ASAT/ALAT ratio provides prognostic information independently of Child-Pugh class,gender and age in non-alcoholic cirrhosis

Objective. The aspartate amino transferase/alanine amino transferase (ASAT/ALAT) ratio is increased in cirrhosis. Some studies indicate that the ratio may provide prognostic information as well. The purpose of this study was to further elucidate the role of the ASAT/ALAT ratio as a predictor of survival by assessing it together with classical risk factors such as age, gender and Child-Pugh (CP) class in a mixed cohort of patients with cirrhosis. Material and methods. Eighty-nine patients with alcoholic cirrhosis and 81 patients with non-alcoholic cirrhosis treated at Aker University Hospital between 1999 and 2004 were identified retrospectively. Survival data from these patients per August 2006 were retrieved from the Norwegian Death Registry. Clinical and biochemical data at time of diagnosis were assessed as predictors of survival using the Kaplan-Meier method and Cox regression models. Results. Median ASAT/ALAT ratio was significantly higher in alcoholic cirrhosis (2.42) as compared with non-alcoholic cirrhosis (1.42). In both groups, a ratio above the median was predictive of poor outcome, p=0.024 and p=0.032, respectively. Other significant predictors of death were CP class (p<0.001), clinical decompensation (p<0.001) and age (p=0.001). Cox regression analyses showed that the ASAT/ALAT ratio was a predictor of death independently of CP class, gender and age in non-alcoholic, but not in alcoholic cirrhosis. The estimated increased hazard (risk of dying) in non-alcoholic cirrhosis was 5% (CI: 1–8%) per 0.10 increase in ASAT/ALAT ratio. Conclusions. A high ASAT/ALAT ratio is associated with increased mortality in cirrhosis. In non-alcoholic patients the ratio may provide prognostic information independently of classical risk factors.     

Incidence rates and causes of cirrhosis in a Norwegian population

Objective. To investigate the incidence rate and causes of cirrhosis in a Norwegian population. We also sought to assess the degree of underreporting of cirrhosis to the Norwegian Death Registry. Material and methods. All 1264 patients treated at Aker University Hospital in the period January 1999 to March 2004 who were given a diagnosis indicating cirrhosis, chronic liver disease or symptoms possibly attributable to cirrhosis were screened retrospectively. A search of the registry of histological diagnoses at Department of Pathology was also carried out. Based on the results of histological examinations and non-histological criteria, cirrhosis was confirmed in 194 patients. Calculations of the incidence rate of cirrhosis and frequencies of the various etiologies were based on 93 patients living in the catchment area of the hospital. Causes of death were retrieved from the Norwegian Death Registry. Results. The incidence rate of cirrhosis was 134 per million per year. The majority of cases were due to alcoholic liver disease (53%), followed by viral liver disease (12%), various autoimmune liver diseases (12%), hemochromatosis (4%) and non-alcoholic steatohepatitis (NASH) (3%). No etiology was established in 16%, a group with a high prevalence of diabetes mellitus, indicating that some of these cases were possibly caused by NASH. Among 105 deaths in this cohort of 194 cirrhotic patients, the diagnosis of cirrhosis was absent in the Norwegian Death Registry in 30% of cases. Conclusions. The incidence of cirrhosis in Norway is relatively low, with alcohol as the most important etiologic factor. Significant underreporting to the Norwegian Death Registry was observed.     

Determinants of myocardial hypoperfusion analyzed for the interventricular septum using power Doppler harmonic imaging with contrast echocardiography in humans: a methodologic approach for clinical practice.

BACKGROUND: To evaluate determinants of myocardial hypoperfusion using power Doppler harmonic imaging (PDHI) with myocardial contrast echocardiography (MCE) in clinical practice, a retrospective clinical study was performed comparing echocardiographic and angiographic data. Angiographic data of patients with a normal coronary angiogram (non-CAD) and symptomatic patients with low flow conditions caused by a stenosis of the left anterior descending coronary artery (LAD) or occlusion, or TIMI-II-flow in the LAD were compared with the PDHI data. METHODS AND RESULTS: In 32 patients, MCE was performed with a System Five Performance ultrasound system (GE Vingmed Ultrasound, Horten, Norway). Myocardial perfusion was semiquantitatively analyzed with the EchoPac 6.2b.134 software, bolus injection with Optison (0.35 mL with 5 mL saline flush), and continuous infusion with Levovist (400 mg/mL(-1); 3.5-5 mL/min(-1)) were performed (8 non-CAD patients, 8 CAD patients, respectively). After bolus injection, Doppler intensity (DI) kinetics showed a significant decrease of maximum DI wash-in rate (eg, apical septum [AS]: 4.9 +/- 3.3 vs 2.4 +/- 1.9 dB/s(-1)), of peak maximum DI (eg, AS: 25.3 +/- 6.3 vs 16.4 +/- 5.7 dB), and of DI determined 10 and 20 seconds after peak maximum DI (eg, AS: 22.1 +/- 4.9 vs 10.8 +/- 4.6 dB; AS: 20.4 +/- 5.3 vs 8.0 +/- 3.8 dB, respectively) using a trigger interval once every 3 cardiac cycles when normal perfused areas were compared with hypoperfused areas. During infusion coronary transit time (3.3 +/- 0.9 vs 7.0 +/- 3.6 seconds), maximum DI wash-in rate (eg, AS: 3.2 +/- 1.3 vs 1.3 +/- 0.8 dB/s(-1)) and DI-maximum plateau (eg, AS: 28.6 +/- 4.7 vs 18.3 +/- 6.4 dB) significantly decreased, respectively. CONCLUSION: Regional myocardial hypoperfusion at rest can be detected by using PDHI with MCE in clinical practice, according to a standardized methodologic protocol.     

Super harmonic imaging: a new imaging technique for improved contrast detection

For ultrasound contrast agents (UCA), nonlinear imaging now has become fundamental. All of the current contrast-imaging methods are dominantly based on the nonlinear response of UCA bubbles. The discrimination between the perfused tissue and the UCA is the challenge in the field of UCA-imaging. This differentiation is usually associated or expressed by the ratio of the scattered power from the contrast agent to the scattered power from the tissue and is termed "contrast-to-tissue ratio" (CTR). Second harmonic imaging showed a better discrimination between tissue and UCA than fundamental imaging because of a higher CTR. We demonstrate, in this study, that the CTR increases as a function of the order of the harmonic frequency. Currently, due to the limited bandwidth of the transducers, only the second harmonic is selectively imaged, resulting in images with a superior quality to fundamental images, but still degraded and not optimal because of the harmonic generation in the underlying tissue (due to nonlinear propagation) and hence giving a limited CTR. To increase the CTR and to take advantage of the higher harmonics (third, fourth, fifth and the ultraharmonics and termed here super harmonics), we have developed a new phased array transducer. The array transducer contains two different types of elements arranged in an interleaved pattern (odd and even elements). The total number of elements is 96. The elements can operate separately and at a distinct frequency, enabling separate transmission and reception modes. The odd elements (48) operate at typically 2.8 MHz center frequency and 80% bandwidth. The even elements (48) have a center frequency of 900 kHz with a bandwidth of 50%. In vitro measurements using the dual frequency probe show an increase of 40 dB in the CTR for super harmonic components over the conventional second harmonic system. The increase in CTR is in agreement with the calculations using existing models for the response of encapsulated bubbles and known theory of nonlinear propagation. Animal experiments have demonstrated the feasibility of this approach using commercially available UCA and showed a similar increase of the CTR.     

Incidence rates and causes of cirrhosis in a Norwegian population

OBJECTIVE: To investigate the incidence rate and causes of cirrhosis in a Norwegian population. We also sought to assess the degree of underreporting of cirrhosis to the Norwegian Death Registry. MATERIAL AND METHODS: All 1264 patients treated at Aker University Hospital in the period January 1999 to March 2004 who were given a diagnosis indicating cirrhosis, chronic liver disease or symptoms possibly attributable to cirrhosis were screened retrospectively. A search in the registry of histological diagnoses at Department of Pathology was also carried out. Based on the results of histological examinations and non-histological criteria, cirrhosis was confirmed in 194 patients. Calculations of the incidence rate of cirrhosis and frequencies of the various etiologies were based on 93 patients living in the catchment area of the hospital. Causes of death were retrieved from the Norwegian Death Registry. RESULTS: The incidence rate of cirrhosis was 134 per million per year. The majority of cases were due to alcoholic liver disease (53%), followed by viral liver disease (12%), various autoimmune liver diseases (12%), hemochromatosis (4%) and non-alcoholic steatohepatitis (NASH) (3%). No etiology was established in 16%, a group with a high prevalence of diabetes mellitus, indicating that some of these cases were possibly caused by NASH. Among 105 deaths in this cohort of 194 cirrhotic patients, the diagnosis of cirrhosis was absent in the Norwegian Death Registry in 30% of cases. CONCLUSIONS: The incidence of cirrhosis in Norway is relatively low, with alcohol as the most important etiologic factor. Significant underreporting to the Norwegian Death Registry was observed.     

A Public T cell Receptor Recognized by a Monoclonal Antibody Specific for the D‐J Junction of the β‐chain

It is becoming increasingly clear that T cell responses against many antigens are dominated by public α/β T cell receptors (TCRs) with restricted heterogeneity. Because expression of public TCRs may be related to resistance, or predisposition to diseases, it is relevant to measure their frequencies. Although staining with tetrameric peptide/major histocompatibility complex (pMHC) molecules gives information about specificity, it does not give information about the TCR composition of the individual T cells that stain. Moreover, next‐generation sequencing of TCR does not yield information on pairing of α‐ and β‐chains in single T cells. In an effort to overcome these limitations, we have here investigated the possibility of raising a monoclonal antibody (moAb) that recognizes a public TCR. As a model system, we have used T cells responding to the 91–101 CDR3 peptide of an Ig L‐chain (λ2³¹⁵), presented by the MHC class II molecule I‐E^d. The CD4⁺ T cell responses against this pMHC are dominated by a receptor composed of Vα3Jα1;Vβ6DβJβ1.1. Even the V(D)J junctions are to a large extent shared between T cell clones derived from different BALB/c mice. We here describe a murine moAb (AB10) of B10.D2 origin that recognizes this public TCR, while binding to peripheral T cells is negligible. Binding of the moAb is abrogated by introduction of two Gly residues in the D‐J junction of the CDR3 of the β‐chain. A model for the public TCR determinant is presented.     

Colorectal Cancer Screening With Repeated Fecal Immunochemical Test Versus Sigmoidoscopy: Baseline Results From a Randomized Trial

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An in vitro assessment of the flow characteristics of spiral-ridged and smooth-walled JJ ureteric stents

OBJECTIVE: To assess drainage through spiral-ridged and smooth-walled JJ ureteric stents (designed to ensure upper tract drainage) and thus determine whether drainage preferentially occurs around rather than through the spiral-ridged stent, promoting renal flow and potentially facilitating the passage of urinary stone fragments. Materials and methods A mechanical ureteric model was constructed to mimic the funnel characteristics of the renal pelvis. A motor pump was used to help simulate respiratory and skeletal movement, resulting in differential motion between the intraluminal stent and the surrounding ureteric wall. Tubes of varying internal diameters were used to simulate different sizes of ureter. Flow rates of standard 7 F smooth-walled stents were compared with 7 F spiral-ridged stents with and without occluded lumens, and with and without standardized excursions. RESULTS: Extraluminal flow (mean rates) with and without movements simulating respiratory excursions were significantly higher with the spiral stent for all stent diameters evaluated. All flow rates increased as the ureteric diameter increased. Total flow past the spiral stent was significantly greater than flow with the smooth-walled stent under all conditions tested. Flows measured around the spiral stent under conditions of excursion were the highest of all categories, 20-fold higher than in smooth-walled, closed, stationary stents. CONCLUSION: Spiral-ridged JJ stents provided substantially greater flow in this in vitro model. Extraluminal flow was markedly increased with the spiral-ridged configuration. The difference in flow rates was more pronounced at the smaller pseudo-ureteric tube diameters, simulating dimensions found in clinical practice. The flow rate also was increased when the central lumen remained open, and was greater still when there was dynamic excursion with respiratory movements.