4 research outputs found
Case Report: Mixed Cholestatic/Hepatocellular Liver Injury Induced by the Herbicide Quizalofop-p-ethyl
Correlation between oxidative stress and immunosuppressive therapy in renal transplant recipients with an uneventful postoperative course and stable renal function
Background Reactive oxygen species (ROS) are important mediators of
cellular damage and lipid peroxidation is the most important expression
of ROS-induced oxidative stress. Recent studies have suggested that
increased plasma malondialdehyde (MDA) levels are a consequence of
specific immunosuppressive therapies. This study aims at investigating
the relation between oxidative stress and immunosuppressive therapies in
renal transplant patients with stable renal function and uneventful
postoperative course.
Methods The study group included 26 renal patients. Two groups of renal
transplant recipients, treated with a different combination of
immunosuppressive agents were studied (Group A: CyA, MMF, Steroids and
Basiliximab, Group B: Tacrolimus, MMF, Steroids and Daclizumab). All
patients had an uneventful postoperative course. Plasma MDA levels were
measured before transplantation, 1 and 6 months after. Plasma
concentration of endogenous creatinine (Cr) was used as a measure of
stable renal function.
Results Levels of MDA were increased before the transplantation in all
renal patients (MDA: 7.81 +/- 4.81, normal levels: 2.23-1.08 nmol/ml, P
< 0.05). Combined therapy with CYA was associated with high values of
MDA at 6 months measurement after transplantation. However this tendency
of increased MDA levels did not achieve a statistical significance
(Group A: 6.97 vs. 9.06 nmol/ml, P > 0.05). On the contrary,
statistically significant diminution of MDA levels was observed in Group
B patients (Tacrolimus-MMF-steroids) at 6 months measurement after
transplantation. (Group B: 8.61 vs. 4.11 nmol/ml, P < 0.02 < 0.05).
Conclusions Immunosuppressive combined therapy with CyA was associated
with the high values of MDA that were measured posttransplantly. Our
study provides strong evidence that Tacrolimus is significantly
associated with improved free radical metabolism
Immunogenicity of recombinant hepatitis B vaccine in treatment-naive and treatment-experienced chronic hepatitis C patients: The effect of pegylated interferon plus ribavirin treatment
AIM: To retrospectively evaluate the vaccination-induced anti-HBs
seroconversion rates in treatment-naive and treatment-experienced
chronic hepatitis C (CHC) patients. Also to prospectively evaluate the
seroconversion rates in CHC patients during pegylated interferon (PEG)
plus ribavirin (RIB) treatment.
METHODS: Seventy treatment-naive CHC patients (group A), 22 sustained
virological responders-SVR following interferon (IFN) plus RIB treatment
CHC patients (group B) and 121 healthy subjects (group C) had been
participated in the same HBV vaccination schedule (20 mu g, 0-1-6 mo).
Seroconversion was considered if anti-HBs levels were above 10 mIU/mL
within 3 mo following the third dose of the vaccine. Moreover, we
prospectively selected 30 non-cirrhotic CHC patients and evaluated them
for the efficacy of the same vaccine schedule randomizing them in two
groups: Group-1, 15 CHC patients received the first dose of the vaccine
in parallel with the initiation of PEG plus RIB treatment and Group-2,
15 patients received the same vaccination schedule without concomitant
treatment. Determination of anti-HBs was performed at mo 1, 2, and 7.
Statistical analysis of data was based on ANOVA student’s t-test and
chi-square analysis (P < 0.05).
RESULTS: Fifty-eight of 70 group A patients (82.85%), 20/22 group B
(90.9%) and 112/121 healthy subjects (92.56%) had been seroconverted.
The seroconversion rates were significantly higher in the control group
than in treatment-naive CHC patients (P = 0.04). The corresponding rates
were comparable between group A and group B CHC patients (P = 0.38). The
vast majority of non-responders (10/14, 71.43%) had been infected by
genotype-1 of HCV. The seroconversion rates were comparable between
group I and 2 CHC patients at mo 1 (20% versus 26.7%, P = 0.67), mo 2
(46.7% vs 60%, P = 0.46) and mo 7 (86.7% versus 93.3%, P = 0.54) of
follow-up.
CONCLUSION: The immunogenicity of HBV vaccine seems to be lower in CHC
patients compared to,healthy subjects. SVR following IFN plus RIB
treatment does not affect the antibody response to HBV vaccine.
Infection by genotype-1 seems to negatively influence the seroconversion
rates. Vaccination against HBV during PEG plus RIB combination treatment
is not beneficial in terms of anti-HBs seroconversion rates. (C) 2006
The WJG Press. All rights reserved
Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy
Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.
Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.
Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21).
Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable