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Background Arterial stiffness is associated with increased risk for cardiovascular disease. The purpose of this study is to investigate the arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 before and after glycemic control by optimal medication. Methods In 50 patients with uncontrolled type 2 diabetes(age:52±10years)and 25 controls of similar age and sex and no atherosclerotic risk factors we measured at baseline and 6 months after glycemic control a) carotid-femoral pulse wave velocity(PWVc m/sec-Complior SP ALAM),central systolic blood pressure(cSBP -mmHg),augmentation index(AI%), of the aortic pulse wave(ArteriographTensioMed) b)S',E'(m/sec)andE'/A'of mitral annulus by Tissue Doppler c)LV longitudinal strain(GLS-%),systolic(LongSr-l/sec)and diastolic(LongSrE-l/sec)strain rate, twisting(Tw-deg),peak twisting(Tw)and untwisting(unTw-deg/sec)velocity using speckle tracking echocardiography.The degree of LV untwisting was calculated as the percentage difference between peak twisting and untwisting at MVO(%dp PeakTw-UntwMVO)and between peak twisting and untwisting at peak and end of the mitral inflow E wave d)perfusion boundary region(PBR- micrometers)of the sublingual arterial microvessels(ranged from 5-25 micrometers)using Sideview,Darkfield imaging(Microscan,Glycocheck).Increased PBR is considered an accurate index of reduced endothelial glucocalyx thickness because of a deeper RBC penetration in the glucocalyx e) Flow mediated dilatation(FMD) of the brachial artery and percentage difference of FMD (FMD%). Results Compared to controls,diabetics had higher PWVa(10.3±2.2 vs. 8.1±1.9), AI(27.9±15 vs. 19.4±14.7), PWVc(11.8±3.2 vs. 8.8±1.3),cSBP(136±20 vs. 119±18),PBR (2.1±0.2 vs 1.89±0.1)and lower GLS(-15±3 vs. -18±3),LongSr(-0.78±0.1 vs. -0.96±0.2),LongSrE(0.77±0.29 vs. 1.2±0.3),S',E' and E/A(p

P300 is the event-related potential (ERP) reflecting cognitive processes. Aim of this study was to assess P300 changes in patients with chronic hepatitis C before and after the novel direct-acting antiviral agents (DAA) therapy. We studied 23 adult patients with chronic hepatitis C undergoing DAA therapy. Eighteen normal subjects of similar age and sex acted as controls. ERPs were recorded from scalp electrodes in response to the classic auditory oddball paradigms, at baseline and 3 months after the end of the treatment. N100, N200, and P300 latencies were measured. Student t-test was applied for statistical analysis. P300 latency was significantly shortened after DAA therapy in patients compared to healthy controls (p

Background Occult hepatitis B virus (HBV) infection can be defined as the long-lasting persistence of viral genomes in the liver tissue, and sometimes also in the serum at low levels of viremia in individuals with undetectable HBV surface antigen (HBsAg). Viral replication can be reactivated by immunosuppressive therapies or immunologic diseases, leading to the development of typical hepatitis B. Methods All patients on the waiting list for renal transplantation at the only 2 transplant centers in our region (Piemonte, Italy) were checked for the presence of occult HBV infection by an highly sensitive quantitative HBV-DNA polymerase chain reaction (PCR) assay (nested PCR); the only exclusion criterion was HBsAg-positivity. The enrollment lasted from October 1, 2006, to May 31, 2007. The prospective follow-up will continue for 5 years. Results HBV-DNA sequences were detected in blood samples from 10 of 300 cases examined (3.3%), being more frequent among Asian (1/3; 33.3%) and African (1/16; 6.25%) subjects as compared with the Caucasians (8/281; 2.8%; P = .011), among anti-hepatitis C virus (HCV) positive versus HCV negative patients (3/32 [9.3%] vs 7/268 [2.6%]; P = .004) and mainly among patients with a previous history of overt liver diseases (3/22 [14%] vs 7/278 [2.5%]; P = .019). HBV-DNA sequences became undetectable at 1 month after renal transplantation in 3 patients; the follow-up is in progress for these and the other patients. Conclusion Occult HBV infection occurs in patients undergoing renal transplantation. Longer observation and prospective studies will clarify the clinical impact of this occult infection on transplant outcomes and the possibility of viral reactivation related to immunosuppressive therapy.

Background: In the treatment of hepatitis C virus (HCV) infection, regimens including pegylated interferon-α are superior to those including standard interferon; the present retrospective study was performed to verify whether the same is applicable to biopsy-proven recurrent hepatitis C (genotype 1b) after liver transplantation (OLT). Methods: Twenty-four patients (16 male) were studied. Twelve had received interferon-α2b (IFN), 9 MU weekly and 12 received pegylated interferon-α2b (PEG-IFN), 0.5 µg/kg weekly. All had received oral ribavirin 600–800 mg/day. Treatment duration was intended for 12 months. A repeat liver biopsy, with evaluation of the Ishak grading and staging scores, was obtained at 1 year. Results: Only 12/24 patients (50%) completed a full year of therapy; 17 (71%) experienced side-effects requiring a 50% dosage reduction or discontinuation of the IFN, PEG-IFN and/or ribavirin. This was observed in 6/12 patients (50%) treated with IFN in comparison to 11/12 patients (92%) treated with PEG-IFN (P

A fully automated computer-assisted system (ATB system, bioMerieux, France) which uses disposable microenzymatic panels was evaluated for its ability to identify 215 strains of anaerobic bacteria (clinical isolates and reference strains). All strains were examined using conventional identification protocols and by gas chromatographic analysis of short-chain fatty acids. Automated reading of Rapid ID32A test kits (bio-Merieux, France) by the ATB system gave correct identification for 195 strains (90.7 %): 92.25 % of gram-negative anaerobes (116 strains) and 89 % of gram-positive anaerobes (99 strains) were correctly identified. Twelve strains (5.6 %) were incorrectly identified and 8 strains (3.7 %) were not identified by the system. For some strains in theBacteroides fragilis group, forClostridium difficile and for theFusobacterium genus, additional tests suggested by the ATB software were necessary to reach a final identification at the species or genus level. On the basis of the high incidence of correct identifications and the comparison of these results with those obtained previously using other commercially available kits, the ATB system was found to be a reliable method for identification of anaerobic bacteria in clinical laboratories.

The histological outcome of chronic hepatitis C is better among carriers of the apolipoprotein E (ApoE) epsilon4 allele, for reasons unknown. The orthotopic liver transplantation (OLT) setting allows to separate the role played by liver-derived ApoE (graft) from ApoE of different origin (recipient).Forty-six OLT recipients with recurrent hepatitis C were studied. Grafts and recipients were genotyped for ApoE. In a follow-up extending up to 4 years, the serum triglycerides-to-cholesterol ratio (T/C ratio) was measured 1 year after OLT, whereas fibrosis progression was assessed yearly and expressed as fibrosis units/month (FU/mo).A T/C ratioor =0.75 was observed in 13/15 cases in which both donor and recipient were epsilon4 carriers, 10/19 cases in which epsilon4 alleles were of exclusive recipient's origin and 5/12 cases in which epsilon4 alleles were of exclusive donor's origin or absent (P0.02). One year after OLT, a fibrosis progressionor =0.100 FU/mo was associated with a low T/C ratio (24/34 vs. 4/12, P0.05). An Ishak staging score2 was reached later by male recipients who were epsilon4 carriers (P0.002).Recipient's carriage of ApoE epsilon4 affects fibrosis progression of recurrent hepatitis C through gender-specific mechanisms, associated with a peculiar, ApoE-associated, lipid profile.

Background/Aims Hepatic iron may act as an important co-morbid factor in non-hemochromatotic liver diseases, but whether it may favour fibrogenesis after liver transplantation is not known. To verify whether the hepatic iron concentration of the graft might play a role in the rapid fibrotic progression frequently observed after liver transplantation for chronic hepatitis C. Methods The hepatic iron concentration, measured at the time of the donor operation, was retrospectively related to the histological follow-up data of 68 recipients (49 males, 19 females), of whom 38 were hepatitis C virus positive. Results The hepatic iron concentration in donor liver biopsies ranged from 25 to 7100 μg/gdw. After a median follow-up of 19 months, nine patients (five HCV positive) had a staging score >3. There was a significant association between a higher frequency of increasing staging and donor age >50 years. In female HCV-positive recipients, a graft hepatic iron concentration >1200 μg/gdw was associated with fibrosis progression >0.15 fibrosis units per month (4/4 vs. 1/7, p Conclusions The graft hepatic iron concentration may be one of the factors involved in early fibrosis progression due to recurrent hepatitis C in female recipients.

in metastasis markers S100A6 and TACSTD2, and the reduction of metastasis suppressors CRABP1 and MTSS1. Conclusions: KRT19 expression in HCC is an independent predictor of tumour recurrence after resection. Furthermore, KRT19 correlates significantly with the expression of well-known markers of hepatic progenitor cells and with a highly elevated serum AFP level. In addition, KRT19-expressing HCCs are decreased in hepatic differentiation and are more prone to metastasis.

In 37 subjects affected by interstitial lung diseases (19 patients with pulmonary sarcoidosis, 11 with hypersensitivity pneumonitis, 7 with idiopathic pulmonary fibrosis), we have compared by discriminant analysis (Statistical Package for the Social Sciences, version 8.3) 17 biological parameters derived from bronchoalveolar lavage analysis, gallium-67 scanning and lung biopsy. The aim of the study was to analyze the parameters of these three groups by forming one or more linear combinations of the discriminant variables. In particular, we tried to define the ability of such parameters to define these interstitial lung diseases and the relative importance of the data examined. The functions obtained are highly discriminant, so that the three groups are well distinguished among themselves; it means that the variables employed discriminate among the diseases studied. Among the variables considered, differential cell count, immune complex determination, gallium-67 lung scanning have the most important discriminant capacity. Discriminant analysis emphasizes that the three diseases are mediated by different immune mechanisms and underlines the role of each mechanism in determining the disease.