AIMTo study the diagnostic accuracy of transient elastography (TE) for detecting clinically significant portal hypertension (CSPH) in Indian patients with cirrhotic portal hypertension.METHODSThis retrospective study ...AIMTo study the diagnostic accuracy of transient elastography (TE) for detecting clinically significant portal hypertension (CSPH) in Indian patients with cirrhotic portal hypertension.METHODSThis retrospective study was conducted at the Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, on consecutive patients with cirrhosis greater than 15 years of age who underwent hepatic venous pressure gradient (HVPG) and TE from July 2011 to May 2016. Correlation between HVPG and TE was analyzed using the Spearman’s correlation test. Receiver operating characteristic (ROC) curves were prepared for determining the utility of TE in predicting various stages of portal hypertension. The best cut-off value of TE for the diagnosis of CSPH was obtained using the Youden index.RESULTSThe study included 326 patients [median age 52 (range 16-90) years; 81% males]. The most common etiology of cirrhosis was cryptogenic (45%) followed by alcohol (34%). The median HVPG was 16.0 (range 1.5 to 30.5) mmHg. Eighty-five percent of patients had CSPH. A significant positive correlation was noted between TE and HVPG (rho 0.361, P < 0.001). The area under ROC curve for TE in predicting CSPH was 0.740 (95%CI: 0.662-0.818) (P < 0.01). A cut-off value of TE of 21.6 kPa best predicted CSPH with a positive predictive value (PPV) of 93%.CONCLUSIONTE has a fair positive correlation with HVPG; thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension. A cut-off TE value of 21.6 kPa identifies CSPH with a PPV of 93%.展开更多
BACKGROUND:Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients.Diagnosis of MHE requires cumbersome tests.Lactulose is effective in the tre...BACKGROUND:Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients.Diagnosis of MHE requires cumbersome tests.Lactulose is effective in the treatment of MHE.This study aimed to evaluate the use of critical flicker frequency (CFF) for the diagnosis of MHE in cirrhotic patients after treatment.METHODS:One hundred and ten patients were evaluated by psychometry (number connection tests A,B or figure connection tests A,B),P300 auditory event related potential (P300ERP),venous ammonia,and CFF for MHE.MHE was diagnosed by abnormal psychometry (>2SD age matched controls) and P300ERP.MHE patients were treated with lactulose for one month.Response was defined by normalization (<2SD of matched controls) of both psychometry and P300ERP.RESULTS:Of the 110 patients [Child Turcott Pugh score A:B:C 39:42:29,(age 41.6±11.6 years,M:F 82:28)],75 (68%) had abnormal results of psychometric tests,and 74 (67%) had prolonged P300ERP.Fifteen (20%) patients with abnormal results of psychometric tests had normal P300ERP.Thus sixty (54.5%) patients were diagnosed as having MHE.After treatment for one month,34 (57%) recovered while 26 (43%) continued to have abnormal resents of psychometric or P300ERP tests.CFF was <39 Hz in 72 (65.4%) patients before treatment and in 20 (33.3%) after treatment.CFF sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy for the assessment of recovery of MHE were 65%,91%,85%,77% and 80%,respectively.CONCLUSION:CFF is a simple,relatively reliable,and accurate test without any dependence on age or literacy in the diagnosis and assessment of recovery of patients with MHE.展开更多
To investigated clinical, endoscopic and histopathological parameters of the patients presenting with ileocecal ulcers on colonoscopy. METHODSConsecutive symptomatic patients undergoing colonoscopy, and diagnosed to h...To investigated clinical, endoscopic and histopathological parameters of the patients presenting with ileocecal ulcers on colonoscopy. METHODSConsecutive symptomatic patients undergoing colonoscopy, and diagnosed to have ulcerations in the ileocecal (I/C) region, were enrolled. Biopsy was obtained and their clinical presentation and outcome were recorded. RESULTSOut of 1632 colonoscopies, 104 patients had ulcerations in the I/C region and were included in the study. Their median age was 44.5 years and 59% were males. The predominant presentation was lower GI bleed (55, 53%), pain abdomen ± diarrhea (36, 35%), fever (32, 31%), and diarrhea alone (9, 9%). On colonoscopy, terminal ileum was entered in 96 (92%) cases. The distribution of ulcers was as follows: Ileum alone 40% (38/96), cecum alone 33% (32/96), and both ileum plus cecum 27% (26/96). The ulcers were multiple in 98% and in 34% there were additional ulcers elsewhere in colon. Based on clinical presentation and investigations, the etiology of ulcers was classified into infective causes (43%) and non-infective causes (57%). Fourteen patients (13%) were diagnosed to have Crohn’s disease (CD). CONCLUSIONNon-specific ileocecal ulcers are most common ulcers seen in ileo-cecal region. And if all infections are clubbed together then infection is the most common (> 40%) cause of ulcerations of the I/C region. Cecal involvement and fever are important clues to infective cause. On the contrary CD account for only 13% cases as a cause of ileo-cecalulcers. So all symptomatic patients with I/C ulcers on colonoscopy are not Crohn’s.展开更多
Epigenetic modifications have been observed as a decline in miRNA-21 expression and breast cancer stem cell(CSC)population after 3 cycles of standard chemotherapy.The epigenetic response(miRNAs expression)and CSCs are...Epigenetic modifications have been observed as a decline in miRNA-21 expression and breast cancer stem cell(CSC)population after 3 cycles of standard chemotherapy.The epigenetic response(miRNAs expression)and CSCs are also correlated in patients with Breast Cancer.In patients who tolerated chemotherapy well,miRNA-21(non-coding RNA)expression decreased significantly after three cycles of chemotherapy.The miRNA-21 expression in breast cancer tissue was quantified by quantitative PCR(real-time PCR)using the standard protocol.In addition,breast CSCs(CD44+/CD24-)were also decreased in these patients.The miRNA-21 regulates cell division,proliferation,and autophagy of cancerous cells(as it targets phosphatase and tensin homolog/AKT/transcription factor EB/programmed cell death 4/autophagy-related protein 5 and chemotherapy also produces similar effects),thereby contributing to these benefits.Therefore,when all of the targets on genes have been explored by mimic miRNA,chemotherapy combined with anti-miRNA21 therapy may prove useful in the care of cancer patients.展开更多
Background:Poor postnatal weight gain is a well-known risk factor for developing retinopathy of prematurity(ROP).Algorithms that predict ROP based on serial weight gain have not been generalizable in non-Caucasian pop...Background:Poor postnatal weight gain is a well-known risk factor for developing retinopathy of prematurity(ROP).Algorithms that predict ROP based on serial weight gain have not been generalizable in non-Caucasian populations.The duration taken to regain the lost weight is culturally important among Indian mothers.We report the correlation between this duration and the risk of developing ROP.Methods:Sixty-eight Asian Indian infants born<2,000 grams at birth or<34 weeks of gestation were enrolled.The number of days taken for these infants to regain baseline birth weight(BW)was recorded.This measure was correlated with the eventual ROP outcome categorized as“no ROP”,ROP that regressed spontaneously(type 2 ROP),and ROP that required treatment(type 1).Results:The mean BW of the cohort was 1,270±340 grams and mean gestational age(GA)was 31±2 weeks.Thirty-three infants(48.5%)developed no ROP,20 infants(29.4%)developed type 2 ROP and 15 infants(22.1%)developed type 1 ROP.The mean number of days to regain the lost weight was 11.9+4.6,17.9+7.9 and 26.6+12.9 days for the No ROP,type 2 and type 1 groups respectively(P<0.0001,one-way ANOVA with Boneferroni correction).Those babies who regained their BW within 10 days were at least risk of developing any stage ROP,moderate risk if they took between 11-20 days and highest risk if they took more than 21 days for developing type 2 or type 1 ROP.Conclusions:The date when a child regains its lost BW is culturally important and easily recalled by mothers.We report the use of this simple estimate as a predictor of ROP.This method could be useful in stratifying risk and predicting the development of“treatment requiring ROP”even before 21 days of life,which is the first mandated screening visit in India.展开更多
AIM:To study the in vivo anti-inflammatory activity of Tabernaemontana divaricata leaf extract on male albino mice.METHODS:Aqueous decoction and methanol leaf extracts were tested for their ability to reduce croton oi...AIM:To study the in vivo anti-inflammatory activity of Tabernaemontana divaricata leaf extract on male albino mice.METHODS:Aqueous decoction and methanol leaf extracts were tested for their ability to reduce croton oil-induced edema in the mouse ear after topical application.The methanol leaf extract dose-dependently inhibited the croton oil-induced ear edema in mice(ID50<500μg·cm 2).A bioassay-guided liquid–liquid fractionation of this methanol extract gave four active fractions:water insoluble(F1),hexane(F2),ethyl acetate(F3)and water(F4).RESULTS:The hexane fraction showed a very high activity(42.1%inhibition at0.7μg·cm 2)as compared to the control.The other fractions were less active(F1:56.1%at 506.2μg·cm-2;F3:57.3%at 289.3μg·cm 2;and F4:31.9%for 203.8μg·cm 2)while indomethacin gave 48.8%of inhibition at 90μg·cm 2.The activity of F1 and F3 may be at least in part explained by the presence of anti-inflammatory flavonoids,while the activity was not correlated to the tannin contents.No compounds were detected in the most active F2 fraction.CONCLUSIONS:The results give a rational support to the traditional use of T.divaricata in tropical India as anti-inflammatory agent.展开更多
Background and Aims:Evaluation of significant liver fibro-sis is important for treatment decision and treatment re-sponse evaluation in patients with chronic hepatitis B. Since liver biopsy is invasive and transient e...Background and Aims:Evaluation of significant liver fibro-sis is important for treatment decision and treatment re-sponse evaluation in patients with chronic hepatitis B. Since liver biopsy is invasive and transient elastography (TE) has limited availability, various non-invasive blood parameters need evaluation for their capabilities for detection of signifi-cant fibrosis. Methods:In this retrospective study, records of patients who had undergone liver biopsy for treatment-na?ve chronic hepatitis B were evaluated to obtain various non-in-vasive blood parameters (aspartate aminotransferase-to-pla-telet ratio index [referred to as APRI], Fibrosis-4 score [referred to as FIB-4], gamma-glutamyl transpeptidase-to-platelet ratio [referred to as GPR], and gamma-glutamyl transpeptidase-to-albumin ratio [referred to as GAR]), in ad-dition to TE, to assess significant liver fibrosis and compare these to fibrosis stage in liver biopsy. Results:A total of 113 patients were included in the study (median age 33 [inter-quartile range: 11-82 years], 74% males). Most (75%) pa-tients were HBeAg-negative. The liver biopsy revealed significant fibrosis (Ishak ≥3) in 13% of the patients and nil or mild fibrosis (Ishak<3) in 87%of the patients. TE findings were available for 85 patients, APRI and FIB-4 for 95 patients, GPR for 79 patients, and GAR for 78 patients. The median values of all the parameters were significantly higher in pa-tients with significant fibrosis, as compared to patients with non-significant fibrosis, and all the blood parameters as well as TE were able to identify patients with significant fibrosis significantly well (p<0.05). All non-invasive parameters had low positive predictive value but negative predictive value above 92%. Compared to TE, all the non-invasive blood pa-rameters had similar area under the curve for detecting sig-nificant fibrosis, with excellent negative predictive value (≥93%). Conclusions: Non-invasive blood parameters (APRI, FIB-4, GPR, and GAR) with negative predictive values above 93%are excellent parameters for ruling-out significant ;fibrosis in patients with chronic hepatitis B. These can be used at bedside in place of TE.展开更多
Reference conditions having no or only minor anthropogenic disturbances, are a basic requirement for ecological studies in rivers. To study ecological impact of a dam, two sites were pre-classiifed as reference or lea...Reference conditions having no or only minor anthropogenic disturbances, are a basic requirement for ecological studies in rivers. To study ecological impact of a dam, two sites were pre-classiifed as reference or least disturbed in the Andhi Khola River, Nepal, using Rapid Field Bioscreening （RFB） protocol. Biological （macroinvertebrates） and physico-chemical samples were collected in the month of January and February 2013. Multi-habitat sampling （MHS） was employed in sample collection of macro-invertebrates fauna. Validation of the pre-classiifed sites was done using several indices viz. Nepalese biotic score （NEPBIOS）, Biological monitoring working party （BMWP）, Hindu-Kush Himalayan biotic score （HKHBIOS）, Hilsenhoff （HILSENHOFF） ＆ National Sanitation Foundation Water Quality Index （NSFWQI）. The NEPBIOS, HKHBIOS, HILSENHOFF, RFB ＆ NSFWQI indices predicted the river quality at al two sites as good with quality class Ⅱ. Only BMWP/ASPT water quality index predicted the river quality at al two sites as Excelent with quality class Ⅰ. Hence preselected sites with quality of rank Ⅱ i.e. good qualities were validated as reference sites. The study demonstrated that the multi-metric approach is suitable for application in the monitoring and assessment of rivers where dams are built to produce hydropower.展开更多
Background:Interleukin-28B (IL-28B) polymorphism is an important predictor for hepatitis C virus (HCV) treatment response.Whether IL-28b genotypes also influence other nontreatment related clinical parameters is uncle...Background:Interleukin-28B (IL-28B) polymorphism is an important predictor for hepatitis C virus (HCV) treatment response.Whether IL-28b genotypes also influence other nontreatment related clinical parameters is unclear.Methods:Patients with HCV-related chronic liver diseases who attended our department during 2012-2014 were retrospectively analyzed.The single nucleotide polymorphisms (SNPs) of rs12979860 (IL-28B) were correlated with various clinical parameters.We also compared these parameters in patients with and without overt diabetes to identify possible associations.Results:A total of 115 patients were included (median age 48,range 15-76 years;70% males).Overall,43/115(37%) patients had chronic hepatitis,while the remaining 72/115 (63%) had cirrhosis.The most common IL-28B genotype was CC,which was found in 53% of patients (61/115),while the remaining 47% were nonCC [CT 42% (48/115) and T-r 5% (6/115)].Clinical and laboratory parameters like Hb,white blood cell (WBC),platelets,bilirubin,transaminases,and albumin were similar in the CC and nonCC genotypes.Overt diabetes mellitus was present in 22% (25/115) of patients.Patients with nonCC genotype had significantly higher prevalence of overt diabetes mellitus than patients with CC genotype (31% [17/54] versus 13% [8/61];p < 0.05).When parameters were compared in patients with and without overt diabetes mellitus,only IL-28B and age were significantly associated with overt diabetes mellitus (p < 0.05).Conclusion:In HCV patients,overt diabetes mellitus was more commonly associated with the nonCC genotype of IL-28B than the CC genotype.Carriers of the T-allele of SNP rs12979860 were more likely to have insulin resistance than CC homozygotes,and this finding may explain the higher prevalence of diabetes in non-CC genotypes.Thus,an IL-28B test may be useful in patients of HCV in order to determine their likelihood of developing diabetes mellitus.展开更多
文摘AIMTo study the diagnostic accuracy of transient elastography (TE) for detecting clinically significant portal hypertension (CSPH) in Indian patients with cirrhotic portal hypertension.METHODSThis retrospective study was conducted at the Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, on consecutive patients with cirrhosis greater than 15 years of age who underwent hepatic venous pressure gradient (HVPG) and TE from July 2011 to May 2016. Correlation between HVPG and TE was analyzed using the Spearman’s correlation test. Receiver operating characteristic (ROC) curves were prepared for determining the utility of TE in predicting various stages of portal hypertension. The best cut-off value of TE for the diagnosis of CSPH was obtained using the Youden index.RESULTSThe study included 326 patients [median age 52 (range 16-90) years; 81% males]. The most common etiology of cirrhosis was cryptogenic (45%) followed by alcohol (34%). The median HVPG was 16.0 (range 1.5 to 30.5) mmHg. Eighty-five percent of patients had CSPH. A significant positive correlation was noted between TE and HVPG (rho 0.361, P < 0.001). The area under ROC curve for TE in predicting CSPH was 0.740 (95%CI: 0.662-0.818) (P < 0.01). A cut-off value of TE of 21.6 kPa best predicted CSPH with a positive predictive value (PPV) of 93%.CONCLUSIONTE has a fair positive correlation with HVPG; thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension. A cut-off TE value of 21.6 kPa identifies CSPH with a PPV of 93%.
文摘BACKGROUND:Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients.Diagnosis of MHE requires cumbersome tests.Lactulose is effective in the treatment of MHE.This study aimed to evaluate the use of critical flicker frequency (CFF) for the diagnosis of MHE in cirrhotic patients after treatment.METHODS:One hundred and ten patients were evaluated by psychometry (number connection tests A,B or figure connection tests A,B),P300 auditory event related potential (P300ERP),venous ammonia,and CFF for MHE.MHE was diagnosed by abnormal psychometry (>2SD age matched controls) and P300ERP.MHE patients were treated with lactulose for one month.Response was defined by normalization (<2SD of matched controls) of both psychometry and P300ERP.RESULTS:Of the 110 patients [Child Turcott Pugh score A:B:C 39:42:29,(age 41.6±11.6 years,M:F 82:28)],75 (68%) had abnormal results of psychometric tests,and 74 (67%) had prolonged P300ERP.Fifteen (20%) patients with abnormal results of psychometric tests had normal P300ERP.Thus sixty (54.5%) patients were diagnosed as having MHE.After treatment for one month,34 (57%) recovered while 26 (43%) continued to have abnormal resents of psychometric or P300ERP tests.CFF was <39 Hz in 72 (65.4%) patients before treatment and in 20 (33.3%) after treatment.CFF sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy for the assessment of recovery of MHE were 65%,91%,85%,77% and 80%,respectively.CONCLUSION:CFF is a simple,relatively reliable,and accurate test without any dependence on age or literacy in the diagnosis and assessment of recovery of patients with MHE.
文摘To investigated clinical, endoscopic and histopathological parameters of the patients presenting with ileocecal ulcers on colonoscopy. METHODSConsecutive symptomatic patients undergoing colonoscopy, and diagnosed to have ulcerations in the ileocecal (I/C) region, were enrolled. Biopsy was obtained and their clinical presentation and outcome were recorded. RESULTSOut of 1632 colonoscopies, 104 patients had ulcerations in the I/C region and were included in the study. Their median age was 44.5 years and 59% were males. The predominant presentation was lower GI bleed (55, 53%), pain abdomen ± diarrhea (36, 35%), fever (32, 31%), and diarrhea alone (9, 9%). On colonoscopy, terminal ileum was entered in 96 (92%) cases. The distribution of ulcers was as follows: Ileum alone 40% (38/96), cecum alone 33% (32/96), and both ileum plus cecum 27% (26/96). The ulcers were multiple in 98% and in 34% there were additional ulcers elsewhere in colon. Based on clinical presentation and investigations, the etiology of ulcers was classified into infective causes (43%) and non-infective causes (57%). Fourteen patients (13%) were diagnosed to have Crohn’s disease (CD). CONCLUSIONNon-specific ileocecal ulcers are most common ulcers seen in ileo-cecal region. And if all infections are clubbed together then infection is the most common (> 40%) cause of ulcerations of the I/C region. Cecal involvement and fever are important clues to infective cause. On the contrary CD account for only 13% cases as a cause of ileo-cecalulcers. So all symptomatic patients with I/C ulcers on colonoscopy are not Crohn’s.
基金Supported by SERB:Department of Science and Technology,New Delhi,No. NPDF:SERB 2015/000322
文摘Epigenetic modifications have been observed as a decline in miRNA-21 expression and breast cancer stem cell(CSC)population after 3 cycles of standard chemotherapy.The epigenetic response(miRNAs expression)and CSCs are also correlated in patients with Breast Cancer.In patients who tolerated chemotherapy well,miRNA-21(non-coding RNA)expression decreased significantly after three cycles of chemotherapy.The miRNA-21 expression in breast cancer tissue was quantified by quantitative PCR(real-time PCR)using the standard protocol.In addition,breast CSCs(CD44+/CD24-)were also decreased in these patients.The miRNA-21 regulates cell division,proliferation,and autophagy of cancerous cells(as it targets phosphatase and tensin homolog/AKT/transcription factor EB/programmed cell death 4/autophagy-related protein 5 and chemotherapy also produces similar effects),thereby contributing to these benefits.Therefore,when all of the targets on genes have been explored by mimic miRNA,chemotherapy combined with anti-miRNA21 therapy may prove useful in the care of cancer patients.
文摘Background:Poor postnatal weight gain is a well-known risk factor for developing retinopathy of prematurity(ROP).Algorithms that predict ROP based on serial weight gain have not been generalizable in non-Caucasian populations.The duration taken to regain the lost weight is culturally important among Indian mothers.We report the correlation between this duration and the risk of developing ROP.Methods:Sixty-eight Asian Indian infants born<2,000 grams at birth or<34 weeks of gestation were enrolled.The number of days taken for these infants to regain baseline birth weight(BW)was recorded.This measure was correlated with the eventual ROP outcome categorized as“no ROP”,ROP that regressed spontaneously(type 2 ROP),and ROP that required treatment(type 1).Results:The mean BW of the cohort was 1,270±340 grams and mean gestational age(GA)was 31±2 weeks.Thirty-three infants(48.5%)developed no ROP,20 infants(29.4%)developed type 2 ROP and 15 infants(22.1%)developed type 1 ROP.The mean number of days to regain the lost weight was 11.9+4.6,17.9+7.9 and 26.6+12.9 days for the No ROP,type 2 and type 1 groups respectively(P<0.0001,one-way ANOVA with Boneferroni correction).Those babies who regained their BW within 10 days were at least risk of developing any stage ROP,moderate risk if they took between 11-20 days and highest risk if they took more than 21 days for developing type 2 or type 1 ROP.Conclusions:The date when a child regains its lost BW is culturally important and easily recalled by mothers.We report the use of this simple estimate as a predictor of ROP.This method could be useful in stratifying risk and predicting the development of“treatment requiring ROP”even before 21 days of life,which is the first mandated screening visit in India.
文摘AIM:To study the in vivo anti-inflammatory activity of Tabernaemontana divaricata leaf extract on male albino mice.METHODS:Aqueous decoction and methanol leaf extracts were tested for their ability to reduce croton oil-induced edema in the mouse ear after topical application.The methanol leaf extract dose-dependently inhibited the croton oil-induced ear edema in mice(ID50<500μg·cm 2).A bioassay-guided liquid–liquid fractionation of this methanol extract gave four active fractions:water insoluble(F1),hexane(F2),ethyl acetate(F3)and water(F4).RESULTS:The hexane fraction showed a very high activity(42.1%inhibition at0.7μg·cm 2)as compared to the control.The other fractions were less active(F1:56.1%at 506.2μg·cm-2;F3:57.3%at 289.3μg·cm 2;and F4:31.9%for 203.8μg·cm 2)while indomethacin gave 48.8%of inhibition at 90μg·cm 2.The activity of F1 and F3 may be at least in part explained by the presence of anti-inflammatory flavonoids,while the activity was not correlated to the tannin contents.No compounds were detected in the most active F2 fraction.CONCLUSIONS:The results give a rational support to the traditional use of T.divaricata in tropical India as anti-inflammatory agent.
文摘Background and Aims:Evaluation of significant liver fibro-sis is important for treatment decision and treatment re-sponse evaluation in patients with chronic hepatitis B. Since liver biopsy is invasive and transient elastography (TE) has limited availability, various non-invasive blood parameters need evaluation for their capabilities for detection of signifi-cant fibrosis. Methods:In this retrospective study, records of patients who had undergone liver biopsy for treatment-na?ve chronic hepatitis B were evaluated to obtain various non-in-vasive blood parameters (aspartate aminotransferase-to-pla-telet ratio index [referred to as APRI], Fibrosis-4 score [referred to as FIB-4], gamma-glutamyl transpeptidase-to-platelet ratio [referred to as GPR], and gamma-glutamyl transpeptidase-to-albumin ratio [referred to as GAR]), in ad-dition to TE, to assess significant liver fibrosis and compare these to fibrosis stage in liver biopsy. Results:A total of 113 patients were included in the study (median age 33 [inter-quartile range: 11-82 years], 74% males). Most (75%) pa-tients were HBeAg-negative. The liver biopsy revealed significant fibrosis (Ishak ≥3) in 13% of the patients and nil or mild fibrosis (Ishak<3) in 87%of the patients. TE findings were available for 85 patients, APRI and FIB-4 for 95 patients, GPR for 79 patients, and GAR for 78 patients. The median values of all the parameters were significantly higher in pa-tients with significant fibrosis, as compared to patients with non-significant fibrosis, and all the blood parameters as well as TE were able to identify patients with significant fibrosis significantly well (p<0.05). All non-invasive parameters had low positive predictive value but negative predictive value above 92%. Compared to TE, all the non-invasive blood pa-rameters had similar area under the curve for detecting sig-nificant fibrosis, with excellent negative predictive value (≥93%). Conclusions: Non-invasive blood parameters (APRI, FIB-4, GPR, and GAR) with negative predictive values above 93%are excellent parameters for ruling-out significant ;fibrosis in patients with chronic hepatitis B. These can be used at bedside in place of TE.
基金funded by the Kathmandu University,Nepal and the Royal Norwegian Government(FFDN-NPL 100062)
文摘Reference conditions having no or only minor anthropogenic disturbances, are a basic requirement for ecological studies in rivers. To study ecological impact of a dam, two sites were pre-classiifed as reference or least disturbed in the Andhi Khola River, Nepal, using Rapid Field Bioscreening （RFB） protocol. Biological （macroinvertebrates） and physico-chemical samples were collected in the month of January and February 2013. Multi-habitat sampling （MHS） was employed in sample collection of macro-invertebrates fauna. Validation of the pre-classiifed sites was done using several indices viz. Nepalese biotic score （NEPBIOS）, Biological monitoring working party （BMWP）, Hindu-Kush Himalayan biotic score （HKHBIOS）, Hilsenhoff （HILSENHOFF） ＆ National Sanitation Foundation Water Quality Index （NSFWQI）. The NEPBIOS, HKHBIOS, HILSENHOFF, RFB ＆ NSFWQI indices predicted the river quality at al two sites as good with quality class Ⅱ. Only BMWP/ASPT water quality index predicted the river quality at al two sites as Excelent with quality class Ⅰ. Hence preselected sites with quality of rank Ⅱ i.e. good qualities were validated as reference sites. The study demonstrated that the multi-metric approach is suitable for application in the monitoring and assessment of rivers where dams are built to produce hydropower.
文摘Background:Interleukin-28B (IL-28B) polymorphism is an important predictor for hepatitis C virus (HCV) treatment response.Whether IL-28b genotypes also influence other nontreatment related clinical parameters is unclear.Methods:Patients with HCV-related chronic liver diseases who attended our department during 2012-2014 were retrospectively analyzed.The single nucleotide polymorphisms (SNPs) of rs12979860 (IL-28B) were correlated with various clinical parameters.We also compared these parameters in patients with and without overt diabetes to identify possible associations.Results:A total of 115 patients were included (median age 48,range 15-76 years;70% males).Overall,43/115(37%) patients had chronic hepatitis,while the remaining 72/115 (63%) had cirrhosis.The most common IL-28B genotype was CC,which was found in 53% of patients (61/115),while the remaining 47% were nonCC [CT 42% (48/115) and T-r 5% (6/115)].Clinical and laboratory parameters like Hb,white blood cell (WBC),platelets,bilirubin,transaminases,and albumin were similar in the CC and nonCC genotypes.Overt diabetes mellitus was present in 22% (25/115) of patients.Patients with nonCC genotype had significantly higher prevalence of overt diabetes mellitus than patients with CC genotype (31% [17/54] versus 13% [8/61];p < 0.05).When parameters were compared in patients with and without overt diabetes mellitus,only IL-28B and age were significantly associated with overt diabetes mellitus (p < 0.05).Conclusion:In HCV patients,overt diabetes mellitus was more commonly associated with the nonCC genotype of IL-28B than the CC genotype.Carriers of the T-allele of SNP rs12979860 were more likely to have insulin resistance than CC homozygotes,and this finding may explain the higher prevalence of diabetes in non-CC genotypes.Thus,an IL-28B test may be useful in patients of HCV in order to determine their likelihood of developing diabetes mellitus.
