Increased prevalence of intestinal inflammation in patients with liver cirrhosis

AIM To investigate the pathophysiology of the digestive tract in patients with liver cirrhosis.METHODS In 42 cirrhotic patients and 20control subjects, the following fecal proteinswere measured by enzyme-linkedimmunosorb6nt assay: albumin (Alb ),transferrin (Tf), and al-antitrypsin (a,-AT) as amarker for intestinal protein l0ss, hemoglobin(Hb) for bleeding, PMN-eIastase for intestinalinflammation, and secretory lgA for intestinalimmunity.RESULTS The fecaI concentrations of Hb, Alb,Tf, al-AT, and PMN’eIastase were increased in13 (3l%), 8(19%), l0(24%), 6(14%), and 1l(26%) cases among 42 patients, resPectiveIy.F6cal concentration of secretory IgA wasdecreased in 7 (l7%) of 42 patients. However,these fecal concentrations were not related tothe severity or etiology of liver cirrhosis. Theserum Alb level was significantIy decreased inpatients with intestinal protein Ioss c0mpared tothat in patients without intestinal protein loss.CONCLUSION These findings suggest that: rob6sides the weIl’known pathological conditions,Such as bleeding and protein loss, intestinaIinflammati0n and decreased intestinaI immunityare found in cirrhotic patients, @ intestinalprotein loss contributes to hypoalbuminemia incirrhotic patients, and @ intestinaI inflammationshouId not b6 0verlooked in cirrhotic patients,since it may contribute to or cause intestinalprotein Ioss and oth6r various pathologicalconditions.

Efficacy and safety of telaprevir- and simeprevir-based triple therapies for older patients with chronic hepatitis C

AIMTo evaluate and compare the efficacy and safety of telaprevir (TVR)-and simeprevir (SMV)-based triple therapies in elderly patients, specifically patients aged 66 years or older. METHODSThe present study enrolled 112 and 76 Japanese patients with chronic hepatitis C virus genotype 1b infection who were treated with a 12-wk TVR-based or SMV-based triple therapy, respectively, followed by a dual therapy that included pegylated interferon α and ribavirin (RBV) for 12 wk. The patients were categorized into two groups according to age as follows: A younger group of patients aged ≤ 65 years old and an older group of patients aged > 65 years old. Among the patients treated with TVR-based triple therapy, 34 patients were included in the older group. The median ages were 56 years (range: 28-65 years) in the younger group and 69 years (range: 66-81 years) in the older group. Among the patients treated with SMV-based triple therapy, 39 patients were included in the older group. The median ages were 59 years (range: 36-65 years) in the younger group and 71 years (range: 66-86 years) in the older group. The clinical, biochemical and virological data were analyzed before and during treatment. RESULTSAmong the patients treated with the TVR-based triple therapy, no significant difference in the sustained virological response (SVR) was found between the younger (80.8%) and older (88.2%) groups. The SVR rates for patients with the interleukin 28B (IL28B) (rs8099917) TG/GG-genotypes (73.9% and 60.0% in the younger and older groups, respectively) were significantly lower than for patients with the IL28B TT-genotype (86.3% and 92.9%, respectively). The cumulative exposure to RBV for the entire 24-wk treatment period (as a percentage of the target dose) was significantly higher in the younger group than in the older group (91.7% vs 66.7%, respectively, P vs 81.9%, respectively). A multivariate analysis identified the TT-genotype of IL28B (OR = 8.160; 95%CI: 1.593-41.804, P = 0.012) and the adherence of RBV (> 60%) (OR = 11.052; 95%CI: 1.160-105.273, P = 0.037) as independent factors associated with the SVR. Adverse events resulted in discontinuation of the treatment in 11.3% and 14.7% of the younger and older groups, respectively. Among the patients treated with the SMV-based triple therapy, no significant difference in the SVR rare was found between the younger (81.1%) and older (82.1%) groups. The SVR rates for patients with the IL28B TG/GG-genotypes (77.8% and 64.7% in the younger and older groups, respectively) were significantly lower than for patients with the IL28B TT-genotype (88.2% and 100%, respectively). A multivariate analysis identified the TT-genotype of IL28B as an independent factor associated with the SVR (OR = 9.677; 95%CI: 1.114-84.087, P = 0.040). Adverse events resulted in discontinuation of the treatment in 7.0% and 14.3% of patients in the younger and older groups, respectively. CONCLUSIONBoth TVR- and SMV-based triple therapies can be successfully used to treat patients aged 66 years or older with genotype 1b chronic hepatitis C. Genotyping of the IL28B indicates a potential to achieve SVR in these difficult-to-treat elderly patients.

Prejudgments for Reference Potential Determination to Quantitative EEG Interpretation:Amplitude Distribution and Ear-lobe Activation

This paper presents an automatic techruque of suitable reference potential selection for quantitative EEG interpretation.The 16-channels EEG recording under mono-polar derivation is analyzed.There are two prejudgments defined for checking the amplitude distribution and ear lobe activation.After prejudgments,the EEG is classified into several cases in cluding diffused case,non-diffused case,and artifact contami nation case.Due to the cases,an automatic reference selection method is applied in order to find out suitable reference potential.Finally,the referential derivation constructed according to the obtained reference potential,is evaluated for further EEG rhythm analysis.The presented technique can high light the EEG rhythm of interest,which is useful for quantitative EEG interpretation by both visual inspection and automatic evaluation.