Urinary Neutrophil Gelatinase Associated Lipocalins (NGALs) predict acute kidney injury post liver transplant

Background

Acute Kidney Injury, a common complication of liver transplant, is associated with a significant increase in the risk of morbidity, mortality and graft loss. Current diagnostic criteria leaves a delay in diagnosis allowing further potential irreversible damage. Early biomarkers of renal injury are of clinical importance and Neutrophil Gelatinase Associated Lipocalins (NGALs) and Syndecan-1 were investigated.

Recruitment of inflammatory monocytes after liver transplantation and correlation with clinical outcome

Background

Ischaemia reperfusion injury is a key cause of mortality and graft loss after liver transplantation. After tissue injury, monocytes are rapidly mobilised and recruited to injured tissue by monocyte chemoattractant protein-1 (MCP-1). Elevated MCP-1 concentrations correlate with poorer outcomes in patients after haemorrhagic stroke but have not been evaluated as a prognostic marker in clinical liver transplantation. We aimed to assess the role of inflammatory monocytes and MCP-1 in ischaemia reperfusion injury

Fully laparoscopic left hepatectomy – a technical reference proposed for standard practice compared to the open approach: a retrospective propensity score model

Background

Laparoscopic left hemihepatectomy (LLH) may be an alternative to open (OLH). There are several original variations in the technical aspects of LLH, and no accepted standard. The aim of this study is to assess the safety and effectiveness of the technique developed at Henri Mondor Hospital since 1996.

Human immunoglobulin M stimulates adipocyte lipogenesis

In view of our recent demonstration that human immunoglobulin G (IgG) and its Fc moiety exert a stimulatory effect on lipogenesis by adipocytes, we have examined the possibility that human immunoglobulin M (IgM) may induce a similar effect upon adipocytes. Three IgM preparations, obtained from patients with Waldenstrom's macroglobulinemia, and a commercial preparation produced consistent dose-related stimulation of lipogenesis by adipocytes. This stimulation was additive to, and greater than, the maximal stimulation produced by insulin; it also neutralized completely by preincubation with mu-chain specific anti-IgM antiserum but not by an excess of anti-insulin antiserum. Similar stimulation of adipocyte lipogenesis was observed with (Fc)5 fragments prepared from IgM fractions. Therefore, IgM exerts a stimulatory effect upon adipocyte lipogenesis similar to that of IgG; this effect is probably mediated through a putative Fc receptor on the adipocyte membrane.     

The effects of diabetes and insulin on glycoprotein metabolism by rat liver

The hepatic metabolism of [125I]agalactoorosomucoid [( 125I]AGOR) was studied in normal and streptozotocin-induced diabetic rats. The blood clearance, hepatic transport time and rate of catabolism of [125I]AGOR were calculated from data of the blood [125I]AGOR disappearance rates and the appearance in blood of acid-soluble catabolites. In control rats the blood clearance of [125I]AGOR was rapid (8.7 +/- 0.6 ml/min) and the hepatic transport time of the ligand was 12.8 +/- 0.7 min. Insulin prolonged the hepatic transport time (18.1 +/- 1.9 min) and depressed ligand catabolism. Chloroquine had similar effects. Diabetes impaired hepatic [125I]AGOR uptake as judged by the prolonged blood clearance rate and depressed ligand catabolism but did not alter ligand transport time. The measured parameters returned to normal when diabetic animals were rendered acutely normoglycaemic. Diabetic rats, in which implanted osmotic insulin pumps had maintained normoglycaemia for 3 days, cleared [125I]-AGOR from the blood more rapidly than controls. This effect appeared to be due to the lower blood glucose levels in this group. The experiments have shown the complexity of the effects of insulin and diabetes mellitus on the uptake and processing of a glycoprotein by the hepatic mannose receptor.     

Factors affecting plasma amino acid concentrations in control subjects

Plasma amino acid concentrations were determined in groups of normal control subjects under fasting and postprandial conditions. Differences were observed that were found to be, to a considerable extent, sex-related. Fasting females had lower concentrations than fasting males of several amino acids, although postprandial differences in concentrations between the sexes were not significant. Under the dietary conditions normal for a British population, no significant diurnal variation of plasma amino acid concentrations was found. Reducing the dietary protein by 30% failed to affect plasma amino acid concentrations; however, increasing the dietary protein by 50% resulted in a significant increase in the plasma concentrations of several amino acids, and induced a significant degree of variation throughout the day in six, proline, half-cystine, methionine, valine, leucine, and isoleucine. The importance of these results with regard to the interpretation of population mean values and disease diagnosis is discussed.     

Physical activity and social and cultural engagement as risk-reducing factors in the prevention of chronic pain in older age: findings from a longitudinal cohort study

Background

Chronic pain is a major public health challenge as people age, and it is linked with impaired physical capacity, falls, fatigue, and depression. Despite growing research on chronic pain management, there is little research into chronic pain prevention. Research suggests that combinations of physical and psychosocial factors could be protective against the development of chronic pain in older age. But there is still a clear need to identify specific multimodal activities that could be encouraged as part of a broader healthy lifestyle.

A primary care-led intervention to reduce cardiovascular disease risk in people with severe mental illness (PRIMROSE): a secondary qualitative analysis

BackgroundDespite various initiatives, the mortality rate in people with severe mental illness increased between 2004 and 2014. Poor health behaviours contribute, including poor diets, physical inactivity, smoking, and excessive alcohol consumption. Evidence is scarce regarding how primary care interventions can influence health behaviour change in people with severe mental illness. We aimed to explore how health behaviours were supported and changed in people with severe mental illness via an intervention (PRIMROSE) informed by the behaviour change wheel.MethodsPRIMROSE was delivered over 6 months in primary care across England. We did a secondary qualitative analysis of semi-structured interviews with staff and patients describing their experiences of PRIMROSE. The sample were selected from a random 20% of primary care practices in England. Topic guides were based on the capability, opportunity, motivation, and behaviour (COM-B) model of behaviour and the Theoretical Domains Framework. We identified how behaviour change techniques were applied by mapping the coded data to the behaviour change technique taxonomy (version 1). We explored barriers, facilitators, and processes of supporting or making health behaviour changes using thematic analysis. Themes were further informed by COM-B.FindingsBetween April 27 and Dec 19, 2016, 15 patients and 15 health-care professionals participated from a broad range of backgrounds across England, but with limited ethnic diversity. We identified 20 behaviour change techniques being used. Six factors affected supporting and changing health behaviours: motivation, motivated patients were more proactive to action advice, which was affected by witnessing physical health benefits; health knowledge or perceptions, developing knowledge on how to change health behaviour facilitated motivation but negative health perceptions could be difficult to change; difficulties with patient capability, mental and physical health status affected motivation; staff proficiency, previous experience with mental health and motivational interviewing skills aided supporting patients; social influences, patients felt pressure to achieve goals to avoid staff disappointment—creating healthy social (peer) norms facilitated motivation whereas unhealthy norms prevented changes; and environmental level influences, access to time and resources were perceived as critical. Making use of existing opportunities for behaviour change, such as open spaces for walking, facilitated positive changes.InterpretationThe value of the application of behaviour change techniques and primary health-care professionals in supporting health behaviour change in this population was variable. For some, such techniques helped to increase motivation, capability, and opportunity to change health behaviours. In others, complex challenges that people with severe mental illness experienced prevented behaviour change. Our findings suggest that with training and appropriate resources, primary care health-care professionals can facilitate health behaviour change in some cases, but policy makers and commissioners should consider enabling more interdisciplinary involvement.FundingUK National Institute for Health Research School for Primary Care Research.     

Index versus delayed cholecystectomy in mild gallstone pancreatitis: results of a randomized controlled trial

Background

Delayed cholecystectomy is associated with increased risk of biliary events. The objectives of the study were to confirm the superiority of index cholecystectomy over delayed operation in mild gallstone pancreatitis.

The associations between social factors and suboptimal use of paediatric dental services (Tiny Teeth): a mixed method study

BackgroundDental decay is the leading reason for hospital admission of children aged 5–9 years. Prevalence of dental decay is strongly associated with deprivation, decreased maternal education, and ethnicity. This study aimed to investigate social and parental factors that prevent timely and regular use of dental services in Haringey and Enfield (London, UK), and to address the suitability of the emergency department (ED) as a site of opportunistic oral health education, using a dental intervention (DI).MethodsThe study was undertaken at the North Middlesex University Hospital's paediatric ED in North London, UK. It was a mixed method study with cross-sectional surveys, a brief DI, and qualitative interviews. Parents of children aged 10 years and younger in the ED were invited to participate in the study. Informed written consent was obtained from 101 participants. Data collection was from Jan 31, 2019, to March 13, 2019. Questionnaires collected background social and medical data, and assessed each caregiver's oral health literacy. The Big Bites and Pearly Whites DI provided parents with up-to-date information about teeth cleaning practices, dentistry, and diet. A post-intervention questionnaire assessed changes in parental knowledge. Adjusted logistic regressions explored associations between social factors and child dental registration. Seven semistructured interviews were conducted, collecting data on barriers faced to the use of paediatric dental services.FindingsBlack British, Caribbean, and African children had an odds ratio of 0·158 (95% CI 0·037–0·679) for dental registration compared with their white counterparts, after adjusting for age of child and sibling number. The DI led to a significant difference between pre and post intervention median knowledge scores (Wilcoxon signed rank test; p=0·009) with a small effect size (r=0·2). Qualitative interviews exposed that current oral health advice, from dentists alone, is inconsistent and not universally delivered, resulting in late, suboptimal, and problem-based attendance.InterpretationTo maximise and reinforce early and universal parental receipt of oral health messages, collaboration and coordination is needed between educational, dental, and general health providers. Disparities in health-seeking behaviour due to ethnicity and knowledge should be accounted for when planning service engagement programmes. The study supports the ED as a site to opportunistically make every contact count by reinforcing preventive oral health messages. The major limitations of the study are its size and cross-sectional design.FundingNone.     

Ethnic differences in bowel cancer awareness: findings from a pharmacy-based community survey

BackgroundWe used London-based multilingual community pharmacies to better understand ethnic inequalities in levels of bowel cancer awareness.MethodsWe invited 206 community pharmacies for this study through the Middlesex Group of Local Pharmaceutical Committees. Participating pharmacies interviewed customers (aged 60 years or older) using a modified version of the Bowel Cancer Awareness Measure. Awareness was divided into symptom, risk factor, and screening awareness. Variation in risk factor and symptom awareness were assessed using stepwise linear regression, whereas variation in screening awareness was assessed using logistic regression. The fully-adjusted model controlled for main spoken language, age, gender, and pharmacy postcode-based index of multiple deprivation rank. No ethical monitoring was required due to complete anonymity of responders and implied consent by return of questionnaire.Findings40 community pharmacies (19% of those invited) interviewed 913 customers. There was no statistically significant difference in area-level deprivation between participating and non-participating community pharmacies (p=0·50). To minimise confounding, individuals who reported a history of bowel cancer were excluded from the analysis (n=49; 5%) leaving 864 participants (95% of the full sample). Among these 864 participants, the sample comprised 578 (67%) English speakers, 412 (48%) women, 406 (47%) men, 406 (47%)white-British, 228 (26%) Indian, 43 (5%) white-Irish, 39 (5%) black Caribbean, 23 (3%) Pakistani, 21 (2%) black African, 16 (2%) of other white ethnicity, and 29 (3%) of other ethnicity. At the univariate level, ethnicity was associated with symptom awareness (p=0·0021) and screening awareness (p<0·0001), but not risk factor awareness (p=0·41). In a fully-adjusted model, screening awareness was statistically significantly lower among black African (adjusted odds ratio 0·37 [95% CI 0·17–0·80; p=0·012), black Caribbean (0·28 [0·10–0·83]; p=0·022), and participants from other ethnic groups (0·19 [0·07–0·48]; p=0·0014), compared with white-British participants. However, symptom awareness was no longer associated with ethnicity. Screening awareness was also higher in pharmacies situated in more affluent areas (7·83 [2·14–28·65]; p=0·002) even after adjusting for other demographics. There was however no association between levels of area-level deprivation and symptom or risk awareness.InterpretationOverall, administering bowel cancer awareness measure was feasible. Although participation of community pharmacies was low, the number of surveys completed was substantial and there was little evidence to suggest selection bias in terms of deprivation. The association between ethnicity and screening awareness was independent of language, which means that unlike symptom awareness, campaigns trying to reduce inequalities in awareness of screening programmes cannot just rely on providing materials in people's native language. Instead, academics and community outreach workers should work with community pharmacies and their customers to co-create materials to improve awareness of the bowel cancer screening programme. Future Bowel Cancer Awareness Measure surveys would also benefit from larger sample sizes among individual ethnic groups and the least and most deprived.FundingNorgine, St Mark's Bowel Cancer Screening Centre.     

Diminished responsiveness of homosexual men to antiviral therapy for HBsAg-positive chronic liver disease

To identify factors predicting response to antiviral therapy, we reviewed the clinical features of 38 male hepatitis B surface antigen (HBsAg) carriers who received adenine arabinoside or lymphoblastoid interferon. All patients were followed for one year or longer. Response was defined as loss of hepatitis B e antigen, hepatitis B virus DNA and DNA polymerase from the serum. Only 2 of 19 (11%) homosexual men responded, compared with 10 of 19 (53%) heterosexual men (P less than 0.02). Both responders in the homosexual group had received lymphoblastoid interferon. None of the 13 homosexual men, but 8 of 16 heterosexual men, responded to adenine arabinoside or its monophosphate (P less than 0.01). Responders to antiviral therapy had higher (P less than 0.05) serum levels of aspartate aminotransferase (median 115, range 51-344) than did non-responders (median 83, range 32-181). The decreased responsiveness of homosexual men to antiviral therapy may be a result of more severe immunologic abnormalities in homosexual than in heterosexual men with HBsAg-positive chronic liver disease.     

Laparoscopic versus open liver resection in the posterosuperior segments: a sub-group analysis from the OSLO-COMET randomized controlled trial

BackgroundLaparoscopic liver resection in the posterosuperior segments is technically challenging. This study aimed to compare the perioperative outcomes for laparoscopic and open resection of colorectal liver metastases located in the posterosuperior segments.MethodsThis was a subgroup analysis of the OSLO-COMET randomized controlled trial, where 280 patients were randomly assigned to open or laparoscopic parenchyma-sparing liver resections of colorectal metastases. Patients with tumors in the posterosuperior segments were identified, and perioperative outcomes and health related quality of life (HRQoL) were compared.ResultsWe identified a total of 136 patients, 62 in the laparoscopic and 74 in the open group. The postoperative complication rate was 26% in the laparoscopic and 31% in the open group. The blood loss was less in the open group (500 vs. 250 ml, P = 0.006), but the perioperative transfusion rate was similar. The operative time was similar, while postoperative hospital stay was shorter in the laparoscopic group (2 vs. 4 days, P < 0.001). HRQoL was significantly better after laparoscopy at 1 month.ConclusionIn patients undergoing laparoscopic or open liver resection of colorectal liver metastases in the posterosuperior segments, laparoscopic surgery was associated with shorter hospital stay and comparable perioperative outcomes.     

The impact of advancing age on incidence of hepatectomy and post-operative outcomes in patients with colorectal cancer liver metastases: a population-based cohort study

Background

Clinical outcomes for elderly patients undergoing liver resection for colorectal cancer (CRC) liver metastases are poorly characterised. This study aimed to investigate the impact of advancing age on the incidence of liver resection and post-operative outcomes.

Effectiveness of a text messaging-based smoking cessation intervention (Happy Quit) in China: a randomised controlled trial

Background

The population of China has the highest proportion of cigarette smokers worldwide, accounting for more than 40% of the world's total cigarette consumption. Despite the acceptability, feasibility, and efficacy of mobile phone-based text messaging interventions for smoking in other countries, there is a lack of smoking cessation services in China. Here we assessed the efficacy of a mobile phone-based smoking cessation intervention (Happy Quit) in China.

Refining the paediatric Ebola case definition: a study of children in Sierra Leone with suspected Ebola virus disease

Background

The case definition for suspected Ebola virus disease is broad, so many negative children are isolated for testing, risking nosocomial infection. We collected data on children admitted to Ebola holding units in Sierra Leone to refine the case definition and describe outcomes of admitted children.

Comparison of long-term clinical outcomes of external and internal pancreatic stents in pancreaticoduodenectomy: randomized controlled study

Background

To determine the most appropriate pancreatic drainage method, by investigating differences in 12-month clinical outcomes in patients implanted with external and internal pancreatic stents as an extension to a previous study on short-term outcome.

Recipient obesity does not affect survival after deceased donor liver transplantation for hepatocellular carcinoma. A national retrospective cohort study in the United States

Background

The oncological effects of obesity on liver transplant (LT) patients with hepatocellular carcinoma (HCC) remains unclear. We investigated patient overall survival and tested two-way interactions between donor and recipient obesity status.