From non-alcoholic fatty liver disease to metabolic-associated steatotic liver disease:Rationale and implications for the new terminology

Non-alcoholic fatty liver disease(NAFLD)was the term first used to describe hepatic steatosis in patients with the metabolic syndrome who did not consume excess amounts of alcohol.Alcoholic liver disease(ALD)has many similarities to NAFLD in both pathogenesis and histology.This entity is now the most prevalent chronic liver disease worldwide as a consequence of the epidemic of obesity.Attempts to incorporate the importance of the metabolic syndrome in the development of steatosis resulted in the renaming of NAFLD as metabolic-associated fatty liver disease.This new term,however,has the disadvantage of the use of terms that may be perceived as derogatory.The terms fatty and non-alcoholic have negative connotations in many cultures.In addition,non-alcoholic is not usually a term applicable to pediatric cases of hepatic steatosis.Recently,an international collaborative effort,with participants from 56 countries,after a global consultation process,recommended to change the nomenclature to steatotic liver disease-including metabolic dysfunction-associated steatotic liver disease,metabolic-associated steatohepatitis and metabolic dysfunction-associated ALD.The new terminology is consistent with most of the previously published epidemiological studies and will have a major impact on research into diagnosis,prognosis and treatment.

Helicobacter pylori and skin autoimmune diseases

Autoimmune skin diseases are characterized by dysregulation of the immune system resulting in a loss of tolerance to skin self-antigen(s). The prolonged interaction between the bacterium and host immune mechanisms makes Helicobacter pylori(H. pylori) a plausible infectious agent for triggering autoimmunity. Epidemiological and experimental data now point to a strong relation of H. pylori infection on the development of many extragastric diseases, including several allergic and autoimmune diseases. H. pylori antigens activate cross-reactive T cells and induce autoantibodies production. Microbial heat shock proteins(HSP) play an important role of in the pathogenesis of autoimmune diseases because of the high level of sequence homology with human HSP. Eradication of H. pylori infection has been shown to be effective in some patients with chronic autoimmune urticaria, psoriasis, alopecia areata and Schoenlein-Henoch purpura. There is conflicting and controversial data regarding the association of H. pylori infection with Beh et's disease, scleroderma and autoimmune bullous diseases. No data are available evaluating the association of H. pylori infection with other skin autoimmune diseases, such as vitiligo, cutaneous lupus erythematosus and dermatomyositis. The epidemiological and experimental evidence for a possible role of H. pylori infection in skin autoimmune diseases are the subject of this review.

Helicobacter pylori infection in patients with selective immunoglobulin E deficiency

AIM: To investigate the prevalence and clinical characteristics of Helicobacter pylori(H.pylori)-infected dyspeptic patients with selective immunoglobulin E deficiency(IgE d).METHODS: All individuals who underwent serum totalimmunoglobulin E(Ig E) measurement at the Leumit Healthcare Services(Israel) in 2012 were identified in an electronic database search(n = 18487).From these,selected case group subjects were ≥ 12 years of age and had serum total Ig E < 2 k IU/L(n = 158).The control group was selected from a random sampling of the remaining subjects ≥ 12 years of age to obtain a case-control ratio of 1:20(n = 3160).Dyspeptic diseases,diagnosed no more than 5 years before serum total Ig E testing,were identified and retrieved from the electronic database using specific International Classification of Diseases diagnostic codes.Results of C13-urea breath tests were used to identify subjects infected with H.pylori.Categorical variables between case and control subjects were analyzed using Fisher's exact tests,whereas continuous variables were analyzed using χ2 tests.RESULTS: Dyspepsia was present in 27.2%(43/158) of case subjects and 22.7%(718/3160) of controls.Of these,significantly more case subjects(32/43,74.4%) than controls(223/718,31.1%) were positive for H.pylori(P < 0.01).Esophagogastroduodenoscopy was performed in 19 case and 94 control subjects,revealing that gastritis was more prevalent in IgE d case subjects than in controls(57.9% vs 29.8%,P < 0.05).Furthermore,a significantly greater proportion of case subjects presented with peptic duodenal ulcers(63.2% vs 15.9%,P < 0.01).Histopathologic examination showed marked chronic inflammation,lymphoid follicle formation and prominent germinal centers,with polymorphonuclear cell infiltration of gastric glands,that was similar in case and control biopsy tissues.Finally,Ig Ed case subjects that underwent esophagogastroduodenoscopy were more likely to exhibit treatment-refractory H.pylori infections that require second-line triple antibiotic therapy(47.4% vs 11.7%,P < 0.01).CONCLUSION: IgE d is associated with higher rates ofH.pylori-associated gastritis and peptic duodenal ulcers.

Possible therapeutic role of Ig E blockade in irritable bowel syndrome

Omalizumab is a humanized monoclonal antibody that binds to the high-affinity type-I Ig E Fc receptors on mast cells(MCs) and basophils, inhibiting the Ig E immune pathway. Irritable bowel syndrome(IBS) is the most common functional gastrointestinal disorder, and dysregulation of the immune system likely contributes to its etiology and/or symptomatology. Colonic biopsies from patients with IBS demonstrate considerable increase in the number of degranulating MCs releasing histamine in proximity to nerves, and this event may underlie the common IBS symptom of abdominal pain. Pharmacologic control of MC activation and mediator release is a current area of active interest in the field of IBS research. Recently, we and Pearson et al described 2 cases of patients with IBS with diarrhea(IBS-D) showing positive clinical response to omalizumab. In both cases, the female patients had severe, long-lasting IBS-D and achieved an almost complete resolution of IBS symptoms. Both patients were also able to discontinue all IBS medications after commencing the anti-Ig E therapy. For both patients, the omalizumab treatment showed a relatively rapid onset of action, resembling the efficacy observed in and previously reported for patients with chronic spontaneous urticaria. In this Editorial, we discuss the possible biological mechanisms that may underlie the clinical efficacy of omalizumab in IBS. We suggest that there is a need for a well-designed prospective study to investigate the therapeutic effects of anti-Ig E in IBS.

Multidisciplinary Approach to Breast Cancer:A New Outlook on Nursing Care

The treatment and general care for womendiagnosed with breast cancer has made a tremendous change andadvance in the last decades. Better methods for early detectionand screening of the disease, higher compliance of women to gofor screening, an open social and political discourse of women andthe health care team and others, are just a few that both enabledand are a result of this change. Nurses have been highly involvedin these changes, which resulted in the specialization of nursingin the field of breast cancer. This article will focus on the mainfour points that influence the nursing specialist care, that is, thetailoring of treatment and the ability to offer women treatmentwhich is more specific to their own cancer; the importance of themultidisciplinary team as providing a State of the Art care; theinvolvement of women in the decision-making regarding theirtreatment and the specific developing role of the specialist breastcare nurse.

Is Neutrophil-to-Lymphocyte Ratio a Prediction Marker for Success of Immunotherapy? Preliminary Results

Background: Cancer immunotherapy treatments enhance the cancer treatment approach. The neutrophil-to-lymphocyteratio (NLR) has been associated with cancer prognosis, affecting progression, chemosensitivity, radiosensitivity and toxicity. Patients and Methods: Ten patients (nine males, one female), aged 68 ± 10 years, were included in this study. Six patients had squamous cell carcinoma of the lungs and two had adenocarcinoma of the lungs. One patient suffered from limb soft tissue sarcoma and one had renal cell carcinoma. All patients had metastatic disease and were pretreated with chemotherapy or biologic agents. The rationale of testing NLR was to compare it to the clinical response of the patients assessed by RECIST criteria using computerized tomography (CT) scans. Results: In regression analysis, older patients were found to respond better to immunotherapy treatment than younger patients. NLR was 4.26 ± 2.25 (p 0.01) in the older patients group and 2.84 ± 0.90 (p 0.01) in the younger patients group. No difference in response according to tumor type (p = 0.479) was observed. Conclusion: We provide preliminary evidence demonstrating that low NLR helps in understanding the value of the underlying immune system in expecting a good outcome to immune treatment. The NLR is a simple and available biomarker, easy to apply in clinical practice.

Combination of several rare complications of myocardial infarction in a single patient

There are three major mechanical complications of acute myocardial infarction: rupture of the left ventricular free wall, rupture of the interventricular septum, and development of mitral regurgitation. Each of these complications is associated with extremely high mortality. Reviewing the scientific literature, we found descriptions of sporadic cases of both of those complications combined. We report an unusual case of simultaneous rupture of free wall and interventricular septum.

Molar incisor hypomineralization and pre-eruptive intracoronal lesions in dentistry-diagnosis and treatment planning

The aim of this study is to report the diagnostic features, prevalence, mineral content, clinical significance and treatment options of molar incisor hypomineralization(MIH) and pre-eruptive intracoronal lesions(PEIR), in order to minimize miss-treatment of primary and permanent teeth in young children.MIH was defined as the occurrence of hypomineralization of one up to four permanent first molars from a systemic origin and frequently associated with affected incisors. PEIR are lesions that are located in the occlusal portion of the crown of unerupted permanent or primary teeth. The prevalence of MIH was reported between 2.5%-40% in the permanent first molars and 0%-21.8% in primary second molars. PEIR was observed in 2%-8% of children, mainly in mandibular second premolars and second and third permanent molars. A number of possible causes for MIH were mentioned, including environmental changes, diet and genetics in prenatal and postnatal periods, but all are questionable. In PEIR, the resorption of the intracoronal dentine begins only after crown development is complete and is caused by giant cells resembling osteoclast observed histologically on the dentine surface close to the pulp. The mineral content in MIH is reduced in comparison to normal enamel and dependent on the severity of the lesion. In PEIR the resorbed surface of enamel showed less mineral content. The hypomineralized enamel in MIH is not suitable for restorations with amalgam or composite materials, and the best material should be based on remineralization material like glass-ionomers. Similar, the resorbed dentin surface in PEIR should be covered by the biocompatible and remineralizing glass-ionomer cement.

Autotransplantation of a premolar to the maxillary anterior region in young children- how long should the donor root be? A case report

Autotransplantation of premolars to anterior region after incisor loss due to trauma is accepted as the best restoration procedure with very long follow-ups. There are two main protocols: Premolars with only two thirds of the root or premolars with complete root development. Premolars with two thirds of the root completed remain vital and show complete pulp obliteration while premolars with closed apex require root canal treatment. The problem arises when the child is very young and the root of the donor premolar is developed for only one third. This case report describes the outcome of an autotransplantation of a lower first premolar with only a third of developed root to the anterior region. The donor tooth was extracted with his follicle and placed instead of tooth No. 21. For the first month esthetics was restored with a glass-fibers ribbon attached to tooth No. 11 and composite material. After a month, the crown erupted and was reshaped to mimic an incisor with composite. Orthodontic movement was performed after 5 mo, in order to alleviate the gingival contour. The final restoration was performed after 15 mo. Follow up showed full root development with normal mobility, continuous periodontal ligament and complete pulp obliteration. A multidisciplinary approach and meticulous preparation are necessary for a positive result in autotransplantation of premolars with only a third of root development to the anterior region and this case report show that this method can be performed in very young children.

1990—2000年以色列学龄儿童肥胖症的10年变化趋势研究

Aim: To analyze trends in childhood body mass index (BMI) in Israel between 1990 and 2000, and to determine the proportion of obese children using US and population- specific reference values. Methods: Cross- sectional data from 13 284 second and fifth- grade schoolchildren were collected, including age, sex, height, weight, country of birth, and time since immigration. Age- and sex- specific BMI means and centiles were calculated, and the prevalence of obesity was determined using Israeli and US reference values. Results: BMI values at the 95th centile increased monotonously over time in all age and sex categories. Between 1990 and 2000, 95th centile values increased by 12.7% and 11.8% among second- grade boys and girls, respectively. Among fifth- grade children, 95th centile values increased by 10.2% and 8.4% , respectively. Among second graders in 2000, 11.4% of both boys and girls exceeded the BMI value recorded at the 95th centile in 1990. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference value (p for all comparisons < 0.001). The proportion of obese children increased over time using both Israeli and US reference values. Conclusion: This substantial increase in childhood obesity poses a serious health threat, and requires implementation of suitable public health interventions.

植物石和毛粪石:10年的经验总结

Introduction: Bezoars are retained concretions of animal or vegetable material in the gastrointestinal tract. Most bezoars reside in the stomach, but they may be encountered elsewhere. Previous gastric surgery, which has resulted in impaired gastric emptying and/or decreased acid production, is usually the cause of bezoars. Phytobezoars are more common, while trichobezoars are rare. Endoscopy and gastrografin swallow may aid in diagnosis. The treatment of bezoars can be either conservative or surgical. Methods: After searching the computerized medical database, all files of hospitalized patients in the years 1992 to 2002 with the diagnoses “bezoars,”“phytobezoars,”and “tricobezoars”were evaluated. Results: Eighteen patients had bezoars: 16 had phytobezoars and 2 patients were diagnosed as having trichobezoars. Eleven of the patients had previous gastric operation. All patients but one were treated surgically. Two unusual cases of trichobe zoar are presented here. Discussion: Thorough understanding of bezoars can allow the clinician to be especially alert when dealing with those patients most likely to develop them, and thus diagnose the condition at an early stage.

苗勒管发育异常、听力丧失与连接蛋白26突变

In a study of the possible inter-relationship among müllerian anomalies,hearing loss,and connexin 26 mutations,we evaluated all women in whom müllerian anomalies were diagnosed on hysterosalpingography during a 6-year period (n=24/519). Audiometric testing revealed five (22.7%) with unrecognized sensorineural hearing loss; however,on genetic evaluation,none harbored a connexin 26 mutation.