HCV very late relapse following an atypical viral kinetics in a HIV patient treated for hepatitis C with direct-acting antivirals

Direct-acting antivirals (DAAs) for the treatment of HCV have dramatically increased the rate of sustained virological response: patients not achieving sustained virological response represent a challenge and rates of late recurrent viremia are very low. We describe here the first case of a very late HCV relapse, following an atypical kinetics (characterized by a spontaneous but transient HCV clearance after an early virological relapse), in a HIV co-infected patient treated with DAAs. Optimal adherence to the therapy was well documented and a phylogenetic analysis ruled out a possible reinfection from a different HCV strain. In conclusion, our case underlines the importance of a long follow-up (>?48 weeks) after DAAs therapies in HCV–HIV co-infected patients who might benefit the most from a very rigorous virological surveillance.     

Oral health-related quality of life and satisfaction before and after treatment with complete dentures in a Dental School in Brazil

Purpose: The aim of this study was to evaluate the impact of treatment with new complete dentures on oral health-related quality of life and satisfaction of edentulous patients attending the Prosthodontic Department in a Dental School in Brazil. Methods: A total of 70 edentulous subjects (37–86 years) treated by undergradute students at the Araçatuba Dental School, University of State of São Paulo, were accessed. A specific questionnaire for edentulous patients (EDENT) based on the Oral Health Impact Profile (OHIP-EDENT) was applied to collect information on patient oral health-related quality of life. Questions related to the personal satisfaction of the edentulous patients with their complete dentures were also included. The patients were accessed before the treatment, and 3 months after receiving the new dentures. Results: After rehabilitation with new complete dentures, all domains of OHIP-EDENT showed significant improvements. There was also a significant improvement in patient satisfaction after placement of new complete dentures. Furthermore, it was possible to observe association between upper denture satisfaction and age. Conclusion: Conventional complete dentures may have a positive impact on oral health-related quality of life and satisfaction of edentulous patients.     

Effective palliation and quality of life outcomes in studies of surgery for advanced,non-curative gastric cancer: a systematic review

Background

Relief of symptoms should be the primary focus of palliative treatment as defined by the World Health Organization. Evaluating the effectiveness of palliative interventions should incorporate this goal and include quality of life (QOL) outcome assessments. A systematic review of the surgical gastric cancer literature was performed to summarize the effectiveness of palliative surgical interventions in addressing QOL.

Methods

An electronic literature search of EMBASE, Medline, and the Cochrane Database of Controlled Trials was performed from January 1, 1985 to December 1, 2009. English language abstracts and articles were reviewed independently by two reviewers. A systematic approach to data abstraction and presentation was followed.

Results

No articles were identified as reporting true QOL outcomes using reliable, validated QOL instruments in surgically managed, advanced gastric cancer patients. Nine articles were identified as reporting outcomes measuring effectiveness of palliation. Commonly reported pre-procedure symptoms were weight loss, abdominal pain, vomiting, obstruction, and bleeding. Time to oral intake was reported in 5 of 9 studies, ranging from a mean of 2.9 days (laparoscopic gastrojejunostomy) to 8 days (surgical bypass). Length of postoperative inpatient stay ranged from a mean of 7 days (gastrojejunostomy) to 28 days (surgical bypass). Other measures of effective palliation included measures of clinical success, hospital re-admission rates, and post-procedure analgesic intake.

Conclusion

A paucity of literature exists regarding the QOL of surgically managed gastric cancer patients. Prospectively designed studies using credible QOL measures are necessary to better inform the treatment decision-making process for these patients.

     

Failure of estrogen to protect the substantia nigra pars compacta of female rats from lesion induced by 6-hydroxydopamine

The immunostaining for tyrosine hydroxylase (TH) in the substantia nigra pars compacta (SNpc) and in the ventral tegmental area (VTA) after intranigral infusion of 6-hydroxydopamine (6-OHDA, 6 microg/side) was analyzed in ovariectomized adult female Wistar rats. Estrogen replacement for 52 days (400-microg 17-beta-estradiol capsules) did not prevent the loss of TH-immunoreactive cells induced by 6-OHDA in the SNpc. This result indicates that the neuroprotective effect of dopaminergic mesencephalic cells is not observed with long-term estrogen replacement.     

High-dose cytarabine as consolidation treatment for patients with acute myeloid leukemia with t(8;21)

Seventeen patients affected by acute myeloid leukemia (AML) with t(8;21) were prospectively programmed to receive three courses of high-dose cytarabine (HDARA-C) as post-remission therapy. The median age was 39 years and in all cases t(8;21) was the only karyotypic abnormality. Complete remission (CR) was achieved in 14 out of 17 cases (82%) and, after first consolidation with NOVIA regimen (intermediate dose ARA-C plus mitoxantrone), all patients received the three planned courses of HDARA-C (3g/m(2) q12h on days 1, 3, 5). There were two documented infections, while all patients experienced fever of unknown origin (FUO). Nonhematological toxicity was mild. Thirteen out of 14 patients are in continuous CR after a median follow-up of 44 months. One patient relapsed at 16 months and, following CR2 achievement, underwent allogeneic transplantation; he died 3 months later while in CR from acute graft versus host disease (GVHD). Survival at 5 years is projected at 79%. Our data confirm the efficacy of repeated courses of HDARAC for patients with t(8;21) AML.     

Detection of TOAD-64 in adult rat brain as revealed by two-dimensional protein gel electrophoresis followed by MALDI mass spectrometry possible modulatory effect of chronic haloperidol treatment

The molecular mechanisms by which antipsychotic effects are achieved remain largely elusive. Possible mechanisms include the modulation of nerve cell gene expression. The antipsychotic drug haloperidol was administered orally (1.6 mg/kg) to adult rats for 3 weeks. Protein patterns in striata and forebrains were studied by two-dimensional gel electrophoresis (2-DE). One differentially regulated protein spot was identified by matrix-assisted laser desorption ionization mass spectrometry (MALDI-MS) after trypsin digest. Turned on after devision-64 kD (TOAD-64), the identified protein, was present in all gels and, in addition, was up-regulated in the striata but not in the forebrains of the haloperidol-treated animals by 43%. It is concluded that TOAD-64, typically regarded as a marker for commitment to neuronal differentiation during fetal development, also plays a role in adult rat forebrain and striatum and that its concentration is possibly modulated by haloperidol treatment.     

Engraftment capacity of mesenchymal cells following hematopoietic stem cell transplantation in patients receiving reduced-intensity conditioning regimen.

The engraftment ability of mesenchymal cells was investigated in 26 patients receiving allogeneic transplantation from HLA-identical siblings with reduced-intensity conditioning (RIC). The stem cell source was bone marrow (BM) in eight patients and G-CSF-mobilized peripheral blood hematopoietic cells in 18 cases. A total of 32 patients engrafted very quickly and the chimerism evaluation (both on myeloid and on lymphoid subsets) showed that they were full donor by day 60. At the time of the study they were in complete hematological remission and displayed a full donor hematopoiesis. Two patients showed early disease progression while one did not engraft. Forty-eight out-marrow samples harvested from the 26 patients generated a marrow stromal layer adequate for the chimerism evaluation. Monocyte-macrophage contamination of marrow stromal layers was always reduced below 2% by repeated trypsinizations and treatment with the leucyl-leucine (leu-leu) methyl ester. The chimerism evaluation was performed by PCR analysis of STRs microsatellites and the amelogenin locus, by using capillary electrophoresis (CE) and by FISH analysis in case of the sex mismatch. In eight patients, a partial donor origin of stromal cells was shown (7-86% cells of donor). The source of hematopoietic cells was BM in three patients and mobilized peripheral blood in the other five.     

Do shoulder patients insured by workers' compensation present with worse self-assessed function and health status?

The purpose of this study was to test the hypothesis that patients whose shoulder problems are covered by workers' compensation insurance perceive worse shoulder function and health status than do comparable patients whose problem is not covered by workers' compensation. Each of 1063 consecutive patients presenting with shoulder problems to an individual consultant completed 2 questionnaires: the Simple Shoulder Test inventory of shoulder function and the Short Form 36 general health assessment. The patients were divided into 2 groups on the basis of whether care of the shoulder problem was covered by injured workers' compensation insurance. The results indicate that patients whose shoulder condition is covered by workers' compensation have significantly lower self-assessed shoulder function and health status than do those patients whose shoulder conditions are not related to on-the-job injuries. The differences between the workers' compensation and non-workers' compensation groups could not be attributed to differences in age, sex, or diagnosis.