Our data confirm the presence of oxidative stress and decreased anti-oxidant metabolites in hyperthyroid patients, which are corrected in euthyroidism, without any influence of thyrostatic drugs per se. Nutritional support with antioxidant agents, which are defective during hyperthyroidism, is warranted.

as the best risk predictor of the first variceal bleeding in The aim of this study was to prospectively evaluate the patients with cirrhosis and esophageal varices, and has been usefulness of the Italian Liver Cirrhosis Project (ILCP) validated by independent groups. 9,10 However, its prognostic classification of esophageal varices, together with the efficiency is far from optimal. 11 Studies are in progress in the gastric features of portal hypertension, in predicting the attempt to improve the accuracy of this index in predicting first upper gastrointestinal bleeding in cirrhosis. The aim of this study was to evaluate prospectively the were graded as absent or present, while congestive gasusefulness of the ILCP classification, together with the gastropathy was considered as absent, mild to moderate, or tric signs of portal hypertension, in predicting the first upper severe. All patients were followed until the first upper gastrointestinal bleeding in cirrhotic patients who had not gastrointestinal bleeding and/or death, or for at least 24 received any treatment for esophageal varices. In the same months. No patient received any treatment to prevent group of patients, the efficiency of a new prognostic index bleeding. Sixty-five patients bled from the upper gastro-(PI) in predicting bleeding was also compared with that of intestinal tract during the study. Univariate analysis the NIEC index. tients with hepatocellular carcinoma, detected by ultrasonography and/or raised a-fetoprotein (more than 10 times the upper normal limit), were excluded. Three hundred forty-four patients were enBleeding from esophageal varices is one of the most severe rolled.complications of cirrhosis because it is burdened by a high All patients gave their informed consent to participate in the chance of death.1-4 For this reason, many trials have been study, which was performed according to the Helsinki Declaration.performed to evaluate medical, endoscopic, or surgical proce-The protocol of the study was approved by the Senior Staff Commitdures to prevent bleeding in cirrhotic patients.tee.An association between the endoscopic appearance of variTwo hundred seventeen patients were men and 127 were women.ces and the risk of bleeding was first reported by Beppu et Supported by a grant from the Ministero dell'Università e della Ricerca Scientifica eThe following six parameters were considered in the ILCP classifiTecnologica (MURST), Rome, Italy, Fondi 40%.cation: location, size, occupancy, blue tone, blue extension, and redAddress reprint requests to:

The treatment of non-alcoholic fatty liver disease may be worthwhile to prevent progression to advanced liver failure, but no therapy is definitely evidence-based. Weight loss or lifestyle modifications remain the primary line of intervention, particularly in overweight or obese subjects. In adult non-alcoholic fatty liver disease, they are effective in the short-term, but require a multidisciplinary team approach that is rarely available in liver units. Insulin-sensitizing agents are probably the treatment of choice. They definitely reduce the insulin resistance that promotes steatosis. Several uncontrolled and controlled studies have documented an improvement in liver biochemistry and in histology, but the long-term results remain unsettled. This is an area where significant advances are expected in the next few years.

No abstract

No abstract

BackgroundT follicular helper cells are critical in the formation of autoantibody-producing ectopic germinal centers in seropositive autoimmune diseases and have attracted interest as potential biomarkers of autoimmune disease activity. A further subset with regulatory properties (Tfr) has also been described but, as yet, not well characterized in autoimmune diseases.ObjectivesThe purpose of this study was to (1) determine the frequencies of Tfh in a range of autoimmune diseases by flow cytometry and a new commercially available Tfh epigenetic marker assay, (2) ascertain if Tfr frequencies vary among AI diseases, (3) determine effect of treatment on Tfh/Tfr frequencies in the autoimmune groups.MethodsPatients were recruited from the Rheumatology or Neurology clinics at the Virginia Mason Clinic in Seattle WA. Healthy controls were recruited from the Seattle community. AI samples were selected regardless of length of disease or therapy; healthy control samples were matched with AI samples for age, gender and race. Cryopreserved peripheral blood mononuclear cells (PBMC) from 50 each of systemic lupus erythematosus (SLE), systemic sclerosis (SSc), multiple sclerosis (MS), rheumatoid arthritis (RA) and healthy volunteers (HV) were analyzed by multicolor flow cytometry for Tfh and Tfr frequencies. Tfh frequencies were also analyzed by a PCR-based assay from Epiontis GmbH, Germany. Initial experiments established that results obtained from fresh versus frozen PBMC were not significantly different. Relative frequencies of Tfh and Tfr were compared among disease/control groups, and in relation to disease activity and concurrent therapies – none, DMARDs, depleting (biologics, Cytoxan, MMF)ResultsElevated frequencies of Tfh were seen in SSc, MS and RA compared with healthy controls, but not in SLE. TFh counts by flow cytometry and Epiontis epigenetic assay were significantly correlated within groups and globally. Tfr percentages were increased in RA, SSc and SLE compared with healthy controls, and the ratio of Tfh/Tfr was reduced in SLE compared with the other study groups. Tfh frequencies were positively correlated with inflammation (ESR) in SLE. Depleting therapy reduced Tfh and/or Tfr frequencies in patients with SLE and SSc.ConclusionsA novel epigenetic marker assay to count Tfh proved to be robust and correlated well with flow cytometry counts. This supports the use of the PCR-based epigenetic marker assay as a replacement for multi-color flow cytometry. This would facilitate standardization of Tfh counts in clinical trials and studies where multiple sites are involved. A range of Tfh and Tfr frequencies were observed in the peripheral blood of patients with autoimmunity, but levels were significantly elevated in SSc, MS and RA patients. In SLE patients, Tfh levels correlated with ESR values and may be indicative of ongoing inflammation. Tfh and/or Tfr levels in SLE and SSc may be modulated though the use of biologics or cytotoxic therapies and further longitudinal studies are indicated.Disclosure of InterestNone declared

No abstract

The data are consistent with a decreased reserve capacity of the liver after short-term, high-dose methotrexate. Long-term survivors deserve monitoring of liver function for safer methotrexate use, in the light of progressive dosage increments to improve prognosis in neoplastic diseases.