Soluble Serum CD81 Is Elevated in Patients with Chronic Hepatitis C and Correlates with Alanine Aminotransferase Serum Activity

Aim: Cellular CD81 is a well characterized hepatitis C virus (HCV) entry factor, while the relevance of soluble exosomal CD81 in HCV pathogenesis is poorly defined. We performed a case-control study to investigate whether soluble CD81 in the exosomal serum fraction is associated with HCV replication and inflammatory activity. Patients and Methods: Four cohorts were investigated, patients with chronic hepatitis C (n = 37), patients with chronic HCV infection and persistently normal ALT levels (n = 24), patients with long term sustained virologic response (SVR, n = 7), and healthy volunteers (n = 23). Concentration of soluble CD81 was assessed semi-quantitatively after differential centrifugation ranging from 200 g to 100,000 g in the fifth centrifugation fraction by immunoblotting and densitometry. Results: Soluble CD81 was increased in patients with chronic hepatitis C compared to healthy subjects (p = 0.03) and cured patients (p = 0.017). Patients with chronic HCV infection and persistently normal ALT levels and patients with long term SVR had similar soluble CD81 levels as healthy controls (p>0.2). Overall, soluble CD81 levels were associated with ALT levels (r = 0.334, p = 0.016) and severe liver fibrosis (p = 0.027). Conclusion: CD81 is increased in the exosomal serum fraction in patients with chronic hepatitis C and appears to be associated with inflammatory activity and severity of fibrosis

Alterações dos hábitos alimentares em pacientes submetidos a laringectomia parcial frontolateral e total

CONTEXT: Swallowing is a continuous dynamic process, characterized by complex stages, that involves structures of the oral cavity, pharynx, larynx and esophagus. It can be divided into three phases: oral, pharyngeal and esophageal. Dysphagia is characterized by difficulty with, or the inability to swallow food of normal consistencies. OBJECTIVE: To investigate the presence of swallowing difficulties and modifications made to the consistency of the food consumed in cases of total and partial laryngectomy, with or without subsequent radiotherapy, among patients who had not been diagnosed as having dysphagia. TYPE OF STUDY: Descriptive study. SETTING: Voice Clinic of São Paulo Hospital, Universidade Federal de São Paulo (UNIFESP)/Escola Paulista de Medicina, São Paulo, Brazil. METHOD: 36 laryngectomy patients: 25 total and 11 frontolateral cases, were studied. A survey consisting of a 23-item questionnaire was applied by a single professional. RESULTS: Among those interviewed, 44% reported having modified the consistency of the food consumed (56% of the total and 20% of the partial frontolateral laryngectomy cases). It was not possible to investigate the influence of radiotherapy on the groups in this study, because the partial frontolateral laryngectomy cases were not exposed to radiotherapy. There was a higher incidence of complaints of swallowing difficulties in total laryngectomy cases (p < 0.027) than in partial frontolateral cases. However, there was no relationship between the surgery and weight loss. We also noted the patients' other problems regarding the eating process, as well as the compensation that they made for such problems. DISCUSSION: Research has shown an association between laryngectomy and swallowing difficulties, although there have been no reports of associated changes in eating habits among laryngectomized patients. CONCLUSIONS: This study showed that difficulty in swallowing is not rare in total and frontolateral laryngectomy cases. Such patients, even those who did not complain of dysphagia, also had minor difficulties while eating, and had to make some adaptations to their meals.CONTEXTO: A deglutição é um processo dinâmico e contínuo, caracterizado por etapas complexas, que envolve estruturas da cavidade oral, faringe, laringe e esôfago. Pode ser dividida em fases: oral, faríngea e esofágica. A disfagia é caracterizada por dificuldades ou inabilidade em deglutir alimentos em consistências normais. OBJETIVO: Investigar a presença de dificuldades de deglutição e mudanças nas consistências dos alimentos em pacientes submetidos a laringectomia total e laringectomia parcial vertical frontolateral, seguidos ou não de radioterapia e sem diagnóstico de disfagia. TIPO DE ESTUDO: Descritivo. LOCAL: Ambulatório de Voz do Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina, São Paulo, Brazil. MÉTODO: 36 pacientes laringectomizados: 25 submetidos a laringectomia total e 11 a laringectomia parcial frontolateral foram incluídos no estudo. Questionário contendo 23 itens, foi aplicado por uma única profissional. RESULTADOS: Dentre os entrevistados, 44% relataram modificações na consistência dos alimentos durante as refeições; dentre estes 56% eram laringectomizados totais e 20%, laringectomizados parciais frontolaterais. Não foi possível investigar a influência da radioterapia nos grupos deste estudo, pois os pacientes laringectomizados parciais frontolaterais não foram expostos à radioterapia. Houve alta incidência de queixas de dificuldades de deglutição entre os pacientes laringectomizados totais (p < 0,027). Entretanto, não houve associação entre cirurgia realizada e perda de peso. Observamos outras queixas relatadas pelos pacientes durante a alimentação, como problemas e compensações realizadas pelos pacientes. DISCUSSÃO: Pesquisas mostraram associação entre laringectomia e dificuldades de deglutição, porém não foram encontrados estudos associando mudanças de hábitos alimentares em pacientes laringectomizados. CONCLUSÃO: Este estudo mostra que a dificuldade na deglutição não é rara nos pacientes submetidos a laringectomia frontolateral e total. Os pacientes, mesmo aqueles que não apresentaram queixas de disfagia, também tiveram pequenas dificuldades durante a alimentação, fazendo algumas adaptações necessárias.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL