Compared with KOH preparation or fungal culture, PCR-REBA has higher sensitivity and specificity. Therefore, PCR-REBA could be a useful method in clinical settings because it can identify species quickly and accurately, and can also determine the existence of pathogens.
Background Increased prevalence of nonalcoholic fatty liver disease (NAFLD) and inflammatory bowel disease (IBD) has been reported; however, the effects of NAFLD on the outcome of IBD remains unclear. We investigated whether the presence of NAFLD could influence the outcomes of patients with IBD. Methods We recruited 3,356 eligible patients with IBD into our study between November 2005 and November 2020. Hepatic steatosis and fibrosis were diagnosed using hepatic steatosis index (HSI) of ≥30 and fibrosis-4 (FIB-4) of ≥1.45, respectively. Primary outcome was clinical relapse, defined based on the following: IBD-related admission, surgery, or first use of corticosteroids, immunomodulators, or biologics agents for IBD. Results Prevalence of NAFLD in patients with IBD was 16.7%. Patients with hepatic steatosis and advanced fibrosis were older, had a higher body mass index, and were more likely to have diabetes (all p<0.05). Multivariate cox regression analysis revealed that hepatic steatosis was independently associated with an increased risk of relapse in patients with ulcerative colitis (UC) (hazard ratio [HR] 1.697, 95% confidence interval [CI] 1.291-2.230; p<0.001) and Crohn’s disease (CD) (HR 1.536, 95% CI 1.130-2.087; p=0.006). Advanced liver fibrosis was not associated with an increased risk of clinical relapse in patients with UC or CD (all p>0.05). Conclusion Hepatic steatosis was independently associated with increased risks of clinical relapse in patients with UC and CD, whereas fibrotic burden in the liver was not. Future studies should investigate whether the assessment and therapeutic intervention of NAFLD will improve clinical outcomes of patients with IBD.
Introduction SPRINT showed that intensive control of systolic blood pressure (SBP) <120mmHg was beneficial when compared to the standard treatment (SBP <140mmHg). In contrast, ACCORD-BP trial failed to prove the benefit of intensive SBP lowering in diabetic patients. J-curve phenomenon might be the key to help understanding the different results of two trials. Methods SPRINT and ACCORD-BP databases were obtained via BioLINCC. Since BP changes along with the time, timing at which BP became stable after treatment were chosen at 9 months for SPRINT and 1 year for ACCORD BP. The final analytic datasets consisted of 8,787 and 4,306 event-free patients at the time of stable BP, respectively. Clinical events were defined at the primary composite endpoint for each trial. The effects of BP on clinical events were modeled using natural cubic splines in Cox regression models. Degrees of freedom of splines curves were chosen using Akaike Information Criterion. Results Analyzing SPRINT database, the spline-based hazard ratio (HR) curve showed a J-curve, which means lowering DBP below 77mmHg could be harmful, while SBP had a linear relationship (HR 1.13 per 10mmHg increase, 95% confidence interval [CI] 1.06∼1.20, p<0.0001; Figure). In ACCORD-BP trial, no J-curve phenomenon was observed. The effect of SBP was linear and almost the same to the result of SPRINT with HR 1.13 (95% CI 1.06∼1.20, p=0.0003). The relationship between DBP and clinical events was non-significant with a negative trend, which means the lower, the worse (HR 0.91, 95% CI 0.82∼1.01 p=0.071). Conclusions Despite the different results regarding the benefit of intensive BP control, the effects of SBP on clinical events were quite similar in SPRINT and ACCORD-BP trial. Instead,differences existed in the relationships between DBP and clinical events. Understanding the meaning of different patterns of relationships including J-curve might be the key to determine the optimal BP control.
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