Impact of direct-acting antiviral treatment of hepatitis C on the quality of life of adults in Ukraine

BACKGROUND

Direct-acting antivirals (DAAs) are highly effective in achieving sustained virologic response among those with chronic hepatitis C virus (HCV) infection. Quality of life (QOL) benefits for an HCV-infected population with high numbers of people who inject drugs and people living with HIV (PLHIV) in Eastern Europe have not been explored. We estimated such benefits for Ukraine.

METHODS

Using data from a demonstration study of 12-week DAA conducted in Kyiv, we compared self-reported QOL as captured with the MOS-SF20 at study entry and 12 weeks after treatment completion (week 24). We calculated domain scores for health perception, physical, role and social functioning, mental health and pain to at entry and week 24, stratified by HIV status.

RESULTS

Among the 857 patients included in the final analysis, health perception was the domain that showed the largest change, with an improvement of 85.7% between entry and week 24. The improvement was larger among those who were HIV negative (104.4%) than among those living with HIV (69.9%). Other domains that showed significant and meaningful improvements were physical functioning, which improved from 80.5 (95% CI 78.9-82.1) at study entry to 89.4 (88.1-90.7) at 24 weeks, role functioning (64.5 [62.3-66.8] to 86.5 [84.9-88.2]), social functioning (74.2 [72.1-76.2] to 84.8 [83.2-86.5]) and bodily pain (70.1 [68.2-72.0] to 89.8 [88.5-91.1]). Across all domains, QOL improvements among PLHIV were more modest than among HIV-negative participants.

CONCLUSION

QOL improved substantially across all domains between study entry and week 24. Changes over the study period were smaller among PLHIV.

Science as a service: understanding successful knowledge transfer in a New Zealand research institute

This paper reports on an exercise conducted within a state-owned body (Crown Research Institute) in New Zealand aimed at building greater understanding of the key factors in successful research programmes. Success was defined in this study as a high level of uptake of the emerging science, with commensurate benefits to both industry and the community. The methodology had three parts. A review of the knowledge and technology transfer literature; a series of 15 semi-structured interviews with science leaders; and a facilitated workshop. The purpose of the review was to generate a robust framework upon which to centre the interview dialogues, and two models were selected. The results varied, reflecting the diversity of research services provided by the organization, but the findings were predominantly new and valuable. The importance of the long term relationship with the end users was the strongest recurring theme. The methodology may have wider application in both research and consulting settings; for the benefits derived from the interactive process with staff, as well as for the specific findings.

Work transitions

The healthcare environment is changing rapidly. Work reorganization and redesign can lead to department and unit closures, resulting in work transitions for many staff members. The authors describe the findings of focus groups held with staff and management on units that have closed. These interviews highlight the difficulties encountered with change and provide suggestions to reduce uncertainty during department or unit closures.

Rapid freezing techniques and cryoprotection of biomedical specimens

It has been realized almost from the start of biological electron microscopy that the use of low temperature in specimen preparation might alleviate the problems associated with conventional chemical fixation and plastic embedding. In practice it has been very difficult to realize any benefits, owing to the problems encountered in trying to prepare samples with the water transformed to ice, yet without the sample itself hopelessly distorted by ice crystals. The difficulty is caused by the poor diffusibility of heat through water, the main constituent of almost all biological samples. Even with a maximal temperature gradient between the sample surface and the coolant, and a perfect contact between the two, heat diffusibility through the sample quickly becomes the limiting parameter affecting cooling rate. Unless the cooling rate is as high as 10(2) or even 10(3) degrees C.msec.-1, the ice formed will be crystalline. Such high cooling rates can only be attained in the first few micrometers of even very small samples: therefore, for bulk samples one must either accept the use of a 'suitable' cryoprotectant, or else accept the presence of ice crystals. Theoretical and practical considerations for freezing samples using liquid and solid coolants will be reviewed. Special consideration will be given to the present status of cryoprotection and the indications and contra-indications for its use.

The antiarrhythmic effect of nortriptyline in cardiac patients with ventricular premature depolarizations

The effect of nortriptyline against ventricular arrhythmias was determined in 16 cardiac patients with 30 or more ventricular premature depolarizations per hour. Nortriptyline was administered orally, 0.5 mg/kg body weight per day, and increased by 0.5 mg/kg per day every third day until ventricular premature depolarizations were suppressed (greater than or equal to 80%), adverse effects occurred or a total daily dose of 3.5 mg/kg per day was given. Each patient had daily 24 hour continuous electrocardiograms, 12 lead standard electrocardiograms and physical examination; blood pressure was measured in the supine and standing position four times a day. Each patient also had radionuclide angiography at rest to measure ejection fraction before and at the effective or maximal dose. Thirteen patients (81%) had an antiarrhythmic response and 11 met the study criterion of at least 80% improvement. Doses ranged from 50 to 200 mg/day (mean 111 +/- 45), steady state plasma concentration ranged from 46 to 410 ng/ml (mean 153 +/- 96) and half-life of elimination of nortriptyline was 4 to 22 hours (mean 13 +/- 4). Administration of nortriptyline did not depress mean ejection fraction (before 42 +/- 12%, after 41 +/- 12%); it was associated with an orthostatic decrease in systolic blood pressure (mean -13 +/- 13 mm Hg). Nortriptyline is an effective antiarrhythmic agent which may be given twice a day even in patients with impaired ventricular function.

A comparison of subcellular element concentrations in frozen-dried, plastic-embedded, dry-cut sections and frozen-dried cryosections

Biological X-ray microanalysis of diffusible elements within cellular and subcellular compartments requires preparation methods to retain electrolytes in the compartments they occupied in vivo. X-ray microanalysis of frozen-dried, plastic-embedded samples has been used to quantitate electrolytes at the cellular level. We have compared the subcellular elemental distribution in dry cut sections from such samples with that in ultrathin frozen-dried cryosections. Rat pancreases were quench-frozen onto a helium-vapor-cooled copper block. Cryosections were cut at 130-150 K, transferred using a Gatan cold stage, frozen-dried in the column and analysed at 190 K. Tissue fragments were frozen-dried at 190 K, and cut on a dry knife at 293 K. Both samples provided images permitting unambiguous identification of all major compartments except the Golgi complex. Intracellular potassium-to-sodium ratios obtained on frozen-dried plastic-embedded sections were lower than for cryosections (e.g. 1.77 in basal cytoplasm in plastic sections as compared to 4.34 for cryosections) and varied with the pre-embedding procedure (e.g. 1.77 in formaldehyde-fixed as compared to 2.87 in osmium-fixed plastic sections). Potassium gradients between adjacent organelles were large in cryosections and insignificant in plastic-embedded material. Higher cytoplasmic phosphorus, potassium and sulfur concentrations were observed in cryosections. Therefore, a redistribution of electrolytes and covalently bound elements occurred subcellularly in the plastic sections. Calcium was quantifiable in most organelles in cryosections but the plastic lowered sensitivity too much to permit routine calcium quantification. We conclude that in our hands frozen-dried, plastic-embedded samples were compromised and provided lower sensitivity than cryosections.(ABSTRACT TRUNCATED AT 250 WORDS)

Perspectives on electrical equipment used in oxygen-enriched atmospheres

The medical community has not seriously examined the safety of using medical devices in oxygen-enriched atmospheres (OEA) or with nitrous oxide. A review of applicable codes and standards, reports of actual incidents, and experiments on minimum ignition energy and on determining the extent of OEA around a patient receiving respiratory therapy suggests that guidelines are needed. Several means of ensuring the safety of electrical equipment to be used in conjunction with oxygen are recommended. These include: compliance with standards for flammable atmospheres; sealing to prevent OEA from reaching electrical components; ventilating to limit oxygen concentration; and limiting potential spark energy and surface temperatures. These recommendations are made in the hope that the medical community will address this issue further.

Inhibition by chloroquine of the secretion of very low density lipoproteins by cultured rat hepatocytes

Cultured rat hepatocytes were incubated in medium containing 1.0 mM oleic acid. The incorporation of [3H]glycerol into cell-associated and medium triacylglycerols was measured after 2 h incubation. More than 95% of the secreted [3H]triacylglycerols were recovered in the very low density lipoprotein (VLDL) fraction (d less than 1.006). Chloroquine and other lysosomotropic amines promoted a marked decrease in [3H]triacylglycerol secretion from the hepatocytes while the synthesis was unaffected. At 50-200 microM final concentration, chloroquine inhibited secretion of triacylglycerols by 70-90% of the control. Similar results were obtained when the mass of secreted triacylglycerols was measured. Chloroquine caused decreased secretion of [3H]triacylglycerols after 15-30 min incubation and the inhibitory effect was completely reversible within 1-2 h after washout of chloroquine. The reduced triacylglycerol secretion was not due to increased reuptake of secreted lipoproteins or decreased protein synthesis caused by chloroquine. Electron microscopy of chloroquine-treated cells showed that the inhibition of VLDL secretion occurs at or prior to the level of the Golgi apparatus. These results suggest that chloroquine interferes with crucial steps in the secretory process and/or that lysosomal function could be essential for secretion of VLDL.

Aminoplastic standards for quantitative X-ray microanalysis of thin sections of plastic-embedded biological material

The preparation of a set of aminoplastic standards for quantitation of sodium, magnesium, phosphorus, sulfur, chlorine, potassium, and calcium in ultrathin plastic sections of soft tissue is described. The standards are low in cost and easy to prepare and handle. They cover concentrations up to 750 mmoles/kg dry weight, and display chemical and physical properties similar to those plastic-embedded samples. The standards can be used to convert peak-to-continuum ratios obtained from the specimen to elemental concentrations. An application of these standards is shown using rat exocrine pancreas as a model. The standards can also be used to advantage for the calibration of the detector efficiency.

Thin frozen-dried cryosections and biological x-ray microanalysis

The application of X-ray microanalysis to problems of cell physiology required the development of methods to retain diffusible substances within the subcellular compartments that they occupied in vivo. Several groups have developed methods of rapidly freezing small samples in ways that minimize mechanical traumae and ice crystal formation. This provides a narrow zone from which cryosections, believed to be representative of the in vivo distribution of electrolytes, can be cut. The production of thin (less than 0.5 micrometers) cryosections that are apparently free of diffusion can be routinely performed when temperature parameters are kept below 173 K. Efficient cryosectioning requires several modifications to commercially available machines, in order to improve the ease and reliability with which various manipulations can be carried out. Initial attempts to localize calcium at the subcellular level were disturbed by the use of mechanically damaged specimens and by insufficiently cold conditions in the cryochamber. Such sections indicated that mitochondria were calcium-rich organelles. When tissue freezing and cryosectioning were performed under optimized conditions, mitochondrial calcium was so low as to be quantifiable only with difficulty. Available microanalytical results show that ER-rich cytoplasm and terminal cisternae of the sarcoplasmic reticulum seem to contain higher levels of calcium than mitochondria. Nuclei and secretory granules also contain more calcium than mitochondria.

Ultrastructural effects of the high molecular weight cryoprotectants Dextran and polyvinyl pyrrolidone on liver and brown adipose tissue in vitro

The ultrastructural changes caused by incubation of rat liver and brown fat in buffered solutions of high molecular weight cryoprotectives (Dextran and polyvinyl pyrrolidone) at high concentrations (up to 25% w/v) have been examined. Under appropriate conditions of incubation rather small qualitative changes were found. Hepatocytes showed some signs of plasmolysis. Evidence for the endocytosis of Dextran and polyvinyl pyrrolidone was obtained. Cryoultramicrotomy of unfixed, quench-frozen specimens after the same incubation procedures showed good cutting properties and only slight ice-crystal damage. Several of the larger tissue compartments were recognizable in such sections. Although high molecular weight cryoprotectants do penetrate cells by endocytosis (and these effects require further functional evaluation), the present observations provide further support for the idea that such compounds significantly improve the quench-freezing of biological specimens and offer a practical way forward for the preparation of material for X-ray microanalysis of diffusible elements.

X-ray microanalysis of epon sections after oxygen plasma microincineration

Dark-gold sections of osmium tetroxide-fixed, Epon-embedded brown adipose tissue before and after low-temperature oxygen plasma microincineration were examined using a high-resolution scanning transmission electron microscope and an energy-dispersive X-ray spectrometer. Microincineration produced ash patterns which were free of organic matrix, chlorine (from the Epon) and probably osmium (from the fixative). X-ray sensitivity was improved by a factor of 2-4 owing to decreased background, and sulphur, calcium and probably phosphorus were detected in the ash. Fidelity of the ash patterns permitted microanalytical spatial resolution of 0.1 micrometer or better. Oxygen plasma microincineration is thus shown to offer advantages for high resolution X-ray microanalysis of conventionally sectioned biological material. Its future application to shock-frozen, frozen-dried, unstained sections is indicated.

Preparation of biological material for X-ray microanalysis of diffusible elements. II. Comparison of different methods of drying ultrathin cryosections cut without a trough liquid

The appearance of ultrathin, dry-cut cryosections of brown adipose tissue and liver was found to be strongly dependent upon adequate freeze-drying. If freeze-drying was inadequate, diffusion of substances could be demonstrated and freezing damage was not apparent. Diffusion was manifested as an electron dense film over structural features such as triglyceride droplet profiles and the edges of the section; when this film was thick, X-ray signals for P, S, Cl, K and Ca could be detected from it, in different proportions to those found in the section. The frequency and intensity of diffusion were lowered by decreasing the temperature in the cryochamber from about 200 K +/- 5 K to 163 K +/- 5 K by forced evaporation of liquid N2 using an extra heater. The lowest incidence of diffusion was obtained in conjunction with this device, by leaving the sections in the cryochamber for at least 2 h during drying, either over a drying agent or under moderate vacuum. Such sections showed a narrow zone (A) at the edge that lacked obvious ice-crystal damage, a thicker zone (B) of moderate ice-crystal damage and the bulk of the interior (zone C) severely damaged by freezing. Qualitatively different, reproducible X-ray spectra could be obtained from ultrastructural features even in areas showing some signs of diffusion.

On the occurence and composition of dense particles in mitochondria in ultrathin frozen dry sections

Clusters of dense particles were observed irregularly in mitochondrial profiles of shock-frozen brown adipose tissue and liver when cryosectioned at a chamber temperature of -80 degrees C and not if sectioning was performed at -110 degrees C. The particles are rich in Ca and P (Ca/P =0.5); they are therefore not any form of tricalcium orthophosphate (e.g. hydroxyapatite). They apparently form by electrolyte diffusion in the section and therefore cannot be considered as representing the in vivo pool of mitochondrial calcium.

Ultrastructrual effects of chemical sympathectomy on brown adipose tissue

Adult rats maintained at 20-22 degrees C, were exposed to 4 degrees C for 30-60 min and injected with 50 or 100 mg/kg 6-hydroxydopamine (6-OHDA) in an attempt to achieve a similar degree of chemical sympathectomy of nerves terminating among the adipocytes and the smooth muscle cells of the blood vessels in the interscapular brown adipose tissue (BAT). After 1, 4 or 10 days the pads of BAT were removed and small sections from each pad prepared for electron microscopy; the remaining tissue was used for noradrenaline (NA) analysis for fluorescence histochemistry. Ultrastructural observations showed that 24 h after the 6-OHDA injection virtually all noradrenergic nerve terminals were distorted and contained aggregates of degenerated cell organelles. The destruction could be correlated with a disappearance of fluorescent varicosities and a reduction of measurable NA to 8-12% of the control value. There was no differential toxic effect of 6-OHDA on the terminals among the adipocytes compared to those associated with blood vessels. Thus, treatment with 6-OHDA is more effective than previous attempts using immunological or surgical methods to produce sympathectomy, because both of the latter methods only eliminate the innervation of the blood vessels and spare the nerve terminals of the adipocytes. 4 days after 6-OHDA injection there was no improvement in the morphology of the terminals but after 10 days there was an increase in the number of terminals and axons with a normal appearance and this was paralleled by an increase in extractable NA to 50% of the control value. Because of the relatively rapid recovery of NA content and reappearance of terminals of normal appearance within 10 days after 6-OHDA injection, these animals should be injected weekly when a more permanent sympathectomy of adipocytes and blood vessels is desired.

Chemical sympathectomy of interscapular brown adipose tissue

Adult non-cold adapted rats were injected with 6-hydroxydopamine (6-OHDA) or saline and their interscapular brown adipose tissue (BAT) was removed after appropriate periods of time. Fluorescence histochemistry of control BAT demonstrated the presence of an extensive network of varicose fibers among the adipocytes and at the blood vessels. This was confirmed by electron microscopy which also revealed large and small dense core vesicles sparsely distributed in axons and terminals indicating the presence of noradrenaline (NA). After 6-OHDA injection the fluorescence from varicosities was abolished both among the adipocytes and at the vessels. Thus, chemical sympathectomy was more effective than surgical- or immunosympathectomy, which spare the innervation of adipocytes. Parallelling the disappearance of fluorescence was a significant decrease of measurable NA. During recovery the extractable NA increased before the reappearance of fluorescent varicosities. This could be explained by transmitter accumulation in the nervetrunks within the tissue, which, in general, appeared unaffected by 6-OHDA. A large number of cells with a strong yellowish fluorescence distributed through the BAT was unaffected by 6-OHDA. There was no evidence for the presence of intrinsic ganglia.

Clinical cholera caused by enterotoxigenic Escherichia coli

A woman returning from Mexico was hospitalized as an emergency patient with hypovolemic shock due to dirrheal disease of less than 1-day duration. Her clinical course was similar to that of severe cholera--she excreted greater than 60 liters of stool and urine in a 4-day period. The etiological agent was a non-enteropathogenic serotype but enterotoxigenic strain of Escherichia coli (063:NM). The patient responded both agglutinating and antitoxic antibodies against this strain and its enterotoxin. An "enteropathogenic serotype," 0111:B4, was also isolated but this finding had no etiological significance.

A cytochemical approach to the lipid composition of mitochondrial matrix granules in brown adipose tissue and liver

Matrix inclusions in mitochondria of prenatal brown fat and liver are rich in lipids, and it has been suggested that these should mainly be phospholipids. This proposition has been investigated. Pellets of glutaraldehyde-fixed mitochondria were extracted with excess hexane or chloroform-methanol (2:1 v/v); in controls buffer was substituted for organic solvent. Following extraction the pellets were postfixed in OsO4. Matrix granules in buffer-treated mitochondria (controls) were strongly osmiophilic and were bleached by H2O2 treatment. In hexane-extracted mitochondria the inclusions were less intensely osmiophilic, but they showed the same response to H2O2 as did the controls. Extraction with chloroform-methanol resulted in empty spaces in place of the matrix granules and H2O2 treatment did not produce significant changes. The fact that the inclusions were not extracted by hexane suggests that they are not composed mainly of neutral lipids. The solubility and osmiophilia of the material in the matrix granules are compatible with the reactions expected of phospholipids, but the evidence does not exclude the possibility that other classes of organic compounds might also be involved.

Observations on peroxisomes in brown adipose tissue of the rat

During cytochemical studies of brown adipose tissue from rat, cytoplasmic organelles that apparently show peroxidative activity have been observed. The majority of the organelles have a diameter of 0.1-0.8 µ and a finely granular homogeneous matrix and are delimited by a single unit membrane. No sign of a "crystalloid" was seen. In order to demonstrate the peroxidative activity of the peroxisomal enzyme catalase in the organelles, brown adipose tissue was incubated in a medium containing 3,3'-diaminobenzidine tetrahydrochloride, after prefixation in 3% glutaraldehyde. The activity was blocked by 3-amino-l,2,4-triazole (an inhibitor of catalase) but not by KCN. Omission of exogenous hydrogen peroxide did not inhibit the reaction in the organelles. It is concluded that rat brown adipose tissue contains peroxisomes and, since the abundance of these organelles varies according to the physiologic activity of the tissue, peroxisomes may have a role in the thermogenic metabolism of brown fat.