Goals and Background-The recently developed histological scoring system for NAFLD by the NASH Clinical Research Network (NASH CRN) is becoming increasingly popular. However, its generalizability to a community setting has not been evaluated. We conducted a study to compare a community general pathologist to an expert hepatopathologist in assessing NAFLD using the NASH CRN scoring system. Study-Forty eight consecutive patients with suspected NAFLD underwent liver biopsy. Histological features of interest such as steatosis, lobular inflammation, balloon degeneration, fibrosis, NAFLD Activity Score (NAS) and the presence of NASH were scored in a blinded fashion by the two pathologists on two separate occasions 3 months apart.Results-The mean (± SD) length of the liver biopsy samples was 25 ± 5 mm. Inter-observer agreement (kappa) between two pathologists was 0.62(0.45-0.80) for steatosis, 0.44(0.23-0.65) for lobular inflammation, 0.25(0.11-0.38) for ballooning, 0.40 for NAS(0.28-0.52) and 0.35 (0.19-0.52) for fibrosis. The two pathologists diagnosed "definite NASH" in a similar proportion of patients (56% vs. 57%), but their inter-observer agreement was only 0.46 (0.24-0.67) as they both diagnosed different levels of NASH (borderline vs. definite) in different subjects. Intraobserver agreement was generally comparable for steatosis, lobular inflammation, NAS and diagnosis of NASH, but not for fibrosis.Conclusions-Clinically important differences exist between community general pathologist and expert hepatopathologist in assessing NAFLD using the NASH CRN scoring system. More studies are needed to investigate its suitability for community-based clinical practice.
BACKGROUND
Randomized controlled trials (RCTs) comparing PEG vs. NaP are inconsistent.
OBJECTIVE
Compare the efficacy of and tolerance to PEG vs. NaP for bowel preparation.
METHODS
We used MEDLINE and EMBASE to identify English-language RCTs published between 1990 and 2008 comparing 4 L PEG with two 45 ml doses of NaP in adults undergoing elective colonoscopy. We calculated the pooled odds ratios (ORs) for preparation quality and proportion of subjects completing the preparation.
RESULTS
From 18 trials (n=2792), subjects receiving NaP were more likely to have an excellent or good quality preparation than those receiving PEG (82% vs. 77%; OR=1.43; 95% CI, 1.01-2.00). Among a subgroup of 10 trials in which prep quality was reported in greater detail, there were no differences in the proportions of excellent, good, fair or poor preparation quality. Among nine trials that assessed preparation completion rates, patients receiving NaP were more likely to complete the preparation than patients receiving 4-L PEG (3.9% vs. 9.8%, respectively, did not complete the preparation; OR= 0.40; CI, 0.17-0.88).
CONCLUSION
Among 18 head-to-head RCTs of NaP vs. 4 L PEG, NaP was more likely to be completed and to result in an excellent or good quality preparation.
BackgroundResults of meta-analyses of randomized trials comparing PEG and NaP are inconsistent and have not included trials comparing either or both preps to less traditional ones.AIM: To perform a meta-analysis by treatment arm.MethodsUsing MEDLINE and EMBASE, we identified English-language trials published from 1990 to 2008 that included PEG and/or NaP, and aggregated them by treatment arm into: 4 liter (L) PEG; 2 L PEG; split-dose PEG; two 45 ml doses of NaP +/- adjunctive medication; and NaP tablets. We compared prep quality and the proportion completing the prep.ResultsAmong 71 trials (patient N = 10,201), excellent prep quality was present in 34% (CI, 26-41%) for 4 L PEG alone; 39% (CI, 26-51%) for 2 L PEG; 37% (CI, 28-46%) for split-dose PEG; 42% (CI, 33-51%) for NaP solution; 44% (CI, 38-51%) for NaP with adjunctive meds; and 58% (CI, 49-67%) for NaP tablets. Patients receiving NaP were more likely to complete the prep (97% [CI, 96-98%] vs. 90% [CI, 87-92%] for 4L PEG alone); however, completion rates for 2L PEG (98%) and split dose PEG (95%) were similar to NaP.ConclusionsNaP tablets resulted in better prep quality and higher completion rates compared to other regimens. In comparisons limited by sample size, split dose PEG was not statistically different from NaP solution for completion rate or prep quality.
Introduction
Oxidative stress plays an important role in the pathogenesis of many liver diseases. Investigators often measure markers of oxidative stress in peripheral veins as a reflection of hepatic oxidative stress as it is not always feasible to measure oxidative stress in liver tissue. However, it is unknown whether markers of oxidative stress measured from peripheral sites accurately reflect hepatic tissue oxidative stress. The aim of this study is to examine the relationship of oxidative stress marker among hepatic tissue, hepatic and peripheral veins and urine.
Methods
Malondialdehyde (MDA), a marker of oxidative stress was measured in hepatic vein, peripheral vein and urine samples from 26 consecutive patients undergoing transjugular liver procedures. In 19 patients undergoing liver biopsies, we measured MDA by immunohistochemical staining of paraffin-embedded liver tissue.
Results
Peripheral venous MDA levels showed significant correlation with hepatic venous MDA levels (r = 0.62, P = 0.02), but they did not correlate with hepatic tissue MDA content (r = 0.22, P = 0.4). Hepatic venous MDA levels did not correlate with hepatic tissue MDA content (r = −0.01, P = 0.9). Subgroup analysis of patients without portal hypertension showed a positive correlation between hepatic venous and hepatic tissue MDA levels, but this was not statistically significant (r = 0.45, P = 0.22). Urinary MDA did not correlate with MDA from any other sampling location.
Conclusion
Oxidative stress measured from the peripheral venous samples is poorly reflective of hepatic tissue oxidative stress. Hepatic venous sampling might be suitable for assessing hepatic tissue oxidative stress in patients without portal hypertension, but a larger study is needed to examine this possibility.
Patients with high-risk findings on index and first surveillance colonoscopies require close surveillance. Those with low-risk findings on index colonoscopy and normal/non-advanced findings on the first surveillance colonoscopy have low subsequent risk of ACN. These and previous data may be useful for generating recommendations for the timing of the second surveillance colonoscopy.
This study suggests that patients with TIPS are potentially at increased risk for abnormal QT prolongation when exposed to oral CYP 3A substrates with QT prolonging effect.
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