bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous treatment of hepatocellular carcinoma
Authors: Gaiani S. , Celli N. , Cecilioni L. , Piscaglia F. , Bolondi L. 
Published: June 2003

SummaryIn early stage hepatocellular carcinoma (HCC), liver transplantation, surgical resection and percutaneous techniques are classified as radical treatments, and may be offered to about 25% of all patients with HCC evaluated in referral centres.The restricted inclusion criteria for surgical resection and the shortage of liver donors for transplantation have stimulated an increasing demand for minimally invasive treatments able to achieve effective and reproducible percutaneous tumour ablation, with less associated morbidity and lower cost than other interventions.Among percutaneous techniques, ethanol injection has proven to be highly effective in single HCC up to 3 cm, with a rate of complete response of 80%, being well tolerated and with a limited risk of minor complication. In larger and/or multinodular HCC the efficacy is reduced to 50% of complete response in nodules between 3 and 5 cm, and to lower rate in larger tumours.Alternative options to ethanol injection have been recently proposed, including radiofrequency, microwave and laser thermal ablation, aimed to extend the necrotic area thus improving the rate of complete response. To date, radiofrequency is the most used technique, with a reported rate of complete response of 90–98% in nodules smaller than 3 cm, and with the advantage of fewer sessions, otherwise counteracted by a higher rate of side‐effects. Microwave and laser are promising technologies, but only few clinical data are available.Randomized controlled trials are needed in order to assess treatment response, long‐term survival, rate of complication and cost‐efficacy of newer technologies in comparison to ethanol injection.
Diagnosis, monitoring and treatment of distal colitis
Authors: Vecchi M. , Saibeni S. , Devani M. , Rondonotti E. , De Franchis R. 
Published: June 2003

SummaryThe diagnostic work‐up of ulcerative colitis at presentation is based on the collection of clinical, microbiological, radiological, endoscopic and histologic data. Serological markers are characterized by too low a sensitivity to be commonly utilized in clinical practice. Although endoscopic and histologic features are characterized by very high sensitivity and specificity for the diagnosis of ulcerative colitis, negative stool cultures and parasites are mandatory to exclude an infectious aetiology at presentation. The treatment of choice of an acute flare‐up of distal ulcerative colitis is represented by oral or topical mesalazine, or a combination of both, whereas the use of topical or systemic steroids should be restricted to patients who prove to be refractory to first‐line treatments. Preliminary data suggest that the achievement of endoscopic and histologic remission after an acute flare of the disease might be associated with a prolonged remission.
Indications for anti‐reflux surgery in gastro‐oesophageal reflux disease
Authors: Mattioli S. , Lugaresi M. L. , Pierluigi M. , Di Simone M. P. , D'Ovidio F. 
Published: June 2003

SummaryGastro‐oesophageal reflux disease (GERD) is a complex multifactorial disorder whose treatment is based on knowledge of its pathophysiology, natural history and evolution. Recently the relationship between the severest degrees of cardial incontinence and hiatus hernia has been emphasized, which causes the impairment of the mechanical properties of the gastro–oesophageal barrier and of oesophageal acid clearing. Among different types of hiatus hernia, those characterized by the permanent axial orad migration of the oesophago‐gastric (EG) junction (nonreducible hiatus hernia) are correlated with severe GERD. Barium swallow may adequately differentiate hiatal insufficiency, concentric hiatus hernia and short oesophagus which are the steps of migration across or above the diaphragm. When associated with panmural oesophagitis and fibrosis of the oesophageal wall, these conditions may be the cause of recurrence of hiatus hernia and reflux after laparoscopic standard anti‐reflux surgical procedures; in the presence of nonreducibility of the EG junction below the diaphragm without tension, dedicated surgical procedures are necessary. It is currently agreed that surgical therapy is indicated for patients affected by severe GERD who are not compliant with long‐term medical therapy, require high dosages of drugs and are too young for lifetime medical treatment. While the existence of severe GERD correlated with an irreversible anatomical disorder represents an elective indication for surgery, warrants further investigation. Accurate identification of the functional and anatomical abnormalities underlying GERD is mandatory in order to decide whether medical or surgical therapy should be implemented, and to tailor the surgical technique, laparoscopic or open, to each patient.
Management of mild and severe gastro‐oesophageal reflux disease
Authors: Tytgat G. N. J. 
Published: June 2003

SummaryTreatment of endosocopy‐negative gastro‐oesophageal reflux disease (s‐GERD) should be directed towards rapid relief of symptoms and then maintenance of relief using minimum yet effective therapy. Responses to proton pump inhibitors are somewhat lower in s‐GERD patients compared to GERD with overt erosive damage (e‐GERD). The reasons for a lower response rate are not clear but may relate to the inclusion of patients who do not have reflux disease or patients with a lower oesophageal sensory threshold. Also poorly understood is the lower yield of complete heartburn relief when the number of associated dyspeptic symptoms is high. Some form of long‐term therapy is needed in the majority of patients. ‘On demand’ proton pump inhibitor therapy to control reflux symptoms is a new and attractive option. Time to study discontinuation due to insufficient control of heartburn, or any other reason resulting in unwillingness to continue with on‐demand therapy, is a pragmatic outcome that is well suited to definition of the efficacy of on‐demand therapy. The goals of treatment of e‐GERD should be to relieve symptoms and to heal lesions. Symptom severity and much less endoscopic abnormalities drives the therapeutic choices. When symptoms are mild or intermittent and when oesophagitis is of limited degree, standard dose proton pump inhibitor is usually instituted. Fewer and fewer clinicians would still opt for an H2‐receptor antagonist. If there is moderate or severe oesophagitis or if symptoms are particularly troublesome, then the patient should start with standard‐dose proton pump inhibitor therapy once a day, but not uncommonly a b.d. dosage maybe necessary. Once the dose of the acid suppressant that relieves symptoms is found, this dose should be maintained for a period of 3 months. After this time, an attempt should be made to reduce the dose. If symptoms recur, then the patients should go back to the full‐dose proton pump inhibitor and a plan should be formulated for long‐term treatment. The long‐term treatment options vary between ongoing acid and suppressant therapy, with occasional attempts to reduce the dose, or to go for ‘on demand’ therapy and (rarely) includes consideration for surgery or endoscopic anti‐reflux therapy.
Test and treat or treat and test in reflux disease?
Authors: Vakil N. 
Published: June 2003

SummaryThe role of diagnostic testing in reflux disease is in evolution. There is little question that patients with dysphagia, bleeding or other ‘alarm’ symptoms, should undergo early endoscopy. A substantial proportion of patients presenting with reflux symptoms have endoscopy negative reflux disease. pH testing is both inconvenient and lacks the sensitivity and specificity required for a ‘gold standard’. Empirical trials of therapy using proton pump inhibitors have shown that a trial of treatment may be the most accurate way of diagnosing gastro‐oesophageal reflux disease (GERD) and may the optimal strategy from a cost‐effectiveness standpoint. On the other hand, the increasing rate of oesophageal adenocarcinoma has raised questions about the possible value of screening endoscopy to determine if Barrett's oesophagus is present. The role of endoscopic testing in the average patient is therefore shifting from a diagnostic modality to one that helps manage risk by identifying Barrett's oesophagus.
Liver transplantation for HCC. Treatment options on the waiting list
Authors: Bolondi L. , Piscaglia F. , Camaggi V. , Grazi G. L. , Cavallari A. 
Published: June 2003

SummaryThe most widely adopted criteria to admit and maintain patients with HCC and cirrhosis in the waiting list for liver transplantation are the Milano criteria, consisting in the presence of a single tumour ≤5 cm in diameter or up to three tumours, none exceeding 3 cm in diameter. Since the average time to transplantation has become longer than 10–12 months in most European and American Centers, the exclusion from the list during the waiting period due to increase of the neoplasm over the established criteria is not uncommon at present. It is mandatory, therefore, to seek an effective therapeutic strategy for patients with HCC waiting for transplantation. Surgical resection and eventual subsequent salvage transplantation seems a cost‐effective strategy in resectable HCC. In unresectable neoplasms both transarterial chemoembolization and percutaneous ablation techniques are currently used and one or the other are chosen according to individual applicability, limitations and specific risks. However, although positive trends were reported, no definitive evidence has been produced so far about their efficacy in increasing patient's survival and decreasing tumour recurrence rates after transplantation. Adult‐to‐adult living donor liver transplantation is one possible way to shorten the waiting list, but this strategy involves important ethical implications. At present it appears justified to take it into consideration only if the waiting time for cadaveric OLT is expected to exceed 7 months. A more general and definitive attempt to overcome problems related to long waiting times for patients with HCC and relatively preserved hepatic function has been introduced in the USA very recently and consists in prioritizing patients with HCC. However, the overall efficacy of this approach will be established only in some years.
Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long‐term survival and tumour recurrence in a single centre
Authors: Grazi G. L. , Cescon M. , Ravaioli M. , Ercolani G. , Gardini A. , Del Gaudio M. , Vetrone G. , Cavallari A. 
Published: June 2003

SummaryBackground : Differences in risk factors for survival and recurrence after liver resection for hepatocellular carcinoma (HCC) in patients with or without cirrhosis are not fully clarified.Aim : To review a single‐centre experience of curative liver resections for HCC in order to evaluate clinicopathologic features and the long‐term outcome of cirrhotic and noncirrhotic patients.Methods : From 1981 to 2002, 308 curative liver resections for HCC on cirrhosis (Group 1) and 135 for HCC without cirrhosis (Group 2) were performed. The main demographic, clinicopathologic and operative parameters, as well as early results were analysed and compared. Overall and disease‐free survival were evaluated. Prognostic factors for survival and for tumour recurrence were studied by univariate and multivariate analysis.Results : Group 1 had worse preoperative liver function and higher frequency of hepatitis C virus infection. In Group 2, HCC showed larger mean tumour diameter (P < 0.001), poorer differentiation (P < 0.05) and more frequent macrovascular invasion (P < 0.05). Although more extended resections were performed in Group 2 (P < 0.001), there were no differences in blood transfusions, while post‐operative complication rate was higher in Group 1 (P < 0.005). After 1992, in‐hospital mortality was 2.9% in Group 1 and 1.1% in Group 2 (P = N.S.). The 3‐ and 5‐year overall survival was 63.7% and 42.2% in Group 1, and 67.9% and 51% in Group 2 (P < 0.05). The 3‐ and 5‐year disease‐free survival was 49.3% and 27.8% in Group 1, and 58% and 45.6% in Group 2 (P < 0.005). Serum bilirubin level > 1.2 mg/dL, multiple nodules, micro and macrovascular invasion, diaphragm infiltration and blood transfusions independently affected survival in Group 1. Blood replacement was the only negative prognostic factor in Group 2. Independent risk factors for tumour recurrence were satellite nodules and resection performed before 1992 in Group 1, and age < 60 in Group 2.Conclusions : Despite a more aggressive behaviour, HCC without cirrhosis led to better overall and disease‐free survival compared to HCC with cirrhosis after curative liver resection. Age and intra‐operative blood transfusions are the only predictors of outcome in patients without cirrhosis. The impact of the latter on long‐term survival in both our groups outlines the importance of surgical technique on the results of hepatectomies.
Lack of association between transporter associated with antigen processing (TAP) and HLA‐DM gene polymorphisms and antibody levels following measles vaccination
Authors: Dhiman N. , Ovsyannikova I. G. , Pinsky N. A. , Vierkant R. A. , Jacobsen S. J. , Jacobson R. M. , Poland G. A. 
Published: June 2003

SummaryThe transporter associated with antigen processing (TAP) and human leukocyte antigen‐DM (HLA‐DM) genes are involved in the antigen‐processing pathway of both HLA class I and class II‐restricted antigen presentation. We hypothesized that polymorphisms within the TAP and DM genes may influence antibody levels following measles vaccination. We examined TAP and DM polymorphisms in 242 school children from Olmsted County, Minnesota, USA who received one dose of measles‐mumps‐rubella‐II (MMR‐II) vaccine at the age of 15 months. Based on the level of serum measles‐specific immunoglobulin G (IgG) antibodies, subjects were classified as seronegatives (n = 72) or seropositives (n = 170). We determined TAP1 and TAP2 allele types by polymerase chain reaction (PCR) amplification of specific alleles (PASA) and determined DM allele type by PCR amplification followed by direct sequencing of the polymorphic sites. We analysed the data for any TAP or DM allelic association with antibody levels post measles vaccination using the chi‐square test and univariate linear regression analysis. We found no trend in the overall distribution of TAP and DM genotype frequencies between seronegative and seropositive subjects, suggesting that TAP and DM polymorphism and antibody levels following measles vaccination are not directly associated. In addition, we did not find an association between TAP (TAP1, P = 0.71; TAP2, P = 0.87) or DM (DMA, P = 0.42; DMB, P = 0.71) homozygosity and seronegativity to measles vaccine in this study group. Our study suggests that TAP and DM gene polymorphisms do not influence antibody levels post measles vaccination.
Tumour immunology, vaccination and escape strategies
Authors: García‐Lora A. , Algarra I. , Collado A. , Garrido F. 
Published: June 2003

SummaryOur increasing knowledge of the mechanisms by which tumour cells escape immune effector cells is helping to establish new approaches to therapeutic vaccination against tumour development. One of the escape mechanisms used by tumour cells is the generation of multiple variants with different HLA phenotypes. These MHC class I phenotypic alterations play a key role in the tumour–host scenario, as they are crucial molecules for antigen presentation to T cells and modulation of natural killer (NK) cell activity. This review presents evidence indicating that tumours develop sophisticated MHC phenotypes that allow them to escape immune surveillance. We evaluate the importance of these alterations in terms of the potential development of therapeutic approaches to immune vaccination.
Recognition of HLA‐A*0248 in a Chinese donor
Authors: Yang K. L. , Gao X. , Lin P. Y. 
Published: June 2003

SummaryHLA‐A*0248, a rare allele originally found in an individual of Filipino background, was detected in a Chinese donor. We confirmed the novel sequence and analysed its serological reaction pattern. The exon 2 sequence of A*0248 was apparently generated in a gene conversion event with an A2 gene, receiving a sequence segment comprising codons 56 to 74 from an A*24 donor gene. Serological typing showed a clear‐cut A2 reaction pattern, indicating that the three amino acid positions 62, 65 and 74, are probably not a critical part of the A2 epitope. Our typing experience also demonstrated that different typing technologies often complement each other in fine HLA typing.
Genetic variation in the IGSF6 gene and lack of association with inflammatory bowel disease
Authors: King K. , Moody A. , Fisher S. A. , Mirza M. M. , Cuthbert A. P. , Hampe J. , Sutherland‐Craggs A. , Sanderson J. , MacPherson A. J. , Forbes A. , Mansfield J. , Schreiber S. , Lewis C. M. , Mathew C. G. 
Published: June 2003

SummaryThe immunoglobulin superfamily 6 gene (IGSF6) on chromosome 16p11‐p12 has been investigated as a positional and functional candidate for inflammatory bowel disease (IBD) susceptibility. Screening of the six exons of IGSF6 for single nucleotide polymorphisms (SNPs) detected four novel SNPs, and validated three of six SNPs listed in the international SNP database (dbSNP). The seven SNPs in IGSF6 formed five distinct linkage disequilibrium groups. There was no evidence for association of the common SNPs with disease in a large cohort of patients with IBD. The novel SNPs and the linkage disequilibrium map will be a useful resource for the analysis of IGSF6 in other immune disorders.
A new allelic variation within the 5′‐flanking region of the interleukin‐10 gene
Authors: Rieth H. , Assohou A. C. , Mörmann M. , Roupelieva M. , Kremsner P. G. , Kube D. 
Published: June 2003

SummaryAt −2471 bp from the transcriptional start site of the interleukin‐10 (IL‐10) gene, the inverted repeat TG/CA was previously identified and designated IL‐10.IR. In an analysis of samples from 200 Germans (Caucasian) and 286 Gabonese (Central African), three different alleles, IL‐10.IR6, IL‐10.IR7 and IL‐10.IR8, were identified. In the Caucasians, IL‐10.IR6 and IL‐10.IR8 were found only once, in each case with IL‐10.IR7 as the corresponding second allele.
Comparison of TAP2 frequencies in type 1 diabetes patients and healthy controls from three ethnic groups indicates an African origin for the TAP2 G allele
Authors: Hoarau J. J. , Cesari M. , Dieye A. , Kotea N. , Surrun S. K. , Moine A. , Caillens H. , Cadet F. , Pabion M. 
Published: June 2003

SummaryIn order to determine the ethnic origin of the transporter associated with antigen processing 2 (TAP2) G allele, initially discovered by us in a group of type 1 diabetes (insulin‐dependent diabetes mellitus) patients living on Reunion Island, HLA TAP2 typing was performed using the polymerase chain reaction–amplification refractory mutation system (PCR‐ARMS) method in type 1 diabetes patients and unrelated healthy controls of three different ethnic groups (Caucasians, Indians and black Africans from Senegal and Mauritius). The comparison of TAP2 allele frequencies in controls showed significant racial (ethnic) differences. The TAP2*0101 and TAP2 C alleles were increased, respectively, in the Caucasian (50% in Caucasians vs. 40% in other groups) and Senegalese (27% in Senegalese vs. 10% in other groups) populations. In comparison with Caucasians, the TAP2*0201 variant was significantly increased in the Indian population and decreased in the Senegalese black population. In addition, the TAP2 G allele was observed in the two African populations studied but not in the Caucasian or Indian population. This observation is consistent with the view that this allele is restricted to populations of African origin. In addition, we have determined the large extended haplotype DQA1‐DQB1‐DRB1 associated with TAP2 G. We found that this allele is preferentially associated with the large conserved haplotype HLA DQA1*0501‐DQB1*0201‐DRB1*0301.
The distribution of 13 killer‐cell immunoglobulin‐like receptor loci in UK blood donors from three ethnic groups
Authors: Cook M. A. , Moss P. A. H. , Briggs D. C. 
Published: June 2003

SummaryKiller‐cell immunoglobulin‐like receptors (KIRs) can inhibit the killing activity of natural killer (NK) cells if they interact with their ligand, class I HLA. Using a modified polymerase chain reaction–sequence‐specific primers (PCR‐SSP) method for typing KIRs using genomic DNA, we compared KIR frequencies in three ethnic populations drawn from UK blood donors. We found a significantly lower frequency of the inhibitory KIRs KIR2DS1 and 3DS1 in Afro‐Caribbean blood donors. Despite this, there was a (non‐significant) increase in the B haplotype in Afro‐Caribbean and Indian Asian donors. Some donors from each group tested negative for all non‐inhibitory KIRs. In addition, we describe several new KIR profiles. Analysis of linkage disequilibrium was consistent with previously published findings.
The HLA‐DRB, ‐DQB polymorphism and anti‐insulin antibody response in Slovenian patients with type 1 diabetes
Authors: Battelino T. , Uršič‐Bratina N. , Dolžan V. , Stopar‐Obreza M. , Pozzilli P. , Kržišnik C. , Vidan‐Jeras B. 
Published: June 2003

SummaryA combination of specific HLA class II antigens and the presence of type 1 diabetes (T1D)‐related antibodies has a high positive predictive value for T1D but low sensitivity. The aim of the present study was to determine the frequencies of HLA‐DRB‐DQB deduced haplotypes associated with susceptibility and protection in Slovenian patients with established T1D, to evaluate the relationship between the HLA‐DRB1‐QBP‐DQB1 haplotypes and the presence of insulin autoantibodies (IAA) and glutamic acid decarboxylase antibodies (GADA), and to access the possible impact of polymorphic QBP promoters on this relationship. A cohort of 135 patients with T1D (age 17.5 ± 7.0 years, duration of T1D 9.14 ± 6.3 years) was investigated. HLA‐DRB1 and DQB1 alleles were typed using the polymerase chain reaction (PCR)–reverse line blot method. QBP promoter region alleles were determined using PCR–sequence‐specific oligonucleotide hybridization (SSO) and PCR–sequence‐specific primers (SSP). IAA and GADA antibodies were determined by enzyme‐linked immunosorbent assay (ELISA). The chi‐square test with Yates’ correction was used for statistical analysis. Deduced haplotypes DRB1*0301‐DQB1*0201 (P = 0.0001, OR = 3.4), DRB1*0401‐DQB1*0302 (P = 0.0001, OR = 29.8), and DRB1*0402‐DQB1*0302 (P = 0.008, OR = 4.7) were significantly more common, and DRB1*1501‐DQB1*0602 (P = 0.0001, OR = 0.03) significantly less common in the investigated cohort than in a Slovenian control group. The highest risk and the strongest protective HLA‐DR‐DQ haplotypes found in Slovenian patients with T1D did not differ from those found in other Caucasian populations. While the DRB1*0301‐QBP2.1‐DQB1*0201 haplotype, where QBP2.1 did not help to further distinguish DQB1*0201‐possessing haplotypes in IAA‐positive and IAA‐negative patients, was strongly associated with the presence of IAA, the DRB1*0101‐QBP5.12‐DQB1*0501 haplotype, although not protective compared to the control population, was associated with an absence of IAA in the investigated cohort. It is suggested that there may be a combined influence of the QBP5.12 promoter and the DQB1*0501 functional molecule on reduced IAA production.