Long-Term Health-Related Quality of Life in Living Liver Donors

BACKGROUND In living donor liver transplantation (LDLT), 2 patients undergo surgery, and the advantages and disadvantages for both patients should be considered. This study evaluated the long-term quality of life in living liver donors, and its impact on their activities of daily living focusing on mood and mental health. MATERIAL AND METHODS In total, 101 living liver donors (69 female and 32 male patients, median age of 36.8 years) were surveyed at a median time of 61.8 months after liver donation (range 7-169 months). The generic Short Form Health Survey (SF-36), the Patient Health Questionnaire 9 (PHQ-9), and the Questionnaire of Physical Activity (IPAQ) were used. The results of SF-36 were compared to a matched control group (n=72) using the Wilcoxon test; the SF-36, the PHQ-9, and the IPAQ scores were analyzed using Spearman's rank correlation. Linear regression model was used to check for dependencies between variables of interest. The IPAQ results were compared between the study group and the general Polish population. RESULTS There were no significant differences in the SF-36 domains between the study group and control group except body pain, which was higher in the living liver donor group (P<0.05). In 30.6% of patients, the PHQ-9 survey revealed mood disturbances. The PHQ-9 scores were higher in female-donors (P<0.05). Both summary scores of the SF-36 correlated to the PHQ-9 (P<0.001). In 89.1% of patients, physical activity was below the population norm and was lower in female donors than in male donors (P<0.01). CONCLUSIONS LDLT had no impact on donors' physical and mental health. Physical activity of living liver donors was lower than that of the general population. The SF-36 and the IPAQ measures seem to be reliable in the care of living liver donors. The PHQ-9 survey results and the inclination to depression of female living liver donors requires further study.

Multifunctional materials based on the double-perovskite organic–inorganic hybrid (CH3NH3)2[KCr(CN)6] showing switchable dielectric, magnetic, and semiconducting behaviour

Herein, we have synthesised and characterised a novel organic–inorganic hybrid crystal, [CH₃NH₃]₂KCr(CN)₆ (MACr).

Autoimmune hepatitis exerts a profound, negative effect on health-related quality of life: A prospective, single-centre study

BACKGROUND AND AIMS

Autoimmune hepatitis is a progressive chronic liver disease. Health-related quality of life in autoimmune hepatitis has not attracted much attention so far. We prospectively assessed various aspects of health-related quality of life in a well characterized group of patients with autoimmune hepatitis.

METHODS

In total, 140 patients with autoimmune hepatitis (mean age 40 ± 17 years) and 170 controls (mean age 36 ± 14 years) were included. Health-related quality of life was evaluated with following questionnaires: The Short Form (36) Health Survey, Modified Fatigue Impact Score, State-Trait Anxiety Inventory and Patient Health Questionnaire-9 assessing depression.

RESULTS

Patients with autoimmune hepatitis showed a significant impairment of health-related quality of life in all, but one, domains of The Short Form (36) Health Survey. Autoimmune hepatitis was associated with pronounced physical fatigue (P < 0.001), anxiety (P < 0.001) and depression (P < 0.001). As compared to males, female patients demonstrated greater impairment of physical aspects of The Short Form (36) Health Survey and Modified Fatigue Impact Score. Twenty-seven patients (19%) had moderate (Patient Health Questionnaire-9 >10) and 14 (10%) moderately severe depression (Patient Health Questionnaire-9 >15). Depression showed a very strong correlation with chronic fatigue (R = 0.68; P < 0.001); physical and mental components of The Short Form (36) Health Survey (R = 0.52/0.68 respectively; P < 0.001) and anxiety (R = 0.47; P < 0.001). There was a trend towards better life's quality in patients treated with budesonide in some aspects of their health-related quality of life. Duration of the disease, age at diagnosis, liver fibrosis and the presence of cirrhosis were not associated with health-related quality of life.

CONCLUSIONS

Health-related quality of life is significantly impaired in patients with autoimmune hepatitis. Depression seems to be a dominant symptom affecting their well-being, not associated with clinical and biochemical features of the disease.

Crystal structural analysis of methyl-substituted pyrazines with anilic acids: a combined diffraction, inelastic neutron scattering,1H-NMR study and theoretical approach

The molecular complexes of the pyrazine derivatives with anilic acids were analyzed in terms of the structure of molecules, the vibrational spectra, INS,¹HNMR and theoretical approach.

Structures and phase transitions in neat 4,4′-di-tert-butyl-2,2′-bipyridyl and in its molecular complexes with either bromanilic or iodanilic acid

Using the DSC method, structural phase transitions (PTs) have been found at 165 and 219 K for 4,4′-di-tert-butyl-2,2′-bipyridyl (dtBBP), whereas for its complex with iodanilic acid (dtBBP·IA) PT is found at 331 K.

The Role of Hypothermia Coordinator: A Case of Hypothermic Cardiac Arrest Treated with ECMO

Darocha, Tomasz, Sylweriusz Kosinski, Maciej Moskwa, Anna Jarosz, Dorota Sobczyk, Robert Galazkowski, Marcin Slowik, and Rafal Drwila. The role of hypothermia coordinator: A case of hypothermic cardiac arrest treated with ECMO. High Alt Biol Med 16:352-355, 2015.—We present a description of emergency medical rescue procedures in a patient suffering from severe hypothermia who was found in the Babia Gora mountain range (Poland). After diagnosing the symptoms of II/III stage hypothermia according to the Swiss Staging System, the Mountain Rescue Service notified the coordinator from the Severe Accidental Hypothermia Center (CLHG) Coordinator in Krakow and then kept in constant touch with him. In accordance with the protocol for managing such situations, the coordinator started the procedure for patients in severe hypothermia with the option of extracorporeal warming and secured access to a device for continuous mechanical chest compression. After reaching the hospital, extracorporeal warming with ECMO support in the arteriovenuous configuration was started. The total duration of circulatory arrest was 150 minutes. The rescue procedures were supervised by the coordinator, who was on 24-hour duty and was reached by means of an alarm phone. The task of the coordinator is to consult the management of hypothermia cases, use his knowledge and experience to help in the diagnosis and treatment. and if the need arises refer the patient for ECMO at CLHG. Good coordination, planning, predicting possible problems, and acting in accordance with the agreed procedures in the scheme, make it possible to shorten the time of reaching the destination hospital and implement effective treatment.

[Altered visual information processing in anorectic girls--the study on potentials related to the test of attention]

AIM

Combined biological and psychological basis of anorexia nervosa, related to increased self-control, low self-esteem and peculiar motivation, makes a synthetic approach still hard to achieve. The presented study assessed cognitive functions in anorectic patients with respect to both neuropsychological (test of attention) and biological (electrophysiology of information processing) approaches, and their reciprocal interrelations as well.

METHODS

Eleven adolescent anorectic females and 10 control subjects performed the Continuous Attention Test CAT. Parameters of potentials elicited by the visual CAT items were referred to the CAT results.

RESULTS

The anorectic girls were more accurate during CAT performance, revealing a lower index of errors, especially of commissions. On the other hand, they revealed a lower amplitude of the P2 component (correlated with index of commissions) and shortened latency of the frontal N2 component (correlated with a lower index of errors). The groups differed in relations between psychometric and biological parameters referring to the earlier stages of information processing. In the control group, high index of detections was correlated to right-sided P1 and P2 components. In the patient group, correlations linked a lowered index of commissions with right-sided N1 and bilateral P2 amplitudes.

CONCLUSIONS

Increased self-control in anorexia nervosa, reflected by lower frequency of needless reactions, is related to alterations in biological visual information processing yet on its early, preconscious stage.

Common genomic HLA haplotypes contributing to successful donor search in unrelated hematopoietic transplantation

The aim of the study was to identify the most frequent HLA haplotypes in order to optimize donor searches in unrelated hematopoietic stem cell (HSC) transplantation. Pediatric patients from the north of France who underwent initial HLA typing for donor search in our center were included. Patients and family members were broadly typed for HLA class I and II. Patients were further DNA typed at the sequence level for HLA-A, -B, -Cw, -DRB1, and -DQB1 alleles. In 200 of 207 patients HLA haplotypes were assigned by the mode of inheritance. The most common haplotypes were defined based on frequencies over 0.75%. Searches for unrelated donors were completed for 86 patients lacking a family donor. Matching criteria were either the optimal level of 10 alleles or a one-HLA class I mismatch as a second choice. Rates of successful search reach 85% for patients (n=20) who express at least one common five-allele (HLA-A/B/Cw/DRB1/DQB1) haplotype, but also 77% for more patients (n=53) who express at least one of the 20 most frequent three-allele (HLA-A/B/Cw) haplotypes. Success rates are clearly less (39%) in patients lacking these haplotypes. The use of these data to delineate search strategies is discussed.

2,3,7,8-tetrachlorodibenzo-p-dioxin-dependent release from contact inhibition in WB-F344 cells: involvement of cyclin A

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is the most potent tumor promoter ever tested in rodents. Although it is known that most of TCDD actions are mediated by binding to the aryl hydrocarbon receptor (AhR), the mechanisms leading to tumor promotion still remain to be elucidated. Loss of contact inhibition is one characteristic hallmark in tumorigenesis. In rat liver epithelial WB-F344 cells, TCDD induces a release from contact inhibition, which is manifested by a twofold increase in cell number when TCDD (1 nM for 48 h) is added to confluent cells in the presence of serum, but not when given to exponentially growing or subconfluent, serum-deprived WB-F344 cells. Loss of G1 arrest was also shown by flow cytometric analysis. We demonstrate that TCDD treatment significantly increases cyclin D2 and cyclin A protein levels and show by immunofluorescence that these proteins accumulate in the nucleus. Although TCDD treatment leads to a strong increase in cyclin D2/cdk4 and cyclin A/cdk2 complex formation, we could only detect an elevation of cyclin A/cdk2 activity. In accordance with a lack of elevated cdk4 activity, no decrease in the amount of hypophosphorylated retinoblastoma protein could be shown after TCDD treatment. The importance of increased cyclin A/cdk2 activity for TCDD-dependent release from contact inhibition was shown by the fact that the cdk2/cdc2-specific inhibitor olomoucine (25 microM) abolished TCDD response. These data indicate cyclin A-dependent loss of G1 arrest after TCDD treatment mainly downstream of the retinoblastoma protein.

[Psychophysiological correlates of primary insomnia]

Psychophysiological differences between 16 patients with primary insomnia, 7 men and 9 women, of mean age 40.8 years, and 16 controls, matched according to age, sex and education, were studied. Insomniacs differed from controls in the following results: their motor activity level was higher during night, sleep efficiency was lower and complexity in slow wave sleep was higher. The Hyperarousal Scale score was higher in insomniacs and it correlated with severity of insomnia in Athens Insomnia Scale. Sleep latency in MSLT was not shorter in patients group. Reaction time was shorter, moreover, the number of presentations necessary to memorize all items of Selective Reminding Test was greater in these patients. Degree of the learning disturbance correlated with the Athens Insomnia Scale score. No correlations were found between Selective Reminding Test and standard polysomnographic parameters. To sum up, the hypothesis on 24-hour hyperarousal in primary insomnia has been confirmed and learning impairment has been documented in the present study, independent of standard polysomnographic parameters.

Prevention of EBV-induced B-lymphoproliferative disorder by ex vivo marrow B-cell depletion in HLA-phenoidentical or non-identical T-depleted bone marrow transplantation

HLA-mismatched bone marrow transplantation (BMT) is hampered by three major complications: graft rejection, acute graft-versus-host disease (aGVHD) and delayed immune reconstitution. Infusion of anti-LFA1 plus anti-CD2 monoclonal antibodies (MAb), combined with ex-vivo T-cell depletion of the graft, was efficient in preventing graft rejection and aGVHD. Nevertheless, disease-free survival was limited by the high frequency of lethal infections, including EBV-induced lymphoproliferative disease (BLPD), which originates mostly from donor B cells, with an incidence of 5-30%. To decrease the rate of this complication, ex-vivo B-cell depletion was attempted. This study compares a group of 19 patients who received a T- and B-cell-depleted marrow from an HLA-mismatched related donor with a retrospective control group of 19 patients, who had received T-cell-depleted marrow by the same method. The level of T-cell depletion was similar in the two groups. For B-cell depletion, two different methods were compared. The median number of B cells infused in the study group was 0.46/kg. Engraftment and aGVHD incidence were similar in the two groups. No EBV donor-derived BPLD occurred in the study group, compared with seven in the control group, four of whom died because of EBV-BPLD. Event-free survival was significantly different between the two groups. We conclude that ex-vivo B-cell depletion of the graft may be a useful means of preventing EBV-BPLD, and warrants further study on a larger group of patients.

[Coexistence of colloid cyst of the third ventricle with pituitary dwarfism in a female aged 16]

A 16-year-old patient with pituitary dwarfism is reported, in whom a colloid cyst was found in the III ventricle. The authors believe that pituitary disorder and colloid cyst were a result of developmental anomalies manifesting themselves at various times.

[A case of multiple tuberculomas of the brain in a 17-year-old male]

The authors describe a case of multiple intracerebral tuberculomas in a man aged 17 years. History data and results of investigations failed to suggest the presence of tuberculoma. The diagnosis was established after histological examination of a surgically removed lesion in the right occipital area. Intensive antituberculous treatment gave complete cure confirmed by CT examination.