The liver has an excellent regenerative capacity after resection. However, below a critical level of future liver remnant volume (FLRV), partial hepatectomy is accompanied by a significant increase ...of postoperative liver failure. There is accumulating evidence for the contribution of bone marrow stem cells (BMSC) to participate in liver regeneration. Here we report our experience with portal vein embolisation (PVE) and CD133+ BMSC administration to the liver, compared with PVE alone, to augment hepatic regeneration in patients with critically low FLRV or impaired liver function.
Eleven patients underwent PVE of liver segments I and IV-VIII to stimulate hepatic regeneration prior to extended right hepatectomy. In these 11 patients with a FLRV below 25% and/or limited quality of hepatic parenchyma, PVE alone did not promise adequate proliferation. These patients underwent additional BMSC administration to segments II and III. Two radiologists blinded to patients' identity and each other's results measured liver and tumour volumes with helical computed tomography. Absolute, relative and daily FLRV gains were compared with a group of patients that underwent PVE alone.
The increase of the mean absolute FLRV after PVE with BMSC application from 239.3 mL±103.5 (standard deviation) to 417.1 mL±150.4 was significantly higher than that from 286.3 mL±77.1 to 395.9 mL±94.1 after PVE alone (p<0.05). Also the relative gain of FLRV in this group (77.3%±38.2%) was significantly higher than that after PVE alone (39.1%±20.4%) (P=0.039). In addition, the daily hepatic growth rate after PVE and BMSC application (9.5±4.3 mL/d) was significantly superior to that after PVE alone (4.1±1.9 mL/d) (p=0.03). Time to surgery was 27 days±11 in this group and 45 days±21 after PVE alone (p=0.02). Short- and long-term survival were not negatively influenced by the shorter waiting period.
In patients with malignant liver lesions, the combination of PVE with CD133+ BMSC administration substantially increased hepatic regeneration compared with PVE alone. This procedure bears the potential to allow the safe resection of patients with a curative intention that would otherwise carry the risk post-operative liver failure.
The main change in the 5th edition (1997) of the TNM classification for gastric cancer compared to the 4th edition (1987) is the use of the number of involved nodes instead of the location of ...positive nodes. As a result stage grouping is also altered. A second change is the requirement for the examination of at least 15 nodes to justify the N0 status. Patients with fewer examined negative nodes are unclassifiable (Nx). Data were retrieved from a randomized trial database comparing D1 and D2 dissection and 633 curatively operated patients were included. According to the criteria of the 5th edition, 39% of the node-positive patients had another N stage compared to the 4th: 21% had a lower and 18% had a higher stage. 5-year survival rates according to the 4th edition N0, N1 and N2 groups were respectively 72%, 34% and 27%. According to the 5th edition these percentages were for the N0, N1, N2, N3 and Nx groups respectively 75%, 38%, 19%, 8% and 65%. The former 1987 N1 and N2 group were significantly split into three new N 1997 groups (P = 0.006, respectively P< 0.0005). The Cox's regression analysis showed the N 1997 classification to be the most important prognostic variable, with a higher prognostic value than N 1987. In addition, the new TNM stage was also a better prognosticator. The requirement for examining at least 15 nodes, however, could not be fulfilled in 38% of all node-negative patients and we found that a minimum of 5 consecutive negative lymph nodes is a reliable number for staging purposes. We conclude that the 5th edition of the TNM classification provides a better estimation of prognosis, however, examination of at least 15 negative regional lymph nodes is too high a threshold and 5 gives similar prognostic value.
To investigate effects of the timing of initial exposure to maternal depression and marital conflict on kindergarten children's mental health symptoms.
For 406 families (of 570 originally recruited), ...mothers reported on major depression and marital conflict on multiple occasions in the child's infancy and toddler/preschool periods. Mothers and teachers completed the MacArthur Health and Behavior Questionnaire when children were in kindergarten.
Children evidenced co-occurring internalizing and externalizing symptoms, although the mix was more toward internalizing for girls and externalizing for boys. Symptoms were more severe among children exposed to either adversity, and these effects were additive. Boys exposed to maternal depression in infancy had a preponderance of internalizing behaviors, but if subsequently exposed to marital conflict, the mix toward externalizing behaviors increased to match levels of clinic-referred children. For girls, the preponderance of internalizing symptoms increased to match levels of clinic-referred children when initial exposure to marital conflict occurred in the toddler/preschool period.
It is important to consider both adversities across developmental periods, to distinguish the symptom severity from directionality, and to consider child gender. Prevention and intervention efforts that consider these findings are warranted.
Background: Several vaccines have been approved in a lot of countries to combat corona-virus disease and distributed throughout the world. Health professional's knowledge and attitude towards a ...second COVID-19 vaccine dose were poorly implemented and understood in Ethiopia's health facilities. The main purpose of conducting this study was to investigate health professionals' knowledge and attitude towards the second COVID-19 vaccine dose at public hospitals in Ethiopia. Methods: A cross-sectional study design was conducted from January to March, 2021 to assess the knowledge and attitude towards second COVID-19 vaccine dose among health professionals working at public health facilities in Ethiopia. A multivariable logistic regression was performed to identify predictors that correlate with knowledge and attitude towards a second COVID-19 vaccine dose with a P-value<0.05 as a cut-off point for statistical significance at 95% confidence interval (CI). Results: Four hundred and nine study subjects participated, with a response rate of 96.7%. In this study, more than half of the respondents had high knowledge towards second COVID-19 vaccine doses. Similarly, 95.6% of respondents had a favorable attitude towards second COVID-19 vaccine doses. Educational status (AOR=1.82, 95% CI=1.1-2.2), age (AOR=2.01, 95% CI=1.76-3.01), and profession (AOR=2.32, 95% CI=1.42-3.01) were variables associated with knowledge towards second COVID-19 vaccine doses. Educational status (AOR=5.42, 95% CI=4.1-6.7), age (AOR=12.4, 95% CI=10.54- 15.8), professionals (AOR=4.33, 95% CI=2.32-6.87), working experience (AOR=4.33, 95% CI=2.32-6.87), marital status (AOR=2.47, 95% CI=1.33-5.95), risk degree (AOR=2.33, 95% CI=1.31-4.11) and gender (AOR=3.42, 95% CI=2.91-4.98) were determinant factors of attitude towards the second COVID-19 vaccine dose. Conclusion: Addressing problems related with risk degree, educational status, and sociodemographic factors will help to increase the overall knowledge and attitude towards second COVID-19 vaccine doses. Keywords: COVID-19, health professionals, attitude, second vaccine dose, knowledge, Ethiopia
Il existe un pourcentage élevé d’hommes présentant une dysfonction érectile (DE) et pourtant non traités. Cela est impressionnant dans un pays aussi médicalisé que la France et à une époque où les ...possibilités thérapeutiques sont nombreuses. Deux enquêtes furent menées par l’Association pour le développement de l’information et de la recherche sur la sexualité (ADIRS) auprès d’associations de patients porteurs de pathologie chronique : les diabétiques et les insuffisants respiratoires ; plus de 65 % des patients souhaitent une aide à ce niveau ; seuls 13 % estiment que la prise en charge par le corps médical est bonne. Deux autres enquêtes, l’une quantitative et l’autre qualitative, furent menées par les laboratoires Lilly ; elles ont permis de conclure que les raisons du refus d’un traitement se répartissaient dans cinq catégories : le refus de ce qui n’est pas naturel (43 %), la peur des effets secondaires (31 %), la peur d’en devenir dépendant (11,6 %), une certaine méfiance (8,7 %), le manque d’efficacité (8 %). De plus, elles ont permis d’identifier trois profils de patients : les patients résignés (moins d’un sur dix), les patients ignorants (environ trois sur dix), les patients hésitants (environ six sur dix). Un meilleur accès à l’information médicale et une communication plus importante sur le thème de la sexualité et de ses problèmes aident les patients à ne pas accepter avec fatalisme la survenue d’un problème sexuel. Des croyances erronées persistent encore, constituant un frein à la mise en route ou à la poursuite du traitement.
Human CD8+ memory- and effector-type T cells are poorly defined. We show here that, next to a naive compartment, two discrete primed subpopulations can be found within the circulating human CD8+ T ...cell subset. First, CD45RA-CD45R0(+) cells are reminiscent of memory-type T cells in that they express elevated levels of CD95 (Fas) and the integrin family members CD11a, CD18, CD29, CD49d, and CD49e, compared to naive CD8+ T cells, and are able to secrete not only interleukin (IL) 2 but also interferon gamma, tumor necrosis factor alpha, and IL-4. This subset does not exert cytolytic activity without prior in vitro stimulation but does contain virus-specific cytotoxic T lymphocyte (CTL) precursors. A second primed population is characterized by CD45RA expression with concomitant absence of expression of the costimulatory molecules CD27 and CD28. The CD8+CD45RA+CD27- population contains T cells expressing high levels of CD11a, CD11b, CD18, and CD49d, whereas CD62L (L-selectin) is not expressed. These T cells do not secrete IL-2 or -4 but can produce IFN-gamma and TNF-alpha. In accordance with this finding, cells contained within this subpopulation depend for proliferation on exogenous growth factors such as IL-2 and -15. Interestingly, CD8+CD45RA+CD27- cells parallel effector CTLs, as they abundantly express Fas-ligand mRNA, contain perforin and granzyme B, and have high cytolytic activity without in vitro prestimulation. Based on both phenotypic and functional properties, we conclude that memory- and effector-type T cells can be separated as distinct entities within the human CD8+ T cell subset.
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