Reduced incidence of type 2 diabetes in patients with chronic hepatitis C virus infection cleared by direct-acting antiviral therapy: A prospective study

AIM

To assess the effect of hepatitis C virus (HCV) eradication on type 2 diabetes mellitus (T2DM). incidence.

METHODS

A prospective multicentre case-control study was performed, which included 2426 patients with HCV, 42% of whom had liver fibrosis stage F0-F2 and 58% of whom had liver fibrosis stage F3-F4. The study population consisted of a control group including 1099 untreated patients and 1327 cases treated with direct-acting antivirals (DAAs). T2DM incidence was assessed during a median (interquartile range) follow-up period of 30 (28-42) months. Risk factors for T2DM were assessed using a Cox regression model (relative risk [RR], hazard ratio [HR], Kaplan-Meier analysis). Insulin sensitivity was evaluated by homeostatic model assessment (HOMA) and changes by repeated-measures ANOVA. Factors independently associated with T2DM were assessed by multivariate analysis.

RESULTS

The absolute incidence of T2DM for controls and cases was 28 and 7/1000 person-years, respectively (P = 0.001). In cases compared to controls, HCV clearance reduced the RR and HR of T2DM by 81% and 75% to 93%, respectively (P = 0.001). It was calculated that, for every 15 patients who obtained HCV clearance, one case of T2DM was saved. HCV clearance was associated with significant reductions in HOMA-insulin resistance and HOMA-β-cell function and an increase in HOMA-insulin sensitivity, as assessed in 384 patients before and after HCV clearance. At multivariate analysis, HCV clearance emerged as independently associated with a reduced T2DM risk.

CONCLUSION

The results showed that HCV clearance by DAA treatment reduces T2DM incidence probably by restoring the HCV-induced alteration of glucose homeostasis mechanisms.

User interfaces for information systems

Se describen cuatro proyectos de interfaces de sistemas de información que se están desarrollando en ESRIN (establecimiento de la Agencia Espacial Europea, en Frascati). Cada uno de ellos muestra un enfoque diferente del diseño de interfaces, pero todos tienen en común el responder a los objetivos, tareas y características de los usuarios. Se sugiere que la próxima generación de sistemas de información científica se tendrá que diseñar para permitir el acceso directo de los usuarios finales a una gran variedad de fuentes de información a través de una interfaz común. El diseño de tales sistemas y de sus interfaces debería basarse en un análisis multinivel de objetivos, tareas y puntos de vista propios de la materia de trabajo de cada usuario.

Hemocoagulative post-operative changes after laparoscopic surgery compared to open surgery: the role of lupus anticoagulant

Although still debated, post-operative modification of hemostasis seems to be less pronounced after laparoscopy compared to open surgery. Antiphospholipid antibodies might play a role in the post-operative thromboembolic risk, although their evaluation in surgical patients has never been performed. Post-operative modification of antiphospholipid antibodies could be related to the surgical approach (laparoscopic or open). In this prospective study, the authors statistically compared the pre-operative values and post-operative modification of antiphospholipid antibodies in two homogeneous groups of patients operated on by laparoscopic and open surgery. No statistical differences within each group and between the two groups were shown comparing mean values of pre-operative and post-operative antiphospholipid antibodies. In the open group, there was a significant difference between pre-operative and post-operative LAC means (P < 0.01). In the laparoscopic group, on the contrary, no significant change in LAC values between pre- and post-operative tests (P = 0.55) was observed. Since LAC could be related to coagulation disorders, this study seems to support that laparoscopic surgery might induce a less risk of post-operative thromboembolic disease.

User interfaces for information systems

This paper presents descriptions of four informa tion/system interface projects in progress at ESRIN, the estab lishment of the European Space Agency (ESA) in Italy. Each project demonstrates a somewhat different approach to mter face design, but all share the commonality of responding to user goals, tasks and charactenstics. It is suggested that next generation scientific information systems will have to be designed for direct access by end users to a large vanety of information sources, through a common interface. Design of such systems, including their interfaces, should be based on a multi-level analysis of user goals, tasks and domain views.

Document classification and searching--a neural network approach

This article introduces the basic concepts of Artificial Neural Networks and the related work that is currently being carried out at ESRIN in the field of document classification and searching. Some of the authors' ideas on the future directions that these techniques might take are also presented.