Objective. The aspartate amino transferase/alanine amino transferase (ASAT/ALAT) ratio is increased in cirrhosis. Some studies indicate that the ratio may provide prognostic information as well. The ...purpose of this study was to further elucidate the role of the ASAT/ALAT ratio as a predictor of survival by assessing it together with classical risk factors such as age, gender and Child-Pugh (CP) class in a mixed cohort of patients with cirrhosis. Material and methods. Eighty-nine patients with alcoholic cirrhosis and 81 patients with non-alcoholic cirrhosis treated at Aker University Hospital between 1999 and 2004 were identified retrospectively. Survival data from these patients per August 2006 were retrieved from the Norwegian Death Registry. Clinical and biochemical data at time of diagnosis were assessed as predictors of survival using the Kaplan-Meier method and Cox regression models. Results. Median ASAT/ALAT ratio was significantly higher in alcoholic cirrhosis (2.42) as compared with non-alcoholic cirrhosis (1.42). In both groups, a ratio above the median was predictive of poor outcome, p=0.024 and p=0.032, respectively. Other significant predictors of death were CP class (p<0.001), clinical decompensation (p<0.001) and age (p=0.001). Cox regression analyses showed that the ASAT/ALAT ratio was a predictor of death independently of CP class, gender and age in non-alcoholic, but not in alcoholic cirrhosis. The estimated increased hazard (risk of dying) in non-alcoholic cirrhosis was 5% (CI: 1-8%) per 0.10 increase in ASAT/ALAT ratio. Conclusions. A high ASAT/ALAT ratio is associated with increased mortality in cirrhosis. In non-alcoholic patients the ratio may provide prognostic information independently of classical risk factors.
The purpose of the present study was to evaluate the use of colour Doppler sonography of ascendent uterine artery perfusion in 91 patients undergoing in-vitro fertilization (IVF)-embryo transfer ...treatment after ovarian stimulation with a depot formulation of goserelin and recombinant human follicle stimulating hormone according to the long protocol. Resistance index (RI), pulsatility index (PI), maximum peak velocity (Vmax) and minimum diastolic velocity (Vmin) were assessed for the left and right ascending uterine artery on day 1 of ovarian stimulation, on day -2 the day of human chorionic gonadotrophin (HCG) application and on day +14 (12 days after embryo transfer). The data of 75 patients who had at least two cleaved preimplantation embryos available for transfer were analysed: 21 patients became pregnant resulting in a pregnancy rate of 28% (21/75). After exclusion of biochemical, ectopic and abortive pregnancies (n = 5), the data from 54 non-pregnant patients and 16 pregnant patients were analysed. No differences with respect to patient age, current cycle number, indication for IVF treatment, endometrial thickness at day -2 and serum oestradiol and serum progesterone concentrations at day -2 were found between the pregnant and non-pregnant groups. Compared to the non-pregnant patients the ascendent uterine artery flow of the pregnant patients showed significantly lower RI (P < 0.009) and PI (P < 0.03) values at the beginning of ovarian stimulation. Vmax and Vmin did not differ between the two groups. On day -2 no differences in RI, PI, Vmax and Vmin were found between pregnant and non-pregnant patients. On day +14 the flow in the ascendent uterine arteries of the pregnant patients showed significantly lower RI (P < 0.008) and PI (P < 0.03) values and significantly higher Vmax (P < 0.003) and Vmin (P < 0.0001) values. RI (P < 0.009) and PI (P < 0.003) values had decreased significantly and Vmax (P < 0.0002) and Vmin (P < 0.0001) had increased significantly on day +14 compared to the previous observation times in both the pregnant and non-pregnant groups. A significant correlation between the increase of serum progesterone concentrations and the decrease of RI (r = 0.68, P < 0.009), and the increase of Vmin (r = 0.67, P < 0.01) was only detected in the pregnant group. In conclusion, the differences found in RI and PI values at the beginning of ovarian stimulation were not clinically helpful as there was a wide overlap between non-pregnant and pregnant patients. The parameters currently used in colour Doppler assessment of uterine artery perfusion are not clinically helpful in discriminating prospectively which patients will and will not become pregnant in an IVF programme. In pregnant patients, increasing progesterone concentration is correlated with a significant decrease in impedance to uterine perfusion in the late luteal phase.
The windings of high-field accelerator magnets are usually made of Rutherford-type superconducting cables. The magnetic field distribution along the axis of such magnets exhibits a periodic ...modulation with a wavelength equal to the twist pitch length of the cable used in the winding. This effect, resulting from quasipersistent currents, was investigated with a Hall probe array inserted inside the aperture of the LHC superconducting dipoles, both in short models and full-scale prototypes. The amplitude and the time dependence of this periodic field oscillation have been studied as a function of the magnet current history. The origin and, the impact on the LHC dipole stability of the nonuniform current redistribution producing such a field modulation are discussed.
The aim of this study was to reduce the rate of graft failure after HLA non-identical stem cell transplantation by using G-CSF mobilized CD34+ peripheral blood progenitor cells (PBPC), either in ...combination with bone marrow or as single grafts. To prevent GVHD, PBPC were highly purified, resulting in a 5 to 6 log T cell depletion. In additon to T cell depletion no further GVHD prophylaxis was used. We transplanted 23 pediatric patients with life-threatening malignant or non-malignant hematological disorders, who had no available matched donor. Engraftment was obtained in 18 of 21 evaluable patients. Five patients developed acute GVHD of grade II and III, which became chronic in four cases and was fatal in four. The use of highly purified PBPC allowed the exact quantification of residual T cells in the grafts and a strict correlation between the residual T cell load and the development of GVHD was observed: patients with GVHD had received numbers of T cells between 8 and 20 x 104/kg, whereas patients without GVHD were grafted with T cell numbers ranging from 0.7 to 6.0 x 104/kg. We therefore clearly demonstrate that a residual T cell content of <5 x 104/kg is safe for prevention of GVHD after HLA non-identical PBPC transplantation in children.
Context: Prader-Willi syndrome (PWS) is a multisymptomatic disease that shares many similarities with the GH deficiency syndrome, including altered body composition with more body fat than lean body ...mass.
Objective: Our objective was to investigate the effect of GH on body composition in adults with PWS.
Design and patients: Forty-six adults with PWS were randomized to GH or placebo treatment for 12 months in a double-blind trial.
Main Outcome Measures: We evaluated change in regional body composition of the abdomen and thigh as measured by computed tomography and change in total body composition as measured by dual-energy x-ray absorptiometry.
Results: Forty patients completed the study. Baseline median IGF-I sd score was −0.4. GH treatment increased IGF-I by 125 μg/liter (1.51 sd score), and based upon computed tomography, body composition improved with a decrease in visceral fat mass of 22.9 ml (P = 0.004), abdominal sc fat mass 70.9 ml (P = 0.003), and thigh fat mass 21.3 ml (P = 0.013), whereas thigh muscle mass increased 6.0 ml (P = 0.005). By dual-energy x-ray absorptiometry, lean body mass improved 2.25 kg (P = 0.005), and total fat mass decreased 4.20 kg (P < 0.001). No major side effects were seen.
Conclusion: Unrelated to the GH-IGF-I levels at baseline, our results showed that long-term treatment with GH effectively improved body composition and represents a safe, potential treatment option, relieving some of the negative consequences of PWS.
Growth hormone therapy in adults with Prader-Willi syndrome improves body composition without any major side effects and represents a logical treatment option.
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