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Tag: edelweiss financial services
Edelweiss Financial Services allots 12,14,863 equity shares
Edelweiss Financial Services said that it has allotted 12,14,863 equity shares under Edelweiss Employee Stock Option Scheme(s) of the Company.
"The Share Allotment Committee has today allotted 12,14,863 Equity Shares of the face value of Re. 1/- each under Edelweiss Employee Stock Option Scheme(s) of the Company," the company said in a filing to the Bombay Stock Exchange.
Meanwhile, shares of the company were trading at Rs 249.90 apiece, down 2.08 per cent from the previous close at 12:50 hours on BSE.
edelweiss financial services
Edelweiss completes acquisition of JPMorgan's onshore fund schemes
Edelweiss, one of India's leading diversified financial services company, on Monday said that its wholly owned subsidiary Edelweiss Asset Management Company has completed the acquisition of the onshore fund schemes managed by JPMorgan Asset Management India.
"Edelweiss Asset Management Company Limited, a wholly owned subsidiary of the company, has, on November 25, 2016, after obtaining the necessary regulatory approvals, completed the acquisition of the onshore fund schemes managed by JPMorgan Asset Management India Private Limited including its India based onshore mutual fund business and the international fund of funds," said Edelweiss Financial Services in a filing to the Bombay Stock Exchange.
Meanwhile, shares of the company settled at Rs 99.80 apiece, up 5.55 per cent, from previous close on BSE.
Edelweiss Financial Q1 net zooms 53% to Rs 139 cr
Edelweiss Financial Services has today reported a rise of 53 per cent in its consolidated net profit at Rs 139.68 crore for the first quarter ended June 30, 2016.
The company had registered a consolidated net profit of Rs 91.28 crore in the corresponding quarter of 2015-16, the company said in a filing to the Bombay Stock Exchange.
"Total income of the company during the quarter surged 27 per cent to Rs 1,472.18 crore for the quarter ended June 2016 as against Rs 1,158.78 crore in the same period a year ago.
Commenting on the performance, Edelweiss Financial Services Limited, Chairman and CEO, Rashesh Shah said, "Q1FY17 saw market sentiments improving led by optimism around the gradual return of growth. Furthermore, the Asset Quality Review process started by RBI is very positive for the economy and marks the beginning of the end of the NPA issue. Recoveries, revival, resolution all these are important aspects of that. As leaders in Asset Reconstruction business, our focus is not only in aggregating assets and finding financial restructuring plan, but also in resolving and reviving businesses."
Equitas Holdings IPO subscribed 9 pct on Day 1
The IPO of Equitas Holdings, the first initial public offering in the current fiscal, was subscribed 9 per cent in the first day of the offer yesterday, reported PTI.
The Rs 2,200 crore-IPO, received bids for 1,21,44,600 shares, as against the total issue size of 13,91,91,802 shares, according to data available with the NSE.
Retail investors portion was subscribed 17 per cent.
Equitas has raised Rs 652 crore from anchor investors.
Equitas Holdings, with a licence for a small finance bank, has fixed the price band at Rs 109-110 per share. The initial share sale programme will close on April 7.
Equitas' IPO comprises fresh issue of shares aggregating Rs 720 crore and an offer for sale of up to 132,425,884 equity shares by existing shareholders, including P N Vasudevan, MD, and private equity stakeholders.
The IPO will bring down the company's foreign holding from the present 93 per cent to 35 per cent.
As per the norms, foreign shareholding should be below 49 per cent to operate as a small finance bank.
Axis Capital, ICICI Securities, HSBC and Edelweiss Financial Services are managing the company's IPO.
equitas holdings


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Home > Community > 'It is the truth:' 16th annual Shootout celebrates Seminole victory
'It is the truth:' 16th annual Shootout celebrates Seminole victory
by Eileen Soler - April 2, 2013 April 9, 2015
BIG CYPRESS — Duane "Handlebar" Decker was given important instructions before heading into a field dressed in 1837 militia garb to reenact a bloody United States versus Seminole battle at the Big Cypress Reservation.
"They told me to go out there, act like I'm scared and make sure I die," said Decker, of Apopka, playing the U.S. side at the 16th annual Big Cypress Shootout – Second Seminole War Reenactment.
Die, indeed. It's a matter of historic accuracy.
The March 1-3 event – with authentic U.S. and Native American camps, weaponry, clothing and the battle reenactment – had to conclude correctly, said Moses Jumper Jr., on horseback as a Seminole warrior.
"What you will see is not John Wayne killing hundreds of Indians and then riding off in victory. This is our story and it is the truth," Jumper said to hundreds gathered on a grassy hill overlooking the battlefield. "We are the Unconquered."
Flanked by his son, Moses Jumper III, and grandson, Andre Jumper, 18, Jumper rode into battle as Abiaka, the great medicine man and war chief the Americans named Sam Jones.
"We came this far south in the River of Grass. We were pursued by the United States and told we were not allowed to stay. But we did not go to the Trail of Tears. We stayed and we fought until the last blood was spilled," Jumper said.
Fighting alongside the Seminoles were African-American freed and escaped slaves who had assimilated into Native American ways. Jumper called them "our black brothers."
Gunfire and cannon blasts filled the air with booms and smoke. Americans, as an expeditionary force complete with land surveyors, were shot down in one of many skirmishes that would lead to Seminole freedom.
About 1,500 Boy Scouts and Girl Scouts, plus troop leaders and families, packed the spectator area. History buffs and photographers jostled for better views. Many in the crowd had camped out on the reservation for the three-day event.
Mike Law, of Lake Worth, attended with his wife, Kathy, son, Alex, 6, and daughter, Elisabeth, 2. For the Law family, the event was about education.
"We had a good idea of how the reenactment would end. Getting to see our history happen is getting to know our country a little better," Law said.
For Mark Lynch, of Miami, it was a powerful reminder.
"The Indian people were screwed over by the government. They took the brunt of racism with the biggest screwing in the world – at least in the United States," he said.
Jumper said the land on which the battle was relived was the site of an actual skirmish led by Abiaka.
Because the Seminoles' knowledge of the land gave them an advantage, their guerrilla tactics in conflicts often led to U.S. defeat, said Jacob "Jake" Osceola, head of operations at Billie Swamp Safari and an organizer of the Big Cypress Shootout.
"Sometimes we would do an ambush to get supplies and shot (guns and ammunition). We had to because very few people would trade with us and we had to protect our land," he said.
At the end of each of three battles, the U.S. and Seminole reenactors lined up for a gunfire salute to veterans of all wars and U.S. troops serving now.
Thousands streamed through the historical encampments where reenactors showcased battlefield life in the 1830s using authentic tents, uniforms, animal hides and Army equipment.
Decker said nearly 100 turned out to relive the U.S. side. Some were members of the 11th Tennessee Brigade and the Sons of Confederate Veterans Camp 2150. On the Native American side, Seminole Tribal members and people from all over Indian Country participated in the reenactment.
Paul Morrison, as the historical Swamp Owl, said he is descended from the Mohawk Tribe and the Mayflower. His third great-grandfather was Hiawatha, co-founder of the Iroquois confederacy, he said.
"I've been doing this for 15 years to bring history to life so you can see it, hear it, smell it, taste it," Morrison said.
Gaha Halftown, a Seneca from Niagara Falls in Canada, said he tries to attend the Shootout as often as possible. This year, about 20 Seneca Tribal members participated.
A section for craft vendors showed off rustic period leather, wood and jewelry. Hands-on activities included archery, tomahawk tossing and mock archaeological digs.
Sharon Downs, of Cherokee descent, said she brought sons Gehjoway Quincy Humes, 7, and Magua Tyler Humes, 13, to learn more about traditional ways. Downs said her great-grandparents let traditions slip because they feared the government.
"We were told about our heritage but we kept it a secret," Downs said. "Now we learn as much as we can with our children, even moccasin and drum making, so that it can be passed down."
Stomp dancing, led by Traditional Arts and Outreach coordinator Pedro Zepeda, was performed for the crowd. Later, more than 50 from the audience held hands with Tribal members in the Friendship Dance.
Necho Logan, 10, of Fort Myers Cub Scout Pack 761, said the "coolest" discovery for him was learning the difference between a crocodile and an alligator, both displayed at a live animal exhibit. But the "most important" realization for Necho, of Cherokee lineage, came as he watched the Shootout.
"Back then the people had to work together to keep their land," he said. "I think I will always remember that when we work together, we can accomplish anything."
Cattlewomen forge ahead, organized and determined
Brighton Field Day at 75: From simple beginnings, a 'diamond' emerges

redpajama_set_name: RedPajamaCommonCrawl


text:
namespace printing {

// Maps a paper vendor ID to a localized name; returns the localized
// name if any is found, else returns an empty string.
std::string LocalizePaperDisplayName(const std::string& vendor_id);

}  // namespace printing

#endif  // CHROME_COMMON_PRINTING_PRINT_MEDIA_L10N_H_

redpajama_set_name: RedPajamaGithub


HFS provided technical consulting and quality assurance for the construction of Fort Hood's Carl R. Darnall Army Medical Center. Our Quality Assurance Representatives ensured optimal integration and compliance with regulatory and procedural requirements relating to equipment, storage of material, and methods of contract performance. Additionally, we prepared a jobsite safety report to ensure OSHA compliance.


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The 1953 season was FC Steaua București's 6th season since its founding in 1947.

Friendly matches

Divizia A

League table

Results

Source:

Cupa României

Results

See also

 1953 Cupa României
 1953 Divizia A

Notes and references

External links
 1953 FC Steaua București Divizia A matches

FC Steaua București seasons
1953–54 in Romanian football
1952–53 in Romanian football
Steaua, București
Steaua, București
Steaua
Steaua
Romanian football championship-winning seasons

redpajama_set_name: RedPajamaWikipedia


New print issues of Black Static, Interzone, and Dreams & Nightmares, plus November issues and posts at Beneath Ceaseless Skies, Daily SF, Strange Horizons, and Tor.com.
• Issue 265, posted November 22, has stories by T.S. McAdams and Dan Micklethwaite, plus an archive story by Caroline M. Yoachim.
• Issue 264, posted November 8, has stories by Margaret Ronald and Jordan Kurella, plus an archive story by A. Merc Rustad.
• Stories in this issue are by Ralph Robert Moore, Steven Sheil, Joanna Parypinski, Giselle Leeb, and Nicholas Kaufmann.
• Flash and short shorts posted in November are by Sandra McDonald, Christie Yant, Nina Kiriki Hoffman, Cat Rambo, Andrew James Dykstal, and others.
• This issue has poetry by Chris Friend, Neal Wilgus, Robert Frazier, Robert Borski, Ruth Berman, Deborah P Kolodji, and others.
• This issue has fiction by Tim Lees, Fiona Moore, Louise Hughes, Eliza Ruslander, Sheldon J. Pacotti, and Natalia Theodoridou.
• Features include an editorial by Tim Lees, columns by Andy Hedgecock and Aliya Whiteley, David Langford's "Ansible Link" news and obits, a book review section with an interview with Aliya Whiteley, and film reviews by Nick Lowe.
• Issue 5 November has fiction by Debbie Urbanski, poetry by R. Mac Jones, and reviews.
• Issue 12 November has fiction by Alena Flick, poetry by Lynne Sargent, and reviews.
• Issue 19 November has fiction by Chimedum Ohaegbu, poetry by Meg Smith, and reviews.
• Issue 26 November has poetry by A.M. Fals, a Scores column by John Clute, an article about Ursula K. Le Guin by Mazin Saleem, and reviews.
• Original fiction posted in November is by Ruthanna Emrys.
• Recent excerpts are by Jenn Lyons, David Weber, R.A. Salvatore, and others.


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Nokia's most trusty handset, the 3310, to return marking the brand's return to its roots
By John McCarthy-15 February 2017 11:06am
The sturdy Nokia 3110 has achieve meme status
The sturdy brick of the fallen Nokia empire, the trusty 3310 handset, could be making a return to market seventeen years after its initial launch.
Known for a lasting battery putting modern handsets to shame and a powerful frame that made cosmetic damage almost impossible, the phone could be making a return with an announcement at MWC in Barcelona.
The dumb phone still holds the record for bestselling phone, at 126m unit sales over a sustained period of five years from 2000. Now, Nokia appears to have licensed out the model to manufacturer HMD Oy Global, a Finnish manufacturer taking the place of the company's devices wing which was sold to Microsoft in 2014.
Wayne Guthrie, co-founder of innovation consultancy Fearlessly Frank, said: "I think it's a great idea and at the right time. Launching something that is like an old friend without any of the addictive traits of smartphones is a great idea. Sign me up! I can see the poster, huge headline on it that says 'Hello, old friend. We used to be so good together'.
"In an age of rising anxiety, due in no small way to smartphone usage – reintroducing a product that is for many people a reassuring old friend,with outstanding battery life to boot, is probably a very good idea. A marketing intervention that could amount to more of a meaningful social intervention if handled well."
He concluded: "Timing, of course, is everything, and it's only recently that we have clocked up enough experience with mobile and the always-on access to the internet in order to start to become conscious, en masse, of the consequences. Therefore it is ripe for a brand to be looking for ways to compensate and balance a new way of living, with what we have known and been comfortable with for over a century."
The returning model will cost a reported €59.
VentureBeat broke the news first.
This article is about: World, Nokia, Mobile, Smartphone, Digital, Mobile, Technology, Brand


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How Did Surfing Begin?
The exact origin of surfing is unknown, but by 400 A.D., people were surfing in Hawaii. The Hawaiian islands are often credited as the birthplace of surfing, although the sport was likely enjoyed in other parts of the world, which were less accessible to explorers. Nevertheless, the lineage of surfing can be traced from the coasts of Hawaii to the worldwide phenomenon that it is today. The British Explorer, Captain James Cook, noted seeing Hawaiian surfers in the 1770s. In 1821, German and Scottish missionaries arrived on the islands. They discouraged the sport, which resulted in it virtually dying out. However, at the start of the 20th century, surfing experienced a great revival, which may have been partly in protest to the overthrow of the Hawaiian Kingdom ~ a surprising political association with the sport. In the early 1900s surfing spread to California, Australia and Britain. The Olympic medalist, Duke Kahanamoku, known as the 'Ambassador of Aloha' is recognized for introducing modern surfing to the world. He even taught Edward Prince of Wales to surf in the 1920s. The American surfing movies of the 1960s showcased the sport as mainstream and, more importantly, 'cool'. More than 1600 years old, surfing is still wildly popular today.
Rajesh Shri answered
It is presumed that surfing was invented by people living in the Pacific islands who are known as Polynesians; according to recent archeological evidence surfing like activities were also enjoyed by people living on the South American coast especially in Peru where the Inca civilization came up.
However it is widely assumed that surfing as a form of entertainment developed in the Pacific islands like Hawaii and Tahiti; there are records of the famous British explorer Captain James Cook sighting the natives in the Polynesian islands floating on the water riding wooden boards in 1778.
Surfing spread to Australia and New Zealand in the chiefly due to Duke Kahanamoku the famous Olympic swimming champion from Hawaii who is credited with popularizing surfing in Australia and the United States. Surfing became popular as a form of entertainment that could be enjoyed by all after the invention of a light weight fiber glass surfboard in the 1950s that was easy to maneuver.
It didnt start in Hawaii it started in Polynesia (near Hawaii ).
Chips Ters answered
If I'm not mistaken, in 1967 some man created a prototype of a sailboard. The whole world became interested in these at one time and more and more often you could see people with boards on the beaches. It's a very exciting and even extreme sport. Engaging in it you will feel a burst of energy every time, because this sport is very much invigorating for you. You can look at windsurfing boards at https://easy-surfshop.com/do/cat/windsurfing-boards/Windsurf-Boards and maybe choose one that you like and on which you will practice. I hope I have helped you with my answer!
Some believe hawaii but I have recently found out it may be peru
Oh my god, why didnt you google it? You people are stupid.
Surfing smells. Skate for life.
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The first circuses were quite different from the ones we are all familiar with. It is very surprised...
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The ancient Egyptians were the first to measure a year with any exactness. They knew that the best time...
When Did Smoking Begin?
The first people to cultivate tobacco—and smoke it—were the Indians of North and South America.When...
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For millions of years, nature has provided man with an abundance of clean water, air and land. The way...
How Did Trial By A Jury Begin?
To us, the right to a trial by jury is one of man's most sacred and natural rights. But it took man a...
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No. In fact the launch of Sputnik by the USSR urged the United States to establish the ARPA or the Advanced...
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Can pregnant women risk their baby's life by not having a healthy and balanced diet? Is a healthy diet essential for a pregnant woman?
How should I go about drawing attention to what I write on Blurtit using Google+?
What happens to someone's online social media profiles and content when they die? What have internet companies done to combat this inevitable problem?
How short it to short for shorts?
What Color Lingerie Do You Think Is Sexy? This Includes To Look At Someone In, Or To Wear .
Why doesn't my boyfriend ever text me back? We are both thirteen so I know he isn't having sex or anything like that. My brother is usually with him because they are friends and he lives across the street from me. Does anyone have any advice?


A man was found lying on Carlls Straight Path, near Villadom Court in Dix Hills.
Dix Hills, NY - November 13, 2013 - Suffolk County Police Second Squad detectives are investigating the circumstances in which a bicyclist was found lying on the road seriously injured in Dix Hills this afternoon.
A motorist was travelling southbound on Carlls Straight Path, near Villadom Court, when she observed a man lying in the roadway at approximately 1:20 p.m. There was a bicycle next to the victim who was semi-conscious and had an apparent head injury.
The victim, Paul Rovelli, 69, of 21 Greenmeadow Court, Deer Park, apparently had been riding a bicycle and was wearing a helmet at the time of the incident. He was transported to Huntington Hospital where he was listed in serious condition. Due to the nature of his injuries, Rovelli has been unable to provide detectives with any information regarding the incident.
The bicycle was impounded and the investigation is continuing. Anyone who may have witnessed the incident is asked to contact Second Squad detectives at 631-854-8252 or call anonymously to Crime Stoppers at 1-800-220-TIPS.
Subject: LongIsland.com - Your Name sent you Article details of "Man With Serious Head Injuries Found in Roadway"


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Alaish, Ram
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
Lundgren, David
Suhr, Ole B.
Werner, Mårten
Karling, Pontus
Safety of azathioprine and 6-mercaptopurine in patients with inflammatory bowel disease naive to thiopurine treatment2017Ingår i: International journal of clinical pharmacology and therapeutics, ISSN 0946-1965, Vol. 55, nr 7, s. 594-600Artikel i tidskrift (Refereegranskat)
Objectives: To determine if 6-mercaptopurine (MP) is better tolerated than azathioprine (AZA) as the initial thiopurine treatment in patients suffering from inflammatory bowel disease (IBD). Switching patients with IBD from AZA to MP is advocated in patients intolerant to AZA. However, no study has determined if MP is more suited than AZA as a first-line treatment for patients who are naive to thiopurine treatment. Study: The tolerance of AZA and MP treatments in clinical practice was retrospectively evaluated from start to 12 months after initiating treatment in 113 patients with IBD who were all naive to thiopurines (82 patients treated with AZA and 31 patients with MP). Results: 65% of the patients treated with AZA and 61% of the patients treated with MP tolerated their treatment during 12 months (i.e., no group difference, p = 0.742). No difference in reported side effects between the two treatments was observed. The mean equivalent initial dose (0.92 vs. 0.61 mg/kg; p < 0.001) and the mean equivalent dose at 12 months (1.98 vs. 1.65 mg/kg; p = 0.014) was significantly higher in the MP group vs. the AZA group. The proportion of patients with.MCV = 7 at 12 months was numerically higher in the MP group than in the AZA group (53% vs. 31%; p = 0.090). Conclusions: In this retrospective observational study, no differences in tolerance or adherence between AZA and MP were observed in patients naive to thiopurines. However, MP treatment was at a higher equivalent thiopurine dose than AZA treatment, which tended to be associated with better treatment response.
Förlagets fulltext
2. Baumeister, Sebastian E.
Schlesinger, Sabrina
Jochem, Carmen
Fournier, Agnes
Kaaks, Rudolf
Trichopoulou, Antonia
Bamia, Christina
La Vecchia, Carlo
Masala, Giovanna
Fasanelli, Francesca
Tumino, Rosario
Grioni, Sara
de Mesquita, Bas Bueno
Vermeulen, Roel
May, Anne M.
Borch, Kristin B.
Oyeyemi, Sunday O.
Ardanaz, Eva
Chirlaque Lopez, Maria Dolores
Felez-Nobrega, Mireia
Sonestedt, Emily
Ohlsson, Bodil
Hemmingsson, Oskar
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
Perez-Cornago, Aurora
Ferrari, Pietro
Stepien, Magdalena
Ward, Heather
Leitzmann, Michael F.
Association between physical activity and risk of hepatobiliary cancers: A multinational cohort study2019Ingår i: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 70, nr 5, s. 885-892Artikel i tidskrift (Refereegranskat)
Background & Aims: To date, evidence on the association between physical activity and risk of hepatobiliary cancers has been inconclusive. We examined this association in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC).
Methods: We identified 275 hepatocellular carcinoma (HCC) cases, 93 intrahepatic bile duct cancers (IHBCs), and 164 non-gallbladder extrahepatic bile duct cancers (NGBCs) among 467,336 EPIC participants (median follow-up 14.9 years). We estimated cause-specific hazard ratios (HRs) for total physical activity and vigorous physical activity and performed mediation analysis and secondary analyses to assess robustness to confounding (e.g. due to hepatitis virus infection).
Results: In the EPIC cohort, the multivariable-adjusted HR of HCC was 0.55 (95% CI 0.38–0.80) comparing active and inactive individuals. Regarding vigorous physical activity, for those reporting >2 hours/week compared to those with no vigorous activity, the HR for HCC was 0.50 (95% CI 0.33–0.76). Estimates were similar in sensitivity analyses for confounding. Total and vigorous physical activity were unrelated to IHBC and NGBC. In mediation analysis, waist circumference explained about 40% and body mass index 30% of the overall association of total physical activity and HCC.
Conclusions: These findings suggest an inverse association between physical activity and risk of HCC, which is potentially mediated by obesity.
Lay summary: In a pan-European study of 467,336 men and women, we found that physical activity is associated with a reduced risk of developing liver cancers over the next decade. This risk was independent of other liver cancer risk factors, and did not vary by age, gender, smoking status, body weight, and alcohol consumption.
Danielsson Borssen, Åsa
Lindgren, S
Bergquist, A
Almer, S
Sangfelt, P
Risk for hepatocellular carcinoma in autoimmune hepatitis: is there an indication for surveillance?2013Ingår i: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 58, nr Suppl. 1, s. S382-S383Artikel i tidskrift (Refereegranskat)
Danielsson Borssén, Åsa
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Departments of Medicine, Sections for Hepatology and Gastroenterology, Umeå University Hospital, Umeå, Sweden.
Almer, Sven
Prytz, Hanne
Wallerstedt, Sven
Friis-Liby, Inga-Lill
Nyhlin, Nils
Hultcrantz, Rolf
Sangfelt, Per
Weiland, Ola
Lindgren, Stefan
Verbaan, Hans
Hepatocellular and extrahepatic cancer in patients with autoimmune hepatitis: a long-term follow-up study in 634 Swedish patients2015Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, nr 2, s. 217-223Artikel i tidskrift (Refereegranskat)
Objectives. Cirrhosis is a well-known risk factor for hepatocellular cancer, but the true risk in autoimmune hepatitis (AIH) is scarcely studied. Other cancers may arise after prolonged use of immune-modulating drugs. The aim of this study was to investigate the cancer risk in a large cohort of AIH patients.
Material and methods. Six hundred and thirty-four Swedish patients in a well-defined cohort were matched to the Cause of Death Registry and the Cancer Registry. Standard incidence ratios were calculated by relating the incidences in the cohort to an age-matched material from the Swedish background population.
Results. A higher overall incidence of malignancies than the background population was found, counting from the date of diagnosis (standard incidence ratio (SIR) 2.08, 95% CI 1.68-2.55). The highest risk was found for hepatocellular carcinoma (HCC). We found 10 cases (4.0%) in 248 patients with cirrhosis, which gives an incidence rate of 0.3%. Standard incidence ratio for developing hepatobiliary cancer was 54.55 (95% CI 19.92-99.99). HCC only occurred in cirrhotic patients. There was also an increased risk for non-melanoma skin cancer (SIR 9.87, 95% CI 6.26-14.81).
Conclusion. A slightly enhanced risk for malignancies in general compared to the background population was found. The risk of hepatobiliary cancer was increased, but the annual risk over the observational period was well under the postulated 1.5% when surveillance in cirrhotic patients is considered to be cost-effective.
Rorsman, Fredrik
Kechagias, Stergios
Nilsson, Emma
Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis2017Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 9, s. 1022-1028Artikel i tidskrift (Refereegranskat)
Background: Epidemiological studies of autoimmune hepatitis (AIH) show varying figures on prevalence and incidence, and data on the long-term prognosis are scarce.
Objective To investigate the epidemiology, long-term prognosis and causes of death in a Swedish AIH cohort.
Material and methods: Data collected from 634 AIH patients were matched to the Cause of Death Registry, and survival analyses were made. Prevalence and incidence were calculated for university hospitals with full coverage of cases and compared to the County of Vasterbotten in Northern Sweden.
Results: AIH point prevalence was 17.3/100,000 inhabitants in 2009, and the yearly incidence 1990-2009 was 1.2/100,000 inhabitants and year. The time between diagnosis and end of follow-up, liver transplantation or death was in median 11.3 years (range 0-51.5 years). Men were diagnosed earlier (p<.001) and died younger than women (p=.002). No gender differences were found concerning transplant-free, overall survival and liver-related death. Cirrhosis at diagnosis was linked to an inferior survival (p<.001). Liver-related death was the most common cause of death (32.7%). The relative survival started to diverge from the general population 4 years after diagnosis but a distinct decline was not observed until after more than 10 years.
Conclusions: Long-term survival was reduced in patients with AIH. No gender difference regarding prognosis was seen but men died younger, probably as a result of earlier onset of disease. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg.
Department of Medicine, Section of Hepatology and Gastroenterology, Karolinska Institutet, Karolinska University Hospital Huddinge.
Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University.
Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge.
Department of Gastroenterology and Hepatology, Department of Medical and Health Sciences, Linköping University.
Department of Gastroenterology, Faculty of Medicine and Health, Örebro University.
Gastroenterology Division, Department of Clinical Sciences, Lund University, University Hospital Skane.
Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitisManuskript (preprint) (Övrigt vetenskapligt)
Background Epidemiological studies of autoimmune hepatitis (AIH) show varying figures on prevalence and incidence, and data on the long-term prognosis are scarce.
Material and methods Data collected from 634 AIH patients were matched to the Cause of Death Registry, and survival analyses were made. Prevalence and incidence were calculated for University Hospitals with full coverage of cases and compared to the County of Västerbotten in Northern Sweden.
Results AIH point prevalence was 17.3/100 000 inhabitants in 2009, and the yearly incidence 1990-2009 was 1.2/100 000 inhabitants and year. The time between diagnosis and end of follow-up, liver transplantation or death was in median 11.3 years (range 0-51.5 years). Men were diagnosed earlier (p<0.001) and died younger than women (p=0.002). No gender differences were found concerning transplant-free, overall survival and liver-related death. Cirrhosis at diagnosis was linked to an inferior survival (p<0.001). Liver-related death was the most common cause of death (32.7%). The relative survival started to diverge from the general population 4 years after diagnosis but a distinct decline was not observed until after more than 10 years.
Conclusions Long-term survival was reduced in patients with AIH. No gender difference regarding prognosis was seen but men died younger, probably as a result of earlier onset of disease. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased.
Palmqvist, Richard
Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
Department of Medicine, Section of Hepatology and Gastroenterology, Karolinska Institutet.
Division of Infectious Diseases, Department of Medicine, Karolinska Institutet.
Gastroenterology Division, Department of Clinical Sciences, Lund University.
Department of Medicine, Section of Hepatology and Gastroenterology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University.
Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis: a cohort study2017Ingår i: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, nr 34, artikel-id e7708 Artikel i tidskrift (Refereegranskat)
Objectives Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease that if left untreated may lead to the development of cirrhosis. Previous studies on AIH patients have suggested that fibrosis and even cirrhosis can be reversed by medical treatment. The aim of this study was to evaluate the efficacy of medical treatment for protection of developing fibrosis and cirrhosis.
Methods Two hundred fifty-eight liver biopsies from 101 patients (72 women, 29 men) were analysed by a single pathologist and classified accordingly to the Ishak grading (inflammation) and staging (fibrosis) system. Liver histology was stratified according to the temporal changes of fibrosis stage (increased, decreased or stable), and groups were compared.
Results Complete or partial response to medical treatment was 94.9%. Reduction of fibrosis stage from the first to the last biopsy was seen in 63 patients (62.4%). We found an association between a reduction in fibrosis stage and continuous glucocorticoid medication, as well as lowered scores of inflammation at last biopsy. Twenty-one patients had cirrhosis (Ishak stage 6) at least in one of the previous biopsies, but only five patients at the last biopsy.
Conclusions Histological improvement is common in AIH patients that respond to medical treatment, and a reduction or stabilization of fibrosis stage occurs in about 2/3 of such patients.
Department of Medicine, Sections for Hepatology and Gastroenterology, Sahlgrenska University Hospital at Östra Sjukhuset, Gothenburg, Sweden .
Department of Medicine, Sections for Hepatology and Gastroenterology, Örebro University Hospital, Örebro, Sweden.
Department of Medicine, Sections for Hepatology and Gastroenterology, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine, Sections for Hepatology and Gastroenterology, University Hospital of Skåne, Malmö, Sweden.
Pregnancy and childbirth in women with autoimmune hepatitis is safe, even in compensated cirrhosis2016Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, nr 4, s. 479-485Artikel i tidskrift (Refereegranskat)
Introduction: Autoimmune hepatitis (AIH) is a liver disease that primarily affects women. Many become ill during childbearing age, and medication can be lifelong. Few studies exist on pregnancy outcome in women with AIH.
Objectives: The aim was to assess the outcome of women with AIH and their children during pregnancy and postpartum.
Materials and methods: Sixty-four women from a well-characterised cohort with AIH filled out a questionnaire with information about their disease, miscarriage/abortion, pregnancies and potential birth defects in 2012. In 2004, 106 women answered the same questionnaire and their results were analysed along with the new questionnaires.
Results: One hundred and thirty-eight women have completed the questionnaire and 100 children have been born by 58 women. Fifty-seven women (41%) had cirrhosis. In 84% of the pregnancies, the AIH was stable or milder, 32% had an increase in activity postpartum. The proportion of preterm births (before week 38) was 22%, caesarean sections 17%, malformations 3%, and two children died. Twenty-three women with cirrhosis had children after diagnosis of cirrhosis but without more complications than for non-cirrhotic mothers. However, they did have a higher prevalence of caesarean sections.
Conclusion: Pregnancy and childbirth in AIH appear to be safe for both child and mother, even in women with compensated liver cirrhosis.
9. Duarte-Salles, Talita
Misra, Sandeep
Plymoth, Amelie
Muller, David
Baglietto, Laura
Turzanski-Fortner, Renee
Lagiou, Pagona
Pala, Valeria
Mattiello, Amalia
Naccarati, Alessio
Bueno-de-Mesquita, H. B(as).
Quiros, J. Ramon
Agudo, Antonio
Sanchez-Cantalejo, Emilio
Gavrila, Diana
Sjoberg, Klas
Wareham, Nicholas J.
Khaw, Kay-Tee
Bradbury, Kathryn E.
Hainaut, Pierre
Beretta, Laura
Circulating Osteopontin and Prediction of Hepatocellular Carcinoma Development in a Large European Population2016Ingår i: Cancer Prevention Research, ISSN 1940-6207, E-ISSN 1940-6215, Vol. 9, nr 9, s. 758-765Artikel i tidskrift (Refereegranskat)
We previously identified osteopontin (OPN) as a promising marker for the early detection of hepatocellular carcinoma (HCC). In this study, we investigated the association between prediagnostic circulating OPN levels and HCC incidence in a large population-based cohort. A nested case-control study was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. During a mean follow-up of 4.8 years, 100 HCC cases were identified. Each case was matched to two controls and OPN levels were measured in baseline plasma samples. Viral hepatitis, liver function, and a-fetoprotein (AFP) tests were also conducted. Conditional logistic regression models were used to calculate multivariable odds ratio (OR) and 95% confidence intervals (95% CI) for OPN levels in relation to HCC. Receiver operating characteristics curves were constructed to determine the discriminatory accuracy of OPN alone or in combination with other liver biomarkers in the prediction of HCC. OPN levels were positively associated with HCC risk (per 10% increment, ORmultivariable = 1.30; 95% CI, 1.14-1.48). The association was stronger among cases diagnosed within 2 years of follow-up. Adding liver function tests to OPN improved the discriminatory performance for subjects who developed HCC (AUC = 0.86). For cases diagnosed within 2 years, the combination of OPN and AFP was best able to predict HCC risk (AUC = 0.88). The best predictive model for HCC in this low-risk population is OPN in combination with liver function tests. Within 2 years of diagnosis, the combination of OPN and AFP best predicted HCC development, suggesting that measuring OPN and AFP could identify high-risk groups independently of a liver disease diagnosis.
10. Efe, Cumali
Al Taii, Haider
Ytting, Henriette
Aehling, Niklas
Bhanji, Rahima A.
Hagstrom, Hannes
Purnak, Tugrul
Muratori, Luigi
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
Muratori, Paolo
Klintman, Daniel
Schiano, Thomas D.
Montano-Loza, Aldo J.
Larsen, Fin Stolze
Alkhouri, Naim
Ozaslan, Ersan
Heneghan, Michael A.
Yoshida, Eric M.
Wahlin, Staffan
Tacrolimus and Mycophenolate Mofetil as Second-Line Therapies for Pediatric Patients with Autoimmune Hepatitis2018Ingår i: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568, Vol. 63, nr 5, s. 1348-1354Artikel i tidskrift (Refereegranskat)
We studied the efficacy and safety of mycophenolate mofetil (MMF) and tacrolimus as second-line therapy in pediatric patients with autoimmune hepatitis (AIH) who were intolerant or non-responders to standard therapy (corticosteroid and azathioprine). We performed a retrospective study of data from 13 centers in Europe, USA, and Canada. Thirty-eight patients (< 18 years old) who received second-line therapy (18 MMF and 20 tacrolimus), for a median of 72 months (range 8-182) were evaluated. Patients were categorized into two groups: Group 1 (n = 17) were intolerant to corticosteroid or azathioprine, and group 2 (n = 21) were non-responders to standard therapy. Overall complete response rates were similar in patients treated with MMF and tacrolimus (55.6 vs. 65%, p = 0.552). In group 1, MMF and tacrolimus maintained a biochemical remission in 88.9 and 87.5% of patients, respectively (p = 0.929). More patients in group 2 given tacrolimus compared to MMF had a complete response, but the difference was not statistically significant (50.0 vs. 22.2%, p = 0.195). Biochemical remission was achieved in 71.1% (27/38) of patients by tacrolimus and/or MMF. Decompensated cirrhosis was more commonly seen in MMF and/or tacrolimus non-responders than in responders (45.5 vs. 7.4%, p = 0.006). Five patients who received second-line therapy (2 MMF and 3 tacrolimus) developed side effects that led to therapy withdrawal. Long-term therapy with MMF or tacrolimus was generally well tolerated by pediatric patients with AIH. Both MMF and tacrolimus had excellent efficacy in patients intolerant to corticosteroid or azathioprine. Tacrolimus might be more effective than MMF in patients failing previous therapy.
Hagström, Hannes
Müller, Niklas F.
Wang, Qixia
Gunşar, Fulya
Parés, Albert
Heurgué-Berlot, Alexandra
Cengiz, Mustafa
Tana, Michele May-Sien
Ma, Xiong
Verma, Sumita
Efficacy and Safety of Mycophenolate Mofetil and Tacrolimus as Second-line Therapy for Patients With Autoimmune Hepatitis2017Ingår i: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 15, nr 12, s. 1950-1956Artikel i tidskrift (Refereegranskat)
BACKGROUND & AIMS: Predniso(lo) ne, alone or in combination with azathioprine, is the standard-of-care (SOC) therapy for autoimmune hepatitis (AIH). However, the SOC therapy is poorly tolerated or does not control disease activity in up to 20% of patients. We assessed the efficacy of mycophenolate mofetil (MMF) and tacrolimus as second-line therapy for patients with AIH. METHODS: We performed a retrospective study of data (from 19 centers in Europe, the United States, Canada, and China) from 201 patients with AIH who received second-line therapy (121 received MMF and 80 received tacrolimus), for a median of 62 months (range, 6-190 mo). Patients were categorized according to their response to SOC. Patients in group 1 (n = 108) had a complete response to the SOC, but were switched to second-line therapy as a result of side effects of predniso(lo) ne or azathioprine, whereas patients in group 2 (n = 93) had not responded to SOC. RESULTS: There was no significant difference in the proportion of patients with a complete response to MMF (69.4%) vs tacrolimus (72.5%) (P = .639). In group 1, MMF and tacrolimus maintained a biochemical remission in 91.9% and 94.1% of patients, respectively (P = .682). Significantly more group 2 patients given tacrolimus compared with MMF had a complete response (56.5% vs 34%, respectively; P = .029) There were similar proportions of liver-related deaths or liver transplantation among patients given MMF (13.2%) vs tacrolimus (10.3%) (log-rank, P = .472). Ten patients receiving MMF (8.3%) and 10 patients receiving tacrolimus (12.5%) developed side effects that required therapy withdrawal. CONCLUSIONS: Long-term therapy with MMF or tacrolimus generally was well tolerated by patients with AIH. The agents were equally effective in previous complete responders who did not tolerate SOC therapy. Tacrolimus led to a complete response in a greater proportion of previous nonresponder patients compared with MMF.
Tascilar, Koray
Henriksson, Ida
Lytvyak, Ellina
Alalkim, Fatema
Trivedi, Hirsh
Eren, Fatih
Eliasson, Johanna
Beretta-Piccoli, Benedetta Terziroli
Fischer, Janett
Caliskan, Ali Riza
Chayanupatkul, Maneerat
Coppo, Claudia
Onnerhag, Kristina
Gunsar, Fulya
Heurgue-Berlot, Alexandra
Guzelbulut, Fatih
Demir, Nurhan
Gonen, Can
Semela, David
Aladag, Murat
Kiyici, Murat
Schiano, Thomas
Montano-Loza, Aldo
Yoshida, Eric
Bonder, Alan
Validation of Risk Scoring Systems in Ursodeoxycholic Acid-Treated Patients With Primary Biliary Cholangitis2019Ingår i: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 114, nr 7, s. 1101-1108Artikel i tidskrift (Refereegranskat)
INTRODUCTION: Risk stratification based on biochemical variables is a useful tool for monitoring ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC). Several UDCA response criteria and scoring systems have been proposed for risk prediction in PBC, but these have not been validated in large external cohorts. METHODS: We performed a study on data of 1746 UDCA-treated patients with PBC from 25 centers in Europe, United States, and Canada. The prognostic performance of the risk scoring systems (GLOBE and UK-PBC) and the UDCA response criteria (Barcelona, Paris I, Paris II, Rotterdam, and Toronto) were evaluated. We regarded cirrhosis-related complications (ascites, variceal bleeding, and/or hepatic encephalopathy) as clinical end points. RESULTS: A total of 171 patients reached a clinical end point during a median 7 years (range 1-16 years) of follow-up. The 5-, 10- and 15-year adverse outcome-free survivals were 95%, 85%, and 77%. The GLOBE and UK-PBC scores predicted cirrhosis-related complications better than the UDCA response criteria. The hazard ratio (HR) for a 1 standard deviation increase was HR 5.05 (95% confidence interval (CI): 4.43-5.74, P < 0.001) for the GLOBE score and HR 3.39 (95% CI: 3.10-3.72, P < 0.001) for the UK-PBC score. Overall, the GLOBE and UK-PBC risk scores showed similar and excellent prognostic performance (C-statistic, 0.93; 95% CI: 0.91%-95% vs 0.94; 95% CI: 0.91%-0.96%). DISCUSSION: In our international, multicenter PBC cohort, the GLOBE and UK-PBC risk scoring systems were good predictors of future cirrhosis-related complications.
13. Fedirko, V.
Lukanova, A.
Bamia, C.
Trichopolou, A.
Trepo, E.
Noethlings, U.
Schlesinger, S.
Aleksandrova, K.
Boffetta, P.
Tjonneland, A.
Johnsen, N. F.
Overvad, K.
Fagherazzi, G.
Racine, A.
Boutron-Ruault, M. C.
Grote, V.
Kaaks, R.
Boeing, H.
Naska, A.
Adarakis, G.
Valanou, E.
Palli, D.
Sieri, S.
Tumino, R.
Vineis, P.
Panico, S.
Siersema, P. D.
Peeters, P. H.
Weiderpass, E.
Skeie, G.
Engeset, D.
Quiros, J. R.
Zamora-Ros, R.
Sanchez, M. J.
Amiano, P.
Huerta, J. M.
Barricarte, A.
Johansen, D.
Lindkvist, B.
Sund, Malin
Crowe, F.
Khaw, K. T.
Ferrari, P.
Romieu, I.
Chuang, S. C.
Riboli, E.
Jenab, M.
Glycemic index, glycemic load, dietary carbohydrate, and dietary fiber intake and risk of liver and biliary tract cancers in Western Europeans2013Ingår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, nr 2, s. 543-553Artikel i tidskrift (Refereegranskat)
The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. The association between dietary GI/GL and carbohydrate intake with hepatocellular carcinoma (HCC; N = 191), intrahepatic bile duct (IBD; N = 66), and biliary tract (N = 236) cancer risk was investigated in 477 206 participants of the European Prospective Investigation into Cancer and Nutrition cohort. Dietary intake was assessed by country-specific, validated dietary questionnaires. Hazard ratios and 95% confidence intervals were estimated from proportional hazard models. HBV/HCV status was measured in a nested case-control subset. Higher dietary GI, GL, or increased intake of total carbohydrate was not associated with liver or biliary tract cancer risk. For HCC, divergent risk estimates were observed for total sugar = 1.43 (1.17-1.74) per 50 g/day, total starch = 0.70 (0.55-0.90) per 50 g/day, and total dietary fiber = 0.70 (0.52-0.93) per 10 g/day. The findings for dietary fiber were confirmed among HBV/HCV-free participants [0.48 (0.23-1.01)]. Similar associations were observed for IBD [dietary fiber = 0.59 (0.37-0.99) per 10 g/day], but not biliary tract cancer. Findings suggest that higher consumption of dietary fiber and lower consumption of total sugars are associated with lower HCC risk. In addition, high dietary fiber intake could be associated with lower IBD cancer risk.
14. Fedirko, V
Trichopolou, A
Bamia, C
Duarte-Salles, T
Trepo, E
Aleksandrova, K
Nöthlings, U
Lukanova, A
Lagiou, P
Boffetta, P
Trichopoulos, D
Katzke, VA
Overvad, K
Tjønneland, A
Hansen, L
Boutron-Ruault, MC
Fagherazzi, G
Bastide, N
Panico, S
Grioni, S
Vineis, P
Palli, D
Tumino, R
Bueno-de-Mesquita, HB
Peeters, PH
Skeie, G
Engeset, D
Parr, CL
Jakszyn, P
Sánchez, MJ
Barricarte, A
Amiano, P
Chirlaque, M
Quirós, JR
Sonestedt, E
Ericson, U
Key, TJ
Khaw, KT
Romieu, I
Riboli, E
Jenab, M
Consumption of fish and meats and risk of hepatocellular carcinoma: the European Prospective Investigation into Cancer and Nutrition (EPIC)2013Ingår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, nr 8, s. 2166-2173Artikel i tidskrift (Refereegranskat)
BACKGROUND: While higher intake of fish and lower consumption of red/processed meats have been suggested to play a protective role in the etiology of several cancers, prospective evidence for hepatocellular carcinoma (HCC) is limited, particularly in Western European populations.
METHODS: The associations of fish and meats with HCC risk were analyzed in the EPIC cohort. Between 1992 and 2010, 191 incident HCC were identified among 477 206 participants. Baseline diet was assessed using validated dietary questionnaires. A single 24-h diet recall from a cohort subsample was used for calibration. Multivariable proportional hazard regression was utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI). In a nested case-control subset (HCC = 122), HBV/HCV status and liver function biomarkers were measured.
RESULTS: HCC risk was inversely associated with intake of total fish (per 20 g/day increase, HR = 0.83, 95% CI 0.74-0.95 and HR = 0.80, 95% CI 0.69-0.97 before and after calibration, respectively). This inverse association was also suggested after adjusting for HBV/HCV status and liver function score (per 20-g/day increase, RR = 0.86, 95% CI 0.66-1.11 and RR = 0.74, 95% CI 0.50-1.09, respectively) in a nested case-control subset. Intakes of total meats or subgroups of red/processed meats, and poultry were not associated with HCC risk.
CONCLUSIONS: In this large European cohort, total fish intake is associated with lower HCC risk.
15. Fedirko, Veronika
Duarte-Salles, Talita
Trichopoulos, Dimitrios
Trepo, Elisabeth
Tjønneland, Anne
Clavel-Chapelon, Françoise
Kvaskoff, Marina
Kühn, Tilman
Lukanova, Annie
Buijsse, Brian
Klinaki, Eleni
Tsimakidi, Chrysanthi
Tagliabue, Giovanna
Bueno-de-Mesquita, H Bas
Siersema, Peter D
Peters, Petra H
Lund, Eiliv
Brustad, Magritt
Standahl Olsen, Karina
Weiderpass Vainio, Elisabete
Zamora, Raul
Sánchez, María-José
Amiano, Pilar
Navarro, Carmen
Quirós, J Ramón
Lindkvist, Björn
Malm, Johan
Travis, Ruth C
Scalbert, Augustin
Romieu, Isabelle
Pre-diagnostic circulating vitamin D levels and risk of hepatocellular carcinoma in European populations: a nested case-control study2014Ingår i: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 60, nr 4, s. 1222-1230Artikel i tidskrift (Refereegranskat)
The association between vitamin D status and hepatocellular carcinoma has not been well investigated, despite experimental evidence supporting an important role of vitamin D in liver pathophysiology. Our objective was to investigate the association between pre-diagnostic circulating 25-hydroxyvitamin D [25(OH)D] serum levels and risk of hepatocellular carcinoma in a prospective, nested case-control study among 520,000 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Each case (n = 138) diagnosed between 1992 and 2010 was matched to one control by age, sex, study center, date and time of blood collection, and fasting status. Serum baseline levels of 25(OH)D were measured by liquid chromatography/tandem mass spectrometry. Multivariable incident rate ratios (IRR) of hepatocellular carcinoma associated with continuous (per 10 nmol/L) or categorical levels (tertiles or a priori-defined categories) of pre-diagnostic 25(OH)D. Higher 25(OH)D levels were associated with a 49% reduction in the risk of hepatocellular carcinoma (highest vs. lowest tertile: multivariable IRR = 0.51, 95% confidence interval, 0.26 to 0.99; Ptrend = 0.04; per 10 nmol/L increase: IRR = 0.80, 95% confidence interval, 0.68-0.94). The finding did not vary substantially by time from enrolment to diagnosis, and did not change after adjustment for biomarkers of pre-existing liver damage, nor chronic infection with hepatitis B or C viruses. The findings were not modified by body size or smoking status. Conclusion: In this prospective study on Western European populations, serum levels of 25(OH)D were inversely associated with risk of hepatocellular carcinoma. Given the rising incidence of this cancer in low-risk developed countries and the strong public health interest surrounding the potentially cancer-protective roles of vitamin D, additional studies in different populations are required. (Hepatology 2014;).
Tran, Hao Quang
Gewirtz, Andrew T
Peeters, Petra H
Bueno-de-Mesquita, H B
Castaño, José María Huerta
Barricarte, Aurelio
Sjöberg, Klas
Department of Surgical and Perioperative Sciences, Kirurgcentrum, Norrlands Universitetssjukhus, Umeå, Sweden.
Department of Medicine Sections for Hepatology and Gastroenterology, Umeå University Hospital, SE-90185 Umeå, Sweden.
Bradbury, Kathryn E
Wareham, Nick
Tsilidis, Konstantinos K
Aune, Dagfinn
Exposure to bacterial products lipopolysaccharide and flagellin and hepatocellular carcinoma: a nested case-control study2017Ingår i: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 72, nr 15 Artikel i tidskrift (Refereegranskat)
BACKGROUND: Leakage of bacterial products across the gut barrier may play a role in liver diseases which often precede the development of liver cancer. However, human studies, particularly from prospective settings, are lacking.
METHODS: We used a case-control study design nested within a large prospective cohort to assess the association between circulating levels of anti-lipopolysaccharide (LPS) and anti-flagellin immunoglobulin A (IgA) and G (IgG) (reflecting long-term exposures to LPS and flagellin, respectively) and risk of hepatocellular carcinoma. A total of 139 men and women diagnosed with hepatocellular carcinoma between 1992 and 2010 were matched to 139 control subjects. Multivariable rate ratios (RRs), including adjustment for potential confounders, hepatitis B/C positivity, and degree of liver dysfunction, were calculated with conditional logistic regression.
RESULTS: = 0.021). This finding did not vary substantially by time from enrollment to diagnosis, and did not change after adjustment for chronic infection with hepatitis B and C viruses.
CONCLUSIONS: These novel findings, based on exposures up to several years prior to diagnosis, support a role for gut-derived bacterial products in hepatocellular carcinoma development. Further study into the role of gut barrier failure and exposure to bacterial products in liver diseases is warranted.
17. Hindorf, Ulf
Jahed, Khatoon
Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Medicin.
Olsson, Rolf
Björnsson, Einar
Peterson, Curt
Almer, Sven H C
Characterisation and utility of thiopurine methyltransferase and thiopurine metabolite measurements in autoimmune hepatitis.2010Ingår i: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 52, nr 1, s. 106-111Artikel i tidskrift (Refereegranskat)
BACKGROUND & AIMS: Corticosteroids alone or in conjunction with azathioprine (AZA) is the standard treatment in autoimmune hepatitis (AiH). Individual variations in thiopurine (TP) metabolism may affect both drug efficacy and toxicity. Our aim was to investigate the utility of thiopurine methyltransferase (TPMT) as well as thioguanine nucleotide (TGN) and methylthioinosine monophosphate (meTIMP) metabolite measurements with regard to clinical outcome. METHODS: Two hundred thirty-eight patients with AiH were included in this cross-sectional study. TPMT status was assessed in all patients, while TGN and meTIMP were measured in patients with ongoing TP medication. Clinical outcome was evaluated by liver tests and the ability to withdraw steroids. RESULTS: TPMT genotyping (n=229) revealed 207 (90.4%) wild-type and 22 heterozygous patients. One hundred forty-three patients had ongoing TP therapy with AZA (n=134) or mercaptopurine (MP; n=9); response was judged as complete response (CR) in 113 patients and partial response (PR) in 30 patients. Both TP dose (1.64 vs 1.19mg/kg; p=0.012) and TPMT activity (14.3 vs 13.5; p=0.05) were higher in PR, resulting in similar TGN levels (PR: 121pmol/8x10(8) red blood cells [RBC]; CR: 113pmol/8x10(8) RBC; p=0.33) but higher meTIMP levels in PR (1350 vs 400pmol/8x10(8) RBC; p=0.004). Patients able to withdraw steroids or who were using 5mg prednisolone daily were treated with lower TP doses than patients on higher steroid doses (1.15 vs 1.18 vs 1.82mg/kg; p<0.001). CONCLUSIONS: TP metabolite measurements are of clinical value in AiH patients who do not respond to standard TP treatment and for the identification of a shifted metabolism, which may demand an alternative treatment strategy.
Ibrahim, Aghil
Dahlqvist, Per
Olsson, Tommy
The clinical course after glucocorticoid treatment in patients with inflammatory bowel disease is linked to suppression of the hypothalamic-pituitary-adrenal axis: a retrospective observational study2017Ingår i: Therapeutic Advances in Gastroenterology, ISSN 1756-283X, E-ISSN 1756-2848, Vol. 10, nr 11, s. 829-836Artikel i tidskrift (Refereegranskat)
Background: Adrenal insufficiency (AI) secondary to treatment with glucocorticoids (GCs) is common in patients with inflammatory bowel disease (IBD), but little is known about the relationship between AI and the clinical course in IBD. The aim of the study was to compare the clinical course in IBD patients with normal adrenal function versus patients with subnormal adrenal function.
Methods: A retrospective observational study on 63 patients with IBD who had performed a low-dose short Synacthen test (LDSST) (1 μg) immediately (1-7 days) after a standard course of GCs. A subnormal LDSST was defined as serum cortisol <550 nmol/L. Outcomes were time to next flare and fecal calprotectin levels.
Results: Sixty-three percent (n = 40) of the IBD patients had a subnormal LDSST. Patients who were steroid-free (n = 41) after the LDSST were observed for 3 years. Patients with a peak serum cortisol <400 nmol/L immediately after GC treatment had significantly longer time until the next flare-up of their IBD and tended to use a lower cumulative prednisolone dose during the study period in comparison to the other subgroups. Fecal calprotectin levels were significantly lower in patients with a peak s-cortisol <550 nmol/L versus patients with peak s-cortisol ⩾550 nmol/L (median 336 µg/g (IQR 521) versus 955 µg/g (IQR 1867); p = 0.012).
Conclusions: GC-induced AI is common in patients with IBD and is associated with lower disease activity. This suggests a link between responsiveness to GC treatment and suppression of the hypothalamic-pituitary-adrenal axis in IBD.
19. Kong, So Yeon
Gewirtz, Andrew T.
McKeown-Eyssen, Gail
Fedirko, Veronika
Bastide, Nadia
Affret, Aurelie
Kritikou, Maria
Vasilopoulou, Effie
Krogh, Vittorio
Bueno-de-Mesquita, H. B.
Ramon Quiros, J.
Sala, Nuria
Sanchez, Maria-Jose
Huerta Castano, Jose Maria
Stavropoulou, Faidra
Bruce, W. Robert
Serum Endotoxins and Flagellin and Risk of Colorectal Cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) Cohort2016Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 25, nr 2, s. 291-301Artikel i tidskrift (Refereegranskat)
Background: Chronic inflammation and oxidative stress are thought to be involved in colorectal cancer development. These processes may contribute to leakage of bacterial products, such as lipopolysaccharide (LPS) and flagellin, across the gut barrier. The objective of this study, nested within a prospective cohort, was to examine associations between circulating LPS and flagellin serum antibody levels and colorectal cancer risk. Methods: A total of 1,065 incident colorectal cancer cases (colon, n = 667; rectal, n = 398) were matched (1:1) to control subjects. Serum flagellin-and LPS-specific IgA and IgG levels were quantitated by ELISA. Multivariable conditional logistic regression models were used to calculate ORs and 95% confidence intervals (CI), adjusting for multiple relevant confouding factors. Results: Overall, elevated anti-LPS and anti-flagellin biomarker levels were not associated with colorectal cancer risk. After testing potential interactions by various factors relevant for colorectal cancer risk and anti-LPS and anti-flagellin, sex was identified as a statistically significant interaction factor (P-interaction < 0.05 for all the biomarkers). Analyses stratified by sex showed a statistically significant positive colorectal cancer risk association for men (fully-adjusted OR for highest vs. lowest quartile for total anti-LPS + flagellin, 1.66; 95% CI, 1.10-2.51; P-trend, 0.049), whereas a borderline statistically significant inverse association was observed for women (fully-adjusted OR, 0.70; 95% CI, 0.47-1.02; P-trend, 0.18). Conclusion: In this prospective study on European populations, we found bacterial exposure levels to be positively associated to colorectal cancer risk among men, whereas in women, a possible inverse association may exist. Impact: Further studies are warranted to better clarify these preliminary observations. (C) 2016 AACR.
Lorenz, Fryderyk
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
Marklund, Stefan
Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap.
Wahlin, Bjorn Engelbrekt
Wahlin, Anders
Fecal calprotectin as a biomarker of intestinal graft versus host disease after allogeneic hematopoietic stem cell transplantation2015Ingår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, s. 7920- Artikel i tidskrift (Refereegranskat)
The diagnosis of gastrointestinal graft versus host disease (GI-GVHD) is based on clinical symptoms and histological findings. In clinical practice, it is often difficult to decide whether abdominal symptoms in an allogeneic transplant recipient are caused by GVHD or other disorders. Endoscopic biopsies are helpful in establishing the diagnosis, but endoscopy is not always possible to perform due to poor general condition of the patients. No biomarkers are routinely used to predict GVHD. The aim of fecal calprotectin and alpha-1 antitrypsin testing in our study was to find out whether determination of the concentrations of these proteins may be used as a screening method for enteric GVHD. We studied prospectively 51 patients, 8 of whom developed GI-GVHD. Our data demonstrate that elevated fecal calprotectin levels were significantly associated with presence of GI-GVHD. We found a positive association between high F-calprotectin and severe gastrointestinal GVHD. In bivariate analysis, only calprotectin but not alpha-1 antitrypsin was independently associated with GI-GVHD. Testing for fecal calprotectin after allogeneic stem cell transplantation may be a useful screening tool.
Lukanova, Annekatrin
Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.
Becker, Susen
Hüsing, Anika
Schock, Helena
Benetou, Vassiliki
Nöthlings, Ute
Dossus, Laure
Teucher, Birgit
Ricceri, Fulvio
Peeters, Petra M
Quiros, Jose Ramon
Duell, Eric J
Molina-Montes, Esther
Chirlaque, Maria-Dolores
Gurrea, Aurelio Barricarte
Johansen, Dorthe
Key, Timothy J
Rinaldi, Sabina
Gunter, Marc J
Pre-diagnostic plasma testosterone, sex hormone binding globulin, IGF-I and hepatocellular carcinoma: etiological factors or risk markers?2014Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 134, nr 1, s. 164-173Artikel i tidskrift (Refereegranskat)
Elevated pre-diagnostic testosterone and insulin-like growth factor-I (IGF-I) concentrations have been proposed to increase risk of hepatocellular carcinoma (HCC). However, the metabolism of these hormones is altered as a consequence of liver damage and they may have clinical utility as HCC risk markers. A case-control study was nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort and included 125 incident HCC cases and 247 individually matched controls. Testosterone, sex hormone binding globulin (SHBG) and IGF-I were analyzed by immunoassays. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by conditional logistic regression. The area under the receiver operating curves (AUC) was calculated to assess HCC predictive ability of the tested models. After adjustments for epidemiological variables (body mass index, smoking, ethanol intake, hepatitis and diabetes) and liver damage (a score based on albumin, bilirubin, aspartate aminotransaminase, alanine aminotransaminase, gamma-glutamyltransferase and alkaline phosphatase concentrations), only SHBG remained significantly associated with risk (OR for top versus bottom tertile of 3.86 (1.32-11.3), ptrend =0.009). As a single factor SHBG had an AUC of 0.81 (0.75-0.86). A small, but significant increase in AUC was observed when SHBG was added to a model including the liver damage score and epidemiological variables (from 0.89 to 0.91, p=0.02) and a net reclassification of 0.47% (0.45-0.48). The observed associations of HCC with pre-diagnostic SHBG, free testosterone and IGF-I concentrations are in directions opposite to that expected under the etiological hypotheses. SHBG has a potential to be tested as pre-diagnostic risk marker for HCC.
22. Schlesinger, Sabrina
Boffetta, Paolo
Dahm, Christina C
Halkjaer, Jytte
Fagherazzi, Guy
Vineis, Paolo
van den Berg, Saskia
Peeters, Petra HM
Braaten, Tonje
Travier, Noémie
Regner, Sara
Wareham, Nicholas
Norat, Teresa
Wark, Petra A
Abdominal obesity, weight gain during adulthood and risk of liver and biliary tract cancer in a European cohort2013Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 132, nr 3, s. 645-657Artikel i tidskrift (Refereegranskat)
General obesity has been positively associated with risk of liver and probably with biliary tract cancer, but little is known about abdominal obesity or weight gain during adulthood. We used multivariable Cox proportional hazard models to investigate associations between weight, body mass index, waist and hip circumference, waist-to-hip and waist-to-height ratio (WHtR), weight change during adulthood and risk of hepatocellular carcinoma (HCC), intrahepatic (IBDC) and extrahepatic bile duct system cancer [EBDSC including gallbladder cancer (GBC)] among 359,525 men and women in the European Prospective Investigation into Cancer and Nutrition study. Hepatitis B and C virus status was measured in a nested case-control subset. During a mean follow-up of 8.6 years, 177 cases of HCC, 58 cases of IBDC and 210 cases of EBDSC, including 76 cases of GBC, occurred. All anthropometric measures were positively associated with risk of HCC and GBC. WHtR showed the strongest association with HCC [relative risk (RR) comparing extreme tertiles 3.51, 95% confidence interval (95% CI): 2.09-5.87; p(trend) < 0.0001] and with GBC (RR: 1.56, 95% CI: 1.12-2.16 for an increment of one unit in WHtR). Weight gain during adulthood was also positively associated with HCC when comparing extreme tertiles (RR: 2.48, 95% CI: 1.49-4.13; <0.001). No statistically significant association was observed between obesity and risk of IBDC and EBDSC. Our results provide evidence of an association between obesity, particularly abdominal obesity, and risk of HCC and GBC. Our findings support public health recommendations to reduce the prevalence of obesity and weight gain in adulthood for HCC and GBC prevention in Western populations.
23. Stepien, Magdalena
Floegel, Anne
Barupal, Dinesh Kumar
Achaintre, David
Assi, Nada
Saieva, Calogero
Agnoli, Claudia
Schmidt, Julie A
Gunter, Marc
Cross, Amanda
Alteration of amino acid and biogenic amine metabolism in hepatobiliary cancers: findings from a prospective cohort study2016Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 138, nr 2, s. 348-360Artikel i tidskrift (Refereegranskat)
Perturbations in levels of amino acids (AA) and their derivatives are observed in hepatocellular carcinoma (HCC). Yet, it is unclear whether these alterations precede or are a consequence of the disease, nor whether they pertain to anatomically related cancers of the intrahepatic bile duct (IHBC), and gallbladder and extrahepatic biliary tract (GBTC). Circulating standard AA, biogenic amines and hexoses were measured (Biocrates AbsoluteIDQ-p180Kit) in a case-control study nested within a large prospective cohort (147 HCC, 43 IHBC and 134 GBTC cases). Liver function and hepatitis status biomarkers were determined separately. Multivariable conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (OR; 95%CI) for log-transformed standardised (mean = 0, SD = 1) serum metabolite levels and relevant ratios in relation to HCC, IHBC or GBTC risk. Fourteen metabolites were significantly associated with HCC risk, of which seven metabolites and four ratios were the strongest predictors in continuous models. Leucine, lysine, glutamine and the ratio of branched chain to aromatic AA (Fischer's ratio) were inversely, while phenylalanine, tyrosine and their ratio, glutamate, glutamate/glutamine ratio, kynurenine and its ratio to tryptophan were positively associated with HCC risk. Confounding by hepatitis status and liver enzyme levels was observed. For the other cancers no significant associations were observed. In conclusion, imbalances of specific AA and biogenic amines may be involved in HCC development.
Racine, Antoine
Napoles, Osmel Companioni
Nyström, Hanna
Key, Timothy J.
Prospective association of liver function biomarkers with development of hepatobiliary cancers2016Ingår i: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 40, s. 179-187Artikel i tidskrift (Refereegranskat)
Introduction: Serum liver biomarkers (gamma-glutamyl transferase, GGT; alanine aminotransferase, ALT; aspartate aminotransferase, AST; alkaline phosphatase, ALP; total bilirubin) are used as indicators of liver disease, but there is currently little data on their prospective association with risk of hepatobiliary cancers. Methods: A nested-case control study was conducted within the prospective EPIC cohort (>520,000 participants, 10 European countries). After a mean 7.5 mean years of follow-up, 121 hepatocellular carcinoma (HCC), 34 intrahepatic bile duct (IHBC) and 131 gallbladder and biliary tract (GBTC) cases were identified and matched to 2 controls each. Circulating biomarkers were measured in serum taken at recruitment into the cohort, prior to cancer diagnosis. Multivariable adjusted conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (OR; 95% CI). Results: In multivariable models, 1SD increase of each log-transformed biomarker was positively associated with HCC risk (OR(GGT) = 4.23, 95% CI: 2.72-6.59; OR(ALP) = 3.43, 95% CI: 2.31-5.10; OR(AST) = 3.00, 95% CI: 2.04-4.42; OR(ALT) = 2.69, 95% CI: 1.89-3.84; OR(Bilirubin) = 2.25, 95% CI: 1.58-3.20). Each liver enzyme (OR(GGT) = 4.98; 95% CI: 1.75-14.17; OR(AST) = 3.10, 95% CI: 1.04-9.30; OR(ALT) = 2.86, 95% CI: 1.26-6.48, OR(ALP) = 2.31, 95% CI: 1.10-4.86) but not bilirubin (OR(Bilirubin) = 1.46,95% CI: 0.85-2.51) showed a significant association with IHBC. Only ALP was significantly associated with GBTC risk (OR (ALP) = 1.59, 95% CI: 1.20-2.09). Conclusion: This study shows positive associations between circulating liver biomarkers in sera collected prior to cancer diagnoses and the risks of developing HCC or IHBC, but not GBTC.
Hughes, David J.
Hybsier, Sandra
Affret, Aurélie
His, Mathilde
Katzke, Verena
Orfanos, Phlippos
Bueno-de-Mesquita, H. B. (as)
Lasheras, Cristina
Bonet Bonet, Catalina
Molina-Portillo, Elena
Maria Huerta, José
Shungin, Dmitry
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
Travis, Ruth C.
Schomburg, Lutz
Circulating copper and zinc levels and risk of hepatobiliary cancers in Europeans2017Ingår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 116, nr 5, s. 688-696Artikel i tidskrift (Refereegranskat)
Background: Copper and zinc are essential micronutrients and cofactors of many enzymatic reactions that may be involved in liver-cancer development. We aimed to assess pre-diagnostic circulating levels of copper, zinc and their ratio (Cu/Zn) in relation to hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBD) and gall bladder and biliary tract (GBTC) cancers. Methods: A nested case-control study was conducted within the European Prospective Investigation into Cancer and Nutrition cohort. Serum zinc and copper levels were measured in baseline blood samples by total reflection X-ray fluorescence in cancer cases (HCC n = 106, IHDB n = 34, GBTC n = 96) and their matched controls (1: 1). The Cu/Zn ratio, an indicator of the balance between the micronutrients, was computed. Multivariable adjusted odds ratios and 95% confidence intervals (OR; 95% CI) were used to estimate cancer risk. Results: For HCC, the highest vs lowest tertile showed a strong inverse association for zinc (OR = 0.36; 95% CI: 0.13-0.98, Ptrend = 0.0123), but no association for copper (OR = 1.06; 95% CI: 0.45-2.46, Ptrend = 0.8878) in multivariable models. The calculated Cu/ Zn ratio showed a positive association for HCC (OR = 4.63; 95% CI: 1.41-15.27, Ptrend = 0.0135). For IHBC and GBTC, no significant associations were observed. Conclusions: Zinc may have a role in preventing liver-cancer development, but this finding requires further investigation in other settings.
26. Trichopoulos, Dimitrios
Noethlings, Ute
Overved, Kim
Outzen, Malene
Clavel-Chapelon, Francoise
Zylis, Dimosthenis
Sacerdote, Carlotta
Van Kranen, Henk J.
Peeters, Petra H. M.
Gonzalez, Carlos A.
Sanchez Perez, Maria-Jose
Lindkvist, Bjorn
Hallmans, Göran
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
Key, Timothy
Chuang, Shu-Chun
Hepatocellular carcinoma risk factors and disease burden in a European cohort: a nested case-control study2011Ingår i: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 103, nr 22, s. 1686-1695Artikel i tidskrift (Refereegranskat)
Background: To date, no attempt has been made to systematically determine the apportionment of the hepatocellular carcinoma burden in Europe or North America among established risk factors.
Methods: Using data collected from 1992 to 2006, which included 4 409 809 person-years in the European Prospective Investigation into Cancer and nutrition (EPIC), we identified 125 case patients with hepatocellular carcinoma, of whom 115 were matched to 229 control subjects. We calculated odds ratios (ORs) for the association of documented risk factors for hepatocellular carcinoma with incidence of this disease and estimated their importance in this European cohort.
Results: Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection (OR = 9.10, 95% confidence interval [CI] = 2.10 to 39.50 and OR = 13.36, 95% CI = 4.11 to 43.45, respectively), obesity (OR = 2.13, 95% CI = 1.06 to 4.29), former or current smoking (OR = 1.98, 95% CI = 0.90 to 4.39 and OR = 4.55, 95% CI = 1.90 to 10.91, respectively), and heavy alcohol intake (OR = 1.77, 95% CI = 0.73 to 4.27) were associated with hepatocellular carcinoma. Smoking contributed to almost half of all hepatocellular carcinomas (47.6%), whereas 13.2% and 20.9% were attributable to chronic HBV and HCV infection, respectively. Obesity and heavy alcohol intake contributed 16.1% and 10.2%, respectively. Almost two-thirds (65.7%, 95% CI = 50.6% to 79.3%) of hepatocellular carcinomas can be accounted for by exposure to at least one of these documented risk factors.
Conclusions: Smoking contributed to more hepatocellular carcinomas in this Europe-wide cohort than chronic HBV and HCV infections. Heavy alcohol consumption and obesity also contributed to sizeable fractions of this disease burden. These contributions may be underestimates because EPIC volunteers are likely to be more health conscious than the general population.
Nthlings, Ute
Lindkvist, Bjoern
Re: Hepatocellular Carcinoma Risk factors and Disease Burden in a European Cohort: A Nested Case-Control Study Response2012Ingår i: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 104, nr 21, s. 1683-1684Artikel i tidskrift (Refereegranskat)
Autoimmune hepatitis in Sweden2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Autoimmune hepatitis (AIH) was identified as an entity by the Swedish professor Jan Waldenström in the 1950s. It was then denoted lupoid hepatitis, characterized by liver inflammation and most often affecting young women. During the years the diagnosis has become more defined (as the non A non B hepatitis has been identified as Hepatitis C) and now can be safely separated from other diseases with liver inflammation. Studies of epidemiological data and long term prognosis have been scarce in the literature. Within a collaboration between the university hospitals in Sweden, we collected what we believe is the largest cohort in the world of patients with AIH. Data from the medical records of 473 individuals was, after AIH-score calculations where the diagnosis was confirmed, collected in a data base, in which most of the analysis was done. Data from the Swedish national registers of cancer, death cause, and birth register was searched for these patients as well as controls. The aim of the thesis was to explore epidemiological and clinical outcome of AIH.The onset of AIH may be at any age, but the incidence seems to increase after 50 years of age; 75% are females, the overall incidence (0.85/ 100,000 inhabitants and year) and prevalence (11/100,000 inhabitants) are figures that are within the range of another but smaller Scandinavian study. Approximately 30 % had cirrhosis already at diagnosis and 87% displayed at some time positive auto-antibodies indicating AIH (Smooth muscle ab and or antinuclear ab). Indications of future risk for liver transplantation or death is an advanced AIH at diagnosis with liver cirrhosis, decompensated liver disease, elevated PK INR as well as age. Acute hepatitis-like onset seems to carry a lower risk for later liver transplantation or death. Current Swedish national therapy traditions with immune suppression seem to be well tolerated. Five and ten years overall life expectancy does not differ from controls. Thirty-five women gave birth to 63 children, for 3 after liver transplantation of the mother. Thirteen of the women had liver cirrhosis. Current pharmacological treatment seems to be safe both for the patient and the foetus. Thirty percent of the patients experienced flair after delivery. It has been supposed that there is an overrisk for hepatocellular cancer (HCC) associated with AIH. Our figures are the first in the world to be presented that confirms a twenty-three fold overrisk (95% Confidence Interval 7.5-54.3) for hepatobiliar cancer. We found as well an overrisk of non-Hodgkin lymphomas of 13.09 (95% CI 4.2-30.6).Conclusion: Our epidemiological results confirm that AIH is a fairly uncommon disease, and that many already at time of diagnosis have an advanced disease with liver cirrhosis. There is a clear overrisk for HCC and lymphoma. For those women with AIH who become pregnant the prognosis for the child as well as for the mother is good, even for those women who already have compensated cirrhosis. There is a risk for relapse after delivery. The overall survival for AIH patients with current therapy is good.
FULLTEXT01
Sandberg-Gertzén, Hanna
Danielsson, Åke
Hepatic and extrahepatic malignancies in autoimmune hepatitis: A long-term follow-up in 473 Swedish patients2009Ingår i: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 50, nr 2, s. 388-393Artikel i tidskrift (Refereegranskat)
BACKGROUND/AIMS: Autoimmune Hepatitis (AIH) is a liver disease which may lead to liver cirrhosis. Cirrhosis is a well-known risk factor for hepatocellular cancer. Lymphoma is a disease, where immune modulating drugs as well as the autoimmune disease itself may contribute to the elevated risk. The aim was to investigate the risks of malignancies in a large cohort of AIH patients. METHODS: Four hundred and seventy-three patients with AIH were matched to the Swedish national cancer register as well as to the death cause register. RESULTS: We found an overall higher risk of malignancies in the cohort of AIH patients from the date of diagnosis with a SIR of 1.51 (95% CI 1.10-2.03). SIR in the subpopulation of well defined catchment areas and complete case finding was 23.28 (95% CI 7.5-54.34) for HCC. Lymphomas were found a SIR of 13.09 (95% CI 4.22-30.56). CONCLUSIONS: There was an overall increased risk of malignancies in a cohort of AIH patients, which manly was caused by hepatobiliary cancers. However, the true risk of HCC in an AIH cirrhotic cohort has yet to be investigated. A significantly higher risk of lymphomas was also found, but no clear cut association to the use of immune modulators.
Broomé, Ulrika
Sangfeldt, Per
Nilsson, Jenny
Autoimmune hepatitis among fertile women: strategies during pregnancy and breastfeeding?2007Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 42, nr 8, s. 986-991Artikel i tidskrift (Refereegranskat)
OBJECTIVE: In published studies there is a lack of data about the risks, management and how women with autoimmune hepatitis (AIH) decide on and are advised about pregnancy. The aim of this study was to investigate how women with AIH consider pregnancies, are advised and pharmacologically treated, as well as the outcome.
MATERIAL AND METHODS: A questionnaire was mailed to 128 women with AIH diagnosed during their fertile period and data from the Swedish National Birth Register was also used for matched controls.
RESULTS: There was an 83% response rate to the questionnaires. Sixty-three pregnancies were reported by 35 women. 48% did not consult their doctors before getting pregnant. More than half of the women reduced or stopped the immune suppression during pregnancy or breastfeeding. Some women were advised to abstain from pregnancy or even to have an abortion. Caesarean sections were performed more frequently in the AIH group (16% compared with 6.5% in the control group p<0.01).There were no significant differences in the number of stillborn infants or infants with malformations. However, 30% of the patients experienced flare-up after delivery.
CONCLUSIONS: In general, the outcome of pregnancy in women with AIH seems to be good. Current pharmacological treatment appears to be safe, including azathioprine during pregnancy and lactation. After delivery an active preparedness to increase pharmacotherapy should be considered.
[Autoimmune hepatitis often requires lifelong treatment]2010Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 21, s. 1388-1391Artikel i tidskrift (Refereegranskat)
Autoimmune hepatitis (AIH) is a rare disease with an incidence of around 1 / 100,000 inhabitants, and a prevalence rate of 16 / 100,000. As many as 30 % of AIH-patients already have liver cirrhosis at diagnosis. The diagnosis is established with liver function tests of hepatocellular pattern, presence of autoimmune antibodies, increased polyclonal IgG, and a compatible liver biopsy. Mostly, immune suppressive treatment with corticosteroids alone or in combination with azathioprine brings the disease into remission. In cirrhotic patients there is an increased risk of hepatocellular cancer (HCC) with a SIR of 23.
Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study2008Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 43, nr 10, s. 1232-1240Artikel i tidskrift (Refereegranskat)
OBJECTIVE: Autoimmune hepatitis (AIH) is a chronic liver disease, which if untreated can lead to cirrhosis and hepatic failure. The aim of the study was to investigate the incidence, prevalence, diagnostic tradition and clinical initial presentation of AIH.
MATERIAL AND METHODS: Analyses were performed in 473 patients identified as having probable or definite AIH. RESULTS: The incidence of AIH was 0.85/100,000 (95% CI 0.69-1.01) inhabitants, which is somewhat lower than reported previously. The point prevalence amounted to 10.7/100,000 (95% CI 8.8-13.1), and 76% of the cases were females. The age-related incidence curve was bimodal but men were found to have only one incidence peak in the late teens, whereas women had a peak after menopause. AIH was presented as a spectrum of clinical settings from detected "en passant" to acute liver failure. Almost 30% of patients already had liver cirrhosis at diagnosis. Autoantibodies indicative of AIH type 1 were found in 79% of cases. Other concomitant autoimmune diseases were frequently found (49%).
CONCLUSIONS: The incidence and prevalence figures confirm that AIH is a fairly uncommon disease in the Swedish population. Symptoms at presentation were unspecific, but almost half of the patients were jaundiced, with around 30% having liver cirrhosis. The majority of Swedish AIH patients had AIH type 1.
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Q: Flexslider caption move upwards instead of fade Is there any way I can move like here: http://ssdigitalmedia.com/
using flex slider on my other site I am using flex slider but flex caption or not working as abve links text are moving ..is there any way I can do with flex or should I go for any other slider?
Thanks
Sudhanshu

A: Flex slider is just slider, you need parallax effect solution.
Check this one
http://nick-jonas.github.io/windows/

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