Prospective assessment of health-related quality of life after endovascular repair of pararenal and thoracoabdominal aortic aneurysms using fenestrated-branched endografts

ObjectiveThe objective of this study was to investigate changes in health-related quality of life (QOL) in patients treated for pararenal aortic aneurysms (PAAs) and thoracoabdominal aortic aneurysms (TAAAs) with fenestrated-branched endovascular aneurysm repair (F-BEVAR).MethodsA total of 159 consecutive patients (70% male; mean age, 75 ± 7 years) were enrolled in a prospective, nonrandomized single-center study using manufactured F-BEVAR (2013-2016). All patients were observed for at least 12 months (mean follow-up time, 27 ± 12 months). Patients' health-related QOL was assessed using the 36-Item Short Form Health Survey questionnaire at baseline (N = 159), 6 to 8 weeks (n = 136), 6 months (n = 129), and 12 months (n = 123). Physical component scores (PCSs) and mental component scores (MCSs) were compared with historical results of patients enrolled in the endovascular aneurysm repair (EVAR) 1 trial who were treated by standard EVAR for simple infrarenal abdominal aortic aneurysms.ResultsThere were 57 patients with PAAs and 102 patients with TAAAs (50 extent IV and 52 extent I-III TAAAs). There were no 30-day deaths, in-hospital deaths, conversions to open surgery, or aorta-related deaths. Survival was 96% at 1 year and 87% at 2 years. Major adverse events occurred in 18% of patients, and 1-year reintervention rate was 14%. There were no statistically significant differences between the groups in 30-day outcomes. Patients treated for TAAAs had lower baseline scores compared with those treated for PAAs (P < .05). PCS declined significantly 6 to 8 weeks after F-BEVAR in both groups and returned to baseline values at 12 months in the PAA group but not in the TAAA group. Patients with TAAAs had significantly lower PCSs at 12 months compared with those with PAAs (P < .001). There was no decline in mean MCS. Major adverse events were associated with decline in PCS assessed at 6 to 8 weeks (P = .021) but not in the subsequent evaluations. Reinterventions had no effect on PCS or MCS. Overall, patients treated by F-BEVAR had similar changes in QOL measures as those who underwent standard EVAR in the EVAR 1 trial, except for lower PCS in TAAA patients at 12 months.ConclusionsPatients treated for TAAAs had lower scores at baseline in their physical aspect of health-related QOL. F-BEVAR was associated with significant decline in PCSs in both groups, which improved after 2 months and returned to baseline values at 12 months in patients with PAAs but not in those with TAAAs. Patients treated for PAAs had similar changes in QOL compared with those treated for infrarenal aortic aneurysms with standard EVAR.     

Polymorphonuclear leukocyte function in the preterm neonate: effect of chronologic age

In this study, effect of chronologic age on polymorphonuclear leukocyte (PMN) chemiluminescence and random and chemotactic motility was evaluated in 38 stable preterm neonates of less than 32 weeks' gestation during the first month of life. Chemiluminescence and random and chemotactic motility of PMNs from preterm neonates were first evaluated at mean postnatal age of 9.8 days and then weekly for an ensuing 21-day period. For comparison, one blood sample was obtained for PMN functions from 14 healthy term neonates younger than 72 hours of age and seven normal adults. On day 1 PMN chemiluminescence and random and chemotactic motility values in preterm neonates were significantly lower (P less than .001) compared with those in term neonates and PMN function values of term neonates were significantly lower (P less than .001) than those of adults. Although initial PMN chemiluminescence and random and chemotactic motility values in preterm neonates were depressed, subsequent values on days 7, 14, and 21 increased significantly (P less than .002). On day 21 (mean postnatal age of 30.8 days) no differences existed in chemiluminescent activity and random motility between preterm and term neonates; chemotactic motility in preterm neonates, however, remained impaired. Mean cumulative age (gestational age at birth plus postnatal age) of preterm neonates on day 21 of study was 32.5 weeks, suggesting that chronologic age has more effect on maturational changes in PMN functions than gestational age.     

Effects of bisphenol A and artificial UVB radiation on the early development of Rana temporaria

Ultraviolet-B (UVB) radiation is one environmental factor that may act in concert with other stressors, such as xenobiotics, to produce adverse effect on amphibian populations. Embryos (< 24 h old) of the common frog (Rana temporaria) were exposed to four concentrations (0, 10, 100, or 1000 microg/L) of bisphenol A (BPA), with and without ultraviolet-B (UVB) radiation, for 20 d in the laboratory. Throughout the experiment the biologically effective daily UVB dose, calculated with Setlow's DNA action spectrum, was 2.80 kJ m(-2). UVB radiation as such did not have any significant effect on frog embryos. However, a BPA treatment of 1000 microg/L had a significant effect on embryos in both the UVB and no-UVB treatments, with the effect being greater with UVB. UVB produced a significant decrease in survival in the newly hatched frog larvae at all BPA concentrations. These results demonstrate that simultaneous exposure to these two stress factors is more harmful to R. temporaria larvae than exposure to one stressor alone.     

Symptom response after palliative radiotherapy for patients with brain metastases

Whole brain radiotherapy (RT) is frequently used to palliate symptoms in patients with brain metastases, but the palliative benefit to patients has not been well documented. We conducted a longitudinal observational prospective study of patients receiving standard RT (20 Gray (Gy)/5 fractions) for symptomatic brain metastases. End-points were observer rating of neurological symptoms, patient-rated symptoms, performance status, neurological functional status, cognitive function and quality of life (QOL). Median survival for the 75 patients was 86 days (95% confidence interval (CI): 65-101 days). At 1 month, 19% of patients showed an improvement or resolution of presenting symptoms, 23% were stable and 55% had progressed or died. Patient-rated symptoms were increased at 1 month in comparison to baseline data. Only 4 patients had an improved performance status and 22 were stable. Many patients with brain metastases have a short life expectancy and may not benefit from even short duration radiation schedules. Further effort is needed to optimise patient selection and tailor treatment appropriately.     

Comparison of two procedures for meniscal cysts. A report of 35 patients with a mean follow-up of 33 months

BACKGROUND: The cause, pathogenesis, and appropriate treatment of meniscal cysts remain controversial. PURPOSE: We wanted to evaluate the results of treatment of meniscal cysts with two different operative procedures. STUDY DESIGN: Prospective cohort study. METHODS: Two different operative procedures were compared. Sixteen patients (group 1) had an open excision of the cyst performed in addition to arthroscopic examination of the knee. Nineteen patients (group 2) were treated entirely arthroscopically. The postoperative treatment course was the same for both groups. The mean length of follow-up was 33 months. RESULTS: The results were excellent or good in 86% of the patients (30 of 35) and were equally good for both procedures. Patients with degenerative changes of the knee joint seemed to have a less favorable outcome. CONCLUSIONS: Good or excellent results can be expected from either open or arthroscopic treatment of meniscal cysts.     

Increased malignant behavior in neuroblastoma cells with acquired multi-drug resistance does not depend on P-gp expression

Acquisition of P-gp-mediated multidrug-resistance does not always correlate with observed malignant behavior of NB. To characterize alterations accompanying development of multidrug-resistance in NB we established two neuroblastoma cell sublines resistant to vincristine (UKF-NB-3rVCR10) and doxorubicin (UKF-NB-3rDOX20). UKF-NB-3rVCR10 and UKF-NB-3rDOX20 overexpressed functional P-gp and developed an increased malignant phenotype: presented constitutive phosphorylation of AKT, resistance to gamma-irradiation, and had increased survival in serum-free medium. Inhibition of P-gp restored chemosensitivity but did not affect increased survival in serum-free medium and sensitivity to gamma-irradiation. Inhibition of AKT had no influence on chemoresistance but restored sensitivity to serum starvation. Both resistant cell lines acquired additional chromosomal changes. UKF-NB-3rVCR10 cells acquired a missense P53 mutation in exon 5, an increased MYCN amplification, an enhanced adhesion to endothelium, a decreased NCAM expression, a distinctly higher clonogenicity, and an increased in vivo tumorigenicity. We conclude that acquisition of increased malignant behavior in neuroblastoma occurs concomitantly with multidrug-resistance and is P-gp-independent.     

The impact of a self-help pamphlet on reducing risk drinking among 30- to 49-year-old men in Helsinki, Finland

This study evaluates the impact of a self-help pamphlet designed to support self-control of drinking. It was conducted in Helsinki, Finland, in 2001 and 2002 and focused on men between 30 and 49 years of age. The respondents were randomly selected in an intervention and a control area and compared with each other before and after the intervention using independent samples (N = 4418) The results support previous findings showing that interventions like this serve as a supplement to other prevention and early treatment measures. Although the results were encouraging, there is a need for more in-depth studies in the field.     

Childhood adversities, adult risk factors and depressiveness

OBJECTIVE: Childhood adversities have been associated with adulthood depressiveness, but the contribution of adult risk factors is seldom described. We examined whether adult risk factors lie on the pathway from childhood adversity to adult depressiveness (pathway hypothesis) or whether the association depends on life events (vulnerability hypothesis). METHOD: Among 21,101 randomly sampled working-aged respondents [the Health and Social Support in Finland (HeSSup) Study], the hypotheses were tested with logistic regression analysis models studying the associations between Beck Depression Inventory (BDI)-assessed depressiveness and self-reported childhood adversities alone and in combination with recent adverse events. RESULTS: Childhood adversities were consistently associated with depressiveness (women, age-adjusted odds ratio 3.1, 95% confidence intervals 2.6-3.7; men, 2.6, 2.1-3.3), although the risks were decreased by more than 30% after adjustments for adult risk factors such as living alone, education, alcohol consumption, social support and negative affectivity. Childhood adversities combined with recent life events were associated with depressiveness in an additive manner. Women with childhood adversities and recent person-independent events especially had increased vulnerability for depressiveness. CONCLUSIONS: The childhood adversity-depressiveness associations were partly mediated by adult risk factors, supporting a pathway from childhood adversities to depressiveness through adult risk factors. Increased vulnerability for depressiveness was found among respondents with childhood adversities in combination with recent death/illness events. The findings emphasize the importance of early risk factors when identifying persons at risk of depression.