Updating on primary fallopian tube carcinoma

Primary fallopian tube carcinoma (PFTC) is rare, constituting about 1% of female genital tract malignancies, and little is known about its etiological, protective, risk or prognostic factors. Earlier, such factors were thought to be similar to those seen in ovarian cancer. The incidence of PFTC has been rising during the last decades, especially in higher social classes and among women in certain occupations. Parity is a strong protective factor for PFTC, with a lower incidence associated with an increasing number of deliveries. Previous sterilisation seems to offer some protection. Earlier suggestions of previous genital infections as risk factors appear not to hold. Previous cancers are frequent among PFTC patients, especially breast cancer. Second primary cancers after PFTC are also frequent, especially non-lymphoid leukemia, colorectal, breast, bladder and lung cancer. Only 4% of primary fallopian carcinomas are correctly diagnosed before operation. Treatment consists of aggressive cytoreductive surgery and adjuvant chemotherapy with a platinum-taxane combination. A high preoperative serum hCGss is a strong prognostic factor for worse prognosis. The 5-year survival rates vary between 22 and 57%.     

Plasma Nitrate and Nitrite Kinetics after Single Intake of Beetroot Juice in Adult Patients on Chronic Hemodialysis and in Healthy Volunteers: A Randomized,Single-Blind,Placebo-Controlled,Crossover Study

Nitric oxide (NO) contributes to maintaining normal cardiovascular and renal function. This bioactive signalling molecule is generally formed enzymatically by NO synthase in the vascular endothelium. NO bioactivity can also be attributed to dietary intake of inorganic nitrate, which is abundant in our diet, especially in green leafy vegetables and beets. Ingested nitrate is reduced to nitrite by oral commensal bacteria and further to NO systemically. Previous studies have shown that dialysis, by means of removing nitrate and nitrite from the body, can reduce NO bioactivity. Hence, dietary intervention approaches aimed to boost the nitrate–nitrite–NO pathway may be of benefit in dialysis patients. The purpose of this study was to examine the kinetics of plasma nitrate and nitrite after a single intake of nitrate-rich concentrated beetroot juice (BJ) in adult hemodialysis (HD) patients and in age-matched healthy volunteers (HV). Eight HD patients and seven HV participated in this single center, randomized, single-blind, placebo-controlled, crossover study. Each participant received a sequential single administration of active BJ (70 mL, 400 mg nitrate) and placebo BJ (70 mL, 0 mg nitrate) in a random order separated by a washout period of seven days. For the kinetic analysis, blood samples were collected at different time-points before and up to 44 h after BJ intake. Compared with placebo, active BJ significantly increased plasma nitrate and nitrite levels both in HD patients and HV. The area under the curve and the maximal concentration of plasma nitrate, but not of nitrite, were significantly higher in HD patients as compared with HV. In both groups, active BJ ingestion did not affect blood pressure or plasma potassium levels. Both BJs were well tolerated in all participants with no adverse events reported. Our data provide useful information in planning dietary nitrate supplementation efficacy studies in patients with reduced NO bioactivity.     

Tissue factor produced by the endocrine cells of the islets of Langerhans is associated with a negative outcome of clinical islet transplantation

There are strong indications that only a small fraction of grafts successfully engraft in clinical islet transplantation. One explanation may be the instant blood-mediated inflammatory reaction (IBMIR) elicited by tissue factor, which is produced by the endocrine cells. In the present study, we show that islets intended for islet transplantation produce tissue factor in both the transmembrane and the alternatively spliced form and that the membrane-bound form is released as microparticles often associated with both insulin and glucagon granules. A low-molecular mass factor VIIa (FVIIa) inhibitor that indirectly blocks both forms of tissue factor was shown in vitro to be a promising drug to eliminate the IBMIR. Thrombin-antithrombin complex (TAT) and FVIIa-antithrombin complex (FVIIa-AT) were measured in nine patients who together received 20 infusions of isolated human islets. Both the TAT and FVIIa-AT complexes increased rapidly within 15-60 min after infusion. When the initial TAT and FVIIa-AT levels were plotted against the increase in C-peptide concentration after 7 days, patients with an initially strong IBMIR showed no significant increase in insulin synthesis after 7 days. In conclusion, tissue factor present in both the islets and the culture medium and elicits IBMIR, which affects the function of the transplanted islets.     

Cultural empathy in physiotherapy students: a pre-test post-test study utilising virtual simulation

Objectives

To investigate how a virtual cultural simulation experience and guided reflection influenced physiotherapy students’ intrapersonal and interpersonal cultural empathy, and to explore students’ satisfaction with the learning experience.

Correction to: Comparison of the 1-year clinical outcome of a novel cryoballoon to an established cryoballoon technology

Journal of Interventional Cardiac Electrophysiology -     

Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to 2000.

AIMS: To investigate if improved treatment of coronary heart disease and hypertension, the major causes of chronic heart failure (CHF), in the last 20 years has had an impact on the incidence of CHF and survival. METHODS: National Swedish registers on hospital discharges and cause-specific deaths were used to calculate age- and sex-specific trends and sex ratios for heart failure admissions and deaths. The study included all men and women 45 to 84 years old hospitalized for the first time for heart failure in 19 Swedish counties between 1988 and 2000, a mean annual population 2.9 million. A total of 156?919 hospital discharges were included. RESULT: In 1988, a total of 267 men and 205 women per 100?000 inhabitants (age adjusted) were discharged for the first time with a principal diagnosis of heart failure. After 1993 a yearly decrease was observed, with 237 men and 171 women per 100?000 inhabitants discharged during 2000. The 30-day mortality decreased significantly. The decrease in 1-year mortality was more pronounced in the younger age groups, with a total reduction in mortality of 69% among men and 80% among women aged 45-54 years. The annual decrease was 9% among men and 10% among women aged 45-54 years (95% CI -7% to -12% and -6% to -14% respectively) and 4% among men and 5% among women (95% CI -4% to -5% for both) aged 75-84 years. CONCLUSION: The decrease in incidence and improved prognosis after a first hospitalization for heart failure coincides with the establishment of ACE-inhibitor therapy, the introduction of beta-blockers for treatment of heart failure, home-care programmes for heart failure, and more effective treatment and prevention of underlying diseases. Notwithstanding, despite considerable improvement, 1-year mortality after a first hospitalization for heart failure is still high.