Subjective Satisfaction and Quality of Life in Patients Prior to Listing for Liver Transplantation

Objectives

Differences in health-related quality of life (HR-QoL) perception between alcohol-abusing and non-substance-dependent subjects with liver cirrhosis could depend on differences in personality profile and influence management of patients awaiting liver transplant.

Methods

We compared the perceptions of disease state in 78 male patients of similar disease severity divided into 2 groups based on etiology of cirrhosis: 47% had alcoholic cirrhosis, and 53% had hepatitis C virus (HCV)-related cirrhosis without alcohol abuse. Patients’ perception of disease state was determined using the SAT-P questionnaire (a self-administered questionnaire that provides a global assessment of perceived HR-QoL and subjective well-being). The assessment yields 2 scales: an analytic scale based on 32 variables and a synthetic scale based on 5 factors.

Results

In patients with alcohol-related disease, “psychological function” was found to be more impaired, while “sleep, diet, and free time” was less impaired compared with subjects with HCV-related cirrhosis, suggesting dysfunction related to substance abuse with personality disturbance.

Conclusions

The perception of disease state is different in alcohol-abusing patients with cirrhosis compared with those with cirrhosis unrelated to alcohol.

Coevolutionary Dynamics of Rice Blast Resistance Gene Pi-ta and Magnaporthe oryzae Avirulence Gene AVR-Pita 1

The Pi-ta gene in rice is effective in preventing infections by Magnaporthe oryzae strains that contain the corresponding avirulence gene, AVR-Pita1. Diverse haplotypes of AVR-Pita1 have been identified from isolates of M. oryzae from rice production areas in the United States and worldwide. DNA sequencing and mapping studies have revealed that AVR-Pita1 is highly unstable, while expression analysis and quantitative resistance loci mapping of the Pi-ta locus revealed complex evolutionary mechanisms of Pi-ta-mediated resistance. Among these studies, several Pi-ta transcripts were identified, most of which are probably derived from alternative splicing and exon skipping, which could produce functional resistance proteins that support a new concept of coevolution of Pi-ta and AVR-Pita1. User-friendly DNA markers for Pi-ta have been developed to support marker-assisted selection, and development of new rice varieties with the Pi-ta markers. Genome-wide association studies revealed a link between Pi-ta-mediated resistance and yield components suggesting that rice has evolved a complicated defense mechanism against the blast fungus. In this review, we detail the current understanding of Pi-ta allelic variation, its linkage with rice productivity, AVR-Pita allelic variation, and the coevolution of Pi-ta and AVR-Pita in Oryza species and M. oryzae populations, respectively. We also review the genetic and molecular basis of Pi-ta and AVR-Pita interaction, and its value in marker-assisted selection and engineering resistance.

Surgical complications of carotid body tumors surgery: a review

Carotid body tumor (CBT) is a rare neoplasm, although it represents about 65% of head and neck paragangliomas. Surgical excision is considered the appropriate therapy for CBTs. The aim of this study was to evaluate surgical outcomes on a large scale. We reviewed 19 studies between 2004 to 2014 with a total of 625 procedures. We observed a higher number of cases in women (62%). Only 3 (0,48%) deaths were reported as surgical complication. Total cranial nerve injuries were 302 (48,32%) of which 194 (31,04%) were transient and 108 (17,28%) were permanent. We found a total of 174 (27,84%) arterial injuries, most of which are external carotid artery (ECA) injuries. Cerebrovascular accident due to surgery were 15 (2,4%). We concluded that surgical resection remains the treatment of choice for these disease despite the related morbidity.

Long-term survival after curative resection for pancreatic ductal adenocarcinoma--Surgical treatment

INTRODUCTION

Recent reports have demonstrated improvement in the 5-years serviva with resecate ductal adenocarcinoma. The aim of study is to determinate the factor influencing long-term survival after DCP.

MATERIALS AND METHODS

We have critically reviewed a group of 85 patients how were admitted to our department with diagnosis of ductal adenocarcinoma of the head of pancreas between January 1974 and January 1998.

RESULTS

Patients were stratified according to stage using TNM classification; in stage I 31 patients with 5 T1aN0M0 disease, 11 patients with T1bN0M0 and 15 patients T2N0M0 disease. By contrast, in stage III 54 patients with 48 patients T2N1M0 and 6 patients with T3N1M0. Tumour size was recorded for 72 patients with a median of 3.8 cm. The R1 dissection was performed in 67 patients. The R2 resection was performed in 18 patients. In our series we verified and analysed the histopathologic features of 5 patients with 15-years survival (5.8%). The features regard age, male or female, tumours size, stage and positive lymph node resection.

DISCUSSION

We found a specifically subset of patients where the combination of prognostic factors, in particular, negative surgical margins R0, tumour size ≤ 30 mm and the absence of lymph node metastasis independently reduced the mortality indicating that earlier tumour detection and histologically curative resection are important factors contributing to long term survival and healing of ductal adenocarcinoma of the head of the pancreas.

Prevalence of Dirofilaria immitis (Nematoda: Filarioidea) in mosquitoes from northeast Arkansas, the United States

A mosquito survey was conducted to identify which species of mosquitoes carry Dirofilaria immitis (Leidy) (Nematoda: Filarioidea), dog heartworm, in northeast Arkansas. Using polymerase chain reaction, mosquitoes were analyzed for D. immitis, Dirofilaria repens Railliet & Henry, and Acanthocheilonema dracunculoides Cobbold. Mosquitoes were collected from April to October 2009 using black light ultraviolet traps baited with dry ice. Sixteen mosquito species were identified. D. immitis was identified in nine mosquito species, which included Aedes vexans (Meigen), Anopheles quadrimaculatus Say, Anopheles punctipennis (Say), Culex pipiens quinquefasciatus Say, Culex erraticus (Dyer & Knab), Culiseta inornata (Williston), Psorophora columbiae (Dyer & Knab), Psorophora ferox (Humboldt), and Psorophora howardii Coquillett. No D. repens or A. dracunculoides DNA was amplified. Of the 1,212 mosquito pools tested, 7.3% were positive for D. immitis. Frequency of D. immitis infections from six collection sites ranged from 2.1 to 19.4%. Ae. vexans and An. quadrimaculatus were the two most abundant species, composing 58.7 and 23.7% of the total mosquitoes collected, with 9.6 and 6.9% of pools positive for D. immitis, respectively. To investigate localized vector infection rates of D. immitis, mosquitoes were collected from inside the kennel of a heartworm-positive dog. Of the 114 mosquitoes collected, 84 (73.7%) were positive for D. immitis. The frequency of D. immitis-infected mosquitoes collected near a heartworm-positive dog was considerably higher than in the original six collection sites, suggesting a single heartworm-positive dog potentially increases infection pressure on susceptible animals sharing mosquito exposure.

The results of the surgical treatment of 64 patients with thoracic and lumbar fracture

A total of 64 patients surgically treated for vertebral fractures were evaluated clinically and radiographically after a mean time of 49.55 months (from 1 to 124). There were 50 males and 14 females. Mean age at the time of surgery was 40.67 years (from 17 to 71). Fractures were divided based on the Denis classification system: comminuted fractures: 45; fractures caused by flexion-distraction: 2; fracture-dislocation: 17; 31 of the fractures were localized at the lumbar level, 30 in the dorsal region, 3 at the dorsolumbar passage. Neurologic evaluation was carried out on admission and at follow-up using the Frankel classification system: type A: 22; type B: 13; type C: 7; type D: 6; type E: 16. 56.25% of the patients (36 cases) were classified as having multiple trauma. Of the 64 patients, 38 had reduction and stabilization within 6 hours of trauma, 26 were treated after a mean time of 2.7 days (from 1 to 6). Harrington-Luque stabilization was carried out in 5 patients, using the Hartshill rectangle in 59. The mean time for hospitalization was 27.68 days (from 9 to 91). Follow-up showed neurologic recovery in all of the patients operated on, with the exclusion of those classified as Frankel A, without sacral sparing. Despite the residual kyphosis and the final anatomic findings which were not always satisfactory, the methods used allowed us to obtain results that could be compared to those obtained by other means of fixation and more complex techniques.

Social support and recovery from sport injury: elite skiers share their experiences

Research suggests that social support can be an important coping resource for athletes recovering from sport injury. Few studies have investigated this claim, however. To address this gap in the literature, 10 elite downhill skiers who had recovered from serious sport injuries were interviewed about the sources of stress associated with injury and the role of social support in recovery from sport injury. This paper presents the social supportfindings that emergedfrom this research'. Content analyses of the social support data revealed that the skiers needed various types of emotional, informational, and tangible support from the occurrence of injury through the return to full activity. Members of the treatment team, the ski team, and the skiers' home support net works provided social support throughout these phases. In general, the skiers were satisfied with the support received, indicating that it reduced distress and kept them motivated throughout recovery. The findings from this research have implications for the design of sport injury interventions.

Loss of red cell A, B, and H antigens is frequent in myeloid malignancies

Loss of A, B, and H antigens from the surface of red blood cells has been a recurrent observation in patients with hematologic malignancy, particularly those malignancies in which the myeloid lineage is involved. To better understand this phenomenon, a 2-color flow cytometric method was developed to determine quantitative and qualitative alterations of A, B, and H antigens in patients with myeloid malignancies. Characteristic patterns, dependent on the genotype, were seen for healthy individuals from each of the blood groups. Fifty-five percent (16/29) of patients of blood group A, B, or AB had a proportion of red cells with decreased expression of A or B antigens compared with no changes in 127 healthy A, B, and AB individuals. In most cases, the changes were not detected by routine serologic typing. The loss of A or B antigens was the primary change in 28% (8/29) of patients. In 17% (5/29) of patients, loss of A or B antigens was an indirect consequence of loss of the precursor H antigen. Alterations involving both the H and the A or B antigens were seen in 10% (3/29) of patients. Loss of H was also detected in 21% (6/28) of group O patients whereas none of 51 healthy O individuals showed changes. Alterations of ABO antigens can now be considered a common event in myeloid malignancy. (Blood. 2001;97:3633-3639)

Tumour-specific distribution of BRCA1 promoter region methylation supports a pathogenetic role in breast and ovarian cancer

The role of BRCA1 in sporadic breast and ovarian cancers remains elusive. Direct involvement of BRCA1 in the development of breast and ovarian cancer is suggested by the finding that the BRCA1 promoter region CpG island is methylated in a proportion of breast and ovarian cancers. The aim of this study was to compare the incidence of BRCA1 promoter region methylation in tumours in which loss of BRCA1 has been shown to play a role in pathogenesis (breast and ovarian carcinomas) with the incidence in tumours in which BRCA1 is unlikely to play a role in pathogenesis. Promoter region hypermethylation was significantly more common (P < 0.008) in breast and ovarian cancer (6/38 tumours methylated) than in colon cancer (0/35 tumours methylated) or in leukaemias (0/19 samples methylated). The restriction of BRCA1 promoter region hypermethylation to breast and ovarian cancer is consistent with a pathogenetic role of BRCA1 promoter methylation in these tumours. We suggest that the rarity of observed BRCA1 mutations in sporadic breast and ovarian cancer is due to the greater likelihood of BRCA1 inactivation by non-mutational mechanisms such as methylation.

Promoter region methylation does not account for the frequent loss of expression of the Fas gene in colorectal carcinoma

Expression of the apoptosis-promoting Fas gene is frequently reduced or lost during the development of colorectal carcinoma. However, loss of heterozygosity at the Fas locus or Fas gene rearrangements do not account for the loss of expression of Fas, raising the possibility that methylation of the Fas promoter may inhibit gene expression in colorectal carcinomas. We have examined the Fas promoter region CpG island for evidence of hypermethylation in colorectal tumours. Forty-seven specimens of colorectal adenoma and carcinoma, as well as six samples of normal colonic mucosa, were examined by Southern blotting for methylation at HpaII and Cfol sites in this region. No methylation was detected in any of the specimens, suggesting that hypermethylation is not primarily responsible for the loss of expression of the Fas gene during colorectal tumorigenesis.

Methylation-sensitive, single-strand conformation analysis (MS-SSCA): A rapid method to screen for and analyze methylation

We have developed methylation-sensitive, single-strand conformation analysis (MS-SSCA) as a method of screening for methylation changes. Bisulfite modification converts cytosines to thymines, but methylated cytosines remain unchanged. This modification creates sequence differences between methylated and unmethylated samples, which can be resolved by SSCA. SSCA is 70-95% efficient at detecting single base changes in a fragment. As bisulfite modification of methylated DNA would typically involve several base changes in a fragment, the efficiency of detecting methylation using MS-SSCA could approach 100%. We applied this method to analyze the BRCA1 promoter CpG island in breast cancer samples. About 20% of sporadic breast cancers are hypermethylated at the BRCA1 promoter CpG island. MS-SSCA rapidly detected those tumors that had previously been shown to be methylated by Southern blotting. The variant bands detected by SSCA were analyzed by sequencing and shown to be methylated. MS-SSCA is a simple method for screening large numbers of samples for methylation and can accelerate genomic sequencing, as all bands can be isolated and sequenced directly.

Sport injury and illness: elite skiers describe their experiences

Injury and illness pose significant physical and psychological challenges for competitive athletes. The present study examined the psychological processes associated with injury and illness among elite skiers. Twelve members of the Canadian Alpine Ski Team who had recovered from a serious sport injury or debilitating illness were interviewed for the study. Inductive analyses of interview transcripts revealed that the experience of sport injury and athlete illness spanned three distinct phases, namely, the injury-illness phase, the rehabilitation-recovery phase, and the return to full activity phase. In addition, it was found that each phase was marked by a series of events that caused the skiers varying degrees of distress. This article traces the skiers' psychological journey from injury and illness through recovery, with an emphasis on factors contributing to stress and the strategies used to manage stress.

Neurological complications in segmental spinal instrumentation: analysis of 750 patients

The authors report on neurological damage caused by the use of sublaminar segmental fixation in the correction of vertebral deformities. Three groups were reviewed: 600 patients instrumented with Harrington rods and segmental wiring, 50 patients treated with the Hartshill system and 100 patients instrumented with Luque bars. All of the patients were operated on using sublaminar wiring fixation. We report two transitory neurological complications among the 600 patients with Harrington rod instrumentation and segmental wiring, two permanent neurological deficits among the 50 cases treated with the Hartshill system and none among the 100 patients instrumented using Luque bars. The purpose of this study is to analyse the causes of these neurological complications, which occurred late in all four of the cases described.

Evaluation of several immunological parameters in patients with aseptic loosening of hip arthroplasty

The authors evaluated several immunological parameters in patients with loosened hip arthroplasty in order to determine the state of sensitization with regard to the metallic constituents of the prosthesis. The results obtained by in vivo epicutaneous testing did not reveal a correlation between loosening and sensitization, as the patch test was positive in only 1 out of 16 cases examined. An evaluation of the lymphocyte subpopulation on peripheral blood demonstrated that patients with prostheses in Cr, Co, Mo, Ni alloy present significant lymphopenia, with a reduction in subpopulations CD4 and CD8 and a decrease in in vitro cytotoxic activity. The meaning of these modifications could be interpreted to be either a toxic effect products released from the implant, or as the recruitment of lymphocytes in the site of loosening, due to lymphocyte sequestration phenomena consequent to a cell-mediated hypersensitivity reaction.

Indications and limits of CT scan in prosthetic loosening

The authors attempt to define the role of computed tomography (CT) in the study of loosened hip prosthesis. To this purpose they have studied 30 patients with clinical and/or radiographic findings of loosening, carrying out a conventional radiographic assessment and a CT scan of the hip in question, and then comparing them. They conclude that CT scan when carried out according to the correct procedures described is very useful. Despite the presence of technical artefacts due to the presence of the metal prosthesis, the test makes a considerable contribution, not so much to the diagnosis of loosening in itself, which continues to be a clinical-radiologic diagnosis, rather to the evaluation of the morphostructural states of the acetabular bone for correct planning of surgery.

Modern diagnostic imaging of lumbar spondylosis

The authors retrospectively analyzed 205 patients affected with low back pain and submitted to conventional radiology, CT scan, MR. The purpose of the study was that of gaining a better understanding of the mechanisms caused by the occurrence of spondylosis and its evolution. In light of the most recent literature, the authors conclude: 1) the degenerative process nearly always initiates with laceration of the anulus; 2) dysfunction of the disc then has repercussions on the posterior structures at varying times and with different modalities; 3) symptoms do not always coincide with radiological findings. Thus, the authors believe that for a more complete understanding of the etiopathogenesis and the evolution of spondylosis, further studies involving long-term follow-up of a young population, in relation to clinical and MR findings are needed. MR is the method of choice in determining disc degeneration.

The anchor nail in osteosynthesis of fractures of the humerus

Osteosynthesis with a humeral anchor nail may be listed along with other methods of intramedullary fixation for the treatment of diaphyseal fractures. The authors report their experience with 33 cases of humeral fractures treated between July 1987 and July 1991. Results were excellent in 61% of the cases, good in 24%, and fair in 15%; no particular complications were reported. The authors believe that the anchor nail constitutes a system of osteosynthesis involving only a small amount of trauma, and allowing for positive elastic stability for the consolidation of the fracture, as well as being a sufficiently safe system so that immobilization in plaster may be avoided. When compared with other systems of intramedullary fixation, the anchor nail is more effective than the Rush nail from a mechanical point of view, and the Kuntscher nail from a biological one.

Arthroplasty in the sequelae of congenital hip dysplasia

The authors report their experience in the surgical treatment of the sequelae of congenital hip dysplasia, more specifically, 125 arthroplasties performed in 116 patients, with specific reference to the technical difficulties encountered and the various surgical methods used. This review suggests that prosthetization yields a high percentage of good results (77%) and constant remission of pain. Nonetheless, joint function, particularly when motion was severely compromised before surgery, or when dislocation was very severe (Crowe grades III and IV), is not always restored.

Fracture of the posterior arch of the atlas

The authors analyzed the results obtained in 10 fractures of the posterior arch of the atlas treated nonsurgically. There was consolidation in all of the cases at the end of treatment. According to the authors the element which most characterizes this fracture is constituted by its radiological diagnosis which principally makes use of lateral projection. In particular cases, when patients are characterized by multiple trauma, the fracture may go unrecognized.

Surgical treatment of vertebral deformity due to myelomeningocele

Surgical treatment of vertebral deformity due to myelomeningocele has always presented important technical problems. Many complications, the foremost of which pseudarthrosis and infection, are reported in the literature. The authors discuss 14 patients with vertebral deformity from myelomeningocele who were treated with different surgical methods and reviewed after an average of eight years. The only conclusion that can be drawn on the basis of both the literature and the present study is that posterior surgery alone is incapable of guaranteeing stable correction over time for severe deformity. Combined anterior and posterior surgery with spinal fusion up to the sacrum yields better results, and the patient is not required to wear a corset afterward.

The nonsurgical treatment of fractures of the dens epistrophei

The authors examined 25 fractures of the dens epistrophei treated conservatively by several methods in order to evaluate the most suitable treatment for this lesion. A Minerva plaster cast proved to be effective in the treatment of type III fractures, while the halo plaster system obtained the best results in type II fractures.

[Prevalence of surface antigens (HBsAg), surface antibody (HBsAb) and anticore antibody (HBcAb) in hospital personnel and patients with and without hepatic pathology]

We studied hepatitis B virus surface antigen (HBsAg), surface antibody (HBsAb) and "core" antibody (HBcAb) prevalence in 166 among hospital personell and patients with and without liver disease. Results show there is a very high prevalence of hepatitis B virus markers in such populations and the presence of HBcAb in absence of the other markers varies from 6% in "high risk" subjects to 30.3% in cirrhotic patients. We conclude that HBcAb seems to be, at moment, the most sensitive serological marker either for epidemiological studies or diagnosis and, in some instances, for prognosis of hepatitis B virus liver diseases.