http://news. brisbanetimes. com.au/breaking- news-national/ kids-with-
hepatitis- go-without- treatment- 20090614- c73m.html

Kids with hepatitis go without treatment

Danny Rose
June 14, 2009

Many Australian children with hepatitis are going without the medicines they
need because of a "head in the sand" approach by health authorities, new
research has found.
The NSW-based study found only six per cent of kids with hepatitis were referred
to a specialist clinic after state health authorities were notified of their
cases.
Dr Edward O'Loughlin, of The Children's Hospital at Westmead, reviewed the cases
of 1,700 children notified to NSW Health as having hepatitis C or hepatitis B.
He found fewer than 110 of the children had been referred on to a specialist
clinic for treatment, and none of those with hepatitis C were put on necessary
anti-viral drugs.
"A majority of these kids aren't receiving appropriate treatment," Dr O'Loughlin
said.
"And we rang our colleagues and spoke to them in the different states... It's
very similar all around Australia."
Dr O'Loughlin's study took in all children with hepatitis who were notified to
NSW Health from 2000 to 2007. Many more children would be living with the
condition across the country, he says.
Despite this, he says, hepatitis-related health programs and clinics often made
no provision for children.
The drugs approved to treat hepatitis C are not listed for use by patients under
18 on the Pharmaceutical Benefits Scheme.
Young people with hepatitis infections in Australia are often the children of
migrants or injecting drug users.
Dr O'Loughlin says he knows of only one Melbourne hospital treating hepatitis C
children on a "compassionate" basis.
If the condition goes untreated, hepatitis infections can cause death or serious
illness through liver fibrosis, cirrhosis and liver cancer.
"Because (health authorities) are burying their head in the sand over this, we
really have no idea what's going on out there in the community," Dr O'Loughlin
says.
"We think what we're seeing is just the tip of the iceberg."
Dr O'Loughlin is calling for the establishment of a coordinated healthcare
service for children with chronic hepatitis in Australia.
His research is published in the Medical Journal of Australia.


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Cannabis Science: Can Cannabis-Based Drugs Slow The H1N1 "Swine Flu" Pandemic?14
Jun 2009   

The World Health Organization declared a swine flu pandemic Thursday, raising
its pandemic warning from phase 5 to 6, making swine flu the first global flu
epidemic in 41 years. Now that H1N1 "Swine Flu" has been elevated to pandemic
status, with reports of outbreaks in Asia, the Middle East and Europe, San
Francisco, USA-based Cannabis Science Inc. (OTCBB: CBIS) CEO Steven Kubby urges
public health officials around the world to "take medical cannabis seriously."

According to the company, which specializes in cannabis research and development
for medical purposes, the world may have at its disposal a means of combating
the affects of this deadly disease. Dr. Robert J. Melamede, Director and Chief
Science Officer for CSI reports, "Research into use of whole cannabis extracts
and multi-cannabinoid compounds has provided the scientific rationale for
medical marijuana's efficacy in treating some of the most troubling diseases
mankind now faces, including infectious diseases such as the flu and HIV,
autoimmune diseases such as ALS (Lou Gehrig's Disease), multiple sclerosis,
arthritis, and diabetes, neurological conditions such as Alzheimer's, stroke and
brain injury, as well as numerous forms of cancer."

Dr. Melamede went on to say, "The high lethality of some strains of flu can be
attributed to the excessive inflammatory response driven by Tumor Necrosis
Factor (TNF). Endocannabinoids are nature's way of controlling TNF activity.
Phytocannabinoids can mimic the natural endocannabinoids to prevent excessive
inflammatory immune responses."

Upon hearing that WHO had elevated the swine flu to pandemic status, CSI's CEO
Steve Kubby said, "Governments all over the world ought to seriously consider
the advantages of medical cannabis."

On Wednesday, WHO said 74 countries had reported nearly 27,737 cases of swine
flu, including 141 deaths. There are over 90 confirmed cases in the United
States, with reports of infections in 11 states, and one U.S. fatality, a 23
month old child in Texas. Symptoms include a high fever, body aches, coughing,
sore throat and severe respiratory congestion.

Chief Science Officer for CSI Dr. Melamede believes the potential for
cannabinoids that naturally prevent excessive inflammatory immune responses is
enormous. He stated, "Based upon recent discoveries regarding the role that
endocannabinoid system plays in maintaining human health, we may have a unique
solution to the looming threat posed by deadly influenza strains that we
believe, if implemented, could save millions of lives."

Source
Cannabis Science, Inc.
________________________________

Article URL: http://www.medicalnewstoday.com/articles/153776.php
Main News Category: Swine Flu
Also Appears In:  Public Health,  Alcohol / Addiction / Illegal Drugs,  Flu /
Cold / SARS,  
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Save time! Get the latest medical news headlines for your specialist area, in a
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ASCO: Ginger Eases Chemo-Related Nausea

By Michael Smith, North American Correspondent, MedPage Today
Published: May 14, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine,
University of California, San Francisco .


TORONTO, May 14 -- Half a teaspoon of ground ginger a day can significantly
reduce the nausea associated with chemotherapy, researchers found.

Action Points
------------ --------- --------- --------- --------- --------- -
Explain to interested patients that ginger is widely used as a folk remedy for
upset stomach and diarrhea.

Note that this randomized controlled trial found it was effective, in
combination with standard antiemetic drugs, in controlling nausea during
chemotherapy.

Note that this study will be presented at a conference. These data and
conclusions should be considered to be preliminary until published in a
peer-reviewed journal.
In a large randomized trial, the spice reduced nausea by 40% when taken along
with standard antinausea medications, according to Julie Ryan, Ph.D., of the
University of Rochester Medical Center in Rochester, N.Y.

Dr. Ryan told reporters that patients in the study took the spice in capsules,
but it should "theoretically" also work in cookies or soft drinks -- as long as
the ginger flavor isn't artificial.

The spice -- usually in the form of ginger tea or ginger ale -- is widely used
as a folk remedy for upset stomach and diarrhea.

Dr. Ryan's study -- discussed during a curtain-raiser press conference for the
annual meeting of the American Society of Clinical Oncology -- is to be
presented in Orlando later this month.

Dr. Ryan and her colleagues enrolled 644 cancer patients, most of whom had
breast cancer, in their study.

After the patients reported nausea during early cycles of chemotherapy, they
were randomized to get either ginger or placebo, along with standard 5-HT3
receptor antagonist antiemetics, such as ondansetron (Zofran) and granisetron
(Kytril).

Participants were divided into four arms -- those getting placebo capsules and
those getting 0.5, 1.0, and 1.5 grams of ginger.

The ginger was started three days before the beginning of a chemotherapy cycle,
and the antiemetics were begun in the first day of each cycle, Dr. Ryan said.

Four times a day during chemotherapy, she said, patients recorded their feelings
of nausea on a seven-point scale, ranging from no nausea to extremely nauseated.

Dr. Ryan said average nausea scores were high on all four arms on the morning of
the first day of a chemo cycle, but dropped significantly (at P=0.003) for the
three ginger arms during the day.

The lower nausea scores were maintained for subsequent days of the cycle, she
said.

Dr. Ryan said the two lower doses of the spice appeared to be more effective
than the 1.5-gram dose. A gram, she said, is equivalent to about half a teaspoon
of ground ginger, dried or fresh.

The research is "an interesting and rigorous study in the field of complementary
medicine," said Douglas Blayney, M.D., of the University of Michigan
Comprehensive Cancer Center in Ann Arbor and the society's president-elect.

He added that the study result is "an important step forward in improving
quality of care for the 70% of patients who undergo chemotherapy and experience
nausea and vomiting."

The study was supported by the National Cancer Institute.
Dr. Ryan did not report any conflicts.


Primary source: American Society of Clinical Oncology

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Chronic Infection Now Clearly Tied to Immune-System Protein
June 13th, 2009
The reason deadly infections like human immunodeficiency virus (HIV) and
hepatitis C never go away is because these viruses disarm the body’s defense
system. Researchers at the University of Alabama at Birmingham (UAB) have
discovered that a key immunity protein must be present for this defense system
to have a chance against chronic infection.
 
Research up to now has tried but failed to decipher the cross-talk between
‘killer T-cells’ and ‘helper T-cells’ in the fight against viruses. The
new UAB study finds this cross-talk can only happen in the presence of
interleukin-21, a powerful immune system protein. If interleukin-21 is missing
for whatever reason, then the immune system’s anti-viral efforts fail, said
Allan Zajac, Ph.D., an associate professor in UAB's Department of Microbiology
and lead author on the study.
The findings are published in the journal Science.
“Adding interleukin-21 back in stimulates the immune response and controls the
infection,” Zajac said. “We demonstrate that the loss of this protein
prevents the control of the infection and diminishes the function of the killer
T-cells, specifically CD8 T-cells.”
The study mice were treated for lymphocytic choriomeningitis, a viral infection
of the membranes surrounding the brain and spinal cord. Measurements were taken
for two types of T-cells, CD4 and CD8 T-cells, before and after the mice were
treated with interleuikin-21.
“Interleukin-21 served as the key messenger between the T-cells, whereas
before we didn’t know exactly how the two types of cells communicated with
each other,” Zajac said. The CD4 T-cells help the immune system do its job by
boosting CD8 T-cells’ ability to fight and kill viruses.
Co-authors on the study include John Yi and Ming Du, Ph.D., both of UAB’s
Department of Microbiology. Research funds came from the National Institutes of
Health.

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http://www3. interscience. wiley.com/ journal/12239472 8/abstract? CRETRY=1&
SRETRY=0

American Journal of Transplantation
Volume 9 Issue 6, Pages 1398 - 1405
Published Online: 20 May 2009




E. C. Verna a , E. De Martin b , P. Burra b , D. Neri b , P. J. Gaglio a , J. C.
Emond a and R. S. Brown, Jr. a,*
a Center for Liver Disease and Transplantation, New York Presbyterian Hospital,
New York, NY, Columbia University College of Physicians & Surgeons, New York, NY
b Department of Surgical and Gastroenterological Sciences, University of Padova,
Padova, Italy
* Corresponding author: Robert S. Brown Jr., rb464@columbia. edu

Copyright Š 2009 American Society of Transplantation and the American Society
of Transplant Surgeons

KEYWORDS
Biliary complication • liver transplant • recurrent hepatitis C virus

ABSTRACT
Recurrent hepatitis C (HCV) and biliary complications (BC) are major causes of
post liver transplant morbidity and mortality. The impact of these complications
may be additive or synergistic. We performed a retrospective cohort study to
analyze the effects of HCV and BC on all patients transplanted at two
institutions over 6 years. BC was defined by imaging findings in the setting of
abnormal liver function tests that required intervention. The primary outcomes
were graft and patient survival over a mean 3.4 years. 709 patients (619
deceased, 90 living donor) were included, 337 with HCV and 372 without. BC was
diagnosed more frequently in patients with HCV, 26% versus 18% (p = 0.008).
One-year and overall patient and graft survival were significantly lower in
patients with HCV, but BC impacted only 1-year graft survival. The combination
of BC and HCV had no additional impact on survival or fibrosis rates on 1-year
protocol biopsies. Multivariate analysis
  revealed HCV (HR 2.1) and HCC (HR 1.9) to be independent predictors of
mortality. Since BC are diagnosed more frequently in HCV patients and only
affect early graft loss, it is likely that recurrent HCV rather than BC accounts
for the majority of adverse graft outcomes.

Received 03 June 2008, revised 04 March 2009 and accepted for publication 04
March 2009

DIGITAL OBJECT IDENTIFIER (DOI)10.1111/ j.1600-6143. 2009.02649.

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The California Hepatitis Alliance CalHEP asks you to join us in Sacramento June
10 for a day of education and ACTION.

Morning Speakers:
¨ State of California Viral Hepatitis Strategic Plan, will be presented by
Rachel McLean, State Adult Viral Hepatitis Prevention Coordinator
¨ Health Care Reform in California and the Nation will be co-presented by Herb
Schultz, Senior Advisor to the Governor, and Jeff Caballero, Executive Director
of the Association of Asian Pacific Community Health Organizations

Afternoon Activities:
¨ March to the Capitol: Join hundreds of allies fighting to protect hepatitis B
and C screening, vaccinations, and prevention as part of the state budget.

Rally and Legislative Visits: Wear red or yellow to show you are part of this
unified action. If you want a meeting with a legislative staff member, please
contact CalHEP via the registration form or by e-mail.
Please visit http://calhep. org for more information about this important event!

The California Hepatitis Alliance (CalHEP) seeks to reduce the scope and
consequences of the hepatitis B and C epidemics, which disproportionately affect
California’s ethnic communities and the socioeconomically underserved.
Committed to culturally competent public education and awareness, CalHep focuses
on sound public health policy and advocacy to improve California’s public
health approach to liver wellness.

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World J Gastroenterol. 2009 May 28;15(20):2506- 11.

Antidiabetic therapy and increased risk of hepatocellular carcinoma in chronic
liver disease.

Donadon V, Balbi M, Ghersetti M, Grazioli S, Perciaccante A, Della Valentina G,
Gardenal R, Dal Mas M, Casarin P, Zanette G, Miranda C.

Department of Medicine, Internal Medicine 3rd, Pordenone Hospital, Pordenone,
Italy. valter.donadon@ aopn.fvg. it


AIM: To explore the association between hepatocellular carcinoma (HCC) and type
2 diabetes mellitus, describe the temporal relations between the onset of
diabetes and the development of HCC and evaluate the possible effects of
antidiabetic therapy on HCC risk. METHODS: We recruited 465 HCC patients, 618
with cirrhosis and 490 control subjects. We evaluated the odds ratio (OR) for
HCC by univariate and multivariate analysis. Moreover, OR for HCC in diabetic
subjects treated with insulin or sulphanylureas and with metformin were
calculated. RESULTS: The prevalence of diabetes mellitus was 31.2% in HCC, 23.3%
in cirrhotic patients and 12.7% in the Control group. By univariate and
multivariate analysis, the OR for HCC in diabetic patients were respectively
3.12 (CI 2.2-4.4, P < 0.001) and 2.2 (CI 1.2-4.4, P = 0.01). In 84.9% of cases,
type 2 diabetes mellitus was present before the diagnosis of HCC. Moreover, we
report an OR for HCC of 2.99 (CI 1.34-6.65, P
  = 0.007) in diabetic patients treated with insulin or sulphanylureas, and an OR
of 0.33 (CI 0.1-0.7, P = 0.006) in diabetic patients treated with metformin.
CONCLUSION: Our study confirms that type 2 diabetes mellitus is an independent
risk factor for HCC and pre-exists in the majority of HCC patients. Moreover, in
male patients with type 2 diabetes mellitus, our data shows a direct association
of HCC with insulin and sulphanylureas treatment and an inverse relationship
with metformin therapy.

PMID: 19469001 [PubMed - in process]
PMCID: PMC2686909


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Some Donor Factors Affect Outcomes for HCV-Positive Liver Transplant Recipients
Posted on: Friday, 29 May 2009, 07:54 CDT Two new studies address donor factors
that could affect outcomes for liver transplant recipients, particularly those
with chronic hepatitis C (HCV). One found that donor steatosis, or fat in the
liver, does not affect liver disease progression or three-year survival in
recipients with or without HCV. However, transplants from people higher on the
Donor Risk Index did adversely affect the outcomes of HCV-positive recipients
more than recipients without HCV.

These studies are in the June issue of Liver Transplantation, a journal
published by John Wiley & Sons The article is also available online at Wiley
Interscience (www.interscience.wiley.com).

HCV is a common cause of end-stage liver disease. It accounts for almost half of
the patients awaiting a liver transplant, 15 percent of whom will die before an
organ becomes available. To address this critical shortage, researchers have
searched for ways to expand the pool of potential donors. They have tried living
donor liver transplantation, partial liver transplants, and the use of grafts
from donors who may be less than ideal. Sub-optimal donors might include those
of advanced age or with other medical conditions such as hepatic steatosis, also
known as fatty liver disease, which is common in overweight individuals.

“There was no correlation between donor graft steatosis and fibrosis after
liver transplantation, irrespective of the etiology of liver disease,” the
authors report. They also found no evidence that steatosis affected patient
survival up to three years post-transplant.

In another study, researchers led by Daniel Maluf of Virginia Commonwealth
University performed a retrospective analysis of 16,678 patients who received a
liver transplant between January 2000 and June 2006. They examined the impact of
the donor risk index (DRI) on patient outcomes.

“Increasing DRI was associated with a statistically significant increase in
the relative risk of graft failure and patient death for both HCV-positive and
HCV-negative individuals,” they report. “However, HCV-positive recipients
demonstrated a significantly higher increase in relative risk of patient and
graft loss as a function of the DRI than HCV-negative subjects, even after
adjustment for several recipient factors including MELD.”

Donor age was the most significant, but not the only, factor that correlated to
worse outcomes. The authors concluded that high DRI grafts should be used
carefully in HCV-positive patients.

In an accompanying editorial, Sandy Feng of the UCSF Medical Center, supports
the findings of these new studies, and highlights the need to focus on survival
benefit for liver transplant recipients in a time of donor organ shortage.

“It is now possible to create an allocation algorithm that can systematically
and objectively account for the variable impact of donor characteristics on
liver transplant outcomes within the context of recipient diagnosis and disease
severity,” she concludes. “I believe that this would be the most equitable
and transparent way to distribute the differential risk posed by the donor pool
to individual transplant candidates.”


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http://www3. interscience. wiley.com/ journal/12241018 2/abstract

Liver Transplantation
See Also:
Hepatology
Volume 15 Issue 6, Pages 592 - 599
Published Online: 28 May 2009

Original Articles
Impact of the donor risk index on the outcome of hepatitis C virus-positive
liver transplant recipients


Daniel G. Maluf 1 *, Erick B. Edwards 3, R. Todd Stravitz 2, H. Myron Kauffman
3§
1Division of Transplantation Surgery, Virginia Commonwealth University,
Richmond, VA
2Section of Hepatology, Hume-Lee Transplant Center, Virginia Commonwealth
University, Richmond, VA
3United Network for Organ Sharing, Richmond, VA

email: Daniel G. Maluf (dgmaluf@vcu. edu)
*Correspondence to Daniel G. Maluf, Department of Surgery, Virginia Commonwealth
University, West Hospital 9th Floor, P.O. Box 980057, Richmond, VA 23298-0248
See Editorial on Page 570
Telephone: 804-628-3956; FAX: 804-828-4858
§Deceased.
Abstract
We have investigated the impact of the donor risk index (DRI) on the outcome of
hepatitis C virus (HCV)-infected patients undergoing liver transplantation
(LTx). Retrospective analysis was performed from the Organ Procurement and
Transplantation Network database (January 1, 2000 to June, 2006). The DRI was
calculated as described by Feng et al. (Am J Transplant 2006;6:783-790) . Model
for End-Stage Liver Disease (MELD) exceptions were excluded from the analysis.
Relative risk (RR) estimates of patient and graft loss were derived from Cox
regression models. The Wald test was used to test the effect of the MELD score
at transplant on the HCV-DRI interaction. Of the LTx recipients (16,678), 76.1%
were Caucasian, and 66.7% were male; the median age was 52 (range, 18-80 years),
and the mean follow-up time was 1148 days (range, 0-2959 days). Forty-six
percent (n = 7675) of LTx recipients were HCV(+). The median DRI was 1.3 (range,
0.77-4.27). Increasing DRI
  was associated with a statistically significant increase in the RR of graft
failure and patient death for both HCV(+) and HCV(-) recipients. However, HCV(+)
recipients demonstrated a significantly higher increase in the RR of patient and
graft loss as a function of the DRI than HCV(-) subjects, even after adjustments
for several recipient factors, including MELD. In conclusion, a synergistic
interaction between donor DRI and recipient HCV status exists, such that an
allograft from a high-DRI donor more adversely affects the outcome of an HCV(+)
recipient than that of an HCV(-) recipient. Liver Transpl 15:592-599, 2009. Š
2009 AASLD.

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http://www3. interscience. wiley.com/ journal/12241019 4/abstract

Liver Transplantation
See Also:
Hepatology
Volume 15 Issue 6, Pages 656 - 661
Published Online: 28 May 2009

Liver Transplantation Worldwide
Safety of invasive procedures in end-stage liver disease patients

James D. Perkins, M.D.
Liver Transplantation Worldwide, University of Washington Medical Center,
Seattle, WA

Abstract
Patients with end-stage liver disease (ESLD) are predisposed to bleeding
complications due to thrombocytopenia, reduced synthesis of coagulation factors,
and increased fibrinolytic activity. The exact incidence of vascular access site
and bleeding complications related to cardiac catheterization in this group
remains unknown. Eighty-eight consecutive patients with ESLD who underwent
left-sided cardiac catheterization from August 2004 to February 2007 were
identified. Eighty-one patients without known liver disease matched for age,
gender, and body mass index who underwent left-sided cardiac catheterization
during the same period were chosen as the control group. Vascular complications
were defined as hematoma>5 cm, pseudoaneurysm, arteriovenous fistula, or
retroperitoneal bleeding. Patients with ESLD had lower baseline mean hematocrit
(32.3 ą 6.0% vs 39.2 ą 6.2%, p


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http://www.ingentac onnect.com/ content/bsc/ jgh/2009/ 00000024/ 00000005/
art00018; jsessionid= ffj2sg45kobo. alice

An evaluation of the potential cost-effectiveness of non-invasive testing
strategies in the diagnosis of significant liver fibrosis

Authors: Carlson, Josh J1; Kowdley, Kris V2; Sullivan, Sean D3; Ramsey, Scott D;
Veenstra, David L

Source: Journal of Gastroenterology and Hepatology, Volume 24, Number 5, May
2009 , pp. 786-791(6)
Publisher: Blackwell Publishing

Abstract:

Background and Aim:
To assess the clinical and economic outcomes of non-invasive testing strategies
in the diagnosis of significant liver fibrosis (Metavir score 2) compared with
liver biopsy.

Methods: 
We developed a decision analytic model of non-invasive testing strategies in a
hypothetical patient population with genotype 1 hepatitis C virus infection,
with no contraindications to liver biopsy. The testing strategies included a
testing algorithm using the Fibrosure test, a non-invasive measure of fibrosis,
followed by liver biopsy for patients with indeterminate results, Fibrospect II,
and Fibroscan. The primary outcomes were sensitivity, specificity, diagnostic
accuracy (true positive, true negatives/total patients), and costs, evaluated
from the health-care payer perspective.

Results:
The testing algorithm using Fibrosure was the most accurate non-invasive
strategy with a sensitivity, specificity, and overall accuracy of 84%, 87%, and
86%, respectively. In comparison with liver biopsy alone, there was a cost
savings of approximately $770/person with the Fibrosure testing algorithm, but a
net decrease in accuracy of 14%. Fibrospect II and Fibroscan had poorer accuracy
(decreases of 12% and 4%, respectively) and lower costs ($138 and −$357,
respectively) compared with the Fibrosure algorithm. In uncertainty analyses in
which biopsy sampling error was considered, the Fibrosure algorithm remained
consistently less accurate (5-14% decrease).

Conclusions:
The results of our study suggest that compared with liver biopsy, non-invasive
testing algorithms can result in short-term cost savings, but the consequences
of misdiagnosis in terms of health outcomes and treatment costs might outweigh
the short-term gains in cost and convenience.


Document Type: Research article
DOI: 10.1111/j.1440- 1746.2009. 05778.x
Affiliations: 1: Institute for Public Health Genetics, School of Public Health
and Community Medicine, 2: Department of Medicine, School of Medicine,
University of Washington, 3: Pharmaceutical Outcomes Research and Policy
Program, School of Pharmacy, University of Washington

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http://www.ingentac onnect.com/ content/bsc/ jgh/2009/ 00000024/ 00000005/
art00019; jsessionid= ffj2sg45kobo. alice

Percutaneous liver biopsy: retrospective study over 15 years comparing
287 inpatients with 428 outpatients

Authors: Weigand, Kilian; Weigand, Kurt1

Source: Journal of Gastroenterology and Hepatology, Volume 24, Number 5, May
2009 , pp. 792-799(8)
Publisher: Blackwell Publishing


Abstract:
Background and Aim:
Liver histology still represents the gold standard for the assessment of liver
inflammation, necrosis, and fibrosis. The least cumbersome way of obtaining
liver tissue is percutaneous liver biopsy. The aim of this retrospective study
was to compare the complications following liver biopsy in in- and outpatients
and to evaluate for which patients the benefit from liver biopsy is highest.
Methods:
All patients undergoing percutaneous liver biopsy at a teaching hospital between
January 1990 and April 2005 were evaluated for indications, complications and
impact of histology. Results: 
Liver biopsy was performed in 287 inpatients and 428 outpatients with a success
rate of 99.4%. The total complication rate was 6.3% in inpatients and 11% in
outpatients. Only two major complications, but no deaths occurred. Pain was the
main complication, especially in young patients with chronic viral hepatitis.
Despite normal alanine aminotransferase (ALT) levels advanced liver fibrosis was
found in 9.3%, 2.6%, and 5.4% of all patients with HBV-, HCV infection, and non
viral liver diseases, respectively. In 3% of all patients evaluated a previously
unrecognized second liver disease was found. In 21.4% of the patients alkaline
phosphatase (AP) levels were elevated, and in more than 90% of these patients
liver biopsy led to the final diagnosis.
Conclusion:
Liver biopsy is safe in in- and outpatients. Biopsy is particularly helpful in
patients suspected of having liver disease in spite of normal ALT levels or in
patients exhibiting unexplained elevated AP levels.
Keywords: hepatitis B; hepatitis C; liver biopsy; liver cirrhosis; liver
histology
Document Type: Research article
DOI: 10.1111/j.1440- 1746.2008. 05718.x
Affiliations: 1: Department of Medicine and Gastroenterology, Stauferklinik
Schwaebisch Gmuend, Teaching Hospital of the University of Ulm, Ulm, Germany

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Phyllis was my favorite friend in advocacy and I always admired her ability to
make a difference and care for the incarcerated as she did.  She presented me
with a plaque back in 2000 and I honestly never felt deserving but it was a nice
gesture of her.   Our last conversation was a month before she passed and she
shared that we had the same middle name which at the time I wondered about and
now I see it was just her way of showing our similarities.   She never
complained a bit and was always there when a patient needed an uplifting. 
Goodbye dear friend, you have been gone over a year now and it still feels like
yesterday at times.
tara


75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
Senate Concurrent Resolution 1
Sponsored by Senator MORRISETTE (at the request of Caring Ambassadors Program)
(Presession filed.)
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not
a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor¢s brief statement
of the essential features of the
measure as introduced.
In memoriam: Phyllis Kaye Beck, 1949-2008.
CONCURRENT RESOLUTION
Whereas Phyllis Kaye Beck of Eugene, Oregon, was a respected nationally
recognized advocate
for and dedicated to serving all people living with or affected by hepatitis C;
and
Whereas Phyllis Kaye Beck, who was born in St. Helens, Oregon, on September 20,
1949, and
adopted by Walter and Beth Beck, made it her mission to bring healing to others;
and
Whereas Phyllis Kaye Beck was the founder of The Hepatitis C Awareness Project,
an Oregon
grassroots organization designed to increase the awareness of viral hepatitis
and to help educate the
community about HCV prevention, diagnosis and treatment; and
Whereas Phyllis Kaye Beck was the founder of The National Hepatitis C Prison
Coalition, a
group formed to bring together organizations and individuals interested in
raising awareness and
providing support to prisoners who suffer from hepatitis and HIV/HCV
co-infections; and
Whereas Phyllis Kaye Beck for more than 10 years led a support group for people
living with
hepatitis C, providing physical, emotional and intellectual support to people in
need; and
Whereas Phyllis Kaye Beck walked many miles in the halls of Congress in
Washington, D.C.,
and the Oregon Legislative Assembly in Salem telling her story and advocating
for change, using
her voice to help the millions of Americans living with viral hepatitis; and
Whereas Phyllis Kaye Beck was a proud mother of two, Greg and Lisa, who will
miss her dearly
but will forever be inspired by her loving spirit; and
Whereas throughout her life Phyllis Kaye Beck believed in the miracle of life
and never forgot
the importance of being here for others, and passed away on March 21, 2008, from
complications of
hepatitis C; now, therefore,
Be It Resolved by the Legislative Assembly of the State of Oregon:
That we, the members of the Seventy-fifth Legislative Assembly, recognize and
express our ap-
preciation for Phyllis Kaye Beck¢s legacy of commitment and devotion to her
community and her
life¢s work on behalf of all Oregonians and the State of Oregon.
NOTE: Matter in boldfaced type in an amended section is new; matter [italic and
bracketed] is existing law to be omitted.
New sections are in boldfaced type.

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http://www3. niaid.nih. gov/volunteer/ HIVandInfectious /ViralHepatitisS
tudies/hcvcv. htm

NIH Treatment Study
NIAID HIV and Emerging Infectious Diseases Program


Rituximab (anti-CD20) for the Treatment of Hepatitis C Associated
Cryoglobulinemic Vasculitis (HCV-CV)

Study Number
02-I-0096

Goal of Study
To determine the safety and efficacy of Rituximab in patients with HCV-CV

Study Regimen

Patients will be randomized to receive either Rituximab 375 mg/M2 on days 1, 8,
15 and 22, beginning at the time of enrollment or 6 months after enrollment.
Patients in both groups will be maintained on stable doses of any
immunosuppressive therapies that they were receiving at the time of enrollment.
Response to Rituximab will be assessed by clinical and laboratory parameters.
Patients will be followed for 12 months following the time of their last
Rituximab infusion. Study drug will be provided.

Eligibility Criteria

Age 18-75 years with documented HCV
Objective evidence of vasculitis
Failure or intolerance to treatment with IFN-alpha/ribavirin
Must have personal physician responsible for HCV care
Not pregnant or breast feeding
Willing to use effective contraception during study and for 12 months following
Rituximab treatment
No new initiation or change in immunosuppressive therapy in past 4 weeks
Not active infections other than HCV
No prior treatment with Rituximab
No history of liver transplant
No co-infection with Hepatitis B (HBV) or HIV
No underlying medical condition, that in the judgment of the investigator, would
put the patient at serious infusion-related adverse events


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http://www.correcti ons.com/news/ article/21586

Correctional Facilities and Viral Hepatitis
By "Centers for Disease Control and Prevention"
Published: 05/25/2009

Editor's note: - the following is from the Centers for Disease Control and
Prevention

Adults in correctional facilities are at risk for hepatitis B virus (HBV)
infection through sex with HBV-infected persons, injection drug use, and sharing
close living quarters with other inmates infected with HBV. In addition, a high
percentage of prison inmates have hepatitis C virus (HCV) infection.
Hepatitis B Vaccination
The Advisory Committee on Immunization Practices recommends hepatitis B
vaccination for adults in correctional settings because of their increased risk
for infection, both inside and outside of prisons and jails. Although the
majority of HBV infections among incarcerated persons are acquired in the
community, infection may also be transmitted within correctional settings.
Furthermore, upon release, susceptible inmates are often at increased risk for
infection if they resume high-risk behaviors.
Correctional settings also provide an opportunity to vaccinate at-risk adults
who do not routinely access prevention services in the community. Vaccinating
inmates in prisons has been demonstrated to be feasible and cost-saving. Many
state prison systems and the Federal Bureau of Prisons have implemented
hepatitis B vaccination programs of varying scope, and acceptance of vaccination
by inmates is high.
Hepatitis C Testing
The prevalence of HCV infection in prison inmates is substantially higher than
that of the general U.S. population. Among prison inmates, 16%�41% have ever
been infected with HCV, and 12%�35% are chronically infected, compared to
1%�1.5% in the uninstitutionalized US population. HCV infection is primarily
associated with a history of injection drug use. CDC recommends that
correctional facilities ask inmates questions about their risk factors for HCV
infection during their entry medical evaluations. Inmates reporting risk factors
should be tested for HCV infection and those who test positive for HCV should
receive further medical evaluation to determine if they have chronic infection
and/or liver disease.


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http://www.localstd testing.com/ 2/Hepatitis. htm?gclid= CMnIqbq-0poCFQWf
nAodDiIL3Q

Hepatitis Testing Available Same Day

Hepatitis B

You can have hepatitis B and not know it. You may not have symptoms. If you do,
they can make you feel like you have the flu. But as long as you have the virus,
you can spread it to others.

Sometimes the virus does not go away. This is called chronic hepatitis B. Over
time, it can damage your liver. Babies and young children infected with the
virus are more likely to get chronic hepatitis B.

What Causes Hepatitis B?

Hepatitis B is caused by the hepatitis B virus. It is spread through contact
with the blood and body fluids of an infected person.
You can get Hepatitis B if you:

Have sex without using a condom.
Share needles to inject drugs.
Get a tattoo or piercing with tools that were not cleaned right.
Share personal items like razors or toothbrushes.

What Are The Symptoms?

Many people with hepatitis B do not know they have it, because they do not have
symptoms. If you do have symptoms, you may just feel like you have the flu.
Symptoms include:

Feeling very tired.
Mild fever.
Headache.
Not wanting to eat.
Feeling sick to your stomach or vomiting.
Belly pain.
Diarrhea or constipation.
Muscle aches and joint pain.
Skin rash.
Yellowish eyes and skin (jaundice). Jaundice usually appears only after other
symptoms have started to go away.
Most people with Hepatitis B have no symptoms.

------------ --------- -----

Hepatitis C

Hepatitis C is a virus that infects the liver. In time, it can lead to permanent
liver damage as well as cirrhosis, liver cancer, and liver failure.

Many people do not know that they have hepatitis C until they already have some
liver damage. This can take many years. Some people who get hepatitis C have it
for a short time and then get better. This is called acute hepatitis C. But most
people who are infected with the virus go on to develop long-term, or chronic,
hepatitis C.

What Causes Hepatitis C Infection?

Hepatitis C is caused by the hepatitis C virus. It is spread from one person's
infected blood to another person's blood.

What are the symptoms?

Many people have no symptoms when they are first infected with the hepatitis C
virus. If you do develop symptoms, they are usually very similar to the symptoms
for hepatitis B.

------------ --------- --------

Our Hepatitis Testing Options

Hepatitis B Surface Antigen Test
This is the most frequently and easily performed test for hepatitis B and is the
first test to show abnormal results. HBsAg generally indicates active hepatitis
B virus infection.

Hepatitis B Surface Antibody Test
This antibody appears approximately 4 weeks after the disappearance of the
surface antigen and signifies the end of the acute infection phase. HBsAb also
signifies immunity to subsequent infections.

Hepatitis B Core Antibody Test
This antibody appears approximately 1 month after infection with HBsAg and
declines over several years. HBcAb is also present in people with chronic
hepatitis B.

Call Now! 1-800-610-0346

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	 * Hepatology. 2004 Sep;40(3):524-6.
Hepatitis C recurrence is more severe after living donor compared to cadaveric
liver transplantation.

Garcia-Retortillo M, Forns X, Llovet JM, Navasa M, Feliu A, Massaguer A,
Bruguera M, Fuster J, Garcia-Valdecasas JC, Rimola A.

Liver Unit, Hospital Clinic, Institut de Malalties Digestives, Institut
d'Investigacions Biomčdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Preliminary reports suggested that hepatitis C virus (HCV) infection has a more
aggressive course following living donor liver transplantation (LDLT) compared
to cadaveric liver transplantation (CLT). The aim of this prospective study was
to establish if HCV disease recurrence differs between LDLT and CLT. A cohort of
116 consecutive HCV-infected patients undergoing 117 LTs in a single center from
March 2000 to August 2003 were followed-up, including systematic liver biopsies.
Severe recurrence (SR) was defined as biopsy-proven cirrhosis and/or the
occurrence of clinical decompensation. After a median follow-up of 22 months
(2.6-44 months), 26 (22%) patients developed SR (decompensation in 12),
involving 17 (18%) of 95 patients undergoing CLT and 9 (41%) of 22 undergoing
LDLT. The 2-year probability of presenting SR was significantly higher in LDLT
compared to CLT (45% vs. 22%, P = .019). By univariate analysis LDLT (P = .019)
and an ALT higher than 80
  IU/L 3 months after LT (P = .022) were predictors of SR. In 93 patients from
whom a liver biopsy was available 3 months after LT, a lobular necroinflammatory
score >1 (P < .01), LDLT (P < .01), and biliary complications (P = .046) were
associated with SR. However, the only variables independently associated with SR
were LDLT (odds ratio [OR], = 2.8; 95% CI,1.19-6.6; P = .024) and a lobular
necroinflammatory score > 1 (OR, 3.1; 95% CI, 1.2-8; P = .013). In conclusion,
HCV recurrence is more severe in LDLT compared to CLT. Although our results were
based on a single-center experience, they should be considered in the
decision-making process of transplant programs, since severe HCV recurrence may
ultimately compromise graft and patient survival. Copyright 2004 American
Association for the Study of Liver Diseases

Publication Types:
	 * Comparative Study
PMID: 15349910 [PubMed - indexed for MEDLINE]

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http://www.reuters. com/article/ GCA-SwineFlu/ idUSTRE54J439200 90520

Advocacy groups deplore cuts to WHO talks agenda
Wed May 20, 2009 10:44am EDT

By Laura MacInnis
GENEVA (Reuters) - H1N1 flu, while worrying, should not have been allowed to
knock other health threats such as hepatitis and food safety from the agenda of
this week's World Health Organization congress, advocacy groups said on
Wednesday.
The U.N. agency's annual assembly was shortened to five days from nine to allow
officials to compare notes on pandemic readiness then return home sooner to
track the new strain that has killed 80 people and infected more than 10,000.
Campaigners for issues that were dropped, such as organ and tissue transplants,
fake drugs, research standards and Chagas disease, bemoaned the decision to
allow the virus that has caused mainly mild symptoms largely to eclipse the
meeting.
"It is right that the WHO is taking H1N1 so seriously and is making
preparations. But to allow a single disease to overshadow everything else is, I
think, very unfortunate, " said Charles Gore, president of the World Hepatitis
Alliance.
Gemma Ortiz of Medecins Sans Frontieres said she was "completely amazed and
gutted at the same time" when she found out discussions on Chagas, an
insect-borne disease, had been postponed until 2010.
She said the international community needed to focus on the 14 million people,
mainly in Latin America, infected with Chagas and the 15,000 a year who die from
it.
"The numbers sort of speak for themselves, for us," said Ortiz, who had hoped
the World Health Assembly would remind governments of the need to improve
diagnosis and treatment for the disease. "We really missed an opportunity, " she
said.
The shortened agenda delayed for a year discussion of a resolution on viral
hepatitis, which afflicts 500 million people and kills one person every 30
seconds.
Gore said the decision to put off that text, which aims to boost awareness,
prevention, diagnosis, treatment and monitoring of hepatitis B and C, was
regrettable.
"One million people will die before the World Health Assembly next meets in
2010," he said. "It does not sit comfortably with me putting something on that
scale to the side."


WHO Director-General Margaret Chan defended the decision to compress the meeting
as a result of H1N1 flu.
"This Health Assembly has been shortened for a good reason. Health officials are
right now too important to be away from their home countries for more than a few
days," she told the opening session on Monday.
"At the same time, we cannot, we dare not, let concerns about a pandemic
overshadow or interrupt other vital health programs," she said, stressing that
efforts to bolster medical care in advance of a pandemic could prove helpful for
"any other public health emergency of international concern."
(Editing by Andrew Dobbie)

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http://www.reuters. com/article/ entertainmentNew s/idUSTRE54J70J2 0090520

Natalie Cole receives new kidney
Wed May 20, 2009

LOS ANGELES (Reuters) - Rhythm and blues singer Natalie Cole, who has been
battling Hepatitis C, received a new kidney in Los Angeles and is resting
comfortably, her spokeswoman said on Wednesday.
Cole, the 59-year-old daughter of R&B legend Nat "King" Cole, underwent surgery
at Cedars-Sinai Medical Center in Los Angeles on Tuesday. The kidney came from a
deceased organ donor, the spokeswoman said in a statement.
She has been receiving kidney dialysis three times a week since September, even
as she toured the world to promote her new album, "Still Unforgettable. " Cole
will recuperate for the next three to four months, forcing her to postpone a
summer tour, the statement said.
The singer revealed her Hepatitis C diagnosis last July, saying she probably
contracted the liver disease from drug use more than 30 years ago.
Hepatitis C is a blood-borne infectious disease that can cause inflammation of
the liver, and in extreme cases, liver cancer. It is usually contracted through
transfusions of unscreened blood, or by injecting or inhaling drugs.
Cole has won nine Grammys in a 30-year career that has included albums such as
"Everlasting" and "Unforgettable ... With Love," which featured her singing a
duet with her late father via electronic technology.
(Reporting by Dean Goodman; editing by Paul Simao)

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http://www.news- medical.net/ news/2009/ 05/15/Pfizer- to-give-away- 70-of-its-
most-widely- prescribed- drugs-to- those-who- lost-jobs. aspx

Pfizer to give away 70 of its most widely prescribed drugs to those who lost
jobs
15. May 2009 18:31

Pfizer on Thursday announced a new program that would provide some of its
existing customers access to more than 70 types of medications at no cost if
they have recently been laid off or lost their prescription drug coverage, USA
Today reports. The program -- called MAINTAIN, or Medicines Assistance for Those
who Are in Need -- will begin July 1.
To receive the drugs, individuals must show that they have been unemployed since
Jan. 1 and that they no longer have prescription drug insurance. They also must
prove that they cannot pay for their medications and that they were taking a
medication listed under the program for at least three months prior to losing
their jobs. Those who meet the eligibility requirements would receive their
medications at no cost for up to one year, or until they have insurance
coverage. Pfizer will accept applications through Dec. 31 (Petrecca, USA Today,
5/15).
According to the AP/Detroit News, medications listed for the new patient
drug-assistance program include some of Pfizer's "top money makers," such as the
anti-cholesterol drug Lipitor, the painkiller Celebrex, the fibromyalgia
treatment Lyrica and the impotency treatment Viagra (Johnson, AP/Detroit News,
5/14).
Ray Kerins, a spokesperson for Pfizer, declined to reveal how much the program
would cost the pharmaceutical company or how many potential customers might
benefit from it (Bloomberg/Miami Herald, 5/15).
According to the AP/News, the program "could earn Pfizer some goodwill" after
"long being a target of critics of drug industry prices and sales practices"
(AP/Detroit News, 5/14). Scott Morgan, president of ad agency Brunner, said, "It
goes beyond goodwill. There's definitely a marketing strategy behind this about
defending against generics and maintaining your consumer base. ... It's a pretty
savvy move" (USA Today, 5/15).


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http://www.newsinfe rno.com/archives /6135

VA Says More Contamination Errors Possible
Date Published: Monday, May 18th, 2009


Veterans have been reported to have tested positive for HIV, hepatitis and other
life-threatening pathogens following shoddy colonoscopies and endoscopies at
three Veterans Affairs (VA) hospitals. The VA says it is unable to confirm if
the cases are connected to treatment at its sites, but has warned nearly 11,000
veterans who received care at those hospitals to undergo blood testing. Many
believe dirty equipment is to blame. Now, according to the Associated Press
(AP), other VA patients have not been warned about similar mistakes with the
same equipment at more than 12 other VA centers.
HIV and hepatitis B and C are spread by contact with infected body fluids,
especially blood. HIV—the human immunodeficiency virus—is the virus that
causes AIDS (acquired immunodeficiency syndrome); AIDS is the final stage of HIV
infection. Hepatitis B and C are liver diseases that can lead to cirrhosis or
cancer of the liver. Vaccines exist only for hepatitis B. HIV/AIDS and hepatitis
B and C can all be fatal.
The shoddy tests were conducted as far back as five years ago and put VA
patients at risk because they were treated with equipment that was not
appropriately sterilized, thus exposing them to the bodily fluids of other
patients, noted the AP in a prior report. The VA acknowledged in its warnings
letters that the invasive procedures potentially exposed them to other
patients’ bodily fluids. Also, the VA admitted in late March that water tubes
and reservoirs it used in colonoscopies and endoscopies were rinsed—not
disinfected—between procedures, which could expose subsequent patients to
contamination.
The VA’s chief patient safety officer, Dr. Jim Bagian, would not name the
additional facilities where incidents may have occurred. He also maintained that
the three VA facilities identified previously—Murfreesb oro, TN, Miami, FL,
and Augusta, GA—are the only ones with “any kind of appreciable risk” of
contamination, reported the AP. As of today, five former patients at the three
hospitals tested positive for HIV; 34 tested positive for hepatitis, said the
AP, which added that infection origin remains unclear.
In an earlier Washington Times article, the VA admitted that the three hospitals
did not appropriately sterilize colonoscopy equipment on a variety of occasions
since 2003. Also, WSMV said in an earlier report that, late last year the VA
found a wrong tubing valve might have been used during procedures as far back as
April 2003, which could have resulted in body fluid transmission between
patients.
Bagian told the AP that conducting blood tests for patients who received
treatment at the other, unnamed locations, would result in unnecessary patient
“anxiety.”
Meanwhile, the U.S. House Committee on Veterans’ Affairs has set a tentative
June date for a hearing in which the VA inspector general is to report on a
review of the issue, following a request by Senator Richard Burr of North
Carolina—the ranking Republican on the Committee.


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http://sev.prnewswi re.com/health- care-hospitals/ 20090518/ 3901226en_
iCrossing1805200 9-1.html

World Health Assembly Forced to Postpone Decision on Viral Hepatitis

- Global Epidemic Kills One Person Every 30 Seconds and One Million People Will
Die Before the World Health Assembly Meets Again in 2010
GENEVA, Switzerland, May 18 /PRNewswire/ -- Ahead of the second annual World
Hepatitis Day, the World Hepatitis Alliance today called on governments not to
forget the plight of 500 million people living with hepatitis B and C, as the
World Health Assembly postpones discussion of a World Health Organization (WHO)
resolution on viral hepatitis - one of the biggest threats to global health.
(Photo: http://www.newscom. com/cgi-bin/ prnh/20090518/ 347266 )

The 62nd World Health Assembly, starting in Geneva on 18 May, has been shortened
in response to the global efforts required to tackle H1N1 influenza. As a result
a scheduled resolution on viral hepatitis, submitted by Brazil and entitled
'Proposal for the Establishment of a World Day for the Struggle against Viral
Hepatitis and other issues relating to the Disease', which calls for action to
improve hepatitis awareness, diagnosis, prevention, treatment and support will
now not be discussed until 2010 at the earliest.
Charles Gore, President of the World Hepatitis Alliance explained that the
hepatitis community recognised the need for a concerted effort to tackle H1N1
influenza, but stressed that global health leaders can no longer afford to
ignore hepatitis B and C. "Viral hepatitis has never been properly addressed at
a global level and the consequences have been disastrous." commented Mr Gore.
"Despite this disappointing postponement, we look forward to working with both
the WHO Executive Board and governments around the world to ensure that a
resolution is passed in 2010 and that a comprehensive, coordinated approach is
adopted before another million people die."
Chronic viral hepatitis B and C affects one in 12 people globally and
approximately one person dies every 30 seconds, meaning that one million people
will die before the World Health Assembly next meets in 2010. Since the
hepatitis B and C viruses were first discovered in 1967 and 1988 respectively,
there has not been a single WHO resolution that fully addresses the challenges
of the global epidemic.
19 May marks the second World Hepatitis Day, and over 200 patient groups from
more than 50 countries have been recognising the day by asking the question 'Am
I Number 12?' - an awareness raising campaign aimed at highlighting the shocking
statistic that one in 12 people worldwide are living with either chronic
hepatitis B or chronic hepatitis C. While this is far higher than the prevalence
of HIV or any cancer, awareness is inexplicably low and the majority of those
infected are unaware.

Did You Know?
- Approximately 500 million people worldwide are currently
infected with hepatitis B or C(1)
- This is over 10 times the number infected with HIV/AIDS(2)
- Between them, hepatitis B and C kill one million people a year(1)
- One in every three people on the planet has been exposed to
either or both viruses
- Most of the 500 million infected do not know

Messages of Support for the World Hepatitis Alliance
The following people have provided quotes expressing their support to the World
Hepatitis Alliance campaign for a WHO resolution on viral hepatitis. For further
information please contact worldhepday@ fleishman. com

- Dr. Michael Houghton, co-discoverer of the hepatitis C virus
- Prof. Baruch Blumberg, Nobel Laureate, co-discoverer of the
hepatitis B virus and co-inventor of the hepatitis B vaccine
- Prof. Muhammad Yunus, Nobel Laureate and global Economist

World Hepatitis Alliance
The World Hepatitis Alliance provides global leadership and supports action that
will halt the death toll and improve the lives of people living with chronic
viral hepatitis B and C. Through better awareness, prevention, care, support and
access to treatment, our ultimate goal is to work with governments to eradicate
these diseases from the planet.
The World Hepatitis Alliance is a Non-Governmental Organisation representing
more than 200 hepatitis B and C patient groups from around the world. The World
Hepatitis Alliance is governed by a representative board elected by patient
groups from seven world regions: Europe, Eastern Mediterranean, Africa, North
America, South America, Australasia and Western Pacific. For further information
visit: http://www.worldhep atitisday. org
World Hepatitis Alliance - Seeking a world without viral hepatitis B and C.
World Hepatitis Day
The second annual World Hepatitis Day will take place on Tuesday 19 May 2009, as
part of an ongoing campaign launched by the World Hepatitis Alliance in 2008. An
entirely patient-led initiative, World Hepatitis Day in 2009 aims to raise
awareness of hepatitis B and C, as well as extend the political support for the
diseases to levels seen in HIV / AIDS, TB and malaria. The long-term objective
of the World Hepatitis Day Campaign is to prevent new infections and to deliver
real improvements in health outcomes for people living with hepatitis B and C.
The campaign theme for 2009 is 'Am I Number 12?' - designed to communicate the
shocking statistic that one in 12 people worldwide are living with either
hepatitis B or hepatitis C.
References
(1)World Health Organization. Viral hepatitis: Report by the Secretariat.
http://apps. who.int/gb/ ebwha/pdf_ files/A62/ A62_22-en. pdf (accessed May 11,
2009)
(2) World Health Organization. Global summary of the AIDS epidemic.
http://www.who. int/hiv/data/ 2008_global_ summary_AIDS_ ep.png (accessed
May 11, 2009)


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http://www.news- medical.net/ news/2009/ 05/18/Denver- Post-examines-
efforts-to- establish- needle-exchange- programs- in-Colorado. aspx

Denver Post examines efforts to establish needle-exchange programs in Colorado
18. May 2009 19:11

The Denver Post on Friday examined efforts to establish needle-exchange programs
in Colorado to reduce the risk of HIV and hepatitis C among injection drug
users.
According to the Post, 185 cities in Colorado have needle-exchange programs, but
legislation that would have legalized needle exchanges statewide did not advance
in the Legislature this year. "The issue is more complex than it perhaps first
appears," Evan Dreyer, a spokesperson for Gov. Bill Ritter (D), said, adding
that "law enforcement and the Colorado Department of Public Health and
Environment both expressed serious reservations" about a proposal that would
have legalized needle-exchanges statewide.

A coalition of public health officials, treatment providers and advocates are
increasing efforts to establish a needle-exchange program in Denver, the Post
reports. The Denver Drug Strategy Commission in February recommended that Mayor
John Hickenlooper consider a pilot needle-exchange program, DDSC Director Karla
Maraccini said. The commission is looking at different programs to develop a
model following Hickenlooper' s request for additional research. However, Denver
District Attorney Mitch Morrissey has concerns that a local needle-exchange
program would violate state law, according to Morrissey's spokesperson Lynn
Kimbrough. Eric Brown, a spokesperson for Hickenlooper, added, "Anything in
contradiction to city or state law would have to be carefully considered."

Proponents of needle-exchange programs say they prevent HIV and hepatitis C, but
opponents say they condone injection drug use. Mark Thrun, director of HIV
prevention for Denver Public Health, said, adding that needle-exchange programs
prevent IDUs from "getting these chronic, potentially fatal diseases" and give
public health workers "an opportunity to link them into treatment; and it
lessens the economic burden on the already overburdened health care system."
Thrun noted that several studies have found that needle-exchange programs do not
encourage or prolong injection drug use and make IDUs more likely to seek
treatment. In addition, a 2005 CDC study found that 86% of exchange programs
make treatment referrals and that more than 80% offer counseling and testing for
HIV/AIDS and hepatitis C.

Nancy Steinfurth, executive director of the Hep C Connection, noted that an
estimated 10% of HIV cases and 70% of hepatitis C cases are transmitted through
needles (Auge, Denver Post, 5/15).

This article is republished with kind permission from our friends at The Kaiser
Family Foundation. You can view the entire Kaiser Daily Health Policy Report,
search the archives, or sign up for email delivery of in-depth coverage of
health policy developments, debates and discussions. The Kaiser Daily Health
Policy Report is published for Kaisernetwork. org, a free service of The Henry
J. Kaiser Family Foundation


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http://www.bclocaln ews.com/bc_ cariboo/williams laketribune/ lifestyles/
45065147. html

Hepatitis C nothing to ignore
Published: May 15, 2009 7:00 PM

TONI PATE is the community’s new part-time Prevention Worker and encourages
young people not to take chances with their health by learning how to protect
themselves from contracting Hepatitis C or HIV/AIDS.
Toni Pate, the community’s new part-time prevention worker, and fellow staff
and patrons of the NOOPA Youth Centre will be recognizing World Hepatitis Day
this Tuesday, May 19 by handing out information material to the public.
Volunteers will be handing out information magnets and pamphlets along with a
cookie, from 11 a.m. to about 2 p.m. at Boitanio Mall, and if weather permits,
at the corner of Third Avenue and Oliver Street, Pate says.
Pate says that world-wide, one in 12 people are living with chronic Hepatitis B
or C, including 600,000 Canadians.
She says one per cent of the population in Canada has the HIV virus, and there
are 5,000 new cases of Hepatitis C in B.C. every year, the majority of them
among youth, and related to lifestyle.
And those are only the one’s who have been diagnosed, Pate says.
“The problem is that many people don’t even know it,” Pate says.
In the Cariboo-Chilcotin she says a 2008 study indicated that 102 people in this
region have Hepatitis C.
Hepatitis C is dangerous because it damages the liver and can lead to liver
failure and liver cancer. Consumption of alcohol speeds up the progression of
symptoms for those who have the virus.
There are vaccinations for Hepatitis A and B but not for Hepatitis C, Pate says.
According to information pamphlets about 20 per cent of people who are infected
with Hepatitis C can get rid of the virus naturally.
While 20 per cent of people will show symptoms right away, for 80 per cent of
people the virus continues as a chronic infection that may not be discovered
until the liver is severely damaged. Between one and four per cent of infected
people will develop liver cancer.
“When it comes to HIV and Hepatitis C ignorance is not bliss. These are
infections we can protect ourselves from but we need to know how,” Pate says.
Like HIV/AIDS she says Hepatitis C is transmitted through blood to blood contact
through open wounds or by unprotected sex.
She says HIV can live in the vacuum of a needle for up to 72 hours.
Hepatitis C can live up to six weeks on a broken piece of glass.
Pate says it is safer to assume that any bodily fluid, needle or broken glass is
infected with HIV or Hepatitis C than to assume that it is not infected.
Don’t do tattoos, piercings, or brandings at home, she advises.
And if you do want a tattoo, go to a professional and make sure the artist is
licensed and uses clean equipment and new ink every time.
She says it only takes one act of unprotected sex to get HIV or Hepatitis C if
the partner is infected.
Sharing cocaine straws or crack pipes is also dangerous. People could have open
sores on the lips or in the mouth through which the virus could be transferred
by sharing a pipe.
Cocaine is like glass and breaks blood vessels in the nose which can release
blood that will be passed from one user to another through a straw or rolled up
bill, Pate says.
Never pick up a needle with bare hands that you may see in a public place.
Call her and someone will come and remove the needle.
She says garbage may contain needles or glass that may be contaminated with
Hepatitis C or HIV, which makes it unwise to push down garbage using hands.
“It is so easy to use these precautions to protect ourselves. I don’t want
people to be afraid. I just want them to be aware,” Pate says.
Pate can be reached at 250-392-5730.


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http://www.frontline-hepatitis-awareness.com/gastrocorner.htm
This is a good article about cirrhosis from our website.  It is under the
Digestion link on the front page in case you lose this URL. 
http://www.frontline-hepatitis-awareness.com/  our website and how to join the
Yahoo listserves.  I do this one called frontline2 and Sherre Martin does the
other one which includes vaccination issues as well as Hepatitis  B and HIV
coinfection. She does an heartfelt good job.

 (I am not particularly pro vaccine of SOME of the vaccines although I do
believe everyone should be vaccinated for certain of the choices like hepatitis,
measles, polio, smallpox etc.)  I do feel that kids are way over vaccinated
today with the average at age 18 months being 23 different vaccines. 
Whew......It is a personal choice and this is how I happen to feel. The
important ones should be given no doubt. I wish to thank Sherre for all her help
as it has kept the list happening, thanks Sherri.

Frontline needs a person to help upload several articles onto the web pages
using 'frontpage.'  Our website is in need of updating.  We did the links
already but the articles (newer ones) would be super.  Thanks in advance.  We
are not a funded group anymore but do have some nice articles to trade for work
done in anyone is willing to help us. I have all the info to enter our docking
persons home to upload as I personally pay for most of Frontline now as a gift
from me to those in need.

As some of you know I went to Seattle to be evaluated for a transplant and got
the boot as it were.  My doctor is furious as she knows of our group and how we
educate so has taken on the whole U of W team to help me.  I am due to see a
case worker and a nutritionalist as my weight is a definate issue.  I also am
advocating to change the wording of transplant so that when a candidate fills up
with the fluid we all do it is not used against our change at a transplant.  I
was told by the doctor I saw there that 75% of candidates on the list with the
beeper become unqualified at the time a liver is available due to the MBI issue
and how the water (up to 20 lbs added weight) keeps one from a transplant.

If anyone wishes to get onboard this issue please let me know and we can work
together.  What I am doing now is researching as to whether this is a transplant
team perogotive or a federal mandate.  I have a way to go that is for sure but
it is very important.  Who wants to go through the waiting and become qualified
only to be knocked off the list and die due to water build up being a part of
the Mas body index number and this the weight.

I am finding myself running out of energy these days and spending a lot of time
in bed so I need some help.  thanks in advance you may use this address: 
skayb@...  to contact me personally.


Tara Balduf
www.Frontline-Hepatitis-Awareness.com

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Hepatology
Published Online: 3 Mar 2009

Association between dietary nutrient composition and the incidence of cirrhosis
or liver cancer in the united states population


1Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget
Sound Health Care System, Seattle, WA
2Research Enhancement Award Program, Veterans Affairs Puget Sound Health Care
System, Seattle, WA
3Division of Gastroenterology, Department of Medicine, University of Washington,
Seattle, WA

email: George N. Ioannou (georgei@medicine. washington. edu)

Funded by:
American Liver Foundation
American Association for the Study of Liver Diseases Jan Albrecht Award


Abstract
Little is known about the impact of dietary factors on the progression of liver
disease. Our aim was to determine whether dietary intake was associated with the
risk of cirrhosis-related or liver cancer-related death or hospitalization in
the U.S. population. Participants included 9221 persons aged 25-74 years without
evidence of cirrhosis at entry into the study or during the first 5 years of
follow-up, who were subsequently followed for a mean of 13.3 years as part of
the first National Health and Nutrition Examination Survey. Dietary intake was
ascertained at baseline using a 24-hour dietary recall questionnaire. During
follow-up, 123 of 9221 participants had a diagnosis of cirrhosis (n = 118) or
liver cancer (n = 5) in hospitalization records or death certificates, including
36 who were diagnosed only on the basis of death certificates. Participants who
reported a diet high in protein were at a higher risk of hospitalization or
death due to cirrhosis
  or liver cancer (P = 0.001), whereas those who reported a diet high in
carbohydrates were at a lower risk (P = 0.003), after adjusting for potential
confounders (daily consumption of protein, carbohydrate, fat, tea or coffee, and
alcohol, gender, race, age, educational attainment, U.S. geographical region,
diabetes, body mass index, and subscapular- to-triceps skinfold ratio). Although
total fat consumption was not significantly associated with the risk of
cirrhosis or liver cancer, cholesterol consumption was associated with higher
risk (P = 0.007), whereas serum cholesterol level was not associated with risk
of cirrhosis or liver cancer. Conclusion: Diet may be an important and
potentially modifiable determinant of liver disease. (HEPATOLOGY 2009.)

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http://www.scienced aily.com/ releases/ 2009/05/09051312 1629.htm

Microwave Technique Successful In Treatment Of Liver Tumors, Surgeon Shows
ScienceDaily (May 14, 2009) — Leicester consultant surgeon who has developed a
pioneering technique using microwaves to destroy liver tumours has treated more
than 100 patients in the UK and other patients are now being treated
internationally.

Worldwide, about one million people a year die of primary liver cancer, with
another million dying with secondary liver cancer where the cancer has spread
from other tumour sites such as cancer of the colon.
The incidence of primary liver cancer is gradually increasing in the Western
world, but it is very common in Asia and the Far East where it is associated
with endemic hepatitis. Most patients with liver cancer are deemed inoperable
but with the development of this microwave equipment, literally thousands of
patients worldwide could be offered curative treatment, even if they have
established liver cirrhosis.
David Lloyd’s research, in collaboration with Professor Nigel Cronin and Dr.
Peter Clegg at the University of Bath, has led to the development and production
of a microwave generator and probe, now being manufactured by Acculis Ltd, UK.
The treatment of more than 100 patients with liver cancer has resulted in curing
or extending life for many of them, whose life prognosis was less than twelve
months. More than one third of the patients treated are still alive after three
years and some have been, quite simply, pronounced cured and discharged.
The earliest patient to be discharged is one of David Lloyd’s trial patients
treated nine years ago. Several more are alive and well five years after
receiving treatment.
The importance of this application of microwave technology is immense, as Mr
Lloyd explained: “The technique will have a significant effect on liver
cancers, because we are operating on people who have been declared inoperable.
Someone with cirrhosis of the liver can’t be operated on in a conventional way
to remove a tumour, but we can place a microwave probe in by keyhole or
percutaneous (through the skin) methods and can destroy these tumours.”
Because of the pioneering research done at the University Hospitals Leicester,
the microwave generator is being used as far afield as Hong Kong, Singapore, the
USA and Australia. In particular, the microwave technology has been embraced by
many of the top cancer hospitals in the US, including the Memorial
Sloan-Kettering Cancer Institute in New York, The Johns Hopkins University in
Baltimore, and the M D Anderson Cancer Centre in Texas. Mr Lloyd added:
“We’ve placed several in France and Switzerland and many of the world’s
leading liver surgeons have now expressed an interest in using the generator.
Because David Lloyd was the only surgeon with this specialised equipment he was
referred patients from all over the world for treatment. He is extremely pleased
that more centres are now using the microwave device and, in the UK, there are
now generators in major teaching hospitals in Liverpool, Manchester, Leeds,
Basingstoke and Edinburgh. David Lloyd calculates that within a couple of years,
every major liver centre in the UK will probably have a microwave generator.
The advantage the microwave technique has over other machines designed to
destroy tumours, such as laser, ultrasound and radio-frequency (which is similar
to an electric current) is that it is quick and produces cancer cell death with
very few side effects.
Only tissue in the immediate field of the microwave energy is destroyed, David
Lloyd explained, and not in other parts of the body, which is a danger with
other methods, such as radio-frequency, where the electric current has to have
an exit point from the body, with the risk of burning at that site.
“Microwaves don’t cause collateral damage elsewhere in the body,” he said.
“They only heat up the tissue at the end of the probe and no energy is sent
through the body. We can now treat very large tumours up to 6-8 cms in diameter
within 4-6 minutes. This makes it ideal for someone who may have multiple
tumours, which by other techniques, might take several hours to treat.
“People have come to Leicester from all over the world,” he added. “It has
really put Leicester on the map, within this field. For the last ten years I
have been invited to every world and European congress in liver surgery to talk
about this development. There has been tremendous interest because of the
frustration with other forms of energy which haven’t delivered. Our system is
safe, fast and reproducible and it does work.
“If it’s used correctly there are no side effects, but because this is a
very powerful device, it has to be used correctly. I tend to work in
collaboration with a radiologist so that accurate placement of the microwave
probe can be achieved. We have not seen significant side-effects so far.”
Mr David M Lloyd, MBBS, MD, FRCS, a consultant surgeon with University Hospitals
Leicester NHS Trust, is also acclaimed for his innovative work in keyhole
surgery. The University of Leicester has awarded him an Honorary Senior
Lectureship, and earlier this month he won the title of Honoured Citizen of the
Year for the City of Leicester.

------------ --------- --------- --------- --------- --------- -
Adapted from materials provided by University of Leicester, via AlphaGalileo.


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http://www.scienced aily.com/ releases/ 2009/05/09050412 2115.htm

Hypothyroidism In Women Associated With Liver Cancer
ScienceDaily (May 8, 2009)

Women with a history of hypothyroidism face a significantly higher risk of
developing liver cancer, according to a new study.
Hypothyroidism is the most common thyroid disorder among U.S. adults, affecting
between 8 and 12 percent of the U.S. population, and more women than men. The
condition can cause hyperlipidemia and weight gain and may play a role in the
development of nonalcoholic steatohepatitis which can progress to more severe
liver disease. Studies have also suggested a clinical association between
hypothyroidism and hepatitis C, which is contributing to the country’s rising
rate of liver cancer.

Researchers, led by Manal Hassan of Anderson Cancer Center at the University of
Texas, designed a case-control study to better understand the association
between hypothyroidism and the development of liver cancer, also known as
hepatocellular carcinoma (HCC), in the U.S.

They included 420 patients with liver cancer and 1,104 healthy controls. From
each subject, the researchers gathered demographic data and information about
liver cancer risk factors, like smoking, alcohol consumption and family cancer
history. The participants were also asked about their history of thyroid
conditions and obesity. They provided blood samples that were tested for
hepatitis B and hepatitis C.

About 15 percent of the liver cancer patients had a history of thyroid disease,
compared to about 12 percent of the healthy controls. Subjects with a history of
hypothyroidism had twice the risk of liver cancer; however the relationship was
only significant for females.

Women who had a prior history of hypothyroidism for more than 10 years had a
threefold higher risk of liver cancer compared to women without a history of
thyroid disorders. Adjusting for obesity did not change the association.

“Whether and why hypothyroidism causes HCC is not clear,” the authors write.
“However, the association between hypothyroidism and NASH can be explained by
the underlying hyperlipidemia, decreased fatty acid oxidation insulin resistance
and lipid peroxidation in patients with hypothyroidism.” And these conditions
may make the patient susceptible to HCC development.

“Further studies among different populations are warranted to confirm the
association between hypothyroidism and HCC and to identify the underlying
biological mechanisms and the genetic predisposition factors that may contribute
to susceptibility to HCC development in the presence of thyroid disorders,”
the authors conclude.

------------ --------- --------- --------- --------- --------- -
Journal reference:
Hassan, Manal; Kaseb, Ahmed; Li, Donghui; Patt, Yehuda; Vauthey, Jean-Nicolas;
Thomas, Melanie; Curley, Steven A.; Spitz, Margaret; Sherman, Steven; Abdalla,
Eddie; Davila, Marta; Lozano, Richard; Hassan, Deena; Chan, Wenyaw; Brown,
Thomas; Abbruzzese, James. Association Between Hypothyroidism and Hepatocellular
Carcinoma: USA Case-Control Study. Hepatology, May 2009
Adapted from materials provided by Wiley-Blackwell.


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http://www.thenews. com.pk/daily_ detail.asp? id=176908

350 people vaccinated for Hepatitis B at KPC



Monday, May 11, 2009
By our correspondent
Karachi
As many as 350 people were vaccinated on Sunday during the second round of
Hepatitis-B vaccination at the Karachi Press Club (KPC). The vaccination was
organised by the Infection Control Society Pakistan (ICSP), in collaboration
with the KPC and the Chief Minister’s Initiative on Hepatitis Control
Programme Sindh (IHCPS).
Deputy Programme Manager Sindh, Dr Syed Ali Anjum, was the chief guest on the
occasion. In his brief address, he appreciated the efforts of ICSP and the KPC
for making this event a great success.
Dr Anjum said that the government had launched this programme in a very
effective way and it was designed in a very short time. According to Dr Anjum,
there are seven treatment centres in Karachi where treatment is provided for
free. He disclosed that so far they have registered 15,000 cases of Hepatitis
‘B’ and ‘C’ out of which around 5,000 are already getting treatment. He
also said that so far they had vaccinated 150,000. They also aimed to vaccinate
around 42,000,000 newborn babies against Hepatitis ‘B’.
Dr Saeed Ahmed Abbasi, who was the chief organiser of the camp from the ICSP,
warned that Hepatitis ‘C’ was spreading very fast. “Whenever we conduct
any screening and testing for Hepatitis ‘B’ and Hepatitis ‘C’ along with
testing for HIV almost 30 to 40 per cent high risk population turn out to be
positive for Hepatitis ‘C’,” he said.
He stressed that a lot of work was needed to impart proper knowledge among the
masses about the methods of prevention for Hepatitis ‘C’, methods of
transmission of Hepatitis ‘C’ and also the hazards of Hepatitis ‘C’.
In the end, KPC Secretary A.H Khanzada thanked all the participants and
appreciated the co-operation of the ICSP and Dr Syed Ali Anjum from CM IHCPS. He
also thanks Aalya Nasir, the principal of the College of Nursing at the Liaquat
National Hospital, for her co-operation. The third and final round of Hepatitis
vaccination will be conducted on July 10, he said.

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http://www.scienced aily.com/ releases/ 2009/05/09050417 1943.htm

Gene Responsible For Acetaminophen- induced Liver Injury Identified

ScienceDaily (May 11, 2009) — Acetaminophen (Tylenol and generics) is one of
the most commonly used over-the-counter drugs in the United States. While
generally safe, acetaminophen is known to cause severe liver injury if taken in
high doses. But likely due to genetics, even the recommended dose can induce
serious liver damage in a significant number of people. Scientists have now
found a genetic marker linked to the risk of acetaminophen- induced liver
injury, using a strategy that will help develop safer drugs in the future.
Acetaminophen is considered safe over long-term use, but recent studies have
indicated that even over a relatively short period, the maximum allowable dose
can induce elevated levels of the liver enzyme ALT in blood serum in
approximately one third of healthy individuals, suggesting possible liver
injury. It is possible that if given high doses, many of these individuals would
be susceptible to acute liver failure. There is likely to be a genetic
predisposition, but finding the variants by scanning human subjects alone can be
very difficult, requiring large studies with many participants. But with a
little help from mice, researchers can overcome these experimental hurdles.
In this study, a team of researchers led by Dr. David Threadgill of North
Carolina State University utilized mouse genetics to aid the search for
candidate genes linked to acetaminophen- induced liver injury in humans. "We
approached the study from the perspective that drugs are used in very
heterogeneous patient populations, and that drug-induced toxicities are likely
the result of a person's genetic makeup," Threadgill explained. The group used a
genetically diverse population of mice to model human genetic variation, taking
advantage of the known genetic differences in these strains to find genes linked
to variable responses to acetaminophen treatment.
Once Threadgill and colleagues narrowed their search to a few candidate genes in
mouse, they sequenced the genetic code of the counterparts of the same genes in
human patients exhibiting elevated levels of serum ALT in response to
acetaminophen. They found that a single letter change to the DNA sequence in one
of these candidate genes, called CD44, is significantly associated with elevated
serum ALT in these patients. While the role of this gene in liver toxicity is
not yet known, CD44 could serve as a potentially useful marker to identify
people at risk for acetaminophen- induced liver damage.
Threadgill noted that in addition to the identification of a gene linked to
acetaminophen- induced liver injury, this study has broader implications for
drug testing, as up until now, genetic differences in humans has not been
considered in pre-clinical tests using animal models. "If genetic differences
are included in early safety testing, more accurate predictions of clinical
response will be obtained," said Threadgill. "The end result will be safer
drugs."
Scientists from the University of North Carolina (Chapel Hill, NC), the Genomics
Institute of the Novartis Research Foundation (San Diego, CA), the Jackson
Laboratory (Bar Harbor, ME), the National Institute of Environmental Health
Sciences (Research Triangle Park, NC), Verto Institute Research Laboratories
(New Brunswick, NJ), the Cancer Institute of New Jersey (New Brunswick, NJ),
Purdue Pharma (Stamford, CT), and North Carolina State University (Raleigh, NC)
contributed to this study.
This work was supported by the National Institutes of Health and the
Environmental Protection Agency.

------------ --------- --------- --------- --------- --------- -
Journal reference:
Harrill, A.H., Watkins, P.B., Su, S., Ross, P.K., Harbourt, D.E., Stylianou,
I.M., Boorman, G.A., Russo, M.W., Sackler, R.S., Harris, S.C., Contractor, T.,
Wiltshire, T., Rusyn, I., and Threadgill, D.W. Mouse population-guided
resequencing reveals that variants in CD44 contribute to acetaminophen- induced
liver injury in humans. Genome Res, DOI: 10.1101/gr.090241. 108
Adapted from materials provided by Cold Spring Harbor Laboratory, via
EurekAlert!, a service of AAAS.

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