{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:39:19Z","timestamp":1761561559612,"version":"3.37.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":1735,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2010,12]]},"abstract":"<jats:sec>\n            <jats:title>Abstract<\/jats:title>\n            <jats:p>\n                                 <jats:bold>The etiology of primary biliary cirrhosis (PBC) is far from clear. Both genetic and environmental factors are likely to be involved. We have previously reported evidence of space-time clustering, suggesting that a transient environmental agent may be involved in etiology. To further examine whether a seasonally varying environmental agent may contribute to the etiology of PBC, we have analyzed seasonal variation with respect to month of diagnosis using population-based data from northeast England over a defined period (1987-2003). Date of diagnosis was defined as the earliest date at which the patient was found to have fulfilled any two of three diagnostic criteria (i.e., antimitochondrial antibody\u2013positive titer \u22651 in 40, cholestatic liver blood tests, diagnostic or compatible liver histology). Monthly expected (E) numbers of cases were calculated under an assumption of a uniform distribution throughout the year. Observed counts (O) were compared with the expected numbers. The chi-squared heterogeneity test was used to test for overall nonuniform variation and also for individual months. Poisson regression analysis was used to fit a sinusoidal (i.e., harmonic) model to the data, using month of diagnosis as a covariate in the model. There was a marked peak for diagnoses in the month of June (O = 115, E = 84.7, O\/E = 1.36;<\/jats:bold>\n                                 <jats:bold>\n                                    P\n                                 <\/jats:bold>\n                                 <jats:bold>= 0.001). Furthermore, there was evidence of a sinusoidal pattern with a June peak (<\/jats:bold>\n                                 <jats:bold>\n                                    P\n                                 <\/jats:bold>\n                                 <jats:bold>= 0.012).<\/jats:bold>\n                              <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>\n                                 <jats:bold>These highly novel results provide further evidence for the involvement of a seasonally varying environmental agent in the etiology of PBC. (Hepatology 2011)<\/jats:bold>\n                              <\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.24597","type":"journal-article","created":{"date-parts":[[2011,8,8]],"date-time":"2011-08-08T15:41:13Z","timestamp":1312818073000},"page":"2099-2103","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":38,"title":["Seasonal variation in the patient diagnosis of primary biliary cirrhosis: Further evidence for an environmental component to etiology"],"prefix":"10.1097","volume":"54","author":[{"given":"Richard J.Q.","family":"McNally","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter W.","family":"James","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Ducker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver F.W.","family":"James","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-23-20250207","doi-asserted-by":"crossref","first-page":"12611273","DOI":"10.1056\/NEJMra043898","article-title":"Primary biliary cirrhosis.","volume":"353","author":"Kaplan","year":"2005","journal-title":"N Engl J Med"},{"key":"R2-23-20250207","doi-asserted-by":"crossref","first-page":"25442555","DOI":"10.1056\/NEJMoa0810440","article-title":"Primary biliary cirrhosis associated with HLA, IL 12A, and IL 12RB2 variants.","volume":"360","author":"Hirschfield","year":"2009","journal-title":"N Engl J Med"},{"key":"R3-23-20250207","doi-asserted-by":"crossref","first-page":"508512","DOI":"10.1136\/gut.2009.184218","article-title":"Casecontrol studies of risk factors for primary biliary cirrhosis in two United Kingdom populations.","volume":"59","author":"Prince","year":"2010","journal-title":"Gut"},{"key":"R4-23-20250207","doi-asserted-by":"crossref","first-page":"415420","DOI":"10.1016\/j.it.2009.05.006","article-title":"The role of environmental factors in primary biliary cirrhosis.","volume":"30","author":"Selmi","year":"2009","journal-title":"Trends Immunol"},{"key":"R5-23-20250207","doi-asserted-by":"crossref","first-page":"11691174","DOI":"10.1002\/hep.23139","article-title":"Are transient environmental agents involved in the cause of primary biliary cirrhosis? Evidence from spacetime clustering analysis.","volume":"50","author":"McNally","year":"2009","journal-title":"HEPATOLOGY"},{"key":"R6-23-20250207","doi-asserted-by":"crossref","first-page":"408414","DOI":"10.1016\/S0168-8278(05)80225-9","article-title":"M2 mitochondrial antibodies and urinary rough mutant bacteria in patients with primary biliary cirrhosis and in patients with recurrent bacteriuria.","volume":"17","author":"Butler","year":"1993","journal-title":"J Hepatol"},{"key":"R7-23-20250207","doi-asserted-by":"crossref","first-page":"12501257","DOI":"10.1053\/jhep.2003.50446","article-title":"Patients with primary biliary cirrhosis react against a ubiquitous xenobioticmatabolizing bacterium.","volume":"38","author":"Selmi","year":"2003","journal-title":"HEPATOLOGY"},{"key":"R8-23-20250207","doi-asserted-by":"crossref","first-page":"84548459","DOI":"10.1073\/pnas.1433063100","article-title":"Does a betaretrovirus infection trigger primary biliary cirrhosis?","volume":"100","author":"Xu","year":"2003","journal-title":"Proc Natl Acad Sci U S A"},{"key":"R9-23-20250207","doi-asserted-by":"crossref","first-page":"586588","DOI":"10.1136\/gut.47.4.586","article-title":"PBC: an infectious disease.","volume":"47","author":"Haydon","year":"2000","journal-title":"Gut"},{"key":"R10-23-20250207","doi-asserted-by":"crossref","first-page":"940945","DOI":"10.1136\/gut.24.10.940","article-title":"Primary biliary cirrhosis: geographical clustering and symptomatic onset seasonality.","volume":"24","author":"Hamlyn","year":"1983","journal-title":"Gut"},{"key":"R11-23-20250207","doi-asserted-by":"crossref","first-page":"390394","DOI":"10.1002\/hep.510300213","article-title":"Primary biliary cirrhosis once rare, now common in the United Kingdom?","volume":"30","author":"James","year":"1999","journal-title":"HEPATOLOGY"},{"key":"R13-23-20250207","doi-asserted-by":"crossref","first-page":"830836","DOI":"10.1093\/ije\/26.4.830","article-title":"Incidence and prevalence of primary biliary cirrhosis in the city of Newcastle upon Tyne, England.","volume":"26","author":"Metcalf","year":"1997","journal-title":"Int J Epidemiol"},{"key":"R14-23-20250207","doi-asserted-by":"crossref","first-page":"235238","DOI":"10.1136\/jech.53.4.235","article-title":"Studying seasonality by using sine and cosine functions in regression analysis.","volume":"53","author":"Stolwijk","year":"1999","journal-title":"J Epidemiol Community Health"},{"key":"R15-23-20250207","first-page":"157175","article-title":"On the criterion that a given system of deviations from the probable in the case of correlated system of variables is such that it can be reasonably supposed to have arisen from random sampling.","volume":"50","author":"Pearson","year":"1900","journal-title":"Philosop Mag"},{"key":"R18-23-20250207","doi-asserted-by":"crossref","first-page":"11941202","DOI":"10.1002\/hep.20907","article-title":"Risk factors and comorbidities in primary biliary cirrhosis: a controlled interviewbased study of 1032 patients.","volume":"42","author":"Gershwin","year":"2005","journal-title":"HEPATOLOGY"},{"key":"R19-23-20250207","first-page":"473485","article-title":"Detection of M2 antibodies in patients with recurrent urinary tract infection using an ELISA and purified PBC specific antigens. 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