GC gene polymorphism and unbound serum retinol-binding protein 4 are related to the risk of insulin resistance in patients with chronic hepatitis c: A prospective cross-sectional study

Insulin resistance (IR) is found in chronic hepatitis C (CHC) more frequently than in other chronic liver diseases. Prospective cross-sectional study to evaluate a wide multitest panel to identify factors related with IR in CHC and their possible interactions. In 76 patients with CHC we performed a series of routine laboratory analysis as well as specifically designed serum biochemical tests [retinol, retinol-binding protein 4 (RBP4), 25-OH vitamin D, Vitamin E, lipopolysaccharide-binding protein (LBP), interleukin-6 (IL-6), and cystatin C]. The single nucleotide polymorphisms rs7041 and rs4588 GC-DBP (group-specific component-Vitamin D-binding protein), rs738409 PNPLA3 (patatin-like phospholipase domain containing 3), and rs12979860 IL28B (interleukin-28 B) genes were determined. Insulin sensitivity was established with the HOMA-IR and IR was diagnosed when HOMA-IR>3. Fibrosis staging was assessed with liver biopsy or transient elastography. After backward logistic regression analysis, independent variables associated with IR were Gc1s/Gc1s DBP phenotype, that results from the homozygous carriage of the rs7041G/rs4588Chaplotype (P¼0.033); low retinol/RBP4 ratio, reflecting a greater rate of unboundRBP4 (P¼0.005); older age (P¼0.01); high serum tryglicerides (P¼0.026); and advanced (F3–F4) fibrosis stage. The AUROC provided by the multivariate model was 0.950 (95% CI¼0.906–0.993). In addition to previously known ones, the Gc1s/Gc1s phenotype variant of DBP and the unbound fraction of plasma RBP4 may be considered as factors related with the incidence, and possibly the risk, of IR in CHC patients.• Instituto de Salud Carlos III, Fondo de Investigación Sanitari: Ayudas PI12/00241 y PI12/00324 • Junta de Extremadura: Ayuda GR15026 • Fondos FEDERpeerReviewe

Bibliografía

RESEÑA 1 de : Beceiro Pita, Isabel; Córdoba de la Llave, Ricardo. Parentesco, poder y mentalidad. La nobleza castellana (siglos XII-XV). Madrid : CSIC, 1990. RESEÑA 2 de : Coll-Vinet, Roberto; Bernal Cruz, Francisco J. Curso de documentación. Madrid : Edit. Dossat, 1990. RESEÑA 3 de : Corral García, Esteban. Ordenanzas de los concejos castellanos : formación, contenidos y manifestaciones: siglos XIII-XVIII. Burgos : S.E., 1988. RESEÑA 4 de : García Oliva, María Dolores. Organización económica y social del concejo de Cáceres en la baja Edad Media. Cáceres : Institución Cultural el Brócense, 1990. RESEÑA 5 de : Magdalena Nom de Deu, JOsé Ramón. Libro de viajes de Benjamín de Tudela. Barcelona : Biblioteca Nueva Sefarad, Ríopiedras Ediciones, 1989. RESEÑA 6 de : TOrres Fontes, Juan. Repartimiento de Orihuela. Murcia : Ed. Academia Alfonso X el Sabio / Patronato Ángel García Rogel, 1988

Transarterial chemoembolisation in intermediate-stage hepatocellular carcinoma. Survey on clinical practice in hospitals in the Madrid Region

Background. Transarterial chemoembolisation (TACE), having demonstrated survival benefits, is the treatment of choice in intermediate-stage hepatocellular carcinoma, although there is great heterogeneity in its clinical application.Material and methods. A survey was sent to the Madrid Regional hospitals to assess applicability, indications and treatment protocols. The assessment was made overall and according to the type of hospital (groups A vs. B and C).Results. Seventeen out of 22 hospitals responded (8/8 group A, 9/ 14 group B-C). All do/indicate transarterial chemoembolisation, 13/17 at their own facilities. Eight of the 17 hospitals have multidisciplinary groups (5/8 A, 3/9 B-C). Nine hospitals perform > 20 procedures/year (7 group A), and 6 from group B-C request/perform < 10/year. It is performed on an “on-demand” basis in 12/17. In 5 hospitals, all the procedures use drug-eluting beads loaded with doxorubicin. The average number of procedures per patient is 2. The mean time from diagnosis of hepatocellular carcinoma to transarterial chemoembolisation is ≤ 2 months in 16 hospitals. In 11/17 hospitals, response is assessed by computed tomography. Radiological response is measured without specific criteria in 12/17 and the other five hospitals (4 group A) assessed using standardised criteria.Conclusion. Uniformity among the Madrid Regional hospitals was found in the indication and treatment regimen. The use of DEB-TACE has become the preferred form of TACE in clinical practice. The differentiating factors for the more specialised hospitals are a larger volume of procedures, decision-making by multidisciplinary committees and assessment of radiological response more likely to be standardised