Recent advances in gastric cancer early diagnosis

Gastric cancer(GC) remains an important cause of cancer death worldwide with a high mortality rate due to the fact that the majority of GC cases are diagnosed at an advanced stage when the prognosis is poor and the treatment options are limited. Unfortunately, the existing circulating biomarkers for GC diagnosis and prognosis display low sensitivity and specificity and the GC diagnosis is based only on the invasive procedures such as upper digestive endoscopy. There is a huge need for less invasive or non-invasive tests but also highly specific biomarkers in case of GC. Body fluids such as peripheral blood, urine or saliva,stomach wash/gastric juice could be a source of specific biomarkers, providing important data for screening and diagnosis in GC. This review summarized the recently discovered circulating molecules such as microRNAs, long non-coding RNAs, circular RNAs, which hold the promise to develop new strategies for early diagnosis of GC.     

风湿病的诊断与治疗最新进展强直性脊柱炎早期诊断研究进展

强直性脊柱炎(ankylosing spondylitis,AS)是一种主要累及中轴关节的慢性炎症性疾病.多发生于青少年.后期脊柱强直以后,病情不能逆转.因此,早期诊断是争取良好预后的关键.现将近年来研究进展概述如下. 1 脊柱关节病和未分化脊柱关节病概念的普及和分类标准的提出脊柱关节病,也称血清阴性脊柱关节病(seronegative spondyloarthropathy,SpA),概念的提出虽然已有20年左右,但其被普遍接受还是近年的事.     

类风湿关节炎早期诊断方法研究进展

类风湿关节炎 (ＲＡ)是一种以慢性进行性关节病变为主的自身免疫病。未经及时诊治的类风湿关节炎患者可出现严重的关节畸形及功能丧失。本病的临床表现多种多样 ,尤其早期患者的症状往往并不典型 ,诊断上有一定的难度。近年来 ,与ＲＡ相关的新的自身抗体相继应用于临床 ,磁共振、超声波检查等技术在本病诊断中的作用也得到肯定。本文就ＲＡ早期诊断方法的研究进展进行讨论。1　血清学检查1.1　类风湿因子和隐匿型类风湿因子类风湿因子 (ＲＦ)是ＲＡ患者血清中出现的针对ＩｇＧＦｃ片段上抗原表位的一类自身抗体 ,包括ＩｇＭ、ＩｇＧ、ＩｇＡ…     

糖尿病性视网膜病变的早期诊断与药物治疗进展

目前,中国人口老龄化问题日益严重。其中,糖尿病性眼病成为了老年人致盲的主要原因之一。但是很多眼病如增殖性糖尿病性视网膜病变（PDR）,糖尿病性黄斑水肿（DME）等发病机制都尚未明确,很多老年人由于科普知识不够发现时为时已晚。所以对于糖尿病性眼病的早期诊断和有效治疗尤其关键。本文就糖尿病性视网膜病变（DR）的相关早期诊断和最新治疗进展作一简要评述。     

Health assessment for chronic HCV infection

The perception that chronic hepatitis C is an asymptomatic disease contrasts with many studies that show a strong association between chronic hepatitis C, hepatocellular cancer, and fatal liver disease. In order to resolve these issues, it is logical to directly evaluate the quality of life in patients with chronic hepatitis C and to compare this to the normal population as well as cohorts of patients with other chronic diseases. The Sickness Impact Profile was used to evaluate the impact of disease and interferon therapy on health-related quality of life in patients with chronic hepatitis C. Using this tool, patients with chronic hepatitis C had a total Sickness Impact Profile score of 9.0, compared with a score of 3.6 among the general population (P<0.05). Patients with chronic hepatitis C also had significantly worse scores in almost every category of the Sickness Impact Profile that could be compared. However, statistically significant differences were observed only at the 24-week evaluation for work and at the end-point evaluation for the sleep and rest and recreation and pastimes categories. A more sophisticated instrument, based on the Medical Outcomes Study 36-item short-form health survey, found that patients with chronic hepatitis C scored significantly lower (P<0.01) than the general population on each of the subscales in this survey. In addition, they scored significantly lower than patients with hypertension in seven of the subscales and two additional generic scales. Patients with chronic hepatitis C were most comparable to those with type II diabetes. A larger, more comprehensive study is underway to further evaluate these relationships.     

Histopathology of HCV infection

The basic morphologic features of acute and chronic viral hepatitis C are similar to those of other hepatitides; however, hepatitis C is characterized by the histologic triad of lymphoid aggregates in portal tracts, epithelial damage of small bile ducts and microvesicular and macrovesicular steatosis of hepatocytes. Significant progress has been made in the demonstration of HCV in infected liver tissues by immunohistochemical and in situ hybridization techniques. The new classification of chronic hepatitis, based on etiology, grading (extent of necroinflammatory activity) and staging (extent of fibrosis) has been widely accepted and will lead to a better understanding of the variable course and response to therapy of this enigmatic disease.     

Endoscopic approach to early diagnosis of pancreatic cancer

Since its development, endoscopic retrograde cholangiopancreatography (ERCP) has been playing a major role in the diagnosis of pancreatic diseases. The recent development of magnetic resonance cholangiopancreatography has accelerated the shift in the role of ERCP toward more therapy-oriented applications. In the diagnosis and treatment of curable pancreatic cancer, however, ERCP remains the mainstay of imaging modalities. ERCP is not simply a method with which to obtain x-ray images of the pancreatic duct. Collection of pure pancreatic juice, transpapillary biopsy/brush cytology of the pancreatic duct, intraductal ultrasonography, and peroral pancreatoscopy are all performed based on the ERCP technique. Endoscopic ultrasonography (EUS) has a high spatial resolution and provides tomographic images of the pancreas and its neighboring organs. EUS is now widely used in evaluation of the local extent of pancreatic cancer and the differential diagnosis of cystic lesions of the pancreas. EUS-guided fine needle aspiration biopsy/cytology is performed to obtain a histologic diagnosis before beginning chemotherapy. Although the number of pancreatic cancer patients who are candidates for surgery is limited at present, there is an increasing need for ERCP-based techniques in both the diagnosis and treatment of pancreatic neoplasms.     

New targets for treatment against HCV infection

Owing to the tremendous effort from both academia and industry, drug development for hepatitis C virus (HCV) infection has been flourishing, with a range of pipeline compounds at various stages of development. Although combination of the recently launched serine protease inhibitors will further improve the response rate of current interferon-based therapy, some intrinsic limitations of these compounds and the tendency of resistance development by the virus, urge the development of alternative or additional therapeutic strategies. In this article we provide an overview of different host and viral factors which have emerged as new potential targets for therapeutic intervention using state-of-the-art technologies.     

Longitudinal variation in hepatitis C virus (HCV) viraemia and early course of HCV infection after liver transplantation for HCV cirrhosis: the role of different immunosuppressive regimens

BACKGROUND: The role of the type of immunosuppression in the natural history of post-transplant hepatitis C virus (HCV) infection is unclear. AIMS: To evaluate the fluctuation of HCV viraemia and the early course of infection, and their relation to the type of immunosuppression in HCV transplant patients. METHODS: In 47 HCV transplant patients, serum HCV RNA levels were determined pretransplant and at one and two weeks, and three and 12 months after transplant. Initial immunosuppression was triple (cyclosporin, azathioprine, prednisolone) in 31, double (cyclosporin, prednisolone) in five, and single (cyclosporin or tacrolimus) in 11 patients. Prednisolone was withdrawn at a median of six months. RESULTS: At three months, HCV RNA levels were higher in patients with single than with triple or double initial therapy. At 12 months, HCV RNA levels correlated only with duration of prednisolone treatment and were relatively higher in patients with triple compared with single initial immunosuppression. A higher necroinflammatory activity at 12 months post-transplant was found in patients with post-transplant acute hepatitis compared with those without. Extent of fibrosis at 12 months was associated with the 12 month HCV RNA level and occurrence of post-transplant acute hepatitis. CONCLUSIONS: HCV RNA levels at three months after transplant are higher in patients treated with single initial immunosuppressive therapy, but at 12 months are higher in patients with longer duration of steroid treatment. HCV viraemia at 12 months seems to be particularly important, as its levels are strongly correlated with the severity of fibrosis.     

Multispecific T cell response and negative HCV RNA tests during acute HCV infection are early prognostic factors of spontaneous clearance

BACKGROUND/AIMS: Hepatitis C virus (HCV) infection results in a high frequency of chronic disease. The aim of this study was to identify early prognostic markers of disease resolution by performing a comprehensive analysis of viral and host factors during the natural course of acute HCV infection. METHODS: The clinical course of acute hepatitis C was determined in 34 consecutive patients. Epidemiological and virological parameters, as well as cell mediated immunity (CMI) and distribution of human leukocyte antigens (HLA) alleles were analysed. RESULTS: Ten out of 34 patients experienced self-limiting infection, with most resolving patients showing fast kinetics of viral clearance: at least one negative HCV RNA test during this phase predicted a favourable outcome. Among other clinical epidemiological parameters measured, the self-limiting course was significantly associated with higher median peak bilirubin levels at the onset of disease, and with the female sex, but only the latter parameter was independently associated after multivariate analysis. No significant differences between self-limiting or chronic course were observed for the distribution of DRB1 and DQB1 alleles. HCV specific T cell response was more frequently detected during acute HCV infection, than in patients with chronic HCV disease. A significantly broader T cell response was found in patients with self-limiting infection than in those with chronic evolving acute hepatitis C. CONCLUSION: The results suggest that host related factors, in particular sex and CMI, play a crucial role in the spontaneous clearance of this virus. Most importantly, a negative HCV RNA test and broad CMI within the first month after onset of the symptoms represent very efficacious predictors of viral clearance and could thus be used as criteria in selecting candidates for early antiviral treatment.     

侵袭性真菌感染诊治进展

随着社会的老龄化,广谱抗生素、糖皮质激素、免疫抑制剂等药物的广泛应用和手术导管、插管的应用、器官移植的日益增多以及免疫缺陷综合征(AIDS) 的流行,侵袭性真菌感染(invasive fungal infections,IFI)明显增多.本文就侵袭性真菌病的现状、诊断标准、治疗和真菌的致病机制、耐药机制的研究进展作一综述.     

Extrahepatic symptoms of HCV infection

Numerous extrahepatic manifestations have been reported in association with hepatitis c virus (HCV) infection, including mixed cryoglobulinemia, porphyria cutanea tarda, membranoproliferative glomerulonephritis, and a high prevalence of autoantibodies. The aims of the present paper is to present the prevalence of clinical and biologic extrahepatic manifestation and to identify associations between these manifestation. The prevalence of dermatologic, rheumatologic, neurological, and nephrologic manifestations, diabetes, arterial hypertension, autoantibodies, and cryoglobulins and liver histologic factors associated with the presence of extrahepatic manifestations reported in the literature.     

Natural history of HCV infection

Background

There is much controversy surrounding the natural history of hepatitis C virus (HCV) infection.

Aims

The aim of this review was to review the natural history of HCV infection.

Methods

Published English literature was searched via pubmed and then reviewed.

Results

Approximately, 75?C85% of HCV-infected persons will progress to chronic HCV infection. The rate of chronic HCV infection is affected by a person??s age, gender, race, and viral immune response. Once chronic HCV infection develops, there are external and host factors that can increase the risk of progression of liver disease. Progression of chronic HCV infection is not linear in time, probably because many cofactors change the rate of development of fibrosis, cirrhosis, and hepatocellular carcinoma. Factors linked with aggressive disease progression include age at infection, duration of infection, heavy alcohol use, co-infections with HIV or hepatitis B virus, male sex, steatosis, insulin resistance (and factors associated with the metabolic syndrome), and host genetics. However, the relative importance of many and varied factors remains uncertain, and further research efforts should be directed toward design of predictive models for effective risk stratification. Interferon-based therapy, particularly among those achieving a sustained virologic response (SVR), is associated with improved fibrosis and inflammation scores, reduced incidence of hepatocellular carcinoma, and prolonged life expectancy.

Conclusions

Despite the progress in understanding the factors affecting the natural history of HCV infection, a great deal remains to be learnt.