Determination of interleukin-6, interleukin-10, and interleukin-18 levels in patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma secondary to HBV infection

Giriş ve Amaç: Viral hepatit B enfeksiyonunun kronikleşmesine yol açan mekanizmalar tam olarak anlaşılamamıştır. Sitokin profilindeki değişimin, enfeksiyonun iyileşmesi veya kronikleşmesi şeklinde sonuçlanabileceği bilinmektedir. Bu çalışma, bazı sitokinler ile hepatit B virüsü enfeksiyonu sonrası oluşan farklı klinik formları arasındaki ilişkiyi ortaya koymak amacıyla yapılmıştır. Gereç ve Yöntem: Çalışmada, hepatit B virüsü enfeksiyonuna ikincil kronik hepatit, karaciğer sirozu ile hepa- tosellüler karsinoma gelişmiş hastalarda interlökin-6, interlökin-10, interlökin-18 düzeyleri ve hastalık progresyonu arasındaki ilişki araştırıldı. Kronik hepatitli 29, karaciğer sirozlu 19, hepatosellüler karsinomalı 19, toplam 67 hepatit B hastası ile 15 sağlıklı kontrol çalışmaya alındı. Bulgular: Hepatit B virüsü hasta grupları arasında hepatit B virüsü DNA düzeyleri açısından anlamlı fark yoktu. İnterlökin-6, interlökin-10 ve inter- lökin-18 düzeyleri hasta olan gruplarda, hastalık progresyonu ile daha belirgin şekilde olmak üzere kontrol grubundan anlamlı şekilde yüksek bulundu. İnterlökin-6 düzeyi hepatosellüler karsinoma grubunda, kontrol grubu, kronik hepatit B ve karaciğer sirozu gruplarına göre anlamlı yüksek olup diğer gruplar arasında ise benzerdi. İnterlökin-10 düzeyinde ise sadece hepatosellüler karsinoma ile kontrol grubu arasında anlamlı fark mevcuttu. İnterlökin-18 düzeyleri ise hepatit B virüsü gruplarında (kronik hepatit B, karaciğer sirozu ve hepatosellüler karsinoma) benzer olmakla beraber her üç grupta da kontrol grubundan anlamlı olarak yüksekti. İnterlökin-6, interlökin-10, interlökin-18 ve alfa fetoprotein düzeyleri arasında istatiksel açıdan anlamlı korelasyon saptandı. Ek olarak hepatosellüler karsinoma grubunda yer alan ve alfa fetoprotein düzeyleri normal sınırlarda olan 3 hastadan ikisinde interlökin-18 düzeylerinin ortalama değerin üzerinde olduğu ve bunlardan birinde interlökin-10 düzeyinin de ortalama değerin üzerinde olduğu saptandı. Sonuç: So- nuç olarak, interlökin-6, 10 ve 18 düzeylerinin hepatit B virüsü enfeksiyonunun farklı evrelerinde artmış olduğu saptandı. İnterlökin-6 ve 10 hepatosellüler karsinomada artarken, interlökin-18, tüm hepatit B virüsü formlarında artmış olarak bulundu.Background and Aims: The mechanisms of chronicity in viral hepatitis B are not yet been fully understood. It has been postulated that the changes in balance of cytokine profiles may result in either healing or chronicity. This study was conducted to reveal the relationship among different clinical forms of hepatitis B virus infection with cytokines. Materials nad Methods: This study aims to reveal the relationship among interleukin-6, interleukin-10 and interleukin-18 levels and disease pro- gression in patients with chronic hepatitis B, liver cirrhosis and hepato- cellular carcinoma secondary to hepatitis B virus infection. A total of 67 hepatitis B virus patients with chronic hepatitis B (n=29), liver cirrhosis (n=19), hepatocellular carcinoma (n=19) and 15 healthy controls were included in the study. Results: Hepatitis B virus DNA levels were not significantly different among the groups. Interleukin-6, interleukin-10 and interleukin-18 levels in patients with hepatitis B virus infection were significantly higher than the control group in association with disease progression. The level of interleukin-6 in hepatocellular carcino- ma group was significantly higher than the control, chronic hepatitis B and liver cirrhosis groups. Interleukin-6 levels were similar among the other groups. At the level of interleukin-10, there was only a significant difference between the control and hepatocellular carcinoma groups. interleukin-18 levels were similar among the groups of hepatitis B virus (chronic hepatitis B, liver cirrhosis, hepatocellular carcinoma), and in all three groups these were significantly higher than in the control group. There was statistically significant correlation between interleukin and al- pha fetoprotein levels. In addition, interleukin-18 levels in two of three patients with alpha fetoprotein levels within the normal range in the hepatocellular carcinoma group were found to be on mean values. In one of them the level of interleukin-10 was found to be on mean val- ues. Conclusions: In conclusion, levels of interleukin-6, 10 and 18 were found to be increased at different stages of hepatitis B virus infection. Interleukin-6 and 10 levels increased in the hepatocellular carcinoma group. Interleukin-18 was increased in all forms of hepatitis B virus

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts

Objective: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. Material and Method: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. Results: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells/Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. Conclusion: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed