 patients available for this analysis, without significant difference between groups (p = 0.4). Multivariate analysis demonstrated that only baseline TCS (p < 0.001), body mass index (p = 0.007) and age (p = 0.006) were independent predictors for the TCS changes.ConclusionsLongitudinal CL changes do not seem to have a measurable effect on the rate of progression of CC.     

Potential role of vitamin K in radiological progression of early knee osteoarthritis patients

BackgroundVitamin K is necessary for the functional activation of vitamin K dependent proteins via gamma-carboxylation process. These proteins are present in bone and cartilage beside their participation in coagulation cascade.Aim of the workThis study aimed to assess plasma vitamin K1 (phylloquinone) concentrations in primary early osteoarthritis (KOA) patients and to correlate these levels with clinical parameters and radiological progression using plain radiography and musculoskeletal ultrasound (MSUS).Patients and methodsWe measured baseline vitamin K1 in the plasma from 40 early KOA patients and from 20 healthy controls. In the patients, numerical rating scale of pain (NRSP) and The Western Ontario McMaster scale (WOMAC) were recorded. The Thomas grading score and MSUS examination were performed at baseline and after 12 months to assess radiological progression.ResultsThe KOA patients had a mean age of 50.4 ± 4.9 years, 36 females: 4 males and had a disease duration of 12.7 ± 5.7 months. In KOA patients plasma vitamin K1 levels (1.6 ± 0.9 nmol/l) were highly significantly decreased compared to healthy control (2.04 ± 0.7 nmol/l) (p < 0.05). In KOA patients, the plasma levels of vitamin K1 significantly correlated with baseline medial condyle cartilage thickness (r = 0.46, p < 0.05), and vitamin K deficiency had a significantly increased risk of radiological progression as assessed by MSUS (p = 0.004) (twofold increased risk, RR 2.08).ConclusionsKnee osteoarthritis patients have significantly decreased plasma levels of vitamin K that was remarkably associated with radiological progression of early disease suggesting that it could be a useful marker to reflect OA severity and implies a possible role in the disease pathogenesis.     

Cierre de orejuela izquierda en pacientes mayores de 85 años: seguridad y eficacia del registro EWOLUTION

Introduction and objectivesElderly patients with atrial fibrillation are at greater risk of both cardioembolic events and major bleeding than younger patients. Left atrial appendage occlusion (LAAO) could be an attractive alternative for these patients, but there are limited data on outcomes with LAAO in patients ≥ 85 years old. The aim of the present study was to assess the safety and efficacy of LAAO in patients ≥ 85 years old.MethodsA total of 1025 patients included in the EWOLUTION registry who underwent LAAO were analyzed and 84 patients ≥ 85 years old were identified and compared with the younger cohort.ResultsPatients ≥ 85 years old had higher estimated stroke and hemorrhagic risks than younger patients (CHA₂DS₂-VASc: 5.2 ± 1.2 vs 4.4 ± 1.6, P < .0001; HAS-BLED: 2.7 ± 1.1 vs 2.3 ± 1.2; P = .003; ≥ 85 years vs < 85 years). Procedural success was high and similar in both groups (98.8% vs 98.5%; P = .99). There were no differences in 7-day device- or procedure-related adverse event rates (2.6% in ≥ 85 years vs 3.1% in < 85 years; P = .80). Despite the higher baseline stroke risk, there was no difference at follow-up between the groups in the annualized stroke rate (0.8/100 patient-years in ≥ 85 years vs 1.3/100 patient-years in < 85 years; P = .649).ConclusionsLAAO in patients ≥ 85 years is safe and effective even though these patients are at high risk for embolic and hemorrhagic events. LAAO may be a reasonable alternative to oral anticoagulation in these patients.     

Daclatasvir,sofosbuvir with or without ribavirin for 24 weeks in hepatitis C genotype 3 cirrhosis: A real-life study

Introduction and aimCirrhotic patients with hepatitis C virus genotype 3 infection show unsatisfactory outcomes after 12 weeks’ treatment with direct antiviral agents. The National Italian Drug Agency allows 24 weeks of therapy in difficult-to-treat patients, including genotype 3 cirrhotics. Aim of this study was to evaluate efficacy and safety of a 24-week course of sofosbuvir plus daclatasvir ± ribavirin in this population.Materials and methods106 consecutive cirrhotics (70.8% males, mean age 55.3 ± 7.6 years) in 8 tertiary hepatology centers received sofosbuvir plus daclatasvir for 24 weeks. Ribavirin was administered in 85 (80.2%) based expected tolerability, at a mean dose of 964 ± 202 mg/day. Baseline Child-Pugh class was A 91.5%, B 6.6%, C 1.9%; mean baseline MELD was 8.5 ± 2.7.ResultsAll patients completed 12-week follow-up post-treatment, and 104 (98.1%) obtained sustained virological response (100% in ribavirin -treated patients vs. 90.4% without ribavirin; p = 0.04). No worsening in renal and liver function was observed, no serious adverse events occurred. Two virological failures showed resistance associated variants (Y93H and S282T).ConclusionAn extended 24-week treatment with sofosbuvir plus daclatasvir + ribavirin obtained 100% efficacy in genotype 3 hepatitis C cirrhosis, with very limited side effects. The role of ribavirin seems crucial in this setting and should be administered if clinically feasible.     

Antiviral therapy and fibrosis progression in patients with mild-moderate hepatitis C recurrence after liver transplantation. A randomized controlled study

Backgrounds/aimsWe evaluated the effect of antiviral therapy on fibrosis progression in patients with histological features of mild/moderate HCV disease recurrence defined by a Grading score ≥ 4 and Staging score up to 3 (Ishak) at 1 year after liver transplantation.MethodsSeventy-three consecutive patients with mild/moderate recurrence were randomized either to no treatment or to receive Pegilated-Interferon-alfa-2b and ribavirin for 52 weeks. Liver biopsies obtained at baseline (1 year after transplantation) and 2 years afterwards were evaluated for assessment of disease progression, defined as worsening of at least 2 staging points or progression to stage 4 or higher.ResultsAs for these two major histological end points there were no statistically significant differences between the 2 groups (36.1% vs. 50%, p = 0.34 and 36.1% vs. 38.9%, p = 1). Fifteen treated patients (41%) achieved a sustained virological response which was associated with a reduced risk of fibrosis worsening for both endpoints when compared to viremic patients (p = 0.04).ConclusionsAlthough antiviral-therapy was beneficial in preventing fibrosis progression in patients achieving a sustained virological response, the majority of the overall population of our patients with mild–moderate disease recurrence could not benefit from antiviral therapy either because they either could not be treated or did not respond to treatment (EudraCT number: 2005-005760).     

Studying progression from glucose intolerance to type 2 diabetes in obese children

AimIdentification of metabolic and genetic factors capable to mediate progression from normal glucose tolerance (NGT) through impaired glucose tolerance (IGT) to type 2 diabetes (T2D) in childhood obesity.Patients and methodsThree groups of obese children with NGT (n = 54), IGT (n = 35), and T2D (n = 62) were evaluated. A control group of non-obese normal children (n = 210) was also studied. In obese patients, an oral glucose tolerance test (OGTT) was performed. Insulin resistance (IR) was assessed using HOMA-IR index. Insulin sensitivity (IS) was assessed according to the Matsuda formula. Genomic DNA from obese and control children was genotyped for genetic variants of PPARG, ADIPOQ, ADIPOR1, FTO, TCF7L2, and KCNJ11 using a real-time PCR strategy. The unpaired Student's t-test and Kruskal–Wallis one-way test were used to compare quantitative data in two and more groups. To assess the extent to which the various genetic variants were associated with pathology, ORs (odds ratios) and 95% CI (confidence interval) were estimated.ResultsIn T2D children, HOMA-IR value (7.5 ± 3.1) was significantly (P < 0.001) higher than that in IGT (4.21 ± 2.25) and NGT (4.1 ± 2.4) subjects. The Matsuda IS index was significantly increased in normoglycemic patients compared to IGT individuals (2.8 ± 1.75 vs. 2.33 ± 1.2, P < 0.05). The Pro12Ala polymorphism of PPARG was significantly associated with obesity (OR = 1.74, 95% CI = 1.19–2.55, P = 0.004) and T2D in obesity (OR = 2.01, 95% CI = 1.24–3.26, P = 0.004).ConclusionIR is a major risk factor that mediates progression from NGT to clinical T2D in Russian obese children. This progression may be genetically influenced by the Pro12Ala variant of PPARG.     

Hepatitis C virus infection impacts work productivity and fatigue: An epidemiologic real-life study

Introduction and ObjectiveHepatitis C virus (HCV) infection and treatment impact the patient's daily life and work productivity. Until recently, treatments were associated with side effects and insufficient virologic and hepatic results.This study evaluated fatigue, work productivity, and treatment modalities in patients with HCV infection.Materials and methodsThis cross-sectional, non-interventional, multicenter study was conducted in real-life settings between March and December 2015 at 109 sites in France.ResultsData from 1269 patients were evaluable. The mean patient age was 55.8 ± 12.5 years; 53.3% (676) patients were male. A total of 80.1% (1015) of patients were Caucasian and 62.3% (791) had a genotype 1 infection, 34.2% (433) had at least one comorbidity and 15.6% (198) had ≥1 clinical sign/symptom. Illicit drug use was the main route of HCV transmission and accounted for 36.8% (466) of all infections. Fibrosis stage F0/F1 was reported in 41.4% (525) of patients. A majority of patients (60.4%, 764) had never been treated. In patients previously treated, 85.8% (430) received ribavirin and pegylated interferon and only 13.4% (67) direct-acting antivirals.The mean percent of global impairment due to health was highest (34.8 ± 30.9%) in patients 18–45 years of age. The prevalence of active employed patients with a total fatigue score ≥ its median value (45/160) was 38.6%. The mean percent work time missed due to health was 9.6 ± 23.6% for working patients of 18–45 years of age and 7.3 ± 21.8% for working patients of 45–65 years of age. The mean overall prevalence of employed patients with impairment due to health issues was 21.8 ± 26.8%. The prevalence of patients with a reduced work activity of ≥50% due to their health status was 32.1%.ConclusionThese data reinforce the request for improved disease management in France, allowing patients with HCV infection to increase work productivity, reduce fatigue, and, hopefully, cure their disease.     

Patterns of Physical Activity Progression in Patients With COPD

IntroductionAlthough mean physical activity in COPD patients declines by 400–500 steps/day annually, it is unknown whether the natural progression is the same for all patients. We aimed to identify distinct physical activity progression patterns using a hypothesis-free approach and to assess their determinants.MethodsWe pooled data from two cohorts (usual care arm of Urban Training [NCT01897298] and PROactive initial validation [NCT01388218] studies) measuring physical activity at baseline and 12 months (Dynaport MoveMonitor). We identified clusters (patterns) of physical activity progression (based on levels and changes of steps/day) using k-means, and compared baseline sociodemographic, interpersonal, environmental, clinical and psychological characteristics across patterns.ResultsIn 291 COPD patients (mean ± SD 68 ± 8 years, 81% male, FEV₁ 59 ± 19%_pred) we identified three distinct physical activity progression patterns: Inactive (n = 173 [59%], baseline: 4621 ± 1757 steps/day, 12-month change (Δ): −487 ± 1201 steps/day), Active Improvers (n = 49 [17%], baseline: 7727 ± 3275 steps/day, Δ: + 3378 ± 2203 steps/day) and Active Decliners (n = 69 [24%], baseline: 11 267 ± 3009 steps/day, Δ: −2217 ± 2085 steps/day). After adjustment in a mixed multinomial logistic regression model using Active Decliners as reference pattern, a lower 6-min walking distance (RRR [95% CI] 0.94 [0.90–0.98] per 10 m, P = .001) and a higher mMRC dyspnea score (1.71 [1.12–2.60] per 1 point, P = .012) were independently related with being Inactive. No baseline variable was independently associated with being an Active Improver.ConclusionsThe natural progression in physical activity over time in COPD patients is heterogeneous. While Inactive patients relate to worse scores for clinical COPD characteristics, Active Improvers and Decliners cannot be predicted at baseline.     

Niveles séricos de IGF-1 e IGFBP-3 en pacientes con esófago de Barrett y adenocarcinoma de esófago. Estudio longitudinal

BackgroundBarrett's esophagus (BE) is an entity with a known histological progression to malignancy. The insulin-like growth factor (IGF) system is involved in the carcinogenesis through obesity-related mechanisms that include IGF and it has been associated with several types of cancer.ObjectivesTo evaluate the serological levels of IGF-1 and IGFBP-3 in patients with BE and esophageal adenocarcinoma.Patients and methodsProspective study of patients with BE and esophageal adenocarcinoma who underwent upper endoscopy between September 2012 and December 2015. A baseline determination of IGF-1 and IGFBP-3 was performed. We included a control group of patients without BE.ResultsOne hundred sixteen patients were included: 36 controls, 62 with BE (42 without dysplasia and 20 with dysplasia) and 18 with adenocarcinoma. IGF-1 and IGF-1/IGFBP-3 molar ratio showed a progression to high levels in BE and adenocarcinoma than in controls (IGF-1: 135.55 ± 66.07 ng/ml, 148.33 ± 81.5 ng/ml, 108.19 ± 46.69 ng/ml, respectively; P = .049) (molar ratio: 0.23 ± 0.91, 0.29 ± 0.11, 0.19 ± 0.06, respectively; P = .001), without differences between the histological types of BE. Fifty-four out of the 65 patients with BE were followed up (median of 58.50 months, range 12–113) and 11 of them (20.4%) presented progression to low-grade dysplasia (n = 8) or high-grade dysplasia/adenocarcinoma (n = 3), without differences in the IGF system compared with patients without progression.ConclusionsPatients with BE and esophageal adenocarcinoma have changes in the IGF system although the serological levels of IGF-1 and IGFBP-3 do not correlate with histological progression of BE.     

Obesity,chronic kidney disease progression and the role of the adipokine C1q/TNF related protein-3

Introduction and aimsObesity is a risk factor for incident chronic kidney disease (CKD). C1q/TNF related protein 3 (CTRP3) is an adipokine with multiple effects and may modulate the association between obesity and vascular diseases. The aim of the study is to explore potential links between obesity, CTRP3 levels and CKD progression.MethodsPatients with stage 3 and 4 CKD without previous cardiovascular events were enrolled and divided into groups according to body mass index (BMI) and sex. Demographic, clinical, analytical data and CTRP3 levels were collected at baseline. During follow-up, renal events (defined as dialysis initiation, serum creatinine doubling or a 50% decrease in estimated glomerular filtration rate were registered).Results81 patients were enrolled. 27 were obese and 54 non-obese. Baseline CTRP3 was similar between both groups (90.1 ± 23.8 vs 84.5 ± 6.2; p = 0.28). Of the sum, 54 were men and 27 women, with higher CTRP3 in women (81.4 ± 24.7 vs 106 ± 24.7; p < 0.01). During a mean follow-up of 68 months, 15 patients had a renal event. Patients in the higher CTRP3 tertile had less events but without statistical significance (p = 0.07). Obese patients in the higher CTRP3 tertile significantly had less renal events (p = 0.049). By multiple regression analysis CTRP3 levels could not predict renal events (HR 0.98; CI95% 0.96–1.06).ConclusionsCTRP3 levels are higher in woman than men in patients with CKD, with similar levels between obese and non obese. Higher CTRP3 levels at baseline were associated with better renal outcomes in obese patients.     

Rendimiento del marcapasos cardiaco Micra en nonagenarios

Introduction and objectivesThe Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years.MethodsWe present a prospective observational study with consecutive patients aged > 70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and < 90 years.ResultsThe Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88 < 90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients < 90 years (P = .58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively (P = .32). Procedure time (26.1 ± 11.6 vs 30.3 ± 14.2 minutes; P = .11) and fluoroscopy time (6.4 ± 4.7 vs 7.2 ± 4.9 minutes; P = 0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged < 90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged < 90 years (18.2%) died during a mean follow-up of 230 ± 233 days and 394 ± 285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up.ConclusionsThe Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population.Full English text available from: www.revespcardiol.org/en     

Progresión de la enfermedad renal crónica en pacientes con hipertensión resistente sometidos a 2 estrategias terapéuticas: intensificación con diuréticos de asa vs. antagonistas de la aldosterona

IntroductionActualy, there are few data about glomerular filtration rate (eGFR) drop in patients with resistant hypertension and how diferent therapies can modify chronic kidney disease progression (CKD).ObjectiveTo evaluate CKD progression in patients with resistant hypertension undergoing 2 diferent therapies: treatment with spironolactone or furosemide.MethodsWe included 30 patients (21 M, 9 W) with a mean age of 66.3 ± 9.1 years, eGFR 55.8 ± 16.5 ml/min/1.73 m², SBP 162.8 ± 8.2 and DBP 90.2 ± 6.2 mmHg: 15 patients received spironolactone and 15 furosemide and we followed up them a median of 32 months (28-41).ResultsThe mean annual eGFR decrease was -2.8 ± 5.4 ml/min/1.73 m². In spironolactone group was –2.1 ± 4.8 ml/min/1.73 m² and in furosemide group was -3.2 ± 5.6 ml/min/1.73 m², P<0.01. In patients received spironolactone, SBP decreased 23 ± 9 mmHg and in furosemide group decreased 16 ± 3 mmHg, P<.01. DBP decreased 10 ± 8 mmHg and 6 ± 2 mmHg, respectively (P<.01). Treatment with spironolactone reduced albuminuria from a serum albumin/creatine ratio of 210 (121-385) mg/g to 65 (45-120) mg/g at the end of follow-up, P<.01. There were no significant changes in the albumin/creatinine ratio in the furosemide group. The slower drop in kidney function was associated with lower SBP (P=.04), higher GFR (P=.01), lower albuminuria (P=.01), not diabetes mellitus (P=.01) and treatment with spironolactone (P=.02). Treatment with spironolactone (OR 2.13, IC 1.89-2.29) and lower albuminuria (OR 0.98, CI 0.97-0.99) maintain their independent predictive power in a multivariate model.ConclusionTreatment with spironolactone is more effective reducing BP and albuminuria in patients with resistant hypertension compared with furosemide and it is associated with a slower progression of CKD in the long term follow up.     

Intestinal permeability is increased in children with non-alcoholic fatty liver disease,and correlates with liver disease severity

BackgroundIncreased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression.AimTo investigate the prevalence of altered intestinal permeability in children with non-alcoholic fatty liver disease, and to study its potential association with the stage of liver disease.MethodsWe performed a case–control study examining intestinal permeability in children using the lactulose–mannitol bowel permeability test.ResultsOverall, 39 consecutive patients (30 males, median age 12 years) and 21 controls (14 males, median age 11.8 years) were included. The lactulose/mannitol ratio resulted impaired in 12/39 patients (31%) and none of the controls. Intestinal permeability was higher in children with non-alcoholic fatty liver disease (lactulose/mannitol ratios: 0.038 ± 0.037 vs. 0.008 ± 0.007, p < 0.05). Within the non-alcoholic fatty liver disease group, intestinal permeability was increased in children with steatohepatitis compared to those with steatosis only (0.05 ± 0.04 vs. 0.03 vs. 0.03, p < 0.05). Pathological lactulose/mannitol ratio correlated with portal inflammation (p = 0.02), fibrosis (p = 0.0002), and ballooning of hepatocytes (p = 0.003). Blood lipopolysaccharides levels were higher in children with steatohepatitis (2.27 ± 0.68 vs. 2.80 ± 0.35, p < 0.05).ConclusionsIntestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with the severity of the disease.     

An a priori prediction model of response to peginterferon plus ribavirin dual therapy in naïve patients with genotype 1 chronic hepatitis C

BackgroundAim was to select naïve patients with genotype 1 chronic hepatitis C having a high probability of response to Peg-interferon + ribavirin therapy.MethodsIn 1073 patients (derivation cohort), predictors of rapid and sustained virological response were identified by logistic analysis; regression coefficients were used to generate prediction models for sustained virological response. Probabilities at baseline and treatment week 4 were utilized to develop a decision rule to select patients with high likelihood of response. The model was then validated in 423 patients (validation cohort).ResultsIn the derivation cohort, 257 achieved rapid virological response and 818 did not, with sustained virological response rates of 80.2% and 25.4%, respectively; interleukin-28B polymorphisms, fibrosis staging, gamma-glutamyl transferase, and viral load predicted sustained virological response. Assuming a <30% sustained virological response probability for not recommending Peg-interferon + ribavirin, 100 patients (25.6%) in the validation cohort were predicted a priori to fail this regimen. Assuming a ≥80% sustained virological response probability as a threshold to continue with Peg-interferon + ribavirin, 61 patients were predicted to obtain sustained virological response, and 55 of them (90.2%) eventually did.ConclusionsThis model uses easily determined variables for a personalized estimate of the probability of sustained virological response with Peg-interferon + ribavirin, allowing to identify patients who may benefit from conventional therapy.     

The effect of linagliptin on renal progression in type-2 diabetes mellitus patients with chronic kidney disease: A prospective randomized controlled study

BackgroundLinagliptin does not require dose adjustment in diabetes mellitus patients with chronic kidney disease (CKD). But, renal effects of linagliptin are not clear. Our aim was to examine the effect of linagliptin on renal disease progression in only insulin dependent type 2 diabetes mellitus (DM) patients with CKD.MethodsStage 3–4 CKD patients were randomized into 2 groups in this prospective randomized controlled study. In the first group, linagliptin 5 mg was added in addition to the background insulin therapy. In the second group, patients continued their insulin therapy. Patients were followed up at 3-month intervals for one year.ResultsThe study population consisted of 164 patients (90 patients in linagliptin group, 74 patients in other group) with a mean age of 67.5 ± 8.8 years. eGFR significantly increased in linagliptin group (p = 0.033), but decreased in other group (p = 0.003). No significant change was observed in total insulin dose in linagliptin group (p = 0.111), but in other group, total insulin dose significantly increased (p < 0.001). Proteinuria levels decreased in both groups, but there was no significant change. In the multiple logistic regression analysis, male gender and proteinuria emerged as variables that showed significant association with increased risk and the use of linagliptin emerged as variable that showed significant association with decreased risk for CKD progression.ConclusionLinagliptin in DM patients with CKD was able to improve renal progression without significant effect on proteinuria and glucose control. With regard to treating diabetic nephropathy, linagliptin may offer a new therapeutic approach.     

Evaluation of the liver condition in chronic hepatitis C virus patients with and without vasculitis

Aim of the workThe association between hepatitis C virus (HCV)-related vasculitis and severe hepatic fibrosis is a controversial issue. In this study, we aimed to evaluate the liver affection in a group of patients with HCV-related vasculitis and a control group with chronic HCV infection without vasculitis.Patients and methodsTwenty-six HCV associated vasculitis patients (22 females, 4 males) with a mean age of 51.9 ± 8.5 years (range 36–72 years) and a control group including 20 age- and sex matched HCV infected patients without any extra-hepatic autoimmune manifestations were recruited in this study. All patients and controls were evaluated by routine biochemical tests, conventional ultrasonography and Fibroscan.ResultsThe mean disease duration in patients with vasculitis and the control group was 7.5 ± 7.3 and 4.1 ± 3.6 years, respectively (p = 0.062). Mean aspartate aminotransferase, bilirubin and international normalized ratio (INR) values were higher in the control group (p = 0.036, 0.041 and 0.017, respectively). Hepatomegaly was found in 11 (42.3%) vasculitis patients and 17 (85%) controls (p = 0.006), while portal hypertension was found in 4 (15.4%) vasculitis patients and 9 (45%) controls (p = 0.046). On Fibroscan, eleven vasculitis patients (42.3%) had mild to moderate liver fibrosis (F1–2), and 10 (38.5%) had severe liver fibrosis (F3–4), while only one patient (5%) of the control group had mild, and 17 (85%) had severe liver fibrosis (p = 0.002).ConclusionPatients with chronic HCV infection without vasculitis have worse liver functions and more advanced liver fibrosis than those with HCV related vasculitis.     

Early progression of cardiac allograft vasculopathy assessed by quantitative coronary angiography: A single centre prospective study

IntroductionEarly diagnosis of cardiac allograft vasculopathy (CAV) becomes a crucial step in management of post-transplant patients since it can be attenuated by specific clinical approaches.Materials and methodsWe enrolled 48 consecutive patients in this prospective, observational, single centre study. Early development of CAV was assessed by two independent reviewers using quantitative coronary angiography (QCA) in the 1st and 12th month after heart transplantation (HTx). We examined the relationship between CAV and selected clinical and serological variables.ResultsA significant mean lumen diameter (MLD) loss was observed in all major coronary artery branches within 12 months after HTx. MLD loss was as follows – RCA (3.52 mm → 3.25 mm, P = 0.0008), LCx (3.68 mm → 3.42 mm, P < 0.0001) and LAD (3.95 mm → 3.69, P < 0.0001). Among the patient cohort, 14 CAV rapid progressors (14/48, 29.2%) were identified. Their sum of MLD loss in all monitored arteries within 12 months after HTx reached ≥10%. An increased heart rate in the 12th month after HTx reflected the younger age of a donor (P = 0.01), but was not associated with rapid progression of CAV. The most important predictor of rapid progression of CAV was increased serum level of B-type natriuretic peptide (BNP) soon after HTx (3rd day after HTx, P = 0.04).ConclusionA significant reduction of MLD was observed in all major coronary arteries as early as within the first year after HTx. Early elevation of BNP serum levels predicted rapid progression of CAV. The presumption that faster heart rate is involved in the development of CAV in HTx recipients was not confirmed.     

Characteristics of newly diagnosed adults with type 1 diabetes in the UK and evolution of glycaemic control,body mass index and Charlson comorbidity index over the first 5 years after diagnosis

AimsThis retrospective, longitudinal study characterised 2430 adults (mean age 40.8 ± 16.1 years) with newly diagnosed type 1 diabetes (T1D) over the first 5 years of insulin treatment.MethodsData from 1 year pre- and up to 5 years post-insulin initiation were extracted from the UK Clinical Practice Research Datalink (1990–2013). Baseline HbA_1c, BMI and Charlson comorbidity index (CCI) score were compared with data at 1, 2, 3 and 5 years.ResultsMean HbA_1c decreased significantly from baseline 95 ± 32.8 mmol/mol (10.8 ± 3.0%) to 61 ± 21.9 mmol/mol (7.7 ± 2.0%) at 1 year, remaining significantly lower at 2, 3 and 5 years (p < 0.0001). One year after initiating insulin, only 6.3% of patients had HbA_1c <48 mmol/mol (<6.5%). There was no further improvement in HbA1c after 1 year. Mean BMI increased significantly from baseline 25.3 ± 5.5 kg/m² to 27.2 ± 5.8 kg/m² at 1 year; p < 0.0001), remaining significantly higher thereafter, with over two-thirds having overweight/obesity by year 5. Mean CCI score increased significantly (1.32, baseline; 1.46, year 1; 1.75, year 5). CCI patterns were similar within BMI and HbA_1c strata.ConclusionsMore intensive support to reach and maintain glycaemic targets soon post-diagnosis, while avoiding weight gain, and prevention and optimal management of comorbidities are warranted.     

Predictors of glycemic control on insulin pump therapy in children and adolescents with type I diabetes

ObjectiveTo determine variables predictive of glycemic control in a large population of pediatric patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII).MethodsCharts of patients on CSII for ≥1 year were reviewed. “Good” control was a priori defined as HbA1c ≤9% in patients under 12 years of age, and ≤8% in patients over 12 years.ResultsNinety-three patients were identified (57 girls and 36 boys). Their mean age at pump start was 11.6 ± 3.1 years with duration of diabetes of 4.7 ± 3.1 years. Average time on pump therapy was 2.4 ± 0.8 years. HbA1C decreased from 8.7 ± 0.9% prior to pump therapy to 8.3 ± 0.6% while on CSII (p < 0.01). Despite analysis of a large number of possible predictors, only number of basal rates (4.4 versus 3.4) and younger age (10.0 years versus 13.1 years) correlated with good control.ConclusionOnly younger age and use of more basal rates were predictive of good diabetes control in children using CSII. Decisions regarding which pediatric patients are most appropriate for CSII must continue to be individualized.