Albumin gradient and portal vein velocity in severe viral hepatitis patients complicated with ascites

BACKGROUND/AIMS: To ascertain the mechanism of development of ascites and the hemodynamic change of portal system, 28 patients who had an episode of severe viral hepatitis with and without spontaneous bacterial peritonitis were studied. METHODOLOGY: By means of a non-invasive duplex system, the relationships between the albumin gradient of serum-ascites and the portal vein velocity were assessed in 10 patients with spontaneous bacterial peritonitis and 18 patients without spontaneous bacterial peritonitis. RESULTS: In the group of patients with severe form of hepatitis but without spontaneous bacterial peritonitis, there is a significant positive linear correlation between the level of serum albumin and the albumin gradient of serum-ascites (P < 0.001). However, a receded linear correlation was found between the serum albumin and the portal vein velocity (P < 0.02), and between the albumin gradient of serum-ascites and the portal vein velocity (P < 0.027) with Spearman linear correlation analysis. CONCLUSIONS: The present study suggests that hypoalbuminemia may be related to impairment of synthesis function in severe hepatitis itself, but not to the intraabdominal shifting of protein. Decreased portal vein velocity may be the first presenting sign in patients with severe form hepatitis complicating simple ascites. Yet this relationship will be masked and complicated once spontaneous bacterial peritonitis occurs.     

Effect of a warm footbath before bedtime on body temperature and sleep in older adults with good and poor sleep: An experimental crossover trial

Background

The decrease in core body temperature before sleep onset and during sleep is associated with dilation of peripheral blood vessels, which permits heat dissipation from the body core to the periphery. A lower core temperature coupled with a higher distal (hands and feet) temperature before sleep are associated with shorter sleep latency and better sleep quality. A warm foot bath is thought to facilitate heat dissipation to improve sleep outcomes.

Objectives

This study examined the effect of a warm footbath (40 °C water temperature, 20-min duration) on body temperature and sleep in older adults (≥55 years) with good and poor sleep.

Design

Two groups and an experimental crossover design was used.

Setting and participants

Forty-three adults responded to our flyer and 25 participants aged 59.8 ± 3.7 years (poor sleeper with a Pittsburgh Sleep Quality Index score ≥ 5 = 17; good sleepers with a Pittsburgh Sleep Quality Index score < 5 = 8) completed this study.

Methods

All participants had body temperatures (core, abdomen, and foot) and polysomnography recorded for 3 consecutive nights. The first night was for adaptation and sleep apnea screening. Participants were then randomly assigned to either the structured foot bathing first (second night) and non-bathing second (third night) condition or the non-bathing first (second night) and foot bathing second (third night) condition.

Results

A footbath before sleep significantly increased and retained foot temperatures in both good and poor sleepers. The pattern of core temperatures during foot bathing was gradually elevated (poor sleepers vs. good sleepers = +0.40 ± 0.58 °C vs. +0.66 ± 0.17 °C). There were no significant changes in polysomnographic sleep and perceived sleep quality between non-bathing and bathing nights for both groups.

Conclusion

A footbath of 40 °C water temperature and 20-min duration before sleep onset increases foot temperatures and distal–proximal skin temperature gradients to facilitate vessel dilatation and elevates core temperature to provide heat load to the body. This footbath does not alter sleep in older adults with good and poor sleep.     

Balloon valvuloplasty treatment of an infolded CoreValve

Transcatheter aortic valve replacement is an approved treatment for select patients with severe aortic stenosis. A rare complication of self‐expanding transcatheter heart valves (THVs) is infolding of the valve stent frame, which results in a malopposed segment, perivalvular aortic insufficiency, and possibly leaflet dysfunction. We report here a successful case of balloon valvuloplasty treatment for severe infolding of a self‐expandable THV in the aortic position, restoring stent frame geometry and leaflet function. © 2015 Wiley Periodicals, Inc.     

Th17 and non-Th17 interleukin-17-expressing cells in chronic lymphocytic leukemia: delineation, distribution, and clinical relevance

Background

The levels and clinical relevance of Th17 cells and other interleukin-17-producing cells have not been analyzed in chronic lymphocytic leukemia. The objective of this study was to quantify blood and tissue levels of Th17 and other interleukin-17-producing cells in patients with this disease and correlate blood levels with clinical outcome.

Design and Methods

Intracellular interleukin-17A was assessed in blood and splenic mononuclear cells from patients with chronic lymphocytic leukemia and healthy subjects using flow cytometry. Interleukin-17A-producing cells were analyzed in formalin-fixed, paraffin-embedded spleen and lymph node sections using immunohistochemistry and immunofluorescence.

Results

The absolute numbers of Th17 cells in peripheral blood mononuclear cells and the percentages of Th17 cells in spleen cell suspensions were higher in patients with chronic lymphocytic leukemia than in healthy subjects; in six out of eight paired chronic lymphocytic leukemia blood and spleen sample comparisons, Th17 cells were enriched in spleen suspensions. Circulating Th17 levels correlated with better prognostic markers and longer overall survival of the patients. Two “non-Th17” interleukin-17-expressing cells were identified in chronic lymphocytic leukemia spleens: proliferating cells of the granulocytic lineage and mature mast cells. Granulocytes and mast cells in normal spleens did not express interleukin-17. Conversely, both chronic lymphocytic leukemia and healthy lymph nodes contained similar numbers of interleukin-17+ mast cells as well as Th17 cells.

Conclusions

Th17 cells are elevated in chronic lymphocytic leukemia patients with better prognostic markers and correlate with longer survival. Furthermore, non-Th17 interleukin-17A-expressing cells exist in chronic lymphocytic leukemia spleens as maturing granulocytes and mature mast cells, suggesting that the microenvironmental milieu in leukemic spleens promotes the recruitment and/or expansion of Th17 and other IL-17-expressing cells. The pathophysiology of Th17 and non-Th17-interleukin-producing cells in chronic lymphocytic leukemia and their distributions and roles in this disease merit further study.     

Silicosis

Silicosis is a fibrotic lung disease caused by inhalation of free crystalline silicon dioxide or silica. Occupational exposure to respirable crystalline silica dust particles occurs in many industries. Phagocytosis of crystalline silica in the lung causes lysosomal damage, activating the NALP3 inflammasome and triggering the inflammatory cascade with subsequent fibrosis. Impairment of lung function increases with disease progression, even after the patient is no longer exposed. Diagnosis of silicosis needs carefully documented records of occupational exposure and radiological features, with exclusion of other competing diagnoses. Mycobacterial diseases, airway obstruction, and lung cancer are associated with silica dust exposure. As yet, no curative treatment exists, but comprehensive management strategies help to improve quality of life and slow deterioration. Further efforts are needed for recognition and control of silica hazards, especially in developing countries.     

Determination of RhD zygosity: comparison of a double amplification refractory mutation system approach and a multiplex real-time quantitative PCR approach

BACKGROUND: Rh isoimmunization and hemolytic disease of the newborn still occur despite the availability of Rh immunoglobulin. For the prenatal investigation of sensitized RhD-negative pregnant women, determination of the zygosity of the RhD-positive father has important implications. The currently available molecular methods for RhD zygosity assessment, in general, are technically demanding and labor-intensive. Therefore, at present, rhesus genotype assessment is most commonly inferred from results of serological tests. The recent elucidation of the genetic structure of the prevalent RHD deletion in Caucasians, as well as the development of real-time PCR, allowed us to explore two new approaches for the molecular determination of RhD zygosity. METHODS: Two methods for RhD zygosity determination were developed. The first was based on the double Amplification Refractory Mutation System (double ARMS). The second was based on multiplex real-time quantitative PCR. For the double ARMS assay, allele-specific primers were designed to directly amplify the most prevalent RHD deletion found in RhD-negative individuals in the Caucasian population. The multiplex real-time quantitative PCR assay, on the other hand, involved coamplification and quantification of RHD-specific sequences in relation to a reference gene, albumin, in a single PCR reaction. A ratio, DeltaCt, based on the threshold cycle, was then determined and reflects the RHD gene dosage. RESULTS: The allele-specific primers of the double ARMS assay reliably amplified the RHD-deleted allele and therefore accurately distinguished homozygous from heterozygous RhD-positive samples. The results were in complete concordance with serological testing. For the multiplex real-time quantitative PCR assay, the DeltaCt values clearly segregated into two distinct populations according to the RHD gene dosage, with mean values of 1.70 (SD, 0.17) and 2.62 (SD, 0.29) for the homozygous and heterozygous samples, respectively (P: <0.001, t-test). The results were in complete concordance with the results of serological testing as well as with the double ARMS assay. CONCLUSION: Double ARMS and real-time quantitative PCR are alternative robust assays for the determination of RhD zygosity.     

Icteric-type hepatoma: magnetic resonance imaging and magnetic resonance cholangiographic features

Background: We evaluated the imaging features of magnetic resonance imaging (MRI) and magnetic resonance cholangiography (MRC) of icteric-type hepatoma and correlated these with the findings of endoscopic retrograde cholangiography (ERC), percutaneous cholangiography, and surgery. Methods: Thirteen patients with viral hepatitis complicated by cirrhosis of the liver and obstructive jaundice underwent MRC and dynamic MRI. Five patients received percutaneous transhepatic cholangiography and drainage; one of these patients also underwent resection of the left hepatic lobe. Another patient received MRC followed by thrombectomy and T-tube insertion. ERC and endoscopic nasobiliary drainage were performed in another patient for bile diversion. Results: Primary liver tumors and dilatation of biliary system were demonstrated in all patients. No capsule formation could be found in any primary liver tumors. MRI showed the simultaneous presence of an intraluminal tumor in the portal trunk and common hepatic duct in eight patients. Three different MRC features were found: (a) an oval defect in the hilar bile duct(s) with dilated intrahepatic ducts (n= 9), (b) dilated intrahepatic ducts with missing major bile ducts (n= 2), and (c) localized stricture of the hilar bile duct(s) (n= 2). Conclusion: The presence of one or more of the following features in multiplanar MRI and MRC help to identify this rare, specific type of hepatocellular carcinoma: (a) the presence of an intraluminal tumor in both the portal trunk and the common hepatic duct, (b) enhancement of the intraluminal tumor in the common hepatic duct on the arterial phase, (c) type I MRC feature, and (d) hemobilia, blood clot within the gallbladder, and/or type II MRC feature. Received: 12 January 2000/Revision accepted: 12 July 2000     

High Nrf2 expression in alveolar type I pneumocytes is associated with low recurrences in primary spontaneous pneumothorax

Recurrent primary spontaneous pneumothorax (PSP) is a troublesome problem and a major concern for the patients. This study examined whether nuclear factor erythroid 2-related factor 2 (Nrf2) expression in alveolar type I pneumocytes was associated with the clinical manifestations of PSP patients including disease recurrence. Eighty-eight PSP patients who were managed with needlescopic video-assisted thoracoscopic surgery (NVATS) were included in this study. Immunohistochemistry (IHC) was assessed to determine Nrf2 expression in resected lung tissues and the results were correlated with clinicopathological characteristics by the chi-square or the Fisher's exact test. The prognostic value of Nrf2 for overall recurrence was evaluated by univariate and multivariable Cox regression model. The expression of Nrf2 was observed in type I pneumocytes of lung tissues from PSP patients by IHC. We found that low Nrf2 expression in PSP patients, especially in young (age ≤ 20, p = 0.033) and body mass index (BMI) ≥18 kg/m² (p = 0.019) groups, was significantly correlated with PSP recurrence. In the univariate and multivariate analyses, high Nrf2 expression was a significant protective factor for overall recurrence in PSP patients (univariate: p = 0.026; multivariate: p = 0.004). The expression level of Nrf2 in alveolar type I pneumocytes was a potential factor involved in PSP recurrence. Our findings suggest that elevated Nrf2 expression in PSP patients may be a promising way for reducing PSP recurrence.