The genomic response to urbanization in the damselfly Ischnura elegans

The complex and rapid environmental changes brought about by urbanization pose significant challenges to organisms. The multifaceted effects of urbanization often make it difficult to define and pinpoint the very nature of adaptive urban phenotypes. In such situations, scanning genomes for regions differentiated between urban and non-urban populations may be an attractive approach. Here, we investigated the genomic signatures of adaptation to urbanization in the damselfly Ischnura elegans sampled from 31 rural and urban localities in three geographic regions: southern and northern Poland, and southern Sweden. Genome-wide variation was assessed using more than 370,000 single nucleotide polymorphisms (SNPs) genotyped by ddRADseq. Associations between SNPs and the level of urbanization were tested using two genetic environment association methods: Latent Factors Mixed Models and BayPass. While we found numerous candidate SNPs and a highly significant overlap between candidates identified by the two methods within the geographic regions, there was a distinctive lack of repeatability between the geographic regions both at the level of individual SNPs and of genomic regions. However, we found "synapse organization" at the top of the functional categories enriched among the genes located in the proximity of the candidate urbanization SNPs. Interestingly, the overall significance of "synapse organization" was built up by the accretion of different genes associated with candidate SNPs in different geographic regions. This finding is consistent with the highly polygenic nature of adaptation, where the response may be achieved through a subtle adjustment of allele frequencies in different genes that contribute to adaptive phenotypes. Taken together, our results point to a polygenic adaptive response in the nervous system, specifically implicating genes involved in synapse organization, which mirrors the findings from several genomic and behavioral studies of adaptation to urbanization in other taxa.

POS1529-HPR SEXUAL DYSFUNCTION AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Sexual health is a major component of human well-being. The World Health Organization (WHO) defines sexual health as “a state of physical, mental, emotional, and social well-being in relation to sexuality”. Sexuality is a very important, inherent part of human functioning. As repeatedly shown in research, satisfaction with sex life and sexual fulfillment correlate positively with quality of life (QoL) in most of its aspects. It is thus true that a reduced quality of one’s sex life and lack of sexual fulfillment can contribute to poorer QoL overall. As poor sex life quality and sexual dissatisfaction result from sexual dysfunction, effective treatment of such a dysfunction can be assumed to contribute significantly to a better QoL.

Objectives

To describe an assessment of sexual problem among RA patients as a part of patient-reported outcome measures assessment.

Methods

171 consecutive RA patients (mean age 48.3±14.6) attending the rheumatology outpatients clinic over 6 months in 2021. Standardized questionnaires were used in the study: The Sexological Questionnaire to assess self-assessment of the incidence of sexual disorders, WHOQOL-BREF to assess QoL level, Disease Acceptance Scale and VAS scale to assess pain intensity.

Results

The mean duration of the disease in the study group was 13±9 years. The mean score of subjective assessment of mobility was 6.2 ± 1.6, and the mean score of the DAS-28 disease activity index was 4.0±1.9. The study group presented a mean level of disease acceptance (AIS 29.6 ± 11.6). The comparative analysis showed significant differences in reaching orgasm and declared sexual dysfunctions. These problems occurred more often in women than in men (34.2% vs. 18% and 43% vs. 40% respectively p=0.002). In univariate analysis, factors correlating positively with the frequency of declaring sexual dysfunction were: subjective motor score less than 6 points, AIS<36 points, WHOQOL-BREF<59 points, disease activity ≥3.5 points and VAS>3. In multivariate logistic regression analysis independent factors positively correlating with frequency of sexual dysfunction declaration were: general QoL (β=1.255; p=0.035) and pain limiting social life (β=1.564; p=0.030). The absence of comorbidities correlated negatively and reduced the prevalence of sexual dysfunction (β=-1.030, p=0.043). Patients with reduced QoL had 3.5 times and patients with pain limiting social life had 4.8 times higher risk of sexual dysfunction than other patients. In contrast, those without comorbidities were 2.8 times more likely to be free of sexual dysfunction than those diagnosed with other chronic diseases besides RA.

Conclusion

Sexual dysfunction is a problem found both in women and in men with RA. The most common problems include lack of orgasm, vaginal dryness in women, and erectile dysfunction in men. Psychological factors that contribute to sexual dysfunction include low or no illness acceptance and poor QoL. The absence of comorbidities is an independent determinant of lower sexual dysfunction incidence, whereas low QoL and pain limiting the patient’s social life are independent determinants of increased incidence of sexual dysfunction in both sexes.

References

[1]Hunter TM, Boytsov NN, Zhang X, et al. Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004-2014. Rheumatol Int. 2017;37:1551.

[2]Tristano AG. Impact of rheumatoid arthritis on sexual function. World J Orthop. 2014;5(2):107-11.

[3]WHO. Sexual and Reproductive Health and Research (SRH). Definition. URL: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjS3fS6gZr1AhXS66QKHbGwDHkQFnoECAwQAQ&url=https%3A%2F%2Fwww.euro.who.int%2Fen%2Fhealth-topics%2FLife-stages%2Fsexual-and-reproductive-health%2Fnews%2Fnews%2F2011%2F06%2Fsexual-health-throughout-life%2Fdefinition&usg=AOvVaw20satnO_o687QKq2N8ELi0 [Accessed: 05.01.2022].

[4]Oettingen J. Sexual dysfunction – approach based on cognitive theory. Polish sexology 2013;11(2):68-75.

Disclosure of Interests

None declared

The impact of sleep disorders on the daily activity and quality of life in rheumatoid arthritis patients - a systematic review and meta-analysis

OBJECTIVE

We aimed at determining the relationship between sleep disorders and daily activity and quality of life (QoL) of patients with rheumatoid arthritis (RA).

MATERIALS AND METHODS

A systematic search of databases was carried out. We used the Cochrane guidelines to perform the meta-analysis following the PRISMA statement. Fifteen full-text papers were ultimately included in the subsequent statistical analyses. The study was registered in the PROSPERO database (No. CRD42021245664).

RESULTS

In group 1, the mean sleep quality score measured with the Pittsburgh Sleep Quality Index (PSQI) was 6.93. The mean QoL score for the physical domain and the mental domain of the Short Form (36) Health Survey (SF-36) was 38.15 and 41.83, respectively. In group 2, the mean PSQI score was 7.21. The mean daily activity score measured with the Health Assessment Questionnaire (HAQ) was 0.80. A strong negative correlation was observed between the PSQI scores, and the SF-36 total score each unit increase in the SF-36 total score was associated with an average decrease of 0.35 points in the PSQI score. A one-point increase in the PSQI score was associated with an average decrease of 2.4 points in the QoL score measured with SF-36.

CONCLUSIONS

RA patients have a low quality of sleep. Sleep disorders correlate negatively with the QoL scores in the physical and mental domains.

Relationship between maximum eye temperature and plasma cortisol concentration in racehorses during intensive training

The aim of the study was to determine the utility of maximum eye temperature measured by infrared thermography (IRT) as a stress indicator compared with plasma cortisol concentration in Thoroughbred and Arabian racehorses. The study included thirty racehorses undergoing standard training for racing. Measurements of maximum eye temperature and blood collection for plasma cortisol concentration were carried out before training (BT), and within 5 (5AT) and 120 minutes (120AT) after the end of the each training session in three repetitions, with a monthly interval. Both parameters were elevated at 5AT compared to BT (p⟨0.001). Compared to BT, at 120AT the maximum eye temperature remained elevated (p⟨0.001) and plasma cortisol concentration decreased (p⟨0.001). The study indicated significant weak correlations (r=0.220; p⟨0.001) between both measurements at all time points. The results support the use of IRT technique to monitor the response of horses to stress, potentially improving animal management and welfare.

Coevolution between MHC class I and Antigen Processing Genes in salamanders

Proteins encoded by antigen-processing genes (APGs) provide major histocompatibility complex (MHC) class I (MHC-I) with antigenic peptides. In mammals, polymorphic multigenic MHC-I family is served by monomorphic APGs, whereas in certain nonmammalian species both MHC-I and APGs are polymorphic and coevolve within stable haplotypes. Coevolution was suggested as an ancestral gnathostome feature, presumably enabling only a single highly expressed classical MHC-I gene. In this view coevolution, while optimizing some aspects of adaptive immunity, would also limit its flexibility by preventing the expansion of classical MHC-I into a multigene family. However, some nonmammalian taxa, such as salamanders, have multiple highly expressed MHC-I genes, suggesting either that coevolution is relaxed or that it does not prevent the establishment of multigene MHC-I. To distinguish between these two alternatives, we use salamanders (30 species from 16 genera representing six families) to test, within a comparative framework, a major prediction of the coevolution hypothesis: the positive correlation between MHC-I and APG diversity. We found that MHC-I diversity explained both within-individual and species-wide diversity of two APGs, TAP1 and TAP2, supporting their coevolution with MHC-I, whereas no consistent effect was detected for the other three APGs (PSMB8, PSMB9, and TAPBP). Our results imply that although coevolution occurs in salamanders, it does not preclude the expansion of the MHC-I gene family. Contrary to the previous suggestions, nonmammalian vertebrates thus may be able to accommodate diverse selection pressures with flexibility granted by rapid expansion or contraction of the MHC-I family, while retaining the benefits of coevolution between MHC-I and TAPs.

Screening for Mollicutes microorganisms in perinatal calf mortality cases in Polish dairy herds

Perinatal calf mortality in dairy herds has been reported worldwide. The etiology of stillbirth is multifactorial, and can be caused by various species of bacteria and environmental factors. Among them some potential pathogens from the Mollicutes class such as Mycoplasma (M.) spp. and Ureaplasma (U.) diversum can be isolated from the bovine genital tract and other organs of the suspected cattle. The aim of this study was to evaluate if the bacteria belonging to the Molli- cutes class i.e. M. bovis, M. bovigenitalium, M. canadense, M. canis, M. arginini, M. bovirhinis, M. dispar, M. alkalescens and U. diversum could have an impact on perinatal calf mortality in selected Polish dairy farms. The material was: 121 stillborn calves (SB), 21 live born calves (C) and 131 cows (dams) from 30 Polish Holstein-Friesian herds. Samples were examined from all the SB calves' and six control euthanized calves' abomasal contents and lung samples collected during necropsy, and from the dams' serum and placenta. In dams the serological ELISA, and in calves and placenta samples molecular PCR/denaturing gradient gel electrophoresis, methods were used. Screening of dams' sera for antibodies to M. bovis (ELISA) showed seven dams positive for M. bovis, whereas none of the nine examined Mollicutes microorganisms were detected in the placenta and calves.

Impact of temperature on the physicochemical, structural and biological features of copper-silica nanocomposites

Classical wet chemical synthesis was used to fabricate a hybrid composite that contained copper nanoparticles (average size ∼1 nm), which were embedded into a silicon oxide carrier. The structural and chemical alternations in the copper-functionalized silica were investigated in systems that were sintered at 573 K, 873 K, 1173 K, and 1473 K. A general trend, which was associated with the transformation of metallic copper with a cubic structure into copper(II) oxide with a monoclinic structure in the heat-treated systems, was found. XPS and FTIR spectroscopies also revealed the presence of copper(I) oxide, which formed a shell around the CuO. SEM and TEM showed gradual densification of the hybrid system at ever higher sintering temperatures, which corresponded with the gradual copper agglomeration. A temperature of 873 K was determined to be the temperature at which amorphous silica was transformed into cristoballite and tridymite, as well as the formation of a bulk-like copper structure. In relation to the physicochemical and structural data, high antimicrobial features that had a relatively low toxicity effect on the normal human fibroblasts (NHDF) below 250 mg/L was found for the initial copper-silica composite and the samples that were sintered at 573 K. In turn, a significant decrease in the biological impact was observed in the samples that were sintered at temperatures above 573 K. As a result, the paper discusses the model of structural modifications in copper-silica nanocomposite concerning their biological impact that was developed.

Evaluation of Serum Acute Phase Protein Concentrations in Dogs with Circumanal Gland Tumours

The aim of this study was to determine the serum concentrations of acute phase proteins (APPs), including C-reactive protein (CRP), serum amyloid A (SAA) and haptoglobin (Hp) in dogs with circumanal gland tumours. Investigations were conducted on 39 male dogs of mixed breed. The animals were divided into four groups depending on the degree of tumour malignancy and type of hormones that were dominant in the bloodstream. All measurements of serum APPs were conducted by the use of commercial diagnostic kits. In dogs with benign tumours, the concentrations of each APP decreased during therapy, while in dogs with malignant tumours, despite anti-tumour therapy, concentrations of APPs in serum increased markedly. The results of this study suggest that changes in serum concentrations of CRP, SAA and Hp during anti-hormone therapy may be a reliable marker for differentiating tumour grade and degree of malignancy. Including APPs in routine diagnostics may assist with formulating a prognosis for the outcome of the disease, before implementing anti-tumour therapy. Moreover, monitoring the effectiveness of therapy may be possible based on the determination of serum APP concentrations.

Physicochemical and structural features of heat treated silver-silica nanocomposite and their impact on biological properties

In the last few decades, many nanostructures with varying properties and possible applications have been developed. These materials have been intended to work in various environmental temperature conditions. In this context, the main challenge has been to comprehend the impact of synergic interaction between individual elements included in non-annealed materials in relation to systems subjected to temperature impact. Another problem has corresponded to the impact of thermal modification on organisms such as bacteria and human cells. Such problems can be solved by the fabrication of a nanocomposite with mono-dispersed 8 nm silver (Ag⁰ or Ag⁺) embedded into a silica carrier, followed by the analysis of the impact of heat treatment under various temperature conditions on its physicochemical features. Therefore, methodical studies reported in this text have shown an increase of silver particle size up to 170 nm, a decrease of its concentration, as well as the formation of sub-nanometer Ag⁺ and/or Ag²⁺ clusters as the temperature rises to 1173 K. In turn, the structurally disordered silica carrier had been entirely transformed to cristobalite and tridymite only at 1473 K as well as partial reduction of Ag²⁺ to Ag⁺. Simultaneously, inhibition of growth of Gram-positive and Gram-negative bacteria, as well as an increase in cytotoxicity towards human cells was observed as the temperature rose. As a final point, for the first time, a "pseudo" phase diagram of the structural alterations in the Ag/SiO₂ nanocomposite has been created, as well as a model of silver-silica transformation to biological systems has been developed.

Evaluation of T regulatory lymphocytes and serum concentration of selected cytokines in dogs with perianal tumors

The purpose of this study was to determine concentrations of IL-2, IL-10, TGF-β1 in serum and T regulatory cell (Treg) percentage in peripheral blood of dogs with perianal tumours. Investigations were conducted on 32 male dogs of mixed breed. The animals were divided into 4 experimental groups and control group. The groups were established depending on the tumour malignancy degree and the type of dominant hormones. All measurements of serum cytokine concentrations were conducted by the use of commercial diagnostic ELISA kits. Treg lymphocyte percentage was measured by flow cytometry. In both groups with benign tumours cytokine levels decreased during therapy, whilst in groups with malignant tumors, in spite of applying anti-tumour therapy, concentrations of cytokines in serum markedly increased. The mean percentage of Treg lymphocytes in dogs with benign tumours (group I and II) was significantly lower than the mean percentage of these cells in control group at all time points, but after applying of anti-hormonal therapy, the significant increase of Treg percentage was observed compared to baseline values. By contrast, in both groups with malignant tumours (group III and IV), the mean percentage of Treg lymphocytes was significantly higher at the beginning of the experiment comparing with the control group as well as both groups with benign tumours and this percentage increased during anti-tumour therapy. The results of this study suggest that monitoring changes in cytokine serum concentrations and Treg percentage in the bloodstream during anti-hormonal therapy may constitute a subsidiary marker in the monitoring of therapy effectiveness, in prognosis the outcome of a disease or in differentiating tumour degree of malignancy.

Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas

Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.

Divergence history of the Carpathian and smooth newts modelled in space and time

Information about demographic history is essential for the understanding of the processes of divergence and speciation. Patterns of genetic variation within and between closely related species provide insights into the history of their interactions. Here, we investigated historical demography and genetic exchange between the Carpathian (Lissotriton montandoni, Lm) and smooth (L. vulgaris, Lv) newts. We combine an extensive geographical sampling and multilocus nuclear sequence data with the approximate Bayesian computation framework to test alternative scenarios of divergence and reconstruct the temporal and spatial pattern of gene flow between species. A model of recent (last glacial period) interspecific gene flow was favoured over alternative models. Thus, despite the relatively old divergence (4-6 mya) and presumably long periods of isolation, the species have retained the ability to exchange genes. Nevertheless, the low migration rates (ca. 10(-6) per gene copy per generation) are consistent with strong reproductive isolation between the species. Models allowing demographic changes were favoured, suggesting that the effective population sizes of both species at least doubled as divergence reaching the current ca. 0.2 million in Lm and 1 million in Lv. We found asymmetry in rates of interspecific gene flow between Lm and one evolutionary lineage of Lv. We suggest that intraspecific polymorphism for hybrid incompatibilities segregating within Lv could explain this pattern and propose further tests to distinguish between alternative explanations. Our study highlights the importance of incorporating intraspecific genetic structure into the models investigating the history of divergence.

Molecular Inversion Probes for targeted resequencing in non-model organisms

Applications that require resequencing of hundreds or thousands of predefined genomic regions in numerous samples are common in studies of non-model organisms. However few approaches at the scale intermediate between multiplex PCR and sequence capture methods are available. Here we explored the utility of Molecular Inversion Probes (MIPs) for the medium-scale targeted resequencing in a non-model system. Markers targeting 112 bp of exonic sequence were designed from transcriptome of Lissotriton newts. We assessed performance of 248 MIP markers in a sample of 85 individuals. Among the 234 (94.4%) successfully amplified markers 80% had median coverage within one order of magnitude, indicating relatively uniform performance; coverage uniformity across individuals was also high. In the analysis of polymorphism and segregation within family, 77% of 248 tested MIPs were confirmed as single copy Mendelian markers. Genotyping concordance assessed using replicate samples exceeded 99%. MIP markers for targeted resequencing have a number of advantages: high specificity, high multiplexing level, low sample requirement, straightforward laboratory protocol, no need for preparation of genomic libraries and no ascertainment bias. We conclude that MIP markers provide an effective solution for resequencing targets of tens or hundreds of kb in any organism and in a large number of samples.

A serological and molecular study on the occurrence of mycoplasmas in European bison (Bison bonasus) from two areas of Eastern Poland

European bison (Bison bonasus) from two different areas of Eastern Poland showing gross pathology possibly associated with mycoplasma infections were tested for ruminant Mycoplasma species using serological and molecular methods. Fifty-five samples, blood or tissue were collected from 28 animals during 2013-2014. Six sera were positive for Mycoplasma bovis. The ELISA and complement fixation test for Mycoplasma mycoides subsp. mycoides gave a few weak reactions, but were negative by immunoblotting and molecular methods.

Influence of season and nutritional status on the direct effects of leptin, orexin-A and ghrelin on luteinizing hormone and growth hormone secretion in the ovine pituitary explant model

The aim of this study was to examine whether leptin (anorexigenic peptide), orexin-A, and ghrelin (orexigenic peptides) could directly (ie, independently of hypothalamic influences) affect the secretion of luteinizing hormone (LH) and growth hormone (GH) by adenohypophyseal (AP) explants obtained from normally fed or fasted (48 h) ewes during the breeding and nonbreeding seasons. In addition, a specific ovine super leptin antagonist (SLAN-3) was used to assess the interactions between leptin and ghrelin and/or orexin-A. Pituitary glands from 16 ovariectomized Polish Longwool ewes that had received estradiol-releasing subcutaneous implants were collected in the breeding (November; n = 8) and nonbreeding (May; n = 8) seasons. The AP explants were incubated for 240 min in a gas-liquid interface and treated with leptin (50 ng/mL), ghrelin (100 ng/mL), orexin-A (100 ng/mL), and SLAN-3 (500 ng/mL) with orexin-A or ghrelin. Treatments with leptin and SLAN-3 + orexin-A increased (P < 0.05) LH concentrations in the cultures of AP explants from fasted animals in the breeding season. Orexin-A increased (P < 0.05) LH secretion by AP explants from both fasted and fed animals in the breeding season. Ghrelin stimulated (P < 0.05) GH secretion by AP explants collected from fasted animals in nonbreeding season and from normally fed ewes in both seasons. Leptin decreased (P < 0.05) GH secretion by AP explants collected from fasted ewes in both seasons and from nonfasted ewes in the breeding season. However, the treatment with SLAN-3 + ghrelin resulted in greater (P < 0.05) GH concentrations compared with leptin treatment of AP explants from fasted ewes in the breeding season and from normally fed ewes in nonbreeding season. In summary, leptin, orexin-A, and ghrelin exerted direct effects on AP secretory function in an ex situ model and both the reproductive season and nutritional status of the animals impinged on the direct effects of the peptides on LH and GH release. Specifically, orexin-A was more potent than leptin in directly stimulating LH secretion in cycling ewes, whereas ghrelin and leptin generally had opposing effects on the secretory function of somatotrophs in sheep.

Development, validation and high-throughput analysis of sequence markers in nonmodel species

DNA sequences derived from multiple regions of the nuclear genome are essential for historical inferences in the fields of phylogeography and phylogenetics. The appropriate markers should be single-copy, variable, easy to amplify from multiple samples and easy to sequence using high-throughput technologies. This may be difficult to achieve for species lacking sequenced genomes and particularly challenging for species possessing large genomes, which consist mostly of repetitive sequences. Here, we present a cost-effective, broadly applicable framework for designing, validating and high-throughput sequencing of multiple markers in nonmodel species without sequenced genomes. We demonstrate its utility in two closely related species of newts, representatives of urodeles, a vertebrate group characterized by large genomes. We show that over 80 markers, c. 600 bp each, developed mainly from 3' untranslated transcript regions (3'UTR) may be effectively multiplexed and sequenced. Data are further processed using standard, freely available bioinformatic tools, producing phase-resolved sequences. The approach does not require barcoded PCR primers, and the cost of library preparation is independent of the number of markers investigated. We hope that this approach will be of broad interest for researchers working at the interface of population genetics and phylogenetics, exploring deep intraspecific genetic structure, species boundaries and phylogeographies of closely related species.

Consumption of unpasteurized milk and its effects on atopy and asthma in children and adult inhabitants in rural Poland

BACKGROUND

Consumption of unpasteurized cow's milk has been identified as a possible protective factor for atopy and asthma. Most studies have been conducted among children and in farming populations. We investigated the effects of consumption of unpasteurized milk in early life on atopy, asthma, and rhinitis in village and town inhabitants in a region of Poland and assessed whether any protective effects of milk consumption differed according to place of residence and farming status.

METHODS

We surveyed the inhabitants (aged >5 years) of a small town and seven nearby villages in southwest Poland (n = 1700, response rate 88%). Participants (or their parents for those <16 years of age) completed a questionnaire on farm exposures and symptoms of asthma and rhinitis. In particular, information was collected on unpasteurized milk consumption in early life. Atopy was assessed using skin prick tests.

RESULTS

Consumption of unpasteurized milk in the first year of life was inversely associated with atopy and asthma both among town and village inhabitants - town: adjusted odds ratio (aOR) for atopy 0.46 [95% confidence interval (CI) 0.37-0.52] asthma 0.51 (0.32-0.74); villages: atopy 0.59 (0.44-0.70) and asthma 0.59 (0.42-0.74). For atopy, the protective effect was more clearly seen among nonfarmers (0.42; 0.34-0.46) than in farmers (0.82; 0.54-1.11). For doctor-diagnosed hay fever and current rhinitis symptoms, the protective effect was only observed among town inhabitants and/or nonfarmers.

CONCLUSIONS

Early-life exposure to unpasteurized milk may protect against atopy, asthma, and related conditions, independently of place of residence and farming status, and in both children and adults.

Influence of selected factors on survival after liver retransplantation

OBJECTIVE

The aim of this study was to examine the survival of adult liver retransplant recipients depending on selected factors: time from the primary transplantation, cold ischemia time, indications for retransplantation, patient age and United Network for Organ Sharing (UNOS) status.

PATIENTS AND METHODS

Between December 1989 and March 2011, we performed 43 orthotopic liver retransplantations (re-OLTs) among patients aged 20-62 years including 24 women and 19 men. The cold ischemia time was 250-820 minutes. UNOS status before re-OLT: UNOS 1 (n=19; 44%) UNOS 2A (n=15; 35%), and UNOS 2B (n=4; 9%). The time from OLT to re-OLT was 1-2, 146 days. The indications for re-OLT were arterial thrombosis (n=14; 33%), anastomotic biliary complication (n=3; 7%), recurrence of the original disease (n=9; 21%), hepatic vein thrombosis (n=1; 2%), primary nonfunction (PNF) dysfunction (n=2; [5%] /6 [14%]), de novo hepatitis C cirrhosis (n=2; 5%) and other etiologies (n=6; 14%).

RESULTS

The 6-year survival among the primary OLT group was 80% compared with 58% among the re-OLT group (P=.0001). One-year survivals in the re-OLT group according to UNOS status 1, 2A, and 2B were 47%, 60%, and 75%, respectively (P=.475). There was a low negative correlation between survival time and time between OLT and re-OLT. There was a low positive correlation between survival time and cold ischemia time. There was a low negative correlation between survival time and patient age.

CONCLUSIONS

There was a significant difference in survival between OLT and re-OLT. There was a correlation between survival time and time to re-OLTx; a shorter time corresponded to longer survival. There was a poor correlation between survival time and patient age. UNOS status before re-OLT and indication for re-OLTx influenced survival.

Prediction of graft loss and death in patients with primary sclerosing cholangitis

BACKGROUND

The prognosis of patients with primary sclerosing cholangitis (PSC) can be accurately determined using the Mayo Clinic Score (MRS), a mathematical model which predicts patient survival. The purpose of our study was to determine the risk of graft loss and/or death among patients who were listed or transplanted because of PSC.

PATIENTS AND METHODS

We analyzed the data of 52 patients, who were placed on the transplant list due to PSC between January 2000 and November 2008 and either did or did not undergo liver transplantation (OLT). The primary end point (EP1) of the study was the patient death for any cause. The secondary end point (EP2) was recurrence of PSC or appearance of CCC or death related to the primary liver disease after OLT (PSC recurrence). The observation time was 60 months. According to the calculated MRS, patients were divided into 3 groups: group A (MRS < 0.56); group B (0.56 < or = MRS < 1.56), and group C (MRS > 1.56). The analysis was performed using the LIFETEST and PHREG Procedures of the SAS System.

RESULTS

The risk of EP1 occurrence was 2.0 per 1 point of MRS (P < .0006). The risk of EP2 was 2.1 per 1 point of MRS (P < .001). Groups B and C compared with group A showed risks of death of: 0.79 (P = NS) and 6.59 (P < .08), respectively. The percentage of 5-year patient survival rate were 94%, 94%, and 45% according to groups A, B, and C, respectively.

CONCLUSION

The risk of death in patients with MRS > 1.56 was 6.59-fold higher than those with MRS < 0.56. MRS > 1.56 significantly decreased 5 year survival among patients with primary sclerosing cholangitis.

Impact of tumor characteristic on the outcome of liver transplantation in patients with hepatocellular carcinoma

INTRODUCTION

Orthotopic liver transplantation (OLT) is a well-established treatment for cirrhotic patients with hepatocellular carcinoma (HCC) who meet the Milan criteria. The aim of this study was to identify predictors of survival among 65 patients with HCC in cirrhotic livers who underwent liver transplantation (OLT).

METHODS

From January 2001 to December 2008, we performed 655 OLT in 615 patients. HCC was diagnosed in 58 patients before OLT and in 65 by histological examination of the explanted livers; 74% of the patients met Milan criteria by histological examination.

RESULTS

The median follow-up was 27 months (range = 1-96). We analyzed patient age and gender, etiology of liver disease, Child score at transplantation, rejection episodes, tumor number/size, vascular invasion, and differentiation grade. There was no significant difference in survival among patients grouped according to the Model for End-stage Liver Disease staging system for HCC. The 5-year survival of patients with low differentiated (G3) HCC was significantly worse than that of those with moderately differentiated (G2) or well-differentiated (G1) HCC: 50%, 81%, and 86% respectively, (P < .01). Patients with microvascular invasion displayed a worse 5-year survival than those without vascular invasion (42% vs 80%; P < .01).

CONCLUSIONS

The analysis indicated that the histological grade of the tumors and evidences of microscopic vascular invasion were the most useful predictive factors for overall survival among patients with cirrhosis after liver transplantation for HCC.

Early expression of hepatocyte growth factor, interleukin-6, and transforming growth factor-beta1 and -beta2 in symptomatic infection in patients who have undergone liver transplantation

INTRODUCTION

Early septic complications may be a deciding factor for successful recovery among patients who have undergone orthotopic liver transplantation. Therefore, monitoring liver function parameters plays an important role in postoperative treatment to achieve an early diagnosis of postsurgical complications. We ought to measure standard liver function parameters and the expression levels for selected cytokines among patients exhibiting symptoms of infection after orthotopic liver transplantation.

MATERIALS AND METHODS

The study was performed on 30 patients who were divided into two groups: SI-0 consisted of patients free of infection, and SI-1, those who had symptoms of infection. We determined standard liver function parameters and expression of hepatocyte growth factor (HGF), interleukin (IL)-6, transforming growth factor (TGF)-beta1, and TGF-beta2.

RESULTS

There were no significant differences in standard liver function parameters between the two groups of patients. There were no significant differences in the levels of expression for the cytokines in question between the two groups of patients.

CONCLUSIONS

Although standard liver function parameters provide diagnostically valuable information on the patient's condition, they cannot be used to determine the extent of systemic infection among patients showing signs of infection after liver transplantation. Determining gene expression levels in circulating lymphocytes is a sensitive method to monitor patients' condition after liver transplantation. The expression levels of HGF, IL-6, TGF-beta1, and TGF-beta2 in circulating lymphocytes were not sufficiently specific to diagnose transitory postsurgical complications such as symptomatic infection.

Influence of mechanical hippotherapy on skin temperature responses in lower limbs in children with cerebral palsy

Therapeutic horse riding is often employed for disabled children. The aim of the present paper was to determine the influence of exercise in a mechanical saddle, imitating horse's walk, on the skin temperature responses in lower limbs in children with cerebral palsy. Sixteen children, aged 14-16, were enrolled into the study. Skin surface temperature was assessed with thermography, using an infrared thermovision camera, AGEMA 550, before and directly after 20 +/-5 min of exercise. The findings demonstrate that mechanical hippotherapy provides an exercise stimulus that is capable of inducing a visible change in skin temperature of paralyzed limbs. The change, however, is one of a decrease in skin temperature, which points to acute vasoconstrictive effects of exercise and to decreased skin blood flow. The results, therefore, do not support the use of mechanical hippotherapy in children suffering from cerebral palsy, with a hope to stimulate blood circulation to spastically altered limb muscles and thereby to improve physical disability, at least in a short-term exercise paradigm.

Clinical significance of lymphocytes hepatocyte growth factor mRNA expression in patients after liver transplantation

Hepatocyte growth factor (HGF) plays a key role in the regulation of liver regeneration after hepatocyte damage. Changes in HGF gene expression reflect the status of the regeneration process.

AIM

The aim of this study was to ascertain the clinical significance of the expression of HGF among liver transplant patients.

METHODS

Expression of the mRNA of HGF among peripheral blood lymphocytes were measured prior to as well as at 1, 2, 6, and 10 days after liver transplantation in a group of 30 liver recipients.

RESULTS

In first 24 hours after reperfusion, the patients with compromised graft function (group 1) showed persistently higher HGF gene expression after reperfusion compared with patients displaying well-functioning grafts (group 0; P = .0189). Between postoperative days 1 and 10, there was a rapid decrease in gene expression among group 0 compared with group 1 (P = .0155). The significant decrease observed in the both groups reached a certain plateau after 48 hours postoperatively. There was no statistical difference in aminotransaminase levels over the days after liver transplantation. The decreased mRNA HGF expression in lymphocytes preceded the decrease in aminotransferase levels.

CONCLUSIONS

HGF was more sensitive to predict early graft function than prothrombin time, aspartate aminotransferase, and alanine aminotransferase levels. The determination of HGF expression level in lymphocytes after liver transplantation may yield valuable information for evaluation of early graft function.

Demographic characteristics and employment among people with severe mental illness in a multisite study

People with psychiatric disabilities experience disproportionately high rates of unemployment. As research evidence is mounting regarding effective vocational programs, interest is growing in identifying subgroup variations. Data from a multisite research and demonstration program were analyzed to identify demographic characteristics associated with employment outcomes, after adjusting for the effects of program, services, and study site. Longitudinal analyses found that people with more recent work history, younger age, and higher education were more likely to achieve competitive employment and to work more hours per month, while race and gender effects varied by employment outcome. Results provide strong evidence of demographic subgroup variation and need.

Primary lymphoma of the liver -- morphological and clinical analysis of 6 cases. Success of aggressive treatment

Histological, clinical and immunohistochemical analysis of 6 cases of primary liver lymphomas (PLL) are presented. PLL represents 4.3% of primary malignant liver tumors diagnosed in our department. The patients were relatively young people, who despite the presence of a large tumor, were in good general health status. There were no signs of scirrhosis, and cancer markers were normal. All lymphomas were CD20, CD79a, BAX positive, CD3, CD30, EMA, CD10, CD5, CD59, c-myc, Bcl2, EBV(LMP), CK negative. The proliferation index (Ki67) was high, ranging from 50-100%. In two cases positive staining for Bcl6 and in another one for cyclin D1 was obtained. The major histological type of the tumor was diffuse large B-cell lymphoma. Positive immunohistochemical results with BAX and the lack of Bcl2, c-myc and CD59 are associated with better prognosis. We have not confirmed the value of Bcl6 and CD10 stains as a predictor of poor outcome. Despite clinically advanced stage at the time of diagnosis, if treated appropriately, the primary lymphoma of the liver has relatively good prognosis (five of our patients are alive).

Vascular complications after liver transplantation

Vascular complications following liver transplantation is reviewed based upon literature data and our own results. Our study conclusions are mostly based on literature data, because our center does not have the liver transplantation experience of other centers worldwide. Thus, we may conclude, that the number and character of complications does not differ from those reported by other centers. The enbloc technique used in liver harvesting minimizes the risk of arterial damage in case of vascular anomalies. Recipient retransplantation is the most effective treatment method in cases of hepatic arterial occlusion. Doppler ultrasound examinations are effective to monitor vascular blood flow in the transplanted liver.

Results of liver transplantation according to indications for orthotopic liver transplantation

OBJECTIVE

This study assessed the results of liver transplantation in patients with a variety of different indications.

METHODS

From 1989 to April 2003, 209 orthotopic liver transplantations (OLTx) were performed on 196 patients, including 178 cases. The diagnoses were: PBC (n = 34); PSC (n = 13); elective postinflammatory cirrhosis in the course of hepatitis C (n = 29); hepatitis B (n = 16); postalcoholic cirrhosis (n = 23), autoimmune cirrhosis (n = 11); Wilson's disease (n = 6); cirrhosis of unknown etiology (n = 10); secondary biliary cirrhosis (n = 5); Budd-Chiari syndrome (n = 6); and benign liver neoplasms (n = 7).

RESULTS

The 3-year survival rate in the group of patients transplanted electively was 74.1%. In other groups it was: PBC, 91.4%; PSC, 69.2%; hepatitis C, 69.6%; hepatitis B, 55.5%; postalcoholic cirrhosis, 80%; autoimmune cirrhosis, 81.8%; Wilson's disease, 57.1%; secondary biliary cirrhosis, 40%; Budd-Chiari syndrome, 66.6%; hemochromatosis, 100%; benign neoplasms of the liver, 87.5%; and liver cysts, 100%.

CONCLUSIONS

Results of liver transplantation were closely related to the urgency of the procedure. Better results were achieved in patients operated upon routinely compared with in those operated upon emergently (74.1% vs 50%). The best results of liver transplantation were achieved in patients transplanted on a routine basis with a diagnosis of PBC (91.4%), autoimmunologic cirrhosis (81.1%), postalcoholic cirrhosis (80%), or hemochoromatosis (100%). Patients with liver insufficiency due to hepatitis B and Wilson's disease have an increased risk of graft destruction, and the rate of survival in these patients is significantly lower than in other patients.

The impact of experience of a transplantation center on the outcomes of orthotopic liver transplantation

The so-called learning factor has been disregarded for many years in analyzing the causes of surgical complications and post-operative mortality; it is also the case for OLT. In our center until April 2003, 209 OLT were performed in 196 patients. We evaluated the impact of experience of the transplantation team on the outcomes of liver transplantation. Thirty-four patients died (mortality rate, 16%) and 1-year survival rate, 64%. Mortality rates varied during different periods of observation due to increasing experience of the transplantation team. The causes of mortality were assessed for a series of 34 patients: it was 75% at the beginning of transplantation procedures while recent deaths have not recently exceeded 10% of cases.

Comparison of the results of liver transplantation for elective versus urgent indications

The authors present an analysis of early and remote liver transplantation outcomes related to the presence of emergent indications among 196 of the 209 operations performed from 1989 to April 2003; namely 178 elective and 18 emergent transplantations. Perioperative mortality was 15%. The survival rate during the first 12 months was 79.8% and within 3 years 73.5% among patients operated on an elective basis (UNOS 3 and 2B). In contrast, patients with acute liver failure (UNOS 1 and 2A) showed rates of 45%, 50%, and 47%, respectively. Liver transplant outcomes depend primarily on the urgency of an operation. Longterm results are much better among patients operated on electively. Liver transplantation in patients with acute hepatic insufficiency is burdened with a high 45% mortality.

The clinical characteristics and the role of surgery and imatinib treatment in patients with liver metastases from c-Kit positive gastrointestinal stromal tumors (GIST)

The purpose of this study was to analyze the clinical features of the group of c-KIT positive GIST patients with liver metastases evaluated and treated in two referral institutions as well as to attempt to define the role of surgery in the management of GIST given the emergence to imatinib as an important part of treatment strategy in GIST patients. Between August 2001 and December 2002, 90 patients with c-KIT positive GIST were referred to our institutions. In 50 patients metastatic disease were disclosed. Of these, 35 patients (35/50; 70%) were rendered to have liver metastases and therefore offered imatinib or surgical therapy depend on CT assessment. The median follow-up of these 35 patients calculated from the time of first operation was 23 months (range 3-246 months). Male patients comprised the majority of patients (70%) with liver metastases. In 14 patients (40%) the metastases were confined only to the liver, in the others 21 patients (60%) the liver metastases were accompanied by intraperitoneal dissemination (17; 48.6%) or local recurrences (4; 11.4%). The period of time between the diagnosis of primary lesion and occurring liver metastases ranged from 0 to 164 months (median time of liver metastases presentation was 16 months for patients undergone primary curative surgery). The liver metastases were estimated as resectable in 3 cases (8.6%) and hepatic resection of all gross lesions was possible. Group of 32 patients with unresectable liver involvement was considered to treatment with imatinib. The median time of imatinib treatment for survivors is 7.5 months (range: 3.5-18.5 months). Twelve patients (37.5%) demonstrated partial response (PR) and 16 patients (50%) stable disease (SD) according to RECIST criteria. We did not observe any complete response (CR). At median follow-up 7 months, 32 of 35 patients (91.4%) were alive, 3 patients (8.6%)remained free of disease and 28 patients (87.5%) remained on imatinib treatment and have maintained disease although with partial response or stabilization only. Radical surgical resection remains the only possibility of cure for GIST patients because the complete response after imatinib therapy is restricted to a few patients only. However, despite the advanced metastatic disease, approximately 90% of patients are alive and continue imatinib treatment with median follow-up time more than 7 months. Surgery in combination with adjuvant imatinib treatment may result in improved survival with patients with advanced GIST.

Evaluation of the influence of systemic neoadjuvant chemotherapy on the survival of patients treated for invasive bladder cancer

OBJECTIVE

To assess the influence of neoadjuvant systemic chemotherapy using a modified methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) scheme in patients with invasive bladder cancer.

PATIENTS AND METHODS

Two groups of patients were reviewed retrospectively; group 1 included 51 who received chemotherapy before cystectomy and group 2 included 62 who were treated only with surgery. The mean (range) duration of follow-up was 3.2 (0.25-10.25) years. The patients in group 1 were divided into two subgroups: those with tumour confined to the bladder (T1, T2 and T3a) and the remaining patients with tumour beyond the bladder (T3b, T4a,b). The chemotherapy was administered as routine MVAC, except vinblastine and methotrexate were given at 15 and 22 days during the cycle. A mean of three cycles were administered.

RESULTS

The 5-year survival rate in group 1 and 2 was 66% and 58%, respectively (P > 0.3); after 8 years of follow-up the survival rates were 58% and 33%, respectively, and significantly different (P < 0.01).

CONCLUSION

Systemic chemotherapy using the modified MVAC scheme in patients subsequently undergoing radical cystectomy improved the survival rate after 8 years of follow-up.

Aortic pulse wave velocity in young normotensives with a family history of hypertension

OBJECTIVE

To assess the effect of selected clinical and biochemical parameters, with particular consideration of familial hypertension, on the pulse wave velocity (PWV) in young normotensives.

SUBJECTS AND METHODS

Seventy voluntary students were enrolled (mean age 22.3+/-2.1 years), 39 men and 31 women, with normal blood pressure. A history was obtained with respect to diabetes mellitus, ischaemic heart disease, lipid disorders and arterial hypertension in the family. The subjects were subdivided into two groups: those with (n = 33) and without (n = 37) a family history of arterial hypertension, and blood pressure and heart rate were measured three times and total cholesterol and its subfractions determined in plasma. The carotid to femoral PWV was measured using an automatic computerized recorder and analysed by the Complior program.

RESULTS

The subjects with a family history of arterial hypertension had higher blood pressure levels (systolic and diastolic blood pressure, pulse pressure and mean arterial pressure), as well as mean body mass index and low-density lipoprotein (LDL) cholesterol. The PWV in this group did not differ from that in the subjects without a family history of arterial hypertension (9.69+/-2.8 versus 9.32+/-2.0). However, the PWV was significantly higher in males than females (10.62+/-2.2 versus 7.86+/-1.13, P < 0.0001) and there was a significant positive correlation between male gender and PWV.

CONCLUSIONS

Familial arterial hypertension does not significantly affect aortic stiffness in terms of PWV. Male gender in this population of young healthy subjects is one of the most important factors associated with central arterial stiffness.