Constraint and adaptation in newt toll-like receptor genes

Acute die-offs of amphibian populations worldwide have been linked to the emergence of viral and fungal diseases. Inter and intraspecific immunogenetic differences may influence the outcome of infection. Toll-like receptors (TLRs) are an essential component of innate immunity and also prime acquired defenses. We report the first comprehensive assessment of TLR gene variation for urodele amphibians. The Lissotriton newt TLR repertoire includes representatives of 13 families and is compositionally most similar to that of the anuran Xenopus. Both ancient and recent gene duplications have occurred in urodeles, bringing the total number of TLR genes to at least 21. Purifying selection has predominated the evolution of newt TLRs in both long (∼70 Ma) and medium (∼18 Ma) timescales. However, we find evidence for both purifying and positive selection acting on TLRs in two recently diverged (2-5 Ma) allopatric evolutionary lineages (Lissotriton montandoni and L. vulgaris graecus). Overall, both forms of selection have been stronger in L. v. graecus, while constraint on most TLR genes in L. montandoni appears relaxed. The differences in selection regimes are unlikely to be biased by demographic effects because these were controlled by means of a historical demographic model derived from an independent data set of 62 loci. We infer that TLR genes undergo distinct trajectories of adaptive evolution in closely related amphibian lineages, highlight the potential of TLRs to capture the signatures of different assemblages of pathogenic microorganisms, and suggest differences between lineages in the relative roles of innate and acquired immunity.

Analysis of problems in the daily functioning of patients after hip arthroplasty

BACKGROUND

Awareness of functional status of patients after arthroplasty helps therapists to select suitable topics of education that will enable the patients to continue rehabilitation on their own and improve the quality of life among hip joint prosthesis recipients.

MATERIAL AND METHODS

The study involved a group of 60 patients (41 men and 19 women) after arthroplasty who were hospitalised in medical rehabilitation wards of Lodz hospitals. The average age of the patients was 65.0±11.2 years (65.4±11.5 years among women and 63.9±10.8 years among men). The functional status of the patients was assessed using the modified Rankin Scale (mRS) for self-evaluation of disability, Barthel Index (BI) to determine the degree of independence in performance of daily living activities and a survey prepared by the authors.

RESULTS

The degree of disability of the study subjects may be assessed as moderate (mRS score: 2.8 overall, 2.6 for women and 3.1 for men). The distributions of disability scores indicate a clinically significant difference in the assessment of disability level between women and men. The functional status of patients with regard to performance of daily living activities was evaluated as moderately severe (BI: 77.7±18.2 overall, 76.8±17.2 for women, 79.5±16.6 for men). The women after hip arthroplasty assessed their ability to dress and undress as significantly poorer than the men did.

CONCLUSIONS

1. The patients assessed their functional status as moderate disability. 2. The study participants faced the most serious problems with bathing, walking up and down stairs, grooming, and dressing and undressing. 3. The women assessed their ability to dress and undress as significantly poorer than the men did. 4. Physiotherapists and nurses were indicated as the main sources of education.

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.

Stimulation and analysis of the immune response in calves from vaccinated pregnant cows

The effect of vaccinating pregnant cows with an inactivated vaccine against Mannheimia haemolytica, BRSV and PI3V infections on selected immune responses in their offspring was examined. Blood samples were collected weekly for 12 weeks from six newborn calves from each of vaccinated (experimental) and unvaccinated (control) dams. Specific antibodies to M. haemolytica, BRSV and PI3V and mean values of IgA, IgG concentrations were significantly higher in the experimental calves compared with the controls. However, specific antibody titres to adenovirus type 3, BHV1 and BVDV in the experimental calves had constant levels while the control group levels changed. The IgM, Hp and SAA concentrations generally increased until week 8 in the experimental group, but the control group titres became higher after week 9. This study demonstrates that specific immunisation of cows pre-partum significantly stimulated parameters associated with immunity and it also controlled the acute phase response intensity in their offspring. Therefore the vaccination of dams may provide additional antibody protection against infection to their offspring.

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.

Oxidative stress in atherosclerosis: the role of microRNAs in arterial remodeling

Atherosclerosis is the underlying condition in most cardiovascular diseases. Among the highly specific cellular and molecular responses, endothelial dysfunction plays a key role in disease initiation and progression. These events coincide with the occurrence of oxidative stress. Increased reactive oxygen species production and oxidization of low-density lipoprotein are detected throughout atherosclerosis progression. MicroRNAs (miRNAs) have emerged as important regulators of gene expression that posttranscriptionally modify cellular responses and function. Accumulating studies indicate an integrated miRNA network in the molecular mechanisms that control cellular homeostasis, vascular inflammation, and metabolism. Experimental models of atherosclerosis highlight a direct link between altered miRNA expression profiles and the pathophysiology of the disease and identify putative miRNA candidates for the development of novel therapeutic strategies. In this review, we provide an overview of the role of miRNA regulatory networks in oxidative stress in atherosclerosis and arterial remodeling and discuss their potential therapeutic implications.

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.

Circulating microRNAs as novel biomarkers for platelet activation

RATIONALE

MicroRNA (miRNA) biomarkers are attracting considerable interest. Effects of medication, however, have not been investigated thus far.

OBJECTIVE

To analyze changes in plasma miRNAs in response to antiplatelet therapy.

METHODS AND RESULTS

Profiling for 377 miRNAs was performed in platelets, platelet microparticles, platelet-rich plasma, platelet-poor plasma, and serum. Platelet-rich plasma showed markedly higher levels of miRNAs than serum and platelet-poor plasma. Few abundant platelet miRNAs, such as miR-24, miR-197, miR-191, and miR-223, were also increased in serum compared with platelet-poor plasma. In contrast, antiplatelet therapy significantly reduced miRNA levels. Using custom-made quantitative real-time polymerase chain reaction plates, 92 miRNAs were assessed in a dose-escalation study in healthy volunteers at 4 different time points: at baseline without therapy, at 1 week with 10 mg prasugrel, at 2 weeks with 10 mg prasugrel plus 75 mg aspirin, and at 3 weeks with 10 mg prasugrel plus 300 mg aspirin. Findings in healthy volunteers were confirmed by individual TaqMan quantitative real-time polymerase chain reaction assays (n=9). Validation was performed in an independent cohort of patients with symptomatic atherosclerosis (n=33), who received low-dose aspirin at baseline. Plasma levels of platelet miRNAs, such as miR-223, miR-191, and others, that is, miR-126 and miR-150, decreased on further platelet inhibition.

CONCLUSIONS

Our study demonstrated a substantial platelet contribution to the circulating miRNA pool and identified miRNAs responsive to antiplatelet therapy. It also highlights that antiplatelet therapy and preparation of blood samples could be confounding factors in case-control studies relating plasma miRNAs to cardiovascular disease.

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.

Aged garlic extract and allicin improve performance and gastrointestinal tract development of piglets reared in artificial sow

This study was performed to investigate whether postnatal administration with aged garlic extract (AGE) and allicin influences performance and systemic development of piglets exposed to early weaning. Twenty-four male piglets were weaned from sows at the age of two days of life, divided into 4 weight-matched groups and kept under conditions of artificial sow for 6 days. The first group consisted of control animals, while piglets that were given AGE daily per os at the dosages of 1 ml and 2 ml/kg body weight, respectively belonged to the second and third group. The fourth group consisted of piglets administered orally with allicin at the dosage of 1.0 mg/kg body weight/day. At the age of 8 days of life all animals were sacrificed. Next to body weight gain and morphological properties of the gastrointestinal tract, the haematological examination was performed, and activity of lysozyme and ceruloplasmin as well as level of gamma-globulins were determined. The obtained results showed that AGE and allicin improved final body weight, morphological properties of intestine villi and non-specific defence mechanisms of pigs. All these results indicate that AGE and allicin induced beneficial effects on health status, performance and systemic development of piglets.

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.