Liver transplantation for hepatocellular carcinoma: A proposal of a prognostic scoring system

Background: The current staging system of hepatocellular carcinoma established by the International Union Against Cancer and the American Joint Committee on Cancer does not necessarily predict the outcomes after hepatic resection or transplantation. Study Design: Various clinical and pathologic risk factors for tumor recurrence were examined on 344 consecutive patients who received hepatic transplantation in the presence of nonfibrolamellar hepatocellular carcinoma to establish a reliable risk scoring system. Results: Multivariate analysis identified three factors as independently significant poor prognosticators: 1) bilobarly distributed tumors, 2) size of the greatest tumor (2 to 5 cm and > 5 cm), and 3) vascular invasion (microscopic and macroscopic). Prognostic risk score (PRS) of each patient was calculated from the relative risks of multivariate analysis. The patients were grouped into five grades of tumor recurrence risk: grade 1: PRS = 0 to 11.0 to 15.0; grade 4: PRS ≥ 15.0; and grade 5: positive node, metastasis, or margin. The proposed PRS system correlated extremely well with tumor-free survival after liver transplantation (100%, 61%, 40%, 5%, and 0%, from grades 1 to 5, respectively, at 5 years), but current pTNM staging did not. Conclusions: 1) Patients with grades 1 and 2 are effectively treated with liver transplantation, 2) patients with grades 4 and 5 are poor candidates for liver transplantation, and 3) patients with grade 1 do not benefit from adjuvant chemotherapy. (C) 2000 by the American College of Surgeons

The Limits of Anthropocene Narratives

The rapidly growing transdisciplinary enthusiasm about developing new kinds of Anthropocene stories is based on the shared assumption that the Anthropocene predicament is best made sense of by narrative means. Against this assumption, this article argues that the challenge we are facing today does not merely lie in telling either scientific, socio-political, or entangled Anthropocene narratives to come to terms with our current condition. Instead, the challenge lies in coming to grips with how the stories we can tell in the Anthropocene relate to the radical novelty of the Anthropocene condition about which no stories can be told. What we need to find are meaningful ways to reconcile an inherited commitment to narrativization and the collapse of storytelling as a vehicle of understanding the Anthropocene as our current predicament

Hepatocellular carcinomas in native livers from patients treated with orthotopic liver transplantation: Biologic and therapeutic implications

The gross and histopathologic characteristics of 212 nonfibrolamellar hepatocellular carcinomas (HCCs) discovered in native livers removed at the time of liver transplantation were correlated with features of invasive growth and tumor-free survival. The results show that most HCCs begin as small well-differentiated tumors that have an increased proliferation rate and induce neovascularization, compared with the surrounding liver. But at this stage, they maintain a near-normal apoptosis/mitosis ratio and uncommonly show vascular invasion. As tumors enlarge, foci of dedifferentiation appear within the neoplastic nodules, which have a higher proliferation rate and show more pleomorphism than surrounding better-differentiated areas. Vascular invasion, which is the strongest predictor of disease recurrence, correlates significantly with tumor number and size, tumor giant cells and necrosis, the predominant and worst degree of differentiation, and the apoptosis/mitosis ratio. In the absence of macroscopic or large vessel invasion, largest tumor size (P <.006), apoptosis/mitosis ratio (P <.03), and number of tumors (P <.04) were independent predictors of tumor-free survival and none of 24 patients with tumors having an apoptosis/mitosis ratio greater than 7.2 had recurrence. A minority of HCCs (< 15%) quickly develop aggressive features (moderate or poor differentiation, low apoptosis/mitosis ratio, and vascular invasion) while still small, similar to flat carcinomas of the bladder and colon. In conclusion, hepatic carcinogenesis in humans is a multistep and multifocal process. As in experimental animal studies, aggressive biologic behavior (vascular invasion and recurrence) correlates significantly with profound alterations in the apoptosis/mitosis ratio and with architectural and cytologic alterations that suggest a progressive accumulation of multiple genetic abnormalities

A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole.

Background: In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges. Objective: Our objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies on poststroke survivors while undergoing rehabilitation at home. Methods: A realist evaluation of a personalized self-management rehabilitation system was undertaken in the homes of stroke survivors (N=5) over a period of approximately two months. Context, mechanisms, and outcomes were developed and explored using theories relating to motor recovery. Participants were encouraged to self-manage their daily walking activity; this was achieved through goal setting and motivational feedback. Gait data were collected and analyzed to produce metrics such as speed, heel strikes, and symmetry. This was achieved using a “smart insole” to facilitate measurement of walking activities in a free-living, nonrestrictive environment. Results: Initial findings indicated that 4 out of 5 participants performed better during the second half of the evaluation. Performance increase was evident through improved heel strikes on participants’ affected limb. Additionally, increase in performance in relation to speed was also evident for all 5 participants. A common strategy emerged across all but one participant as symmetry performance was sacrificed in favor of improved heel strikes. This paper evaluates compliance and intensity of use. Conclusion: Our findings suggested that 4 out of the 5 participants improved their ability to heel strike on their affected limb. All participants showed improvements in their speed of gait measured in steps per minute with an average increase of 9.8% during the rehabilitation program. Performance in relation to symmetry showed an 8.5% average decline across participants, although 1 participant improved by 4%. Context, mechanism, and outcomes indicated that dual motor learning and compensatory strategies were deployed by the participants

Protective effects of curcumin against gamma radiation-induced ileal mucosal damage

The major objective of this study was to test curcumin as a potential radioprotectant for the ileum goblet cells of the rat. Wistar albino rats were used in the study. Group A was the control group and group B was the single dose radiation group. Group C was the two dose radiation group (4 days interval). The rats in groups D and E were given a daily dose of 100 mg/kg of curcumin for 14 and 18 days, respectively. During the curcumin administration period, the rats in group D were exposed to abdominal area gamma (γ)-ray dose of 5 Gy on the 10th day and group E was exposed to same dose radiation on the 10th and 14th day. Irradiation and treatment groups were decapitated on the 4th day after exposure to single or two-dose irradiation and ileum tissues were removed for light and electron microscopic investigation. Single or two dose 5 Gy γ-irradiation caused a marked intestinal mucosal injury in rats on the 4th day. Radiation produced increases in the number of goblet cells. Curcumin appears to have protective effects against radiation-induced damage, suggesting that clinical transfer is feasible

Impact of climate variability on pineapple production in Ghana

Background: Climate variations have a considerable impact on crop production. For pineapple, variable temperatures and rainfall patterns are implicated, yet there is limited knowledge of the conditions and consequences of such variations. Pineapple production plays a major role in Ghana, primarily via socioeconomic impacts and the export economy. The aims of this study were to assess the impact of current climatic trends and variations in four pineapple growing districts in Ghana to provide stakeholders, particularly farmers, with improved knowledge for guidance in adapting to changing climate. Results: Trend analysis, standardized anomaly, correlation analysis as well as focus group discussions were employed to describe climate and yields as well as assess the relationship between climate and pineapple production from 1995 to 2014. The results revealed that, relative to Ga district, temperature (minimum and maximum) in the study areas was increasing over this period at a rate of up to 0.05 °C. Rainfall trends increased in all but Nsawam Adoagyiri district. Rainfall and temperature had different impacts on production, and pineapple was particularly sensitive to minimum temperature as accounting for up to 82% of yield variability. Despite consistent report of rainfall impact on growth stages later affecting quantity and quality of fruits, minimal statistical significance was found between rainfall and yield. Conclusions: With continuously increasing stresses imposed by a changing climate, the sustainability of pineapple production in Ghana is challenged. This subsequently has detrimental impacts on national employment and exports capacity resulting in increased poverty. Further research to explore short- and long-term adaption options in response to challenging conditions in the pineapple industry in Ghana is suggested

Syntaxin 16 is a master recruitment factor for cytokinesis

Recently it was shown that both recycling endosome and endosomal sorting complex required for transport (ESCRT) components are required for cytokinesis, in which they are believed to act in a sequential manner to bring about secondary ingression and abscission, respectively. However, it is not clear how either of these complexes is targeted to the midbody and whether their delivery is coordinated. The trafficking of membrane vesicles between different intracellular organelles involves the formation of soluble N-ethylmalei­mide–sensitive factor attachment protein receptor (SNARE) complexes. Although membrane traffic is known to play an important role in cytokinesis, the contribution and identity of intracellular SNAREs to cytokinesis remain unclear. Here we demonstrate that syntaxin 16 is a key regulator of cytokinesis, as it is required for recruitment of both recycling endosome–associated Exocyst and ESCRT machinery during late telophase, and therefore that these two distinct facets of cytokinesis are inextricably linked

Far-ultraviolet aurora identified at comet 67P/ Churyumov-Gerasimenko

Having a nucleus darker than charcoal, comets are usually detected from Earth through the emissions from their coma. The coma is an envelope of gas that forms through the sublimation of ices from the nucleus as the comet gets closer to the Sun. In the far-ultraviolet portion of the spectrum, observations of comae have revealed the presence of atomic hydrogen and oxygen emissions. When observed over large spatial scales as seen from Earth, such emissions are dominated by resonance fluorescence pumped by solar radiation. Here, we analyse atomic emissions acquired close to the cometary nucleus by the Rosetta spacecraft and reveal their auroral nature. To identify their origin, we undertake a quantitative multi-instrument analysis of these emissions by combining coincident neutral gas, electron and far-ultraviolet observations. We establish that the atomic emissions detected from Rosetta around comet 67P/Churyumov-Gerasimenko at large heliocentric distances result from the dissociative excitation of cometary molecules by accelerated solar-wind electrons (and not by electrons produced from photo-ionization of cometary molecules). Like the discrete aurorae at Earth and Mars, this cometary aurora is driven by the interaction of the solar wind with the local environment. We also highlight how the oxygen line O I at wavelength 1,356 Å could be used as a tracer of solar-wind electron variability

Statistical learning in songbirds:From self-tutoring to song culture

At the onset of vocal development, both songbirds and humans produce variable vocal babbling with broadly distributed acoustic features. Over development, these vocalizations differentiate into the well-defined, categorical signals that characterize adult vocal behaviour. A broadly distributed signal is ideal for vocal exploration, that is, for matching vocal production to the statistics of the sensory input. The developmental transition to categorical signals is a gradual process during which the vocal output becomes differentiated and stable. But does it require categorical input? We trained juvenile zebra finches with playbacks of their own developing song, produced just a few moments earlier, updated continuously over development. Although the vocalizations of these self-tutored (ST) birds were initially broadly distributed, birds quickly developed categorical signals, as fast as birds that were trained with a categorical, adult song template. By contrast, siblings of those birds that received no training (isolates) developed phonological categories much more slowly and never reached the same level of category differentiation as their ST brothers. Therefore, instead of simply mirroring the statistical properties of their sensory input, songbirds actively transform it into distinct categories. We suggest that the early self-generation of phonological categories facilitates the establishment of vocal culture by making the song easier to transmit at the micro level, while promoting stability of shared vocabulary at the group level over generations

Therapy refractory hypertension in adults: aortic coarctation has to be ruled out

In patients with unexplained hypertension, especially in combination with a cardiac murmur, the presence of an aortic coarctation should always be ruled out given the high morbidity and mortality. However, particularly patients with an isolated coarctation often remain asymptomatic for years and the defect may be unnoticed even until the fifth or sixth decade of life. In the present article, we describe two patients with late detected coarctation to illustrate the clinical consequences, diagnostic clues for earlier detection and current therapeutic options to achieve optimal treatment. The key sign of an aortic coarctation, a difference in arterial blood pressure measured between the upper and lower extremities, should always be examined, followed by echocardiography. We conclude that even in case of a late detected severe coarctation, surgical or percutaneous repair has proven to be feasible and substantially effective, improving quality of life and lowering the risk of further hypertension-associated problems