Chronic hepatitis C:This and the new era of treatment

Over the last years it has started a real revolution in the treatment of chronic hepatitis C. This occurred for the availability of direct-acting antiviral agents that allow to reach sustained virologic response in approximately 90% of cases. In the near future further progress will be achieved with the use of pan-genotypic drugs with high efficacy but without side effects.

Effects of L-carnitine in patients with hepatic encephalopathy

AIM: To evaluate the influence of L-carnitine on mental conditions and ammonia effects on patients with hepatic encephalopathy (HE).METHODS: One hundred and fifty patients (10 patients with alcoholism, 41 patients with hepatitis virus B infection, 78 patients with hepatitis C virus infection,21 patients with cryptogenetic cirrhosis) meeting the inclusion criteria were randomized into group A receiving a 90-d treatment with L-carnitine (2 g twice a day) or into group B receiving placebo in double blind.RESULTS: At the end of the study period, a significant decrease in NH4 fasting serum levels was found in patients with hepatic encephalopathy (P＜0.05) afler the treatment with levocarnitine (LC). Significant differences were also found between symbol digit modalities test and block design in patients with hepatic encephalopathy (P＜0.05).CONCLUSION: Results of our study suggest an important protective effect of L-carnitine against ammonia-precipitated encephalopathy in cirrhotic patients.

Hepatocellular carcinoma and the risk of occupational exposure

Hepatocellular carcinoma(HCC)is the most common type of liver cancer.The main risk factors for HCC are alcoholism,hepatitis B virus,hepatitis C virus,nonalcoholic steatohepatitis,obesity,type 2 diabetes,cirrhosis,aflatoxin,hemochromatosis,Wilson’s disease and hemophilia.Occupational exposure to chemicals is another risk factor for HCC.Often the relationship between occupational risk and HCC is unclear and the reports are fragmented and inconsistent.This review aims to summarize the current knowledge regarding the association of infective and non-infective occupational risk exposure and HCC in order to encourage further research and draw attention to this global occupational public health problem.

L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-α 2b plus ribavirin

AIM:To evaluate the efficacy of L-carnitine on alleviating anemia,thrombocytopenia and leukopenia,and minimizing dose reductions in patients with chronic hepatitis C virus(HCV)in treatment with Interferonα(IFN-α)plus ribavirin.METHODS:Sixty-nine patients with chronic hepatitis C were enrolled in the study and divided into two groups.group A(n=35)received Peg-IFN-α2b plus ribavirin plus L-carnitine,and group B(n=34)received Peg-IFN-αand ribavirin for 12 mo.All patients underwent laboratory investigations including:red cell count,he-moglobin,white cell count,platelets,bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),and viremia.RESULTS:After 12 mo in group A compared to group B we observed significant differences in AST 108.8 vs 76.8(IU/L;P<0.001),ALT 137.vs 112.3(IU/L;P 0.001),viremia 4.04 vs 2.36(106 copies/mL;P< 0.001),Hb 1 vs 3.5(g/dL;P<0.05),red blood cells 0.3 vs 1.1(X1012/L;P0.001),white blood cells 1.5 vs 3(10/L;Pn0.001)and platelets 86 vs 85(×10/L;P0.001).The end treatment responders were 18 vs 12(60%vs>44%)and the non responders were 12 vs 15(40%vs<50%)[odds ratio(OR)1.65,n5%CI =0.65-5.37,P<0.05?.In group A compared to group B there was a significant improvement of sustained vi-rological response in 15 vs 7 patients(50%vs>25%),while the relapsers were 3 vs 5(10%vs<18%)(OR>3.57,n5%CI=0.65-1n.3,Pn0.001).CONCLUSION:L-carnitine supplementations modulate erythropoiesis,leucopoiesis and thrombocytopoiesis,and may be useful in patients treated for HCV.L-carni-tine treatment offers the possibility of achieving a sustained virological response while preventing overtreatment.

Decrease of serum carnitine levels in patients with or without gastrointestinal cancer cachexia

瞄准：在消化机关与癌症在病人评估浆液肉毒碱的层次并且把他们与另外的癌症作比较以便提供新卓见进极度瘦弱的机制。方法：55 个恶病质病人与或没有胃肠的癌症在现在的学习被注册。他们经历了平淡的实验室调查，包括在浆液在场的肉毒碱的各种各样的形式的层次的检查(即，长链的酰肉毒碱，短链的酰肉毒碱，免费肉毒碱，和全部的肉毒碱) 。这些价值与 30 个健康控制题目在好营养的地位以及与那些在 60 个癌症病人发现的那些相比。结果：当没有胃肠的癌症，有胃肠的癌症的恶病质病人与恶病质病人相比时，差别是在免费肉毒碱的 -6.8 micromol/L (P 【 0.005 ) ，在长链酰肉毒碱的 0.04 micromol/L (P 【 0.05 ) ，在全部的肉毒碱的 8.7 micromol/L (P 【 0.001 ) 。在恶病质病人与或没有胃肠的癌症，差别是在免费肉毒碱的 12.2 micromol/L ( P 【 0.001 )，在短链酰肉毒碱的 4.60 micromol/L ( P 【 0.001 )，并且在长链的酰肉毒碱的 0.60 微摩尔 /L ( P 【 0.005 )并且在全部的肉毒碱的 17.4 micromol/L ( P 【 0.001 )。在有胃肠的癌症和健康控制题目的恶病质病人，差别是在免费肉毒碱的 15.5 micromol/L ( P 【 0.001 )，在短链的酰肉毒碱的 5.2 微摩尔 /L ( P 【 0.001 )，在长链酰肉毒碱的 1.0 micromol/L ( P 【 0.001 )，并且在全部的肉毒碱的 21.8 micromol/L ( P 【 0.001 )。结论：在终端的肉毒碱的低浆液层次肿瘤的病人由于减少的饮食的吸入极大地被减少并且损害了这种物质的内长的合成。这些低浆液肉毒碱层次也在癌症病人贡献极度瘦弱的前进。

Toxic hepatitis in occupational exposure to solvents

The liver is the main organ responsible for the metabolism of drugs and toxic chemicals, and so is the primary target organ for many organic solvents. Work activities with hepatotoxins exposures are numerous and, moreover, organic solvents are used in various industrial processes. Organic solvents used in different industrial processes may be associated with hepatotoxicity. Several factors contribute to liver toxicity; among these are: species differences, nutritional condition, genetic factors, interaction with medications in use, alcohol abuse and interaction, and age. This review addresses the mechanisms of hepatotoxicity. The main pathogenic mechanisms responsible for functional and organic damage caused by solvents are: inflammation, dysfunction of cytochrome P450, mitochondrial dysfunction and oxidative stress. The health impact of exposure to solvents in the workplace remains an interesting and worrying question for professional health work.

Efficacy and limits of sildenafil citrate in patients with arterial erectile dysfunction： role of peripheral arterial disease and cardiovascular comorbidities

Aim： To evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction （ED） was related to their peak systolic velocity （PSV）, peripheral atherosclerosis, cardiovascular risk factors （RF） and/or comorbidities at low cardiovascular risk. Methods： We enrolled 97 patients with 1-2 RF and comorbidities, combined with arterial ED alone （group A, n = 27）, ED plus atherosclerotic carotid artery （group B, n = 23）, ED plus lower limb artery abnormalities （group C, n = 25）, and ED plus carotid and lower limb artery abnormalities （group D, n = 22）. Sildenafil efficacy （100 mg twice a week for 12 weeks） was also examined in patients with ≥ 3 RF, peripheral a（herosclerosis and no cardiovascular comorbidities （group E, n = 20）. Results： Median PSV was 24.1, 21.0, 19.3, 14.5 and 17.5 cm/s in groups A, B, C, D and E, respectively. Sildenafil response was higher in group A patients （77.8%）, intermediate in groups B and C （65.2% and 56%） and lowest in groups D （45.4%） and E （50%）, and the response in latter two groups was significantly lower than in the other three groups. In addition, sildenafil response was nega- tively influenced by： 〉 3 RF, peripheral atherosclerosis and no systemic comorbidity, or presence of 1-2 RF associated with extended atherosclerosis and comorbidities. The number of comorbidifies was positively related to atherosclerosis localization or extension （25, 35, 38 and 47 in groups A, B, C and D, respectively）. Conclusion： Low sildenafil efficacy in patients with arterial ED was associated with extended atherosclerosis. These patients should undergo extensive ultrasonography and a full cardiovascular examination.

The Role of Work in Breast Cancer Patients

Background: Since the survival rates of cancer have increased considerably, the long-term side effects of cancer and cancer-related treatments may impact survivors’ capability to regain normal lives. The aim of this study was to evaluate the effects of the breast cancer on the job satisfaction and the quality of life. Methods: We enrolled 130 women divided into four groups: 1) 40 breast cancer survivors (aged 39 - 50);2) 44 women diagnosed with breast cancer (aged 35 - 49);3) 46 women in good health status (aged 37 - 48). Job satisfaction was measured with the Warr-Cook-Wall (WCW) Job satisfaction scale that measures overall job satisfaction and satisfaction with nine aspects of work. Results: Compared to healthy subjects, breast cancer survivors reported a poorer number of hours of work (p < 0.05) and a significant amount of variety in job (p < 0.01), opportunity to use abilities (p < 0.001), income (p < 0.01). Compared to patients with breast cancer at diagnosis, breast cancer survivors reported a significant amount of variety in job (p < 0.05), opportunity to use abilities (p < 0.05), amount of responsibility (p < 0.05), income (p < 0.05). In our study, the comparison between breast cancer survivors, breast cancer at diagnosis, and healthy subjects does not differ significantly in overall job satisfaction. Conclusions: Understanding the job problems associated with cancer can provide relevant information regarding potential treatment and psychological support in breast cancer survivors.

Work Productivity and Activity Impairment in Colorectal Cancer Patients Treated with Capecitabine

Background: The employment status of workers with cancer has important implications for impairment of intimate and family relationships and for economic, social and psychological health. The aim of the present study was to evaluate the effect of chemotherapy with capecitabine in patients with colorectal cancer on work productivity and daily activity. Methods: 30 patients with primary diagnosis of stage III colorectal cancer were enrolled for our study. All patients received capecitabine twice daily at a cumulative dose of 2500 mg/m2 on days 1 -14 and repeated on day 22. Work productivity was determined using the WPAI questionnaire. Results: We observed a significant increase in absenteeism after 1 cycle, after 6 cycles of therapy and at follow-up (p 0.001). On the other hand, presenteeism, work productivity loss and daily activity impairment, increased after 1 cycle and 6 cycles of therapy, but we could not find statistically different significances. Conclusions: Colorectal cancer diagnosis and treatment are associated with frailty and vulnerability. Chemotherapy with capecitabine may result in negative consequences for job performance.

Work Productivity and Activity Impairment in Breast Cancer Patients Treated with Capecitabine

Background: Although the majority of breast cancer patients are able to work, lower work ability and reduced job retention have been reported. The aim of the present study was to evaluate the effect of chemotherapy with capecitabine in patients with breast cancer on work productivity and daily activity. Methods: 34 patients with metastatic breast cancer were enrolled for our study. Capecitabine was given twice daily at a cumulative dose of 2500 mg/m2 on days 1 - 14 and repeated on day 22. Work productivity was determined using the WPAI questionnaire. Results: We observed an increase in absenteeism, presenteeism, work productivity loss and daily activity impairment after 1 cycle and 6 cycles of therapy, but we could not find statistically different significances. Conclusions: This study provides some data indicating an association between problems in breast cancer and work. Our results confirm that capecitabine may improve quality of life of patients with metastatic breast cancer.