Liver transplantation for acute liver failure: are there thresholds not to be crossed?

Factors predicting survival after liver transplantation (LT) for irreversible acute liver failure (ALF) are rare. The aim of this study was to identify prognostic preoperative factors of patients with ALF that predict mortality after LT to avoid futile transplantation. From chart review, we identified 57 patients receiving transplants for ALF from 12/2000 to 09/2010. Recipient and donor data were analyzed and correlated with in‐hospital mortality and patient survival by univariable/multivariable logistic regression and Cox proportional hazards. The survival rates at 30 days and 12 months were 77.2% and 64.9%, respectively. The in‐hospital mortality rate was 29.8%. Follow‐up of patients discharged from the hospital alive showed 30‐day and 12‐month survivals of 100% and 92.5%, respectively. Multivariable analysis of factors known preoperatively showed that the lowest pH of the recipient before LT (P = 0.03) was independently associated with in‐hospital mortality, and the recipient's BMI (P = 0.03) and the lowest pH before LT (P = 0.03) were independently associated with patient survival. A pH of 7.26 was the calculated cutoff (ROC) for increased in‐hospital mortality. Donor factors did not affect patient survival. Patients with ALF and a pH ≤ 7.26 have the worst outcome after liver transplantation. Therefore, emergency liver transplantation should be critically discussed for each individual.     

异基因造血干细胞移植受者代谢综合征的发生情况

异基因造血干细胞移植（hematopoieticcelltransplantation,HCT）后代谢综合征的发生主要由预处理导致的神经激素系统紊乱、血管内皮损伤、移植物的免疫和炎症作用以及继发的移植物抗宿主病及其治疗等引起。对代谢综合征及其组分（糖尿病、高血压、血脂紊乱等）的筛查可以尽早地调整治疗策略,控制危险因素的发生,进而降低远期的心血管疾病的发生率和致死率。为此,美国的研究人员回顾性分析了86例异基因HCT受者代谢综合征的发生情况,并与代谢综合征在普通人群中的流行情况进行比较。     

DNA AMPLIFICATION OF A REPETITIVE SEQUENCE - IS 6110 IN THE EARLY DIAGNOSIS OF EXTRA PULMONARY TUBERCULOSIS

DNA amplification by Polymerase Chain Reaction (PCR) of a repetitive sequence specific for Mycobacterium tuberculosis, from clinical samples of extra pulmonary origin were evaluated. The 123 base pair fragment of the insertion element IS 6110 in Mycobacterium tuberculosis was amplified. A total of 50 samples were analysed by PCR and compared with culture on Lowenstein-Jensen medium (LJ) and the clinical findings of the patient. Out of the total 26 samples were positive by PCR, while only seven grew the bacilli in culture. 24 samples were negative by PCR and culture. All the seven samples that grew the bacilli on culture were positive by PCR. In remaining 19 cases that were positive by PCR but did not grow the bacilli clinical features, radiological findings and Mantoux test were strongly suggestive of M. tuberculosis. All the amplification negative cases had no positive evidence of tuberculosis but were being followed up. When correlated with culture and clinical history the sensitivity of PCR for the diagnosis of active tuberculosis was 100%. However, the specifity was only 55.8% as culture on LJ (Gold Standard) was positive in only 7 samples out of 26 samples that were positive by PCR.KEY WORDS: DNA Amplification, IS 6110, Mycobacterium tuberculosis.     

Vector Databank in the Indian Armed Forces

Background

Medical intelligence of disease vectors deals with understanding vector distribution and control.

Methods

An entomological baseline survey using standard vector sampling techniques was done as a pilot study to map the vectors of defence importance in two cantonments of Pune with a view to establish a vector databank and impart training to armed forces personnel in vector surveillance.

Result

The project trained 142 armed forces personnel in surveillance techniques in three years. Seventeen species of mosquitoes comprising of eight vector species were collected. Three other vectors viz. Rhipicephalus sanguineus, Xenopsylla cheopis and Leptotrombidium deliense are reported.

Conclusion

The study emphasizes the need for vector mapping /surveillance in each area for preventing morbidity and mortality amongst troops. It also focuses on indigenous fabrication of vector sampling tools and training of personnel for capacity building which in turn will enable such surveys to be undertaken in other units and deployment areas.Key Words: Leptotrombidium, Mosquitoes, Rhipicephalus, Surveillance, Xenopsylla     

The impact of comorbidity on the survival of postmenopausal women with breast cancer

Purpose The aim was to assess the impact of comorbidity on survival of postmenopausal women with breast cancer diagnosis in the period 1995–1997.Methods The level of comorbidity was described by the methods suggested by Satariano and Charlson. Coxs proportional hazard models were used to explore the impact of comorbidity on all-cause mortality.Results After a median follow-up time of 52 months, an increasing level of comorbidity was associated with a higher all-cause mortality. Compared to patients without comorbid conditions, the hazard ratio of death (HR) was 1.2 (95% CI: 0.8–1.7) for Satariano index 1 and HR 2.3 (95% CI: 1.5–3.5) for Satariano index 2, and HR 1.6 and 2.1 for the Charlson comorbidity index, respectively. Independent of comorbidity, the treatment pattern had a strong impact on survival. The level of comorbidity has an influence on the 3-year survival of postmenopausal women with breast cancer.Conclusions Long-term follow-up is required to appraise these findings in relation to treatment strategies.     

Immunologic Identification of Tissue Factor (Thromboplastin) Synthesized by Cultured Fibroblasts

The proliferative capacity of bone marrowcells from thymus-deprived nude mice wasinvestigated in lethally irradiated recipients. Although the colony-forming capacityof these cells was found to be similar tothat of normal littermates, a reduction inthe number of nucleated cells was observed in the bone marrow of nude mice.Moreover when the radioprotective effectof such cells was studied, it was foundthat 5 x 10⁵ or 2 x 10⁶ bone marrowcells from nude mice were less effectivein restoring hemopoiesis and establishingpermanent chimerism than similaramounts of bone marrow cells of normalcontrols. In addition, irradiated animalssurviving after injection of bone marrowcells from nude mice were found to havelower immune responses to SRBC thannormal chimeras. The possibility that mortality of irradiated recipients injected withbone marrow of nude mice is due to thepresence of a latent infective agent or ofsome inhibitory factor of hematopoiesis inthe bone marrow of such nude mice isshown to be improbable. Alternatively it issuggested that nude mice suffer from anintrinsic defect in the proliferative capacityof their bone marrow colony-forming cells(CFUs).

Submitted on February 12, 1973 Revised on March 29, 1973 Accepted on April 20, 1973