Histological findings, genotype distribution and percentage of patients fulfilling the treatment criteria among patients with chronic hepatitis C virus infection in a single Swedish centre

BACKGROUND: Genotype distribution of chronic hepatitis C in Sweden has shown a predominance of genotype non-1. With recent improvements in therapy, genotypes 2 and 3 infections can, according to consensus, be treated without histological assessment. The aim of this study was to evaluate the genotype distribution, histological stage and grade, and the percentage of patients fulfilling the histological treatment criteria. METHOD: A total of 323 patients with chronic hepatitis C were tested for genotype, histological findings and the percentage fulfilling the histological treatment criteria as stated by Swedish consensus; i.e. having fibrosis stage II or more, or fibrosis stage I with inflammation grade II or more. RESULTS: The patients had a mean age of 45 years (range 16-71 years) and 62% were males. Genotypes were determined in 79% of patients and genotype 2b or 3a was found to predominate, comprising 56%. Former intravenous drug use was found to be the predominant mode of acquisition, noted in 60%. The mean disease duration was 21 years (range 3-40) after which time 14% of patients had developed cirrhosis (stage IV). In the total material, 77% fulfilled the histological treatment criteria, 76% and 86%, respectively, among genotype I and genotype non-1 (2b and 3a) patients. CONCLUSIONS: Genotype non-1 (2b or 3a) predominated among Swedish patients, 14% of whom developed cirrhosis after a mean follow-up time of 21 years. Furthermore, an absolute majority fulfilled the histological criteria used to judge patients' eligibility for antiviral therapy, supporting the recent Swedish consensus decision to treat genotypes 2 and 3 infected patients without a previous biopsy.     

The results of a randomized trial looking at 24 weeks vs 48 weeks of treatment with peginterferon alpha-2a (40 kDa) and ribavirin combination therapy in patients with chronic hepatitis C genotype 1

Summary. Peginterferon‐α plus ribavirin is the most effective therapy for chronic hepatitis C. This study was designed to evaluate the effect of peginterferon α‐2a (40 kDa) plus ribavirin on sustained virological response (SVR) when administered for 24 vs 48 weeks in genotype 1 naïve patients. One hundred and seventeen patients were enrolled in this controlled trial. Genotype 1 patients were randomized to 24 weeks treatment vs 48 weeks treatment. Genotype non‐1 patients received 24 weeks treatment as an observational group. Outcomes were SVR (defined by hepatitis C virus‐RNA‐negative at week 24 of follow‐up) and tolerability across the study period. The end‐of‐treatment response was 59% for genotype 1 (24 weeks treatment), 80% for genotype 1 (48 weeks treatment) and 92% for genotype non‐1 (24 weeks treatment). The end‐of‐follow‐up response was 19% (95% confidence interval (CI): 7.2–36.4) (genotype 1, 24 weeks) and 48% (95% CI: 30.2–66.9; P = 0.0175) (genotype 1, 48 weeks). Among genotype non‐1, SVR was 76% (95% CI: 62.3–86.5). There were no unexpected adverse events.Almost half of the genotype 1 patients achieved an SVR after 48 weeks treatment with peginterferon α‐2a (40 kDa) and low‐dose ribavirin and confirmed that they should be treated for 48 weeks. Safety profile was acceptable.     

Recurrent abdominal pain in children revisited: irritable bowel syndrome and psychosomatic aspects. A prospective study

Background: Since Apley, more than 40 years ago, concluded that less than 10% of cases with recurrent abdominal pain (RAP) are of organic origin, medical technology has improved, the knowledge has expanded and new methods of investigation have been developed. The lack of organic findings in many children with RAP has led to the conclusion that psychological factors are important. Methods: Forty‐four children with RAP underwent an investigation programme to find organic abnormalities that might explain the symptoms. Current criteria for irritable bowel syndrome (IBS) in children were used to find out what proportion fulfilled these criteria, irrespective of the organic findings on clinical investigation. A standardized questionnaire, the CBCL (Child Behaviour Checklist), was used to evaluate emotional and behavioural disturbances in children referred for RAP. Results: Thirteen out of 26 (50%) children with no signs of organic disease fulfilled the IBS criteria as opposed to 7 out of 18 (39%) children in the group with organic findings (P?=?0.68). The total score for the CBCL was in the normal range for 32 out of 36 of the children. Conclusions: We found a high proportion of children fulfilling the IBS criteria in both groups, thus organic abnormalities have to be excluded before making the IBS diagnosis. The results of the CBCL forms did not show any difference between children with organic versus those with non‐organic abnormalities, both groups within the normal range.     

Comparison of the different classification criteria sets for primary Sjögren's syndrome

OBJECTIVE: To assess the comparability of different classification criteria sets for primary Sj?gren's syndrome (pSS). METHODS: In a prospective study we examined all patients with suspected pSS who were admitted to our Department of Rheumatology or referred to our outpatient clinic between 1 January 2001 and 31 December 2002. The Copenhagen, Californian, 1996 European, and American-European consensus group (US-EU) criteria sets were used to assess each patient. RESULTS: Ninety out of 222 patients (41%) were diagnosed with pSS by fulfilling at least one classification criteria set. The highest number of patients who were diagnosed with pSS fulfilled the European criteria set (36%), followed by the Copenhagen (28%), the US-EU (26%), and the Californian (9%) criteria sets. On average, the group of patients fulfilling the Californian criteria set were 5.6 years older than the patients in the other three groups (p < 0.05). In addition, the disease duration before diagnosis was 2.6 years longer than in the other three groups. The groups of patients fulfilling either the Californian or the US-EU criteria sets had a higher prevalence of leucopaenia (p < 0.05). Those fulfilling the US-EU criteria set also had a higher prevalence of arthritis (p < 0.05). No significant differences were found in the prevalence of the other clinical and laboratory parameters studied. CONCLUSIONS: Different patients are diagnosed with pSS if different classification criteria sets are used. Therefore, studies based on different classification criteria sets for diagnosing pSS are not directly comparable.     

The clinical picture of rheumatoid arthritis according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria: Is this still the same disease?

Objective

To examine the implications of using the new classification criteria for rheumatoid arthritis (RA) in clinical practice in a cohort of patients with very early arthritis.

Methods

The study group comprised 301 disease‐modifying antirheumatic drug–naive patients with early arthritis. The baseline diagnosis was assessed by applying the 1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) criteria for RA as well as established diagnostic criteria for other rheumatic diseases. Diagnostic and prognostic data were collected after 2 years of followup. Fulfillment of the 2010 ACR/EULAR criteria was evaluated in the subset of patients in whom undifferentiated arthritis (UA) was diagnosed when the 1987 ACR criteria were applied, and fulfillment of RA criteria over time was tested by applying the 2 different criteria sets.

Results

The median arthritis duration at baseline was 4 months (range 0–12 months). At baseline, 28% of the patients fulfilled the 1987 ACR criteria, and 45% fulfilled the 2010 ACR/EULAR criteria for RA. Among the patients classified as having UA at baseline according to the 1987 ACR criteria, 36% had fulfilled the 2010 ACR/EULAR criteria already at baseline. Among the patients classified as having UA at baseline but who fulfilled the 1987 ACR criteria after 2 years of followup, 85% had fulfilled the 2010 ACR/EULAR criteria at baseline. Patients with early disease who fulfilled the 2010 ACR/EULAR criteria were less likely to be autoantibody positive and more likely to have monarthritis at presentation than those fulfilling the 1987 ACR criteria.

Conclusion

Use of the 2010 ACR/EULAR criteria clearly allows earlier diagnosis of RA, although the clinical picture is slightly different on the group level, and RA may be falsely diagnosed in some patients with self‐limiting disease.

     

Clinicopathological features and genotype distribution in patients with hepatitis C virus chronic liver disease

Background and Objective  Hepatitis C virus (HCV) genotype influences the severity of disease and response to therapy. This retrospective study examined the clinical and histological features and the genotype distribution in biopsied patients with HCV related chronic liver disease. Methods  Of 105 biopsies from patients with HCV infection, 96 from patients with chronic liver disease were reviewed. The Ishak scoring system was used for histological analysis. Results  Genotype 3 was most common accounting for 77.1%, and genotype 1 for 9.4% of cases. There was no significant association of transaminase levels, viral load or necro-inflammatory activity score with genotype. A severe degree of fibrosis was seen in 77.8% cases of genotype 1 and in 63.5% of genotype 3 (p=0.76). Variable degrees of steatosis were noted in 68.8% of cases. However, severe steatosis was noted only in genotype 3 (7 cases). Serum transaminase levels did not correlate with either histological activity (p=0.43) or degree of fibrosis (p=0.72). Severe fibrosis / cirrhosis was seen in 74.24% of patients above 40 years of age as compared to 33.3% of patients below 40 years (p=0.001). The frequency of Mallory hyaline was significantly different between genotypes 1 and 3 infection (P<0.001). Conclusions  This study confirms the preponderance of genotype 3 in Indian patients with HCV related chronic liver disease. Severe steatosis was seen only in genotype 3 and Mallory hyaline was very common in genotype 1. The small numbers of patients in non genotype 3 could be a reason for the apparent lack of histological differences between different HCV genotypes. Severe fibrosis seen in older age groups confirms that HCV infection is progressive and major acceleration of the disease process occurs after 40 years of age.     

Evaluation of factors associated with recruitment in hematological clinical trials: a retrospective cohort study

Abstract

The objectives of this study were to measure the recruitment, to study characteristics associated with recruitment, and to explore reasons for non-recruitment in clinical trials for malignant hematological diseases. Trials opened between 2002 and 2008 were selected. If the patient fulfilled the main criteria of the protocol, all eligibility criteria of the protocol were assessed. A total of 1394 patients-protocol were identified in 17 protocols (697 patients, since a patient could have been eligible for more than one protocol) and 195 patients-protocol (186 patients) of these fulfilled the main criteria of the protocol. Among the 195 patients-protocol, 133 (68·2%) fulfilled all the eligibility criteria and 45 (23·1%) were recruited. Patients, physicians, and protocol characteristics were not associated with recruitment. The most common reasons for not being recruited were as follow: 40·7%, not fulfilling all eligibility criteria; 31·3%, protocol not being proposed according to the chart; and 22·7%, patients' refusal.     

Expanded Makuuchi's criteria using estimated indocyanine green clearance rate of future liver remnant as a safety limit for maximum extent of liver resection

BackgroundRecent advances in liver surgery have dramatically improved the safety of hepatectomy for hepatocellular carcinoma (HCC). The aim of this study was to compare outcomes for patients fulfilling an extended criteria vs. those fulfilling the conventional criteria based on the bilirubin and indocyanine green (ICG) clearance (Makuuchi's criteria).MethodsThe short term outcomes of patients undergoing hepatectomy for HCC and who fulfilled the expanded criteria (ICG clearance of future remnant liver [ICG-Krem] ≥ 0.05 estimated using 3-D volumetry) were retrospectively reviewed and were compared between those fulfilling the conventional criteria. Postoperative hepatic insufficiency (PHI) was defined as peak total bilirubin >7 mg/dL.ResultsA total of 323 patients undergoing resection of whom 269 (83%) met conventional criteria (In-M) and 54 (17%) extended criteria (Ex-M). The overall morbidity rates were not significantly different. The incidence of PHI was 0.37% in In-M and 3.7% in Ex-M (P = 0.074), with no liver-related deaths. When the ICG-Krem ≥ 0.05 criterion was included, major hepatectomy was performed in 24 patients (41%) in Ex-M with no significant increase in major morbidity (13%), PHI(3.3%), or liver-related death (0%) compared with minor hepatectomy (n = 30) in Ex-M(10%, 4% and 0%, respectively).ConclusionsObjective criteria using ICG clearance rate and 3-D volumetry may offer opportunities for safe surgical resection in selected patients exceeding the conventional criteria.     

High prevalence of metabolic complications in patients with non‐alcoholic fatty liver disease

Background: Non‐alcoholic fatty liver disease (NAFLD) is considered to be the liver component of the metabolic syndrome and is frequently associated with obesity, dyslipidemia and type II diabetes mellitus (NIDDM). We aimed to determine the development of liver function tests (LFTs) and metabolic complications in patients previously diagnosed with NAFLD. Methods: One‐hundred‐and‐two patients with NAFLD diagnosed in the period 1994–2001 were identified. Eighty were brought in for new investigations, including LFTs, blood pressure, BMI, lipid profile, blood glucose and insulin. Original liver biopsy was re‐evaluated. Results: Sixty‐two patients (77%) were males (median age 46 years; mean follow‐up time 2.8?±?1.2 years). Fifty‐four patients (68%) were light to moderately overweight with body mass index (BMI) 25–30?kg/m ² . Mean BMI (28.2) was the same at diagnosis and at follow‐up (28.3). At the new examination, 18 patients (23%) had developed diabetes mellitus type II (n?=?6) or had impaired fasting glucose (IFG) (n?=?12), compared to only 2 patients at diagnosis. Hyperinsulinemia was observed in 19 patients (24%). Dyslipidemia, with elevated triglycerides and/or hypercholesterolemia, was now present in 65 patients (81%). Twenty‐two patients (27%) had hypertension compared to 9 (11%) at diagnosis. Liver biopsy was performed in 24%, and 89% of those fulfilled the criteria for NASH. However, mild inflammation and fibrosis was observed, grade 1–2 (n?=?17), stage I–II (n?=?13) and none had cirrhosis. Conclusion: A significant proportion of patients with both clinical and histological diagnosis of NAFLD develop metabolic problems soon after diagnosis. These patients should be screened regularly for metabolic disorders.     

Diagnosis of left-ventricular non-compaction in patients with left-ventricular systolic dysfunction: time for a reappraisal of diagnostic criteria?

AIMS: Left-ventricular non-compaction (LVNC) is characterized by excessive and prominent left-ventricular (LV) trabeculations and may be associated with systolic dysfunction in advanced disease. We sought to determine the proportion of patients fulfilling LVNC criteria in an adult population referred to a heart failure clinic using current diagnostic criteria. METHODS AND RESULTS: One hundred and ninety-nine patients [age 63.5 +/- 15.9 years, 124 (62.3%) males] with LV systolic impairment were studied. All underwent clinical examination, electrocardiography, and 2-D echocardiography. The number of patients fulfilling diagnostic criteria for LVNC was retrospectively determined using three published definitions. Results were compared with 60 prospectively evaluated normal controls (age 35.7 +/- 13.5 years; 31 males, 30 blacks). Forty-seven patients (23.6%) fulfilled one or more echocardiographic definitions for LVNC. Patients fulfilling LVNC criteria were younger (P = 0.002), had larger LV end-diastolic dimension (P < 0.001), and smaller left atrial size (P = 0.01). LVNC was more common in black individuals (35.5 vs. 16.2%, P = 0.003). Five controls (four blacks) fulfilled one or more LVNC criteria. CONCLUSIONS: This study demonstrates an unexpectedly high percentage of patients with heart failure fulfilling current echocardiographic criteria for LVNC. This might be explained by a hitherto underestimated cause of heart failure, but the comparison with controls suggests that current diagnostic criteria are too sensitive, particularly in black individuals.     

Early decline of the HCV core antigen can predict SVR in patients with HCV treated by Pegylated interferon plus ribavirin combination therapy

OBJECTIVE: Pegylated interferon (PEG‐IFN) plus ribavirin (RBV) combination therapy is now a popular treatment for patients with chronic hepatitis C; however, the reported sustained virologic response (SVR) rate remains at nearly 50% in genotype 1b infected patients. Therefore, it is of clinical benefit to be able to predict the effect of combination therapy on individual patients earlier in the treatment. We estimated the predictive serum HCV core antigen levels for SVR in the early therapeutic stage of combination therapy. METHODS: The HCV core antigen in patients with high‐level HCV viremia, in whom standard PEG‐IFNα2b plus RBV combination therapy had been completed, was measured at baseline and at 3, 7, 14, 28 and 84 days of treatment, and their SVR was determined at 24 weeks after treatment. Sixty genotype 1b‐ and 30 genotype 2‐infected patients were included. RESULTS: Thirty (50%) genotype 1b and 27 (90%) genotype 2 patients achieved a SVR. In genotype 1b patients the decline of HCV core antigen levels was statistically different between the SVR and non‐SVR groups. When we defined a separation level at 500 fmol/L, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for SVR at day 7 was 79.4%, 88.5%, 90%, 76.7%, and 83.3%, respectively. In genotype 2 patients, there was no significant difference in the HCV core antigen values between the SVR and non‐SVR groups. CONCLUSION: In genotype 1b patients, 500 fmol/L of HCV core antigen level at day 7 was the best predictor for therapeutic response in the early stage of treatment.     

Concordance between the old and new diagnostic criteria for periprosthetic joint infection

Purpose

There is no uniform definition for periprosthetic joint infection (PJI). New diagnostic criteria were formulated in an international consensus meeting in 2013 and adopted by Centers for Disease Control (CDC) in 2016. The purpose of this study is to compare the new diagnostic criteria with the old CDC criteria from the year 1992.

Methods

Patients, who had been treated for PJI of hip or knee from 2002 to 2014, in a tertiary care hospital, were identified. Patient records were reviewed by a physician to identify PJI cases fulfilling the old or new CDC criteria and to record data concerning the diagnostic criteria. PJI frequencies were calculated for the two diagnostic criteria sets. Cross tables were formed to compare the concordance between the two sets of criteria in the whole material and in different clinical subgroups.

Results

Overall 405 cases fulfilling either or both sets of criteria for PJI were identified. 73 (18%) of the patients fulfilled only the old criteria, whereas only one (0.2%) fulfilled only the new criteria. Of the patients who did not fulfil the new criteria, in 39 (53%) the diagnosis was based solely on the clinician’s opinion.

Conclusions

The number of PJIs is notably lower when using the new, more objective, diagnostic criteria. A large portion of the cases diagnosed as infection by the treating clinician, did not fulfil the new diagnostic criteria.

     

Factors affecting the changes in molecular epidemiology of acute hepatitis B in a Southern Italian area

Summary. To explore changes in molecular epidemiology of acute viral hepatitis B (AVH‐B), hepatitis B virus (HBV) genotypes were determined by direct sequencing of the Pre‐S‐S region in 123 consecutive patients, with AVH‐B observed in Naples or its surroundings in the last decade (group AVH‐B) and in 123 HBV chronic carriers [chronic carrier of HBV (CC‐B) group] from the same areas, who had been hepatitis B surface antigen‐positive for more than 10 years. Genotype D was less frequently detected in patients with AVH‐B than in those in the CC‐B group (76.4%vs 97.5%, P < 0.0001). In the AVH‐B group, intravenous drug addiction (IVDA) was the prevalent risk factor (55.3%) for acquiring HBV in the 94 patients with HBV genotype D, but it was rarely recorded (6.9%) in the 29 patients with genotypes non‐D (P < 0.0001); unsafe sexual intercourse was prevalent in patients with genotype non‐D (72.3%) and less frequent in those with genotype D (28.8%, P < 0.005). In the AVH‐B group, the prevalence of non‐D genotypes increased during the observation period from 11.1% in 1999–2003 to 41.1% in 2004–2008 (P < 0.0005), paralleling the increase in the prevalence of patients with unsafe sexual intercourse; similarly, the progressive decrease in IVDA paralleled the decrease in the prevalence of genotype D (from 88.3% in 1999–2003 to 11.7% in 2004–2008). The prevalence of HBV non‐D genotypes recorded in the last 10 years in AVH‐B in this area shows a progressive increase, most probably because of recent changes in HBV epidemiology, namely, the HBV mass vaccination campaign and increased immigration from areas with high HBV endemicity.     

Hepatocellular carcinoma in Sweden: its association with viral hepatitis, especially with hepatitis C viral genotypes

Viral markers of chronic hepatitis were tested for in 95 frozen serum samples from 299 patients from Malm?, Sweden, with hepatocellular carcinoma (HCC), diagnosed between 1977 and 1994. Hepatitis B analysis included anti-HBc, HBsAg and, if anti-HBc positive, HBV DNA. Hepatitis C infection analysis included anti-HCV screening, RIBA, HCV RNA and HCV genotyping. HCV genotyping was also carried out in 9 HCV-viraemic HCC-patients from Gothenburg. HCV genotype distribution in HCC cases was compared with Swedish HCV-infected blood donors. Among the 95 patients from Malm?, 28 (29%) had anti-HBc, but only 5 (5%) were chronic HBV carriers, compared with 16 (17%) with chronic hepatitis C (p = 0.021). HCV-related HCC was more common among immigrants (8/16 vs. 8/79; p < 0.001). Genotyping of 25 HCV-infected cases showed genotype 1a in 6 (24%), genotype 1b in 13 (52%), genotype 2b in 4 (16%), and genotype 3a in 2 (8.0%) patients. Genotype 1b was more common among HCC patients than among blood donors (p < 0.001), but 8 of 13 genotype 1b-infected patients were from countries where genotype 1b is predominant. Among native Swedes there was no difference between the HCV genotypes infecting blood donors and those found in HCC patients.     

Chronic hepatitis C in Sweden: genotype distribution over time in different epidemiological settings.

Hepatitis C virus (HCV) strains are divided into 6 genotypes and several subtypes. Recent studies reported a change in the relative frequency of genotypes within certain regions. We studied the HCV genotype in 312 Swedish patients with chronic hepatitis C, using a core region primer-specific PCR, and grouped the patients according to parenteral risk factors. The date of infection could be estimated in 127 cases. Genotypes 1a (35%) and 3 (31%) were the most common genotypes, followed by genotype 2 (17%), while only 6% had genotype 1b. Genotype 3 was relatively more frequent among subjects infected sexually or by intravenous drug use. The genotype distribution was different from that in studies from other parts of the world, with a lower frequency of genotype 1 (especially 1b) and a higher frequency of genotype 3. The frequency of genotype 1b has decreased and genotype 3 increased over time. The reasons for a different distribution of genotypes in Sweden, compared with other countries, might be a relatively recent introduction of HCV into the population, or a different pattern of transmission.     

Prevalence,treatment patterns and control rates of metabolic syndrome in a Chinese diabetic population: China Cardiometabolic Registries 3B study

Aims/Introduction

To investigate the prevalence and risk factors of metabolic syndrome (MetS) in Chinese type 2 diabetes mellitus patients, and assess the effect of MetS on the treatment patterns and blood glucose, blood pressure and blood lipids goal achievements.

Materials and Methods

Data from 25,454 type 2 diabetes mellitus patients including demographic data, anthropometric measurements, treatment patterns, and blood glucose and lipid profiles were retrospectively analyzed.

Results

Using modified Adult Treatment Panel III MetS criteria, the prevalence of MetS was 57.4% in type 2 diabetes mellitus patients. Multivariable logistic regression analysis showed that type 2 diabetes mellitus patients, who also fulfilled the criteria for MetS, tended to be women, living in the northeast, with a diabetes duration ≥5 years and leading a sedentary lifestyle. Most MetS (53.4%) and non‐MetS (57%) diabetes patients received oral hypoglycemic drugs. Insulin or insulin combination therapies were more applied in MetS (37.5%) than in non‐MetS (33.1%) diabetes patients, and the percentages of MetS diabetes patients receiving antihypertensive and lipid‐modulating drugs were 52.9% and 28.2% vs 38.3% and 19.3% of the non‐MetS diabetes patients. Just 37.5%, 15.6% and 32.9% of the MetS diabetes patients vs 54.6%, 45.6% and 40.4% of the non‐MetS diabetes patients achieved the individual target goals for control of blood glucose (glycosylated hemoglobin <7%), blood pressure (systolic blood pressure <130 mmHg, diastolic blood pressure <80 mmHg) and blood lipids (total cholesterol <4.5 mmol/L), whereas just 2.1% achieved all three target goals.

Conclusions

MetS with a high prevalence in Chinese type 2 diabetes mellitus patients is associated with poor blood glucose, blood pressure and blood lipids control rate.     

Distribution frequency of hepatitis C virus genotypes in 2231 patients in Iran

Aim: Given the importance of frequency distribution of HCV genotypes, we studied genotypic distribution of HCV in Iran. In this cross-sectional study, 2231 patients with hepatitis C who presented in hepatitis clinics in Tehran were investigated for HCV genotypes. Methods: Genotyping was performed by genotype specific primers. Results: The highest frequency was for genotype 1a, with 886 (39.7%) of subjects. Genotype 3a and 1b were the other frequent genotypes, with 613 (27.5%) and 271 (12.1%) subjects, respectively. Of the samples, 401 (18%) had an undetermined genotype. Mixed genotypes were also found in 33 samples (1.6%). Genotype 1b frequency in patients under 20 years old was 10.2%, while its frequency in patients over 60 years old was 18.5%. Genotype 1b frequency significantly increased by age (P = 0.02). Conclusion: This study indicates that the dominant HCV genotype among patients living in Tehran was 1a.     

Changes in the epidemiology and distribution of the hepatitis C virus genotypes in North-Eastern Spain over the last 35 years

Background

Genotypic distribution and epidemiology of HCV infection in Western Europe countries has changed over the last decades.

Gastritis and Acid Secretion in Patients with Gastric Ulcers and Duodenal Ulcers

Background: The aim of this study was to clarify whether the results of surgical treatment of ruptured hepatocellular carcinoma (HCC) are poorer than the results of surgical treatment of non‐ruptured HCC. Methods: Out of a total of 224 HCC patients, the 6 patients with ruptured HCC were compared with 15 patients with non‐ruptured HCC based on TNM stage IVA and having a Cancer of the Liver Italian Program (CLIP) score of 1 or 2. Results: There were no significant differences in clinical and pathological features between the two groups. The 1‐year and 3‐year overall survival rates were 69.3% and 21.2%, respectively, in the ruptured HCC group and 51.3% and 20.5%, respectively, in the non‐ruptured HCC group. The 1‐year and 3‐year disease‐free survival rates were 33.0% and 0%, respectively, in the ruptured HCC group and 38.9% and 15.6%, respectively, in the non‐ruptured HCC group. The differences in survival rates between these two groups did not reach statistical significance. Conclusion: Hepatic resection as definitive treatment after recovery from the initial insult of the rupture of HCC yields results similar to those obtained by surgical treatment of non‐ruptured HCC at the same tumor stage and with the same degree of liver damage.