30 research outputs found
Psychological response and quality of life after transplantation: a comparison between heart, lung, liver and kidney recipients
PRINCIPLES: Various non-specific questionnaires were used to measure quality of life and psychological wellbeing of patients after organ transplantation. At present cross-organ studies dealing specifically with the psychological response to a transplanted organ are non-existent in German-speaking countries. METHODS: The Transplant Effects Questionnaire TxEQ-D and the SF-36 Quality of Life Questionnaire were used to examine the psychological response and quality of life of 370 patients after heart, lung, liver or kidney transplantation. The organ groups were compared with regard to psychosocial parameters. RESULTS: 72% of patients develop a feeling of responsibility for the received organ and its function. This feeling is even stronger towards the patient's key relationships i.e. family, friends, the treatment team and the donor. 11.6% worry about the transplanted organ. Heart and lung patients report significantly fewer concerns than liver and kidney patients. Overall, only a minority of patients report feelings of guilt towards the donor (2.7%), problems in disclosing their transplant to others (2.4%), or difficulties in complying with medical orders (3.5%). Lung transplant patients show significantly better adherence. CONCLUSIONS: A feeling of responsibility towards those one is close to and towards the donor is a common psychological phenomenon after transplantation of an organ. Conscious feelings of guilt and shame are harboured by only a minority of patients. The fact that heart and lung patients worry less about their transplant might have primarily to do with the greater medical and psychosocial support in this group
F-18-Fluorodeoxyglucose (FDG) Positron-Emission Tomography of Echinococcus multilocularis Liver Lesions: Prospective Evaluation of its Value for Diagnosis and Follow-up during Benzimidazole Therapy
Background:: Long-term benzimidazole therapy benefits patients with non-resectable alveolar echinococcosis (AE). Methods to assess early therapeutic efficacy are lacking. Recently, AE liver lesions were reported to exhibit increased F-18-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET). To assess the value of FDG-PET for diagnosis and follow-up of AE patients. Patients/Methods:: Twenty-six consecutive patients with newly diagnosed AE were enrolled. Baseline evaluation included CT and FDG-PET. Thirteen patients (11 women; median age 50 years, range 40-76) were resected, the remaining 13 (8 women; median age 60 years, range 39-72) had non-resectable disease, were started on benzimidazoles, and CT and FDG-PET were repeated at 6, 12 and 24 months of therapy. Twelve consecutive patients with newly diagnosed cystic echinococcosis (CE) of the liver were also subjected to baseline FDG-PET. Results:: In 21/26 AE patients, baseline PET scans showed multifocally increased FDG uptake in the hepatic lesions' periphery, while liver lesions were FDG negative in 11/12 CE patients. Thus, sensitivity and specificity of FDG-PET for AE vs. CE were 81% and 92%, respectively. In 5 of 10 non-resectable patients with increased baseline FDG uptake, the intensity of uptake decreased (or disappeared) during benzimidazole therapy, in 3 by â„2 grades within the initial 6 months. Conclusions:: FDG-PET is a sensitive and specific adjunct in the diagnosis of suspected AE and can help in differentiating AE from CE. The rapid improvement of positive PET scans with benzimidazole therapy in some patients indicates that absent FDG uptake does not necessarily reflect parasite viabilit
The ESPRI project: astrometric exoplanet search with PRIMA I. Instrument description and performance of first light observations
The ESPRI project relies on the astrometric capabilities offered by the PRIMA
facility of the Very Large Telescope Interferometer for the discovery and study
of planetary systems. Our survey consists of obtaining high-precision
astrometry for a large sample of stars over several years and to detect their
barycentric motions due to orbiting planets. We present the operation
principle, the instrument's implementation, and the results of a first series
of test observations. A comprehensive overview of the instrument infrastructure
is given and the observation strategy for dual-field relative astrometry is
presented. The differential delay lines, a key component of the PRIMA facility
which was delivered by the ESPRI consortium, are described and their
performance within the facility is discussed. Observations of bright visual
binaries are used to test the observation procedures and to establish the
instrument's astrometric precision and accuracy. The data reduction strategy
for astrometry and the necessary corrections to the raw data are presented.
Adaptive optics observations with NACO are used as an independent verification
of PRIMA astrometric observations. The PRIMA facility was used to carry out
tests of astrometric observations. The astrometric performance in terms of
precision is limited by the atmospheric turbulence at a level close to the
theoretical expectations and a precision of 30 micro-arcseconds was achieved.
In contrast, the astrometric accuracy is insufficient for the goals of the
ESPRI project and is currently limited by systematic errors that originate in
the part of the interferometer beamtrain which is not monitored by the internal
metrology system. Our observations led to the definition of corrective actions
required to make the facility ready for carrying out the ESPRI search for
extrasolar planets.Comment: 32 pages, 39 figures, Accepted for publication in Astronomy and
Astrophysic
Genome-wide Association Study and Meta-analysis on Alcohol-Associated Liver Cirrhosis Identifies Genetic Risk Factors
International audienceBackground and aims - Only a minority of heavy drinkers progress to alcohol-associated cirrhosis (ALC). The aim of this study was to identify common genetic variants that underlie risk for ALC. Approach and results - We analyzed data from 1,128 subjects of European ancestry with ALC and 614 heavy-drinking subjects without known liver disease from Australia, the United States, the United Kingdom, and three countries in Europe. A genome-wide association study (GWAS) was performed, adjusting for principal components and clinical covariates (alcohol use, age, sex, body mass index, and diabetes). We validated our GWAS findings using UK Biobank. We then performed a meta-analysis combining data from our study, the UK Biobank, and a previously published GWAS. Our GWAS found genome-wide significant risk association of rs738409 in patatin-like phospholipase domain containing 3 (PNPLA3) (odds ratio [OR]Â =Â 2.19 [G allele], PÂ =Â 4.93Â ĂÂ 10 ) and rs4607179 near HSD17B13 (ORÂ =Â 0.57 [C allele], PÂ =Â 1.09Â ĂÂ 10 ) with ALC. Conditional analysis accounting for the PNPLA3 and HSD17B13 loci identified a protective association at rs374702773 in Fas-associated factor family member 2 (FAF2) (ORÂ =Â 0.61 [del(T) allele], PÂ =Â 2.56Â ĂÂ 10 ) for ALC. This association was replicated in the UK Biobank using conditional analysis (ORÂ =Â 0.79, PÂ =Â 0.001). Meta-analysis (without conditioning) confirmed genome-wide significance for the identified FAF2 locus as well as PNPLA3 and HSD17B13. Two other previously known loci (SERPINA1 and SUGP1/TM6SF2) were also genome-wide significant in the meta-analysis. GeneOntology pathway analysis identified lipid droplets as the target for several identified genes. In conclusion, our GWAS identified a locus at FAF2 associated with reduced risk of ALC among heavy drinkers. Like the PNPLA3 and HSD17B13 gene products, the FAF2 product has been localized to fat droplets in hepatocytes. Conclusions - Our genetic findings implicate lipid droplets in the biological pathway(s) underlying ALC
Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial
BACKGROUND
Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH.
METHODS
In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH, non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2-F3, or F1 with at least one accompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpoints for the month-18 interim analysis were fibrosis improvement (â„1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2-F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6.
FINDINGS
Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1-F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2-F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1-F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group).
INTERPRETATION
Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes.
FUNDING
Intercept Pharmaceuticals
Improving tokamak vertical position control in the presence of power supply voltage saturation
Fragebogen zur psychischen Verarbeitung einer Organtransplantation: Deutsche Validierung des Transplant Effects Questionnaire (TxEQ)
Fragestellung: In der vorliegenden Arbeit wird untersucht, (a) ob die deutsche Version des Transplant Effects Questionnaire (TxEQ-D), welcher die psychische Verarbeitung einer Organtransplantation erfasst und Hinweise zur Indikation psychosozialer Interventionen liefert, die gleiche faktorielle Struktur wie die englische Originalversion aufweist und (b) ob die Skalenkennwerte sowie die Korrelationen mit den Skalen des SF-36 (Fragebogen zum physischen und psychischen Gesundheitszustand) vergleichbar sind.
Methode: Der ins Deutsche ĂŒbersetzte Fragebogen TxEQ wurde von einer Stichprobe von 370 herz-, lungen-, leber- und nierentransplantierten Patienten ausgefĂŒllt und einer Faktoren- sowie Itemanalyse unterzogen. Zudem wurde zur PrĂŒfung der ValiditĂ€t der LebensqualitĂ€ts-Fragebogen SF-36 eingesetzt.
Ergebnisse: Der TxEQ-D hat die gleiche faktorielle Struktur wie die englische Originalversion und vergleichbare psychometrische Eigenschaften. Die höchsten Korrelationen mit den 10 Skalen des SF-36 weist der Faktor »Sorge um das Transplantat« auf, die niedrigsten der Faktor »Adherence«.
Schlussfolgerungen: Der TxEQ-D ist ein fĂŒr die psychosomatische Forschung und psychotherapeutische Praxis geeignetes Screeningintrument zur Erkennung von Patienten mit einer problematischen psychischen Verarbeitung einer Organtransplantation, die zusĂ€tzlich zur somatischen Nachbehandlung professionelle psychosoziale UnterstĂŒtzung erhalten sollten. = Objectives: The present study investigates a) whether the German version of the Transplant Effects Questionnaire (TxEQ-D), which measures the emotional response to an organ transplantation, has the same factorial structure as the English original version and b) whether the psychometric properties as well as the correlations with the scales of the SF-36 are comparable.
Methods: The questionnaire TxEQ was translated into German and filled out by 370 heart, lung, liver and kidney transplant patients. Subsequently, factor and item analyses were conducted. The SF-36 was used to test validity.
Results: The TxEQ-D has the same factorial structure as the English version as well as comparable psychometric properties. The TxEQ-D factor âworry about transplantâ shows the highest correlations with the 10 scales of the SF-36, the lowest correlations with the 10 scales of the SF-36 scales are found for the factor âadherenceâ.
Conclusions: The TxEQ-D is a useful screening instrument in psychosomatic research and in the psychotherapy practice to detect patients with problematic emotional responses to an organ transplantation