Insulin-like growth factor-II is a useful marker to detect hepatocellular carcinoma?

BackgroundHepatocellular carcinoma (HCC) is a typical hypervascular tumor. The utility of serum alpha-fetoprotein (α-FP) in its detection is questionable. Over-expression and high circulating levels of insulin-like growth factor-II (IGF-II) were reported in tissue and in serum of patients with HCC. We investigated the diagnostic application of IGF-II in the diagnosis of HCC.MethodsSerum IGF-II and α-FP levels were measured in 178 patients (82 with HCC and 96 with liver cirrhosis) and in 30 healthy controls. Spearman test, non parametric combination test and confidence interval analysis were used for statistical evaluation of data.ResultsThe best cut-off values selected by ROC curves were 796 ng/ml for IGF-II and 132 ng/ml for α-FP. IGF-II mean values were higher in patients with HCC than in those with liver cirrhosis (LC) (p = 0.0001) but lower in LC than in controls (p = 0.0001). Serum IGF-II levels above cut-off were found in 22% of patients with HCC, in 9.3% of those with cirrhosis and in 20% of controls. α-FP serum levels > 132 ng/ml were observed in 48% of HCC, in 3.1% of LC and in none of control group. By correlation study, serum IGF-II levels were significantly correlated with serum α-FP levels (r = 0.427, p = 0.0001) and with nodules' diameter (r = 0.252, p = 0.0130) but not with nodules' number (p > 0.050). Finally, IGF-II showed lower sensitivity, specificity and predictive values than α-FP.ConclusionCirculating IGF-II is not a useful marker for HCC. Further researches are however needed to evaluate its diagnostic accuracy before and after nutritional adjustment.     

Maternal thyroid function in different conditions of iodine nutrition in pregnant women exposed to mild-moderate iodine deficiency: an observational study

Objective We examined the effect of different conditions of nutritional iodine intake on maternal thyroid function throughout gestation in a cohort of healthy, anti‐thyroid antibody‐negative women from a mild‐moderately iodine‐deficient (ID) area. Design Observational cohort study. Patients The study included 168 women receiving prenatal preparations containing 150 μg of iodine from early pregnancy (150‐I group); 105 women who had regularly used (>2 years) iodized salt prior to becoming pregnant (I‐salt group); 160 women neither taking iodine supplements nor using iodized salt (no‐I group). Measurements Maternal TSH, FT3 and FT4 were determined throughout gestation. Results Mean TSH concentrations were higher among the 150‐I women than in the remaining two groups, and in a high proportion of them, TSH values were found to exceed the upper limit for gestational age. Conversely, the prevalence of low free‐thyroxine levels in the 150‐I women was similar to that observed in the I‐salt women and markedly lower than that recorded for the no‐I group. Conclusions The regular use of iodine‐containing supplements proved effective in reducing the risk of inappropriately low FT4 levels during pregnancy. The observed TSH increase in 150‐I women may be because of a transient stunning effect on the thyroid gland, occurring as a result of the abrupt increase in daily iodine intake. Whilst the importance of gestational iodine supplementation is undisputed, we believe that in mild‐moderately ID areas, women considering conception should be advised to take iodine supplementation for several months prior to pregnancy.     

Estimated acceptance of HPV vaccination among Italian women aged 18-26 years

In Italy vaccination against human papillomavirus (HPV) was introduced in the national immunization programme in 2007; the primary target for this vaccination is 11-year-old females, whereas vaccination for older age groups is still a matter of debate. This project was carried out in the period 2007-2009 to estimate the acceptance rate among 18-26-year-old, to whom free-of-charge vaccination was actively offered. Socio-demographic factors associated with acceptance were also investigated. A sample of 1159 women was randomly selected from resident population lists of 10 Local Health Units in 6 of Italy's 21 Regions; 1032 women were deemed eligible for the study. Of the eligible women, 580 received at least one vaccine dose for an acceptance rate of 56.2% and 542 received all three vaccine doses (52.6%). The acceptance rate was significantly higher for: residents of northern and central Italy (OR_adj = 2.22, 95%CI 1.64-3.01 and OR_adj = 1.77, 95%CI, 1.20-2.61 respectively), compared to southern Italy; women with a high educational level (OR_adj = 1.41; 95%CI: 1.02-1.93); and students (OR_adj = 1.64; 95%CI: 1.13-2.37). The low immunization rate highlights the difficulties of reaching young adult women, although the current coverage rates observed in the primary target population of HPV vaccination campaign (64%) emphasize that achieving high coverage rates is challenging also in younger age groups. Our results suggest that it would be premature to extend the active free-of-charge offer of HPV vaccination to older women and that efforts should be focused on the priority target, considering that the objective of 95% coverage established for this age group is still far from being attained.     

A comparison of uncovered metal stents for the palliation of patients with malignant biliary obstruction: nitinol vs. stainless steel

BackgroundVarious types of self-expandable metal stents have been introduced for the palliation of malignant biliary obstruction.AimsTo compare the outcomes of WallFlex™ and Wallstent™ uncovered biliary self-expandable metal stents (SEMSs) for the palliation of patients with malignant biliary obstruction.MethodsBetween October 2008 and December 2009, all SEMSs placed for malignant biliary obstruction were WallFlex™: all patients palliated were included in the study. Before October 2008, all the SEMSs placed for malignant biliary obstruction were Wallstent™, and the patients palliated from July 2007 to September 2008 were the comparative group.ResultsA total of 58 WallFlex™ and 54 Wallstent™ SEMSs were placed, and efficacious biliary decompression was achieved in all patients. Early complications occurred in 5 patients in the WallFlex™ group and in 3 in the Wallstent™ group (p = ns). Late complications occurred in 6 patients in the WallFlex™ group and in 16 in the Wallstent™ group (p < 0.01). The overall patency of the self-expandable metal stent in the WallFlex™ and the Wallstent™ groups was similar (227 days vs. 215 days, p = ns). Mean patient survival was 242 days in the WallFlex™ group and 257 days in the Wallstent™ group (p = ns).ConclusionsWe found no difference in terms of overall patency between the two types of SEMSs, but there was an increased rate of late adverse events in the Wallstent™ group.