Results:  CMV DNA was detected in 897% of non-responders and in

Results:  CMV DNA was detected in 89.7% of non-responders and in 34.6% of sustained virological responders. Patients with reactivated Linsitinib CMV had significantly higher fibrosis scores (72.7%) than those with undetectable CMV DNA (23.8%, P = 0.002). Patients

with positive CMV had higher rates of non-response and relapse (79.5%) than those with negative CMV DNA (19%). Chronic HCV patients with latent CMV had higher rates of response (81%) to treatment than those with reactivated CMV (20.5%, P < 0.001). Therefore, HCV patients with reactivated CMV and advanced fibrosis were least likely to achieve a sustained virological response following interferon therapy. This possibility is reduced to 50% of its original value in patients with reactivated CMV without fibrosis. Conclusions:  Besides the staging of liver fibrosis, CMV co-infection should be considered as an extremely important factor when designing predictive models for HCV response to interferon treatment. “
“The jaundiced patient may represent a wide spectrum of disease, from common benign conditions to a number of malignant processes. Differentiating between these conditions can be challenging. In this chapter, three cases have been chosen to demonstrate key issues in the investigation and management of the jaundiced patient. The first case focuses on an unusual presentation

of pancreatic disease, the second looks at choledocholithiasis and its complications, and the final case examines pancreatic cancer. In all cases, the importance of interpreting results of investigations within the clinical context is emphasized. “
“During chronic liver disease, tissue remodeling leads to dramatic changes and

accumulation of matrix components. Matrix metalloproteases MCE and their inhibitors have been involved in the regulation of matrix degradation. However, the role of other proteases remains incompletely defined. We undertook a gene-expression screen of human liver fibrosis samples using a dedicated gene array selected for relevance to protease activities, identifying the ADAMTS1 (A Disintegrin And Metalloproteinase [ADAM] with thrombospondin type 1 motif, 1) gene as an important node of the protease network. Up-regulation of ADAMTS1 in fibrosis was found to be associated with hepatic stellate cell (HSC) activation. ADAMTS1 is synthesized as 110-kDa latent forms and is processed by HSCs to accumulate as 87-kDa mature forms in fibrotic tissues. Structural evidence has suggested that the thrombospondin motif-containing domain from ADAMTS1 may be involved in interactions with, and activation of, the major fibrogenic cytokine, transforming growth factor beta (TGF-β). Indeed, we observed direct interactions between ADAMTS1 and latency-associated peptide-TGF-β (LAP-TGF-β). ADAMTS1 induces TGF-β activation through the interaction of the ADAMTS1 KTFR peptide with the LAP-TGF-β LKSL peptide.

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