AST‐to‐platelet ratio index in non‐invasive assessment of long‐term graft fibrosis following pediatric liver transplantation

Long‐term graft fibrosis occurs in the majority of pediatric liver transplant recipients. Serial biopsies to monitor graft health are impractical and invasive. The APRI has been evaluated in pediatric liver disease, but not in the context of post‐transplantation fibrosis. We aimed to investigate the validity of APRI as a predictor of long‐term graft fibrosis in pediatric liver transplant recipients. This was a retrospective, observational study of a cohort of children who underwent liver transplantation at King's College Hospital between 1989 and 2003, with a relevant dataset available. Protocol liver biopsies were performed at 10‐yr follow‐up and fibrosis was graded using the Ishak scoring system, with S3‐6 denoting “significant fibrosis.” APRI was calculated concurrently with biopsy. A total of 39 asymptomatic patients (20 males; median age at transplant, 1.43 yr) underwent protocol liver biopsies at a median of 10.39 yr post‐transplantation. APRI was associated with significant fibrosis (p = 0.012). AUROC for APRI as a predictor of significant fibrosis was 0.74 (p = 0.013). The optimal cutoff APRI value for significant fibrosis was 0.45 (sensitivity = 0.67; specificity = 0.79; PPV = 0.67; NPV = 0.79). APRI appears to be a useful non‐invasive adjunct in the assessment of significant graft fibrosis in the long‐term follow‐up of pediatric liver transplant survivors.     

Interleukins and their signaling pathways in the Reactome biological pathway database

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Revitalizing long-acting reversible contraceptives in settings with high unmet need: a multicountry experience matching demand creation and service delivery

BackgroundContraception in many developing countries is characterized by high unmet need, irregular access, low utilization and presumed demand for long-acting reversible contraceptives (LARCs).Study DesignA 13-country initiative focused on increasing consumer demand and high quality services for intrauterine devices (IUDs) began in 2009. Services were provided through (a) private sector-franchised or affiliated clinics; (b) providers seconded to the public sector and (c) special “event” days. Client intake data are used to compare the profile of IUD acceptors with IUD users from representative national datasets of select countries, as well as examine trends in IUD uptake.ResultsDuring 2009–2010, 575,601 IUDs were inserted across the 13 countries. Compared to national IUD users, users in this project were slightly younger and less educated. Among IUD acceptors, 24% used no modern method at the time of IUD initiation, and 28% reported injectable use in the three previous months.ConclusionsConvenient, quality, affordable services with demand creation can result in significant uptake of LARCs in settings with low use.     

Two assessments to evaluate imagery ability: translation, test-retest reliability and concurrent validity of the German KVIQ and Imaprax

ABSTRACT: BACKGROUND: A combination of physical practice and motor imagery (MI) can improve motor function. It is essential to assess MI vividness in patients with sensorimotor impairments before implementing MI interventions. The study's aims were to translate the Canadian Kinaesthetic and Visual imagery Questionnaire (KVIQ) and the French Imaprax, and to examine reliability and validity of the German versions. METHODS: Questionnaires were translated according to guidelines. With examiners help patients (diagnosis: stroke: subacute/chronic, brain tumour, Multiple Sclerosis, Parkinsons disease) were tested twice within seven days (T0, T1). KVIQ-G: Patients were shown a movement by the examiner, before executing and imagining the movement. They rated vividness of the image and intensity of the sensations on a five-point Likert-scale. Imaprax required a 3-step procedure: imagination of one of six gestures; evaluation of gesture understanding, vividness, and imagery perspective. Questionnaire data were analysed overall and for each group. Reliability parameters were calculated: intraclass correlation coefficient (ICC), Cronbach's alpha, standard error of measurement, minimal detectable change. Validity parameters included Spearman's rank correlation coefficient and factor analysis of the KVIQ-G-20. RESULTS: Patients (N = 73, 28 females, age: 63 +/- 13) showed the following at T0: KVIQ-G-20vis 41.7 +/- 9, KVIQ-G-10vis 21.1 +/- 5. ICC for KVIQ-G-20vis and KVIQ-G-10vis was 0.77; KVIQG- 20kin 36.4 +/- 12, KVIQ-G-10kin 18.3 +/- 6. ICCs for KVIQ-G-20kin and KVIQ-G-10kin were 0.83/0.85; Imapraxvis 32.7 +/- 4 and ICC 0.51. Internal consistency was estimated for KVIQ-G- 20 alphavis = 0.94/alphakin = 0.92, KVIQ-G-10 alphavis = 0.88/alphakin = 0.96, Imaprax-G alphavis = 0.70. Validity testing was performed with 19 of 73 patients, who chose an internal perspective: rs = 0.36 (p = 0.13). Factor analysis revealed a two factors correlating with r = 0.36. Both explain 69.7 % of total variance. CONCLUSIONS: KVIQ-G and Imaprax-G are reliable instruments to assess MI in patients with sensorimotor impairments confirmed by a KVIQ-G-factor analysis. KVIQ-G visual values were higher than kinaesthetic values. Patients with Multiple Sclerosis showed the lowest, subacute stroke patients the highest values. Hemiparetic patients scored lower in both KVIQG subscales on affected side compared to non-affected side. It is suggested to administer the Imaprax-G before the KVIQ-G to test patients ability to distinguish between external and internal MI perspective. Duration of both questionnaires lead to an educational effect. Imaprax validity testing should be repeated.     

Effects of occupational stress on the gastrointestinal tract

The aim of this review is to provide a general overview of the relationship between occupational stress and gastrointestinal alterations. The International Labour Organization suggests occupational health includes psychological aspects to achieve mental well-being. However, the definition of health risks for an occupation includes biological, chemical, physical and ergonomic factors but does not address psychological stress or other affective disorders. Nevertheless, multiple investigations have studied occupational stress and its physiological consequences, focusing on specific risk groups and occupations considered stressful. Among the physiological effects of stress, gastrointestinal tract (GIT) alterations are highly prevalent. The relationship between occupational stress and GIT diseases is evident in everyday clinical practice; however, the usual strategy is to attack the effects but not the root of the problem. That is, in clinics, occupational stress is recognized as a source of GIT problems, but employers do not ascribe it enough importance as a risk factor, in general, and for gastrointestinal health, in particular. The identification, stratification, measurement and evaluation of stress and its associated corrective strategies, particularly for occupational stress, are important topics to address in the near future to establish the basis for considering stress as an important risk factor in occupational health.     

Local politics and retail cannabis markets: The case of the Dutch coffeeshops

BackgroundCannabis coffeeshops are concentrated in specific areas in the Netherlands; close to 80% of Dutch municipalities have no coffeeshops. We investigated why such wide local differences exist.MethodsRegression analyses were carried out on data regarding the number of coffeeshops per municipality, local council seat distribution and area demographic characteristics. A contrast analysis of municipalities with no/few vs. many coffeeshops was also performed.ResultsWhether a town has one or more coffeeshops can be predicted in part by its population size, but more strongly by political composition of the local council. The larger the percentage of progressive councillors, the greater the probability that coffeeshops are allowed. The number of coffeeshops in a town depends primarily on the demand for cannabis (reflected in factors like local population size); it generally has little to do with national-level party political preferences about drug policy.ConclusionBoth the demand for coffeeshops and local political preference influence coffeeshop policy in the Netherlands.     

A pilot clinical study of hair grafting in chronic leg ulcers

Epidermal sheets spread centrifugally postinjury from the hair follicle infundibulum to reepithelialize the wound bed. Healing progresses faster in skin areas rich in terminal hair follicles. These observations are consistent with the role of the hair follicle as a major reservoir for progenitor cells. To evaluate the feasibility and potential healing capacity of autologous scalp follicular grafts transplanted into the wound bed of chronic leg ulcers, 10 patients with ulcers of an average 36.8 cm² size and a 10.5‐year duration were included in this pilot study. Within each ulcer we randomly assigned a 2 × 2 cm “experimental” square to receive 20 hair grafts and a nongrafted “control” square of equal size. The procedure seemed to be safe, although major unrelated complications occurred in two patients. At the 18‐week end point, we observed a 27.1% ulcer area reduction in the experimental square as compared with 6.5% in the control square (p = 0.046) with a maximum 33.5% vs. 9.7% reduction at week 4 (p = 0.007). Histological analyses showed enhanced epithelialization, neovascularization, and dermal reorganization. We conclude that terminal hair follicle grafting into wound beds is feasible in an outpatient setting and represents a promising therapeutic alternative for nonhealing chronic leg ulcers.