Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests

Unlike for advanced liver fibrosis, the practical rules for the early non-invasive diagnosis of cirrhosis in NAFLD remain not well defined. Here, we report the derivation and validation of a stepwise diagnostic algorithm in 1568 patients with NAFLD and liver biopsy coming from four independent cohorts. The study algorithm, using first the elastography-based tests Agile3+ and Agile4 and then the specialized blood tests FibroMeterV3G and CirrhoMeterV3G, provides stratification in four groups, the last of which is enriched in cirrhosis (71% prevalence in the validation set). A risk prediction chart is also derived to allow estimation of the individual probability of cirrhosis. The predicted risk shows excellent calibration in the validation set, and mean difference with perfect prediction is only −2.9%. These tools improve the personalized non-invasive diagnosis of cirrhosis in NAFLD

Measurements of particulate contamination and migration under vacuum using a large sensitive area particle counter

A large area (50 cm(2)) particle counter working under vacuum (10(-7) mbar) has been developed at CERN and applied to measurements of particles released by several vacuum components like valves, gauges and ion pumps. This technique has also been applied to study the migration of particles under vacuum with and without an applied electric field. This counter, which is based on the scattering of laser light by particles, is described with comments on the technical choices. The results of the contamination released by vacuum components and the effects of an electric field will be presented. (C) 1999 Elsevier Science Ltd. All rights reserved

Analysis of medical prescribing practices for hepatitis B serology tests.

International audienceThe aim of this survey was to study the requests written for hepatitis B virus (HBV) serology tests to ascertain their compliance with French prescription guidelines; additional costs incurred by inappropriate requests were also determined, as was the appropriateness of the physicians' interpretation of the test results. This was a cross-sectional practice inquiry involving 118 prescriptions for HBV serology tests. Data were prospectively collected in June 2005 from laboratory heads and prescribing physicians. The prescriptions were written for 188 patients (64% women), aged 35 years on average, mostly by general practitioners (65%) and gynecologists (25%). Prescribing physicians reported the following clinical situations as their main reasons for ordering HBV serology tests: pregnancy (25%); vaccination (20%); acute hepatitis (18%) and screening a patient with a risk factor (19%). Failure to comply with current guidelines was noted in 74% of the prescriptions and vague wording in 45%. The additional cost due to ordering inappropriate serology tests was 43.41 euro per prescription. The physician's interpretation of the test results was considered excellent (27%), fair (59%) or false (14%). Guidelines for the prescribing of hepatitis B serology tests need to be more rigorously applied in daily clinical practice. City hospital networks should promote further in-service training for physicians

Longitudinal evaluation of a fibrosis index combining MMP-1 and PIIINP compared with MMP-9, TIMP-1 and hyaluronic acid in patients with chronic hepatitis C treated by interferon-alpha and ribavirin.

International audienceWe have recently described a fibrosis index combining serum procollagen type III N-terminal peptide (PIIINP) and matrix metalloproteinase 1 (MMP-1) concentrations for evaluating the amount of liver fibrosis in chronic hepatitis C patients. The aims of the present study were to validate this score in another cohort of patients and to assess its variations along those of TIMP-1, hyaluronic acid (HA) and MMP-9 during antiviral treatment. Seventy-nine patients treated by interferon-alpha and ribavirin for 24 or 48 weeks were included. A liver biopsy was performed within the 6 months before the start of treatment. Serum markers were measured in serum collected the day of the liver biopsy, at start of treatment, and every 3 months during treatment and a 6-month follow-up period. The PIIINP/MMP-1 index was significantly correlated to the METAVIR fibrosis (r = 0.68, P < 0.001). Its overall diagnostic value defined by the area under the receiver operating characteristics curves was 0.77 for discriminating F1 vs F2F3F4, and 0.81 for discriminating F1F2 vs F3F4, and was better than that observed for HA and TIMP-1. At the end of follow-up, the PIIINP/MMP-1 index significantly decreased in responders and remained stable in nonresponder patients. This decrease occurred early and continued regularly during the treatment period. This variation was because of both a decrease of PIIINP and an increase of MMP-1 concentrations. HA and TIMP-1 serum concentrations were also significantly lower at the end of follow-up in responder patients, but early changes were minimal and not influenced by the response to treatment. Our study shows that a noninvasive index combining PIIINP and MMP-1 is a useful tool to follow-up fibrosis change during and after antiviral therapy chronic hepatitis C patients