Is sofosbuvir/ledipasvir safe for the hearts of children with hepatitis C virus?

Background

Symptomatic bradycardia has been reported in adults treated for chronic hepatitis C using sofosbuvir based regimens.

Pneumatosis intestinalis following pediatric live‐related liver transplant: A case report and successful conservative approach

PI has been rarely reported following pediatric live‐related liver transplantation. Such a disorder is characterized by accumulation of gas in the bowel wall. The cause of PI has not been yet established; however, it has been strongly linked with steroid therapy. In this report, we present a case of PI following pediatric live‐related liver transplantation that has been successfully managed conservatively.     

Emotional regulation training for intensive and critical care nurses

Professional quality of life is related to psychological well‐being for nurses with implications for quality patient care. This study evaluated the effectiveness of emotional regulation training on depression, anxiety and stress, and professional quality of life for intensive and critical care nurses. In this experimental comparison trial, 60 intensive and critical care nurses were randomly assigned to treatment and wait‐list control groups. The treatment group received six sessions of emotional regulation training, while the wait‐list control group received no treatment. Outcome measures were: the Cognitive Emotion Regulation Questionnaire; the Depression, Anxiety and Stress Scale; and the Professional Quality of Life Scale in a pre‐post design. The treatment group demonstrated greater improvements in burnout and compassion satisfaction compared with the wait‐list control group. No significant reduction in compassion fatigue was found compared with controls. Some cognitive coping strategies improved in the treatment group compared with controls, with greater reductions in depression, anxiety, and stress. This study indicates the benefits of implementing emotional regulation training programs to improve psychological well‐being and professional quality of life for intensive and critical care nurses.     

Baseline Sarcopenia is Associated with Lack of Response to Therapy,Liver Decompensation and High Mortality in Hepatocellular Carcinoma Patients

Objective: hepatocellular carcinoma (HCC) is a dreadful complication of liver cirrhosis. Aim was to study the effect of sarcopenia on the survival in patients with HCC. Methods: we included 262 patients and were followed up for 12 months. Sarcopenia was calculated by skeletal muscle index (SMI). Sarcopenia was defined by SMI ≤39 cm2/m2 for women and ≤50 cm2/m2 for men. Results: patients with sarcopenia (n= 113, 43.1%) were older, mainly males, Child-Pugh class B and smokers. Patients with sarcopenia had lower survival than those without (10.09 vs. 11.72 months). Survival was also lower in Barcelona clinic liver cancer stage C than B and A (9.02 vs. 11.21 vs. 11.89 months). Age and sarcopenia were hazardous of mortality (p <0.05). There was statistically significant difference of serial SMI in patients without baseline sarcopenia unlike patients with baseline sarcopenia. On follow up patients with sarcopenia had higher incidence of ascites (45% vs. 20.4%), spontaneous bacterial peritonitis (21.7% vs. 11.6%), hepatic encephalopathy (28% vs. 11.5%) and bleeding (22.9% vs. 12.7%). Totally patients with sarcopenia had higher incidence of progressive HCC (39% vs. 25.5%). Conclusion: Sarcopenia is associated with lack of response to therapy, liver decompensation and higher mortality in hepatocellular carcinoma patients.     

Multimodal Percutaneous Intervention for Critical Venous Occlusive Disease

Critical deep venous thrombosis and occlusion constitutes a small percentage of patients with venous disease, who exhibit severe symptomatology. This study examined the results of multimodal percutaneous therapy for the treatment of complex critical venous thrombotic and occlusive disease. Twenty-five patients presented with critical venous thromboses or occlusions (11 with debilitating unilateral lower extremity edema causing ambulatory impairment, 2 with debilitating bilateral lower extremity edema, 3 with phlegmasia cerulea dolens, 2 with venous claudication, 2 with superior vena cava (SVS) syndrome with respiratory compromise, 4 with debilitating upper extremity edema, and 1 with renal insufficiency). Therapeutic modalities including thrombolysis, mechanical thrombectomy, percutaneous venoplasty and stent placement, temporary inferior vena cava filtration, and ultrasound guidance were used in all cases in conjunction with long-term systemic anticoagulation. The venous access site was determined by the anatomic location of the lesion and included popliteal, femoral, brachial, and lesser saphenous. Patients were followed with clinical exam and duplex surveillance. Resolution of symptoms was achieved in 18 of 25 patients (72%) and partial resolution occurred in 4 of 25 (16%). Failure of treatment identified as both lack of clinical response and evidence of continued venous thrombosis occurred 3 of 25 patients (12%). Restoration of arterial pulses and limb salvage was achieved in the three patients with phlegmasia cerulea dolens and acute limb-threatening ischemia. Both patients with SVC syndrome experienced resolution of respiratory compromise and facial edema. The mean length of follow-up was 11 ± 2.7 months. Complications included transfusion requirement (2), hematuria (2), retroperitoneal hematoma (1), and cellulitis (1). Acute critical venous thrombotic and occlusive disease is responsive to multimodal percutaneous treatment. The relief of pain and resolution of acutely life and limb-threatening conditions in this most severely symptomatic subset of patients represents the immediate goal of treatment.Presented at the Twenty-ninth Annual Meeting of the Peripheral Vascular Surgery Society, Anaheim, CA, June 4-5, 2004.     

Natural Products for Chemopreventive and Adjunctive Therapy in Oncologic Disease

Nutritional supplements or complementary and alternative medicines (CAM) are currently being investigated for their use in preventing, inhibiting, and reversing the progression of cancer. Natural agents and their derivatives such as vitamin A, selenium, green tea, resveratrol, aspirin, and probiotics have potential benefits in chemoprevention. There is also growing evidence for the use of natural products as adjunctive therapy alongside conventional cancer treatments. Nutritional supplements expenditures demonstrated greater growth than pharmaceuticals, with approximately 80% of cancer patients using natural products. Current issues with nutritional supplements use in cancer treatment include insufficient or conflicting evidence, poor quality control, potential interactions with chemotherapy, and potential efficacy in relation to changes in certain biomarkers, but long-term implications remain largely unresolved. Continued research is needed to lend credibility to these potentially valuable naturally driven supplements in the prevention and potentially in the treatment of cancer in conjunction with standard pharmaceuticals.     

Potential of dose optimisation in MRI-based PDR brachytherapy of cervix carcinoma

BACKGROUND AND PURPOSE: In this study on PDR treatment planning of utero-vaginal carcinoma, we analysed the dosimetry of traditional X-ray based plans as it presents on MR images. The potential gain of MRI-based dose optimisation was assessed. PATIENTS AND METHODS: Sixteen patients boosted with PDR brachytherapy after external beam therapy were included. The clinical X-ray based plans were projected on MR images. The GTV, HR-CTV and IR-CTV were retrospectively contoured, as well as the bladder, rectum and sigmoid colon. The dose in the critical organs and target coverage was investigated. In a second phase, the plans were manually optimised using the MR information. The objectives were to lower the dose in the critical organs (85Gy(alphabeta3) for bladder, 75Gy(alphabeta3) for rectum and sigmoid colon) and to increase the HR-CTV dose to D9085Gy(alphabeta10). RESULTS: In the X-ray based plans, D(2cc) in bladder and sigmoid colon exceeded the tolerance doses in 10/16 and 7/16 patients, respectively. Coverage of the IR-CTV with the 60Gy(alphabeta10) was acceptable. D90 of the HR-CTV was below 85Gy(alphabeta10) in 13 out of 16 patients. After optimisation, the dose constraints in the OAR were not exceeded anymore in any patient. The average D(2cc) dose reduction was 7+/-6Gy(alphabeta3) in the bladder and 7+/-4Gy(alphabeta3) in the sigmoid colon for those patients in which the dose constraint was initially exceeded. In addition, an average dose increase of 3Gy(alphabeta10) was accomplished in the HR-CTV. CONCLUSIONS: MRI-based dose optimisation can play an important role to reduce the dose delivered to the critical organs and to improve target coverage.