Choledochoduodenostomy is a Safe Alternative to Roux-en-Y Choledochojejunostomy for Biliary Reconstruction in Liver Transplantation

Introduction  Bile duct reconstruction during liver transplantation is usually performed by a duct-to-duct anastomosis or a Roux-en-Y choledochojejunostomy (CDJ). Direct anastomosis of the bile duct to the duodenum (choledochoduodenostomy—CDD) is another option for biliary reconstruction. This technique has been used with good outcome for the treatment of choledochal cysts, ampullary stenosis, and major bile duct injuries; however, there is little published experience with CDD in liver transplantation. We provide preliminary evidence that CDD is a safe technique for biliary anastomosis in liver transplant recipients. Methods  From September 2000 to August 2007 a total of 619 adult first-time cadaveric or living donor liver transplants were performed at the University of Colorado Health and Science Center. Bile duct repair was performed by direct end-to-end anastomosis in 466 patients and by choledocoenterostomy in the remaining 153 patients, 82 of whom were cadaveric recipients. The cadaveric choledocoenterostomy patients were divided into two groups: CDD in 25 and CDJ in 57 recipients. Results  There were no significant differences in the 1-year patient or graft survival between the cadaveric groups. The 1-year patient survival was 100% in the CDD group and 97.1% in the CDJ group. The CDD group did not experience more surgical complications compared to the CDJ group. Conclusions  Choledochoduodenostomy is a safe alternative to CDJ biliary anastomosis when a duct-to-duct anastomosis cannot be performed. There is no significant difference in mortality, graft survival, or biliary complications. In addition, CDD offers the advantage of postoperative access to the billiary system by endoscopy and avoids complications associated with the CDJ bowel anastomosis.     

Identification of functional domains involved in BTG1 cell localization.

We have previously shown that BTG1 stimulates myoblast differentiation. In addition, this protein displays a major nuclear localization in confluent myoblasts, decreasing during the early steps of differentiation, and is essentially detected in the cytoplasm of mature myotubes. To identify the domains involved in the cellular trafficking of BTG1, we observed the localization of several BTG1 sequences fused to betaGalactosidase. The highly conserved B box among all members of the BTG family induces a significant nuclear localization of the betaGal moiety, enhanced by presence of the BTG1 carboxy-terminal sequence. In addition, a functional Nuclear Export Signal (NES) overlaps the B box. Moreover, presence of the first 43 NH(2)-terminal amino acids reduced the nuclear localization of each chimeric protein tested. Last, the BTG1 amino-terminal domain bears an LxxLL motif favouring nuclear accumulation, and another region encompassing the A box inhibiting nuclear localization. In contrast to a BTG1 mutant exclusively localized in the cytoplasm, transient expression of a mutant displaying a nuclear localization enhanced myoblasts withdrawal from the cell cycle and terminal differentiation, thus mimicking the myogenic influence of BTG1. In conclusion, several regions of BTG1 are implicated in its cellular localization, and BTG1 myogenic activity is induced at the nuclear level.     

Turno nocturno: un factor de riesgo en la salud y calidad de vida del personal de enfermería

ObjectivesTo study shift-related differences (day shift vs. night shift) in health and quality of life in nursing staff in hospitals in the Catalan public health system.MethodWe performed a cross-sectional multicenter study in a sample of 476 nursing staff in the wards and special services of five Catalan public hospitals working for at least 6 consecutive months on the day shift or night shift. The nurses completed a validated, self-administered questionnaire on quality of life (M. Ruiz and E. Baca) and another questionnaire on health-related aspects such as sleep, working conditions, and demographic variables.ResultsNurses working on the night shift showed a higher prevalence of appetite disturbance (45.2% vs 34.4%; p=0.01) and varicose veins (46.6% vs 36.4%; p=0.008). Sleeping disorders were also more frequent on the night shift, including insomnia and sleep fragmentation, with no differences in those who slept during the day (22.3%vs 33.7% ) or night (17.6% vs 30%) with respect to the day shift (12.2% vs 22.6%). Multivariate analysis of the results of the quality of life questionnaire revealed the night shift to be associated with the dimensions of social support (OR: 1.17; 95% CI, 1.01–3.01), physical/psychological well-being (OR: 1.04; 95% CI, 1.004–1.07) and leisure time (OR: 1.07; 95% CI, 1.003–1.1), although the overall score was similar.ConclusionsThe night shift is associated a higher incidence of varicose veins, appetite disturbance and sleep disorders, as well as alterations related to social support, leisure time, and physical and physiological well-being.     

Fertility Decline in Paraguay

Recent reproductive health surveys show that the fertility rate in Paraguay decreased precipitously from 4.3 lifetime births per woman in 1995–98 to 2.9 births in 2001–04. In this study, we establish data consistency between the 1998 and 2004 surveys by comparing a series of cohort-specific period rates and use the Bongaarts framework of proximate determinants of fertility to demonstrate that an increase in the contraceptive prevalence rate (CPR) between 1998 and 2004 fully accounts for the fertility decline. Decomposition of rates shows that changes in group-specific CPRs explain a greater proportion of the change in the overall CPR than do changes in population composition by educational attainment, urban residence, region, and language spoken at home. Finally, we show that younger cohorts of women in 2004 reported ideal completed fertility desires of less than 2.9 births, suggesting that the fertility rate is likely to continue to decrease.     

5-Nitro-2-furyl derivative actives against Trypanosoma cruzi: Preliminary in vivo studies

Ten 5-nitro-2-furyl derivatives, with good to excellent in vitro anti-Trypanosoma cruzi activity, and nifurtimox were tested oral and intraperitoneally on healthy animals for its acute toxicity on murine models. According to animals' survival percentage, organ histological results, biochemical and haematological findings, three new derivatives, with toxicity like nifurtimox, were selected to test in vivo as antichagasic agents. Clearly, dependences between chemical structure and both acute toxicity and in vivo anti-T. cruzi activity were observed. 4-Hexyl-1-[3-(5-nitro-2-furyl)-2-propenylidene]semicarbazide displayed good profile as anti-T. cruzi agent and better acute toxicity profile than nifurtimox.     

Psychosocial stressors may be strongly associated with suicide attempts

Stressful life events are associated with a high proportion of suicide attempts. The aim of this study is to clarify the importance of psychosocial stressors in suicidal behaviour. A total of 258 suicide attempters seen at a general hospital emergency room, and 325 blood donors without suicide/psychiatric disorder history were recruited. Acute and chronic life events were assessed with the St. Paul Ramsey Life Experience Scale and Holmes and Rahe's Social Adjustment Scale, respectively. Lifelong adverse experiences were also assessed. After univariate analyses, the significant variables were introduced in a multivariate analysis (logistic regression). The logistic regression with a dependent variable (attempter versus control status) included psychosocial stressors (partner conflicts [odds ratio (OR) = 33.6] and other interpersonal conflicts [OR = 10.5], modification of life habits [OR = 14.6], and adult physical abuse [OR = 7.1]). Confounding factors with significant ORs were Cluster B traits [OR = 21.2]; and two protective factors, living with a partner [OR = 0.25] and currently working [OR = 0.06]. Psychosocial stressors and Cluster B traits appeared to be strongly associated with suicide attempter status. One limitation of the study is the lack of inclusion of psychiatric controls (psychiatric patients without history of suicide attempts). Another limitation is the difficulty of determining suicide intent. Finally, this study is mainly a replication of prior knowledge of psychosocial stressors, but compares their association strength (OR > 10) with the association strength of prior biological findings (OR = 1–2). Copyright © 2007 John Wiley & Sons, Ltd.