Glycated hemoglobin and antidiabetic strategies as risk factors for hepatocellular carcinoma

AIM: To evaluate the relationship between glycemic control [assessed by glycated hemoglobin (HbA1c)], antidiabetic therapies and the risk of hepatocellular carcinoma (HCC).METHODS: We recruited 465 patients with HCC, 618 cases with liver cirrhosis and 490 controls with no liver disease. Among subjects with type 2 diabetes mellitus (DM2), the associations between the antidiabetic strategies and HbA1c level with HCC were determined through 2 series of multivariate logistic regression models using cirrhotic patients and controls as comparison groups. RESULTS: DM2 prevalence was 31.2% in patients with HCC, 23.2% in cirrhotic patients and 12.6% in controls (P < 0.0001). In 86% of study subjects, DM2 had been diagnosed for more than 1 year before the HCC diagnosis. HCC patients with DM2 had a 1.52.5fold increased risk of liver cancer. The HbA1c mean levels were signif icantly higher in DM2 patients with HCC than in cirrhoticand control DM2 patients. Antidiabetic treatment with metformin was more common among cirrhotic and control DM2 subjects than among cases with HCC. In both series of multivariate analyses, treatment with metformin signif icantly reduced the risk of HCC by more than 80% compared with sulphonylureas and insulin therapy. No signif icant differences were seen between sulphonylureas and insulin treatment. Elevated HbA1c levels were positively related to the risk for HCC in diabetic patients, with a 26%50% increase in risk for each 1% increase in HbA1c values.CONCLUSION: In patients with preexisting DM2, the risk of HCC is positively associated with poor chronic glycemic control and significantly decreased by metformin therapy.

Mechanism of Japanese encephalitis virus genotypes replacement based on human,porcine and mosquito-originated cell lines model

Objective:To examine the multiplication efficiency Japanese encephalitis virus(JEV)genotype Ⅰ(G Ⅰ) and genotype Ⅲ(GⅢ) of different cell lines which originated from human,porcine,mosquitoes in order to prove mechanism of JEV G Ⅰ replacement JEV GⅢ since it emerging in nature recent decades.Methods:The mixture of Gi and GⅢ JEV isolates was inoculated on human rhabdomyosarcoma(RD).pig kidney epithelial(PS) and Aedes albopictus C6/36 clone(C6/36) which originated from human,porcine and mosquitoes,respectively.Plaque assays were performed to calculate virus titer and real-time RT-PCR with GⅠand GⅢspecific primer sets to quantify the number of GⅠ and GUI RNA copies.Results:The highest virus titer reached at the 3rd day of post infection when G Ⅰand GⅢ mixture was inoculated on RD and PS and that of C636 was at the 4^(th)day.JEVs were amplified and maintained by C6/36 cells after 10 passages whereas that by RD and PS only limited within 8 and 6 passages,respectively.GⅠ strain amplified and maintained more efficiently on C6/36 and PS but not RD.whereas GⅢ strain amplified and maintained more efficiently on RD.Conclusions:There is a correlation between the multiplication efficiency of GⅠ and GⅢ JEV strains when these two genotype strains co-infected on different cell lines with the predominance of GⅠstrains in C6/36 and PS and the limited detection of G 1 strains in RD cells proving a possible mechanism of shift JEV genotypes in nature recent decades since GⅠ emerging.

Impact of parietal cell autoantibodies and non-organ-specific autoantibodies on the treatment outcome of patients with hepatitis C virus infection: A pilot study

AIM: Various side effects have been reported in patients infected with hepatitis C virus (HCV) who were treated with interferon-alpha (IFN-α), including the appearance or exacerbation of underlying autoimmune diseases and the development of a variety of organ and non-organ specific autoantibodies (NOSA). However, very few studies in adults have been strictly designed to address: whether the prevalence and the titre of organ and NOSA in serial samples of HCV-treated patients were affected by IFN-α, and the impact of these autoantibodies on the treatment outcome of HCV patients. METHODS: We investigated whether parietal cell autoantibodies (PCA) and/or NOSA were related with treatment-outcome in 57 HCV-treated patients (19 sustained-responders, 16 relapsers, 22 non-responders). Serum samples from patients were studied blindly at three time-points (entry, end of treatment and end of followup). For the detection of autoantibodies we used indirect immunofluorescence, commercial and in-house ELISAs. RESULTS: Sustained biochemical response was associated with ANA-negativity at the entry or end of follow up. Sustained virological response was associated with the absence of PCA at the entry. Combined virological and biochemical sustained response (CVBSR) was associated with the absence of antinuclear antibodies (ANA) at the end of follow up and PCA-negativity at the entry. Sustained virological and CVBSR were associated with a reduction of ANA and SMA titers during therapy. CONCLUSION: Although PCA and/or NOSA seropositivity should not affect the decision to treat HCV patients, the presence of some of them such as ANA, PCA and SMA before treatment or their increase during therapy with IFN- a may predict a worse response, indicating the need for a closer monitoring during treatment of HCV patients positive for these autoantibodies.

Role of Aedes aegypti and Aedes albopictus during the 2011 dengue fever epidemics in Hanoi, Vietnam

Objective: To record the human cases of dengue fever(DF) and investigate the Aedes mosquito species circulating during the Hanoi 2011 DF epidemics. Methods: 24 different outbreak points were recorded in 8 districts between August and December 2011. Results: 140 patients were hospitalized following dengue diagnostic with a predominance of males(59.3%) and the 15-34 age class. Only DENV-1(11.27%) and DENV-2(88.73%) serotypes were detected in human samples. Mosquito sampling performed in and around patients households revealed the predominance of Aedes aegypti(95.15%) versus Aedes albopictus(4.85%). There is a positive correlation between the population density of Aedes aegypti and the number of human cases and duration of outbreaks. Conclusions: This was not observed for Aedes albopictus. 3 pools of Aedes aegypti were positive with dengue virus, two with DENV-1 and one with DENV-2.

A genome-wide scan for pleiotropy between bone mineral density and nonbone phenotypes

Osteoporosis is the most common metabolic bone disorder globally and is characterized by skeletal fragility and microarchitectural deterioration.Genetic pleiotropy occurs when a single genetic element is associated with more than one phenotype.We aimed to identify pleiotropic loci associated with bone mineral density(BMD)and nonbone phenotypes in genome-wide association studies.In the discovery stage,the NHGRI-EBI Catalog was searched for genome-wide significant associations(P value<5 x 108),excluding bone-related phenotypes.SNiPA was used to identify proxies of the significantly associated single nucleotide polymorphisms(SNPs)(r2=1).We then assessed putative genetic associations of this set of SNPs with femoral neck(FN)and lumbar spine(LS)BMD data from the GEFOS Consortium.Pleiotropic variants were claimed at a false discovery rate<1.4x 103 for FN-BMD and<1.5 x 10-3 for LS-BMD.Replication of these genetic markers was performed among more than 400000 UK Biobank participants of European ancestry with available genetic and heel bone ultrasound data.In the discovery stage,72 BMD-related pleiotropic SNPs were identified,and 12 SNPs located in 11 loci on 8 chromosomes were replicated in the UK Biobank.These SNPs were associated,in addition to BMD,with 14 different phenotypes.Most pleiotropic associations were exhibited by rs479844(AP5B1,O V O L 1 genes),which was associated with dermatological and allergic diseases,and rs4072037(M U C 1 gene),which was associated with magnesium levels and gastroenterological cancer.In conclusion,12 BMD-related genome-wide significant SNPs showed pleiotropy with nonbone phenotypes.Pleiotropic associations can deepen the genetic understanding of bone-related diseases by identifying shared biological mechanisms with other diseases or traits.

Association between measles antibodies in vaccinated and naturally infected mothers with protective antibodies and the occurrence of measles in their children:A cross-sectional study in the Bavi district of Hanoi

Objective:To determine the concentration and rate of decay of maternal IgG antibodies against measles prevalence in infants of vaccinated or naturally infected mothers and study initial measles immunization occurs in nine-month-old children.Methods:In total,401 pregnant women and the same number of their subsequent newborns were recruited in the Bavi district of Hanoi in 2016-2017;they were divided into two groups:Older women(born before 1985,n=201)and younger women(born after 1990,n=200).Samples were collected at five time-points;week 36 of pregnancy,birth(cord),and 3,6,and 9 months after birth.Measles-specific IgG antibody levels were recorded.Results:In total,77.06% of the 401 pregnant women were seropositive for measles-specific IgG antibodies.A significantly greater proportion of mothers aged 30 and older(88.06%)and their newborn(93.53%)were seropositive compared to the mothers aged 25 and younger(66.00%),and their newborn(72.00%)(P<0.001).The infants of older mothers had significantly higher geometric mean titres(GMT)of measles IgG antibodies than the infants of younger mothers(P<0.001)at all time-points of the study period.The proportion of measles IgG antibodies together with GMT decreased from 82.97%(506.96)at the age of three months to 23.19%(45.22)at the age of nine months.Conclusions:This study provides a profile of maternal antibodies against measles in Vietnamese infants and investigates the early susceptibility to measles in both the infants of vaccinated mothers and mothers with naturally acquired immunity.These data suggest that determining the appropriate age for measles vaccination is paramount for the elimination of measles in Vietnam.

Surveillance of dengue and chikungunya infection in Dong Thap,Vietnam:A 13-month study

Objective:To establish a surveillance in Dong Thap,at the border with Cambodia by assessing the presence of DHNV serotypes and CHIKV among patients hospitalized at Dong Thap general hospital.Methods:Cross-sectional descriptive analysis was conducted on a cohort of 131 patients hospitalized with acute fever and symptoms compatible with dengue or chikungunya.The study was conducted from January 2012 to February 2013.The full clinical picture was established as well as serological and molecular detection.Serological analysis was sequentially performed on blood samples collected on admission and an average of seven days after admission.The detection of IgM antibody to DENV was performed by IgM capture ELTSA and the detection of DENV and CHIKV RNA was done by reverse-transcription multiplex PCR.Results:101 patients out of 131(77%) were confirmed with dengue.All four dengue serotypes were detected with a predominance of DENV2 and DENV4.No chikungunya infection was detected although reported in neighboring Cambodia.A differential efficiency of serological dengue detection was observed.Efficiency was 29%upon admission and 53%after seven days on the same patients.30 patients out of 131(23%) were negative with both DENV and CHIKV.Conclusions:Dengue is at risk of being underestimated and chikungunya is not systematically detected.Changes in detection and surveillance procedures are therefore discussed to increase efficiency of dengue detection and continue the monitoring the emergence of CHIKV in Dong Thap province and in Vietnam.

Geohelminths eggs contamination of sandpits in Vladivostok, Russia

Objective: To detect nematode eggs in sandpits in urban area in Vladivostok. Methods: Totally 60 samples were collected from five districts. Sand samples were analyzed using combined flotation-sedimentation method. In result, 18 sand samples were positive for at one or two parasites species. Results: Overall, only 3 genera of helminths were recovered. Most samples were positive for Toxocara spp. eggs. Toxocara spp. eggs were found in each district. More samples with Toxocara spp. eggs were found in Pervomaiskii district. Ascaris spp. eggs were also appeared in each district, however Ascaris eggs rate of contamination was less than rate of Toxocara spp. contamination. Toxascaris leonina eggs were the less frequent species in sandpits, it was found only in Sovetskii and Pervomaiskii districts. Ascaris eggs rate of contamination was less than rate of Toxocara spp. contamination. Toxascaris leonina eggs were the less frequent species in sandpits, it was found only in two districts. No correlation between districts and helmiths eggs present in soil samples was found(P>0.05). Conclusions: Considering the high sand contamination with parasite infective elements of both human and animal origin, measures to improve environmental and sanitary conditions are indicated, as well as promoting the concept of responsible pet ownership.

Environmental risk and risk perception management in public health

When evaluating environmental risk and its perception, psychosocial and psychosomatic factors may be of fundamental importance for public health programming and the promotion of quality of life. This is the case in particular where knowledge of the true health consequences of environmental exposure to given risk factors are incomplete or its action is within the range of values where we do not anticipate the measurable biological effect. This applies not only in the case of the indoor environment related complaints but also to that of non-ionizing electromagnetic radiation and electroionic microclimate, among many others. A serious consequence found in the syndrome of mass hysteria is the fact that due to differently motivated information and disinformation, part of the population can suffer from psychosomatic symptoms and deterioration quality of life for those affected.

Food Is Security: The Nexus of Health Security in Fragile and Failed States

Global food security is a major development challenge dictated by state stability, resilience to geopolitical and economic shocks and is linked to health security. Fragile and failed nation-states are at risk of extreme poverty and lead to war and conflict. Fragile states experience, corrupt financial regimes and are influenced by skewed global market systems and reduced equitable market access that decrease food and health security. This qualitative review describes the critical cross sections of food security, the influence of global market systems and state stability and institutions that form the nexus of global health security. We outline how the manipulation of free market systems and decreased state capacity not only decrease food and health security but also contribute to state fragility and failure. Improved public health policy mechanisms, decreased dependence on foreign financial structures and extractive mechanisms are crucial to improving food and health security at present, and to further increase state stability in the future.

Simple hematological predictors of AF recurrence in patients undergoing atrial fibrillation ablation

Backgound Red cell distribution width(RDW) and neutrophil-to-lymphocyte ratio(NLR) are simple hematologic indices that have been used to predict adverse outcomes in different clinical settings. The aim of our study is to determine whether RDW and NLR can predict atrial fibrillation(AF) recurrence in patients undergoing AF ablation. Methods Consecutive patients, without known hematological disorders, who underwent AF catheter ablation between January 2014 and April 2017 were enrolled into this study. Blood samples were taken one day before and five hours after the ablation procedure. Results A total of 346 patients(224 males(65%), mean age: 59 ± 11 years old) were included. After a mean follow up of 26.2 ± 12.1 months, 80(23.1%) patients experienced late AF recurrence(defined as any recurrence after the blanking period of three months), while 97(28%) patients experienced early AF recurrence during the blanking period. Univariate analysis showed that early arrhythmia recurrence, type of AF and NLR after the procedure were significantly associated with late AF recurrence, while early arrhythmia recurrence and NLR remained significant in multivariate analysis. RDW was not associated with late AF recurrence. None of the parameters above predicted early arrhythmia recurrence. Conclusions Simple and inexpensive hematological indices such as NLR should be evaluated for their ability to predict AF recurrence in patients undergoing catheter ablation in larger prospective studies.

Short mucin 1 alleles are associated with low virulent H pylori strains infection

TO THE EDITORWe read with interest the article published by Nguyen et al in the World Journal of Gastroenterology, showing an association between short MUC6 alleles and H pjloff infection. These results, together with previous observations by Vinall et al, reinforce the role of mucin genes （MUC6 and MUC1） VNTR polymorphisms for the variability in individual susceptibility to H pylori infection that cannot be explained by differences in environmental factors.

Interferon-伪 plus lamivudine vslamivudine reduces breakthroughs, but does not affect sustained response in HBeAg negative chronic hepatitis B

AIM： To investigate the efficacy of combination treatment of IFN-α and lamivudine compared to lamivudine monotherapy, after 24 mo of administration in HBeAgnegative hepatitis B patients. METHODS： Fifty consecutive patients were randomly assigned to receive IFN-α-2b （5 MU thrice per week, n = 24） plus lamivudine （100 mg daily） or lamivudine only （n = 26） for 24 mo. Patients were followed up for further 6 mo. The primary outcome was the proportion with sustained virological response （undetectable serum HBV DNA concentrations） and or sustained biochemical response （transaminase levels within normal range） at 30 mo （6 mo after the end of therapy）. Secondary end-points were timed from initial virological （biochemical） response to VBR （BBR, respectively） and the emergence of YMDD mutants across the two arms. RESULTS： Five of twenty-four （21%） patients in the combination arm vs 3/26 （12%） in the lamivudine arm had sustained response （i.e., normal serum transaminase levels and undetectable HBV DNA by PCR assay） 6 mo after treatment discontinuation. A reduction in the emergence of YMDD mutants and in the development of virological breakthroughs was observed in patients receMng combination treatment （10% vs46% , P= 0.01 and 14% vs46% , P= 0.03, respectively）. Time from initial virologic response to virologic breakthrough （VBR） was greater among initial responders receiving combination treatment compared to those receiving lamivudine （22.9 mo vs 15.9 mo, respectively; P = 0.005）.CONCLUSION： Our results demonstrate that IFN-α plus lamivudine combination therapy does not increase the sustained response, compared to lamivudine. However, combination therapy reduces the likelihood of VBR due to YMDD mutants and prolongs the time period until the breakthrough development.

Hepatoprotective effect of nitric oxide in experimental model of acute hepatic failure

AIM: To evaluate the effect of nitric oxide (NO) on the development and degree of liver failure in an animal model of acute hepatic failure (AHF).

Crohn’s disease incidence evolution in North-western Greece is not associated with alteration of NOD2/CARD15 variants

AIM: To assess the trends in the incidence of inflammatory bowel disease (IBD) over 23 years in the same area and to identify genetic factors related to incidence evolution. METHODS: Patients with IBD arising from North- western Greece were systematically recorded through the 1983-2005 period. Trends in disease incidence and genetic patterns related to CARD15 variants were documented and correlated. RESULTS: A total of 447 patients with IBD were recorded (23.5% Crohn’s disease, 72.7% Ulcerative colitis and 3.8% indeterminate colitis). Mean annual incidence rates of CD and UC were 0.9/100 000 (95% CI 0.1-1.7) and 2.7/100 000 (95% CI 1.7-4.1) inhabitants, respectively. There was a statistically significant increase of CD incidence (P < 0.01) during the study period, in contrast to the UC incidence. There were no statistical differences in CARD15 variants over the study period. CONCLUSION: The incidence of CD in North-western Greece has risen disproportionately to that of UC in the 21st century. This is not related to alterations of genetic background though.

Viral co-infections among children with confirmed measles at hospitals in Hanoi,Vietnam,2014

Objective:To characterize viral co-infections among representative hospitalized measles cases during the 2014 Hanoi outbreak.Methods:Throat swabs were collected from 54 pediatric patients with confirmed measles,and molecular diagnostics performed for 10 additional viral respiratory pathogens(Influenza A/H1N1pdm09;A/H3N2 and influenza B;Parainfluenza 1,2,3;Respiratory Synctial Virus,RSV;human Metapneumovirus,hM PV;Adenovirus and Picornavirus).Results:Twenty-one cases(38.9%) showed evidence of infection with other respiratory viruses:15 samples contained measles plus one additional virus,and 6 samples contained measles plus 2 additional viruses.Adenovirus was detected as a predominant cause of co-infections(13 cases;24.1%),followed by RSV(6 cases;11.1%),A/H1N1pdm09(3 cases;5.6%),PIV3(3 cases;3.7%),Rhinovirus(3 cases;3.7%) and hM PV(1 case;1.96%).Conclusions:Viral co-infections identified from pediatric measles cases may have contributed to increased disease severity and high rate of fatal outcomes.Optimal treatment of measles cases may require control of multiple viral respiratory pathogens.

Retrospective survey of avian influenza H5N1 infection in Northern Vietnam by using a combinational serologic assay

Outbreaks of highly pathogenic avian influenza H5N1 virus have occurred in Vietnam since 2003. However, how people got avian H5N1 infection in Northern Vietnam is still unclear. We therefore performed a combination of the serologic assays H5N1 ELISA and H5 western blot to detect anti-H5N1 specific antibodies. Sera samples of 149 subjects with suspected H5N1 infection from three provinces of Northern Vietnam were collected from September 2006 to March 2007. Our results indicated that this combinational assay showed high sensitivity (100%) and specificity (95%) when compared with hemagglutinin inhibition (HI) assay. Fifty-one sera samples (34.2%) contained specific antibodies against H5N1 viruses. Poultry raisers (32/77;41.6%) showed higher H5N1 infection rates than slaughterers (12/41;29.3%) and health care workers (7/31;22.6%). Contact history with sick or dead poultry in household or slaughter-house (p < 0.05) and lack of protective equipment use when in contact with dead poultry (p < 0.05) were risk factors found to be associated with H5N1 infection. In this study, we established an alternative serologic assay for H5N1 diagnosis, and we hereby present seroepidemiologic data of H5N1 infection in Northern Vietnam.

Food insecurity: How to orchestrate a global health crisis

In 2007-2008, the world experienced over 1 billion people going hungry. This complex food security and public health crisis have many levels, actors and stakeholders. There lacks equity in access food markets, unbalanced consumption of nutrients and poor state institutions that, all negatively impact food security. Global financial products and regimes can greatly influence food prices, and if not properly regulated, this can lead to whole market manipulation and starvation. This paper discusses the basics of food security in a public health framework and describes the legal and financial mechanisms that lead to food insecurity.

Evaluation of Steroid Receptors mRNA Fingerprints in Two Groups of Normozoospermic Patients: Men from Unexplained Infertility Couples vs. Men from Couples with Tubal Factor Infertility

The study of sperm cellular components at molecular level is crucial for the diagnosis of male unexplained infertility. The aim of the study was to compare the molecular profile of steroid receptors and aromatase in spermatozoa obtained from two normozoospermic groups of patients issued from couples treated for infertility. We investigated 46 male patients from unexplained infertility couples and from men, 38 where female partners presented with tubal infertility. Sperm ERs (estrogen receptors: alpha and beta), GPER (G protein-coupled estrogen receptor), AR (androgen receptor) and aromatase mRNA expression levels by TaqMan qPCR were analyzed. AR transcript level was significantly lower in sperm of men from unexplained infertility couples vs. men from couples with tubal factor infertility (P = 0.04). Although the AR mRNA expression level did not had any effect on embryo development and its implantation, a significant correlation between AR mRNA levels and clinical pregnancy in unexplained infertility patients was observed. Taken together, AR transcript presence in ejaculated spermatozoa could be a potential marker for unexplained infertility.