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Chronic kidney disease.

PubMed Kidney Transplant - Fri, 11/24/2017 - 13:45

Chronic kidney disease.

Nat Rev Dis Primers. 2017 Nov 23;3:17088

Authors: Romagnani P, Remuzzi G, Glassock R, Levin A, Jager KJ, Tonelli M, Massy Z, Wanner C, Anders HJ

Abstract
Chronic kidney disease (CKD) is defined by persistent urine abnormalities, structural abnormalities or impaired excretory renal function suggestive of a loss of functional nephrons. The majority of patients with CKD are at risk of accelerated cardiovascular disease and death. For those who progress to end-stage renal disease, the limited accessibility to renal replacement therapy is a problem in many parts of the world. Risk factors for the development and progression of CKD include low nephron number at birth, nephron loss due to increasing age and acute or chronic kidney injuries caused by toxic exposures or diseases (for example, obesity and type 2 diabetes mellitus). The management of patients with CKD is focused on early detection or prevention, treatment of the underlying cause (if possible) to curb progression and attention to secondary processes that contribute to ongoing nephron loss. Blood pressure control, inhibition of the renin-angiotensin system and disease-specific interventions are the cornerstones of therapy. CKD complications such as anaemia, metabolic acidosis and secondary hyperparathyroidism affect cardiovascular health and quality of life, and require diagnosis and treatment.

PMID: 29168475 [PubMed - in process]

Effects of nutraceuticals on sexual satisfaction and lower urinary tract symptoms in a cohort of young-old men.

PubMed Kidney Transplant - Fri, 11/24/2017 - 13:45

Effects of nutraceuticals on sexual satisfaction and lower urinary tract symptoms in a cohort of young-old men.

Phytother Res. 2017 Nov 23;:

Authors: Perri A, Ilacqua A, Valenti M, Aversa A

Abstract
The aim of this study was to evaluate the effects of nutraceuticals containing multiple supplemental facts (Virherbe®/Rekupros®) on sexual satisfaction and lower urinary tract symptoms (LUTS) in young-old men. In an open-label trial, 40 males (mean age 66 ± 13) with sexual disturbances and mild LUTS but without cognitive/motor impairment and clinical hypogonadism were enrolled. Sexual desire (SD; IIEF-SD domain) and satisfaction (Global Assessment Question; GAQ), the capacity to perform daily activities (evaluated by 6-min walking test [6MWT]), and International Prostate Symptoms Scores (IPSS) were evaluated before and after oral administration of 2 capsules/day of each supplement for 8 weeks. The difference from baseline for SD was +2.6 (p < .05) and -4.2 points for IPSS (p < .05), with significance in subscales of urinary streaming/nocturia (p < .01), respectively; 6MWT increased from 507 ± 44 versus 527 ± 58 meters (p < .001). GAQ scale-responses showed overall improvement in overall 75% population, with a significant improvement in QoL (p < .01). These changes returned to baseline at 1-month withdrawal follow-up. No adverse events were reported. These supplemental facts improved sexual desire, satisfaction with sex life, physical performance, and LUTS in young-old men, suggesting that they may be effective in patients in whom standard treatments are not suitable.

PMID: 29168235 [PubMed - as supplied by publisher]

Clinical potential of mesenchymal stem/stromal cell-derived extracellular vesicles.

PubMed Kidney Transplant - Fri, 11/24/2017 - 13:45

Clinical potential of mesenchymal stem/stromal cell-derived extracellular vesicles.

Stem Cell Investig. 2017;4:84

Authors: Giebel B, Kordelas L, Börger V

Abstract
Within the last two decades mesenchymal stem/stromal cells (MSCs) emerged after hematopoietic stem cells as the second most investigated and applied somatic stem cell entity so far. MSCs mediate immunosuppressive as well as pro-regenerative activities. Against the initial assumption, MSCs may not primarily exert their therapeutic functions in a cellular but rather in a paracrine manner. Here, extracellular vesicles (EVs), such as exosomes and microvesicles, have been identified as major mediators of these paracrine effects. Meanwhile, MSC-EVs have been applied to an increasing amount of different animal models and were tested in a patient suffering from steroid-refractory acute graft-versus-host disease (acute GvHD) as well as in a patient cohort with chronic kidney disease. So far, the MSC-EV administration appears to be safe in humans and all tested animal models. Improvements were reported in all settings. Thus, MSC-EVs appear as promising novel therapeutic agents which might help to improve disease associated symptoms in millions of patients. Here, we review some of the milestones in the field, briefly discuss challenges and highlight clinical aspects of acute GvHD and its treatment with MSCs and MSC-EVs.

PMID: 29167805 [PubMed]

Disparities in Health Literacy and Healthcare Utilization among Adolescents and Young Adults with Chronic or End-stage Kidney Disease.

PubMed Kidney Transplant - Fri, 11/24/2017 - 13:45

Disparities in Health Literacy and Healthcare Utilization among Adolescents and Young Adults with Chronic or End-stage Kidney Disease.

J Pediatr Nurs. 2017 Oct 31;38:57-61

Authors: Levine R, Javalkar K, Nazareth M, Faldowski RA, de Ferris MD, Cohen S, Cuttance J, Hooper SR, Rak E

Abstract
PURPOSE: Low health literacy adversely affects health outcomes in adults with chronic kidney disease. The current study examined associations between limited/inadequate health literacy and health services utilization among adolescents and young adults (AYA) with chronic or end-stage kidney disease (CKD or ESKD).
DESIGN AND METHODS: This was a retrospective cohort study that enrolled patients from both the pediatric- and adult-focused nephrology clinics of a major university hospital. Demographic information, patients' health literacy and numeracy skills (Newest Vital Sign), and health services utilization (emergency department visits, preventable hospitalizations, total hospitalizations, and length of stay in the hospital) were evaluated. A negative binomial regression model for counts tested the association between AYA patients' literacy/numeracy skills and health services utilization.
RESULTS: The study enrolled 142 participants, 66 (46.5%) patients from adult nephrology and 76 (53.5%) from pediatric nephrology clinics, with a mean age of 20.8±5.60years (range 12-31). Half of the sample (n=72, 51%) had limited health literacy skills. Health literacy/numeracy level was not significantly associated with total hospitalizations, preventable hospitalizations, emergency department (ED) visits, or length of hospital stay. However, public insurance/self-pay, minority race, and kidney transplant/dialysis diagnoses were associated with more preventable hospitalizations.
CONCLUSIONS: Among AYA with CKD/ESKD, there were no differences between the low and adequate health literacy groups on health care utilization outcomes when modeling clinical outcomes (total hospitalizations, preventable hospitalizations, ED visits, and length of hospital stay) after adjusting for demographics and disease type. This suggests that other factors warrant consideration in healthcare utilization rates.

PMID: 29167082 [PubMed - as supplied by publisher]

Multimodal imaging of retinal pigment epithelial detachments in patients with C3 glomerulopathy: case report and review of the literature.

PubMed Kidney Transplant - Fri, 11/24/2017 - 13:45

Multimodal imaging of retinal pigment epithelial detachments in patients with C3 glomerulopathy: case report and review of the literature.

BMC Ophthalmol. 2017 Nov 22;17(1):207

Authors: Kheir V, Dirani A, Halfon M, Venetz JP, Halabi G, Guex-Crosier Y

Abstract
BACKGROUND: To describe the optical coherence tomography angiograhy (OCTA) of drusenoid pigment epithelial detachments (PEDs) in a woman affected by Complement 3 (C3) glomerulopathy, which represents a spectrum of glomerular diseases characterized on fluorescent microscopy by C3 accumulation with absent, or scanty, immunoglobulin deposits. It is due to acquired or genetically defective alternative pathway control and is generally associated with drusen-like deposits in Bruch's membrane, as well as choriocapillaris. These retinal lesions can be associated with choroidal neovascularization and central serous chorioretinopathy (CSCR). OCTA is useful to detect neovascularization without injecting a contrast product, particularly in these patients who may have renal insufficiency.
CASE PRESENTATION: A 28-year-old woman affected by C3 glomerulpathy was diagnosed with asymptomatic multiple bilateral PEDs during a routine ophthalmologic consultation. To better characterize the lesions, multimodal imaging was performed and included: optic coherence tomography (OCT), en-face OCT, OCTA, fluorescence and indocyanine angiography. The OCTA clearly identified vascular network rarefaction with decreased choriocapillary vascularization. It confirmed that PEDs associated with C3 glomerulonephritis are not vascularized, but rather of serous type.
CONCLUSIONS: Patients affected by C3 glomerulopathy can develop neovascular membranes as retinal complications of pigment epithelial detachments. Optical coherence angiography may be indicated to identify this complication, without injecting any contrast product that could produce further kidney damage.

PMID: 29166869 [PubMed - in process]

Growth rates of pulmonary metastases after liver transplantation for unresectable colorectal liver metastases.

PubMed Lung Transplant - Fri, 11/24/2017 - 13:45

Growth rates of pulmonary metastases after liver transplantation for unresectable colorectal liver metastases.

Br J Surg. 2017 Nov 23;:

Authors: Grut H, Solberg S, Seierstad T, Revheim ME, Egge TS, Larsen SG, Line PD, Dueland S

Abstract
BACKGROUND: The previously reported SECA study demonstrated a dramatic 5-year survival improvement in patients with unresectable colorectal liver metastases (CLM) treated with liver transplantation (LT) compared with chemotherapy. The objective of this study was to assess whether immunosuppressive therapy accelerates the growth of pulmonary metastases in patients transplanted for unresectable CLM.
METHODS: Chest CT scans from 11 patients in the SECA study resected for 18 pulmonary metastases were reviewed retrospectively. Tumour diameter, volume and CT characteristics were registered and tumour volume doubling time was calculated. Findings in the SECA group were compared with those of a control group consisting of 12 patients with non-transplanted rectal cancer resected for 26 pulmonary metastases. Disease-free survival (DFS) and overall survival (OS) after first pulmonary resection were determined.
RESULTS: Median doubling time based on tumour diameter and volume in the SECA and control groups were 125 and 130 days (P = 0·658) and 110 and 129 days (P = 0·632) respectively. The metastases in both groups were distributed to all lung lobes and were mostly peripheral. Median DFS after LT in the SECA group and after primary pelvic surgery in the control group was 17 (range 6-42) and 18 (2-57) months respectively (P = 0·532). In the SECA group, estimated 5-year DFS and OS rates after first pulmonary resection were 39 and 51 per cent respectively.
CONCLUSION: Patients treated by LT for unresectable CLM have a good prognosis following resection of pulmonary metastases. Doubling time did not appear to be worse with the immunosuppression used after LT.

PMID: 29168565 [PubMed - as supplied by publisher]

Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension.

PubMed Lung Transplant - Fri, 11/24/2017 - 13:45

Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension.

Circulation. 2017 Nov 22;:

Authors: da Silva Gonçalves Bos D, Van Der Bruggen CE, Kurakula K, Sun XQ, Casali KR, Casali AG, Rol N, Szulcek R, Dos Remedios C, Guignabert C, Tu L, Dorfmuller P, Humbert M, Wijnker PJM, Kuster DWD, van der Velden J, Goumans MJ, Bogaard HJ, Vonk-Noordegraaf A, de Man FS, Handoko ML

Abstract
Background -Beneficial effects of parasympathetic stimulation have been reported in left heart failure, however, whether it would be beneficial for pulmonary arterial hypertension (PAH) remains to be explored. Here, we investigated the relationship between parasympathetic activity and right ventricular (RV) function in PAH-patients, and the potential therapeutic effects of pyridostigmine (PYR), an oral drug stimulating the parasympathetic activity through acetylcholinesterase (AchE) inhibition, in experimental pulmonary hypertension (PH). Methods -Heart rate recovery (HRR) after maximal cardiopulmonary exercise test was used as a surrogate for parasympathetic activity. RV ejection fraction (RVEF) was assessed in 112 PAH-patients. Expression of nicotinic (α-7nAchR) and muscarinic (m2AchR) receptors, and AchE activity were evaluated in RV (n=11) and lungs (n=7) from PAH-patients undergoing heart/lung transplantation and compared with tissue obtained from controls. In addition, we investigated the effects of PYR (40 mg/kg/day) in experimental PH. PH was induced in male rats by SU5416 (25 mg/kg; s.c.) injection followed by 4 weeks of hypoxia. In a subgroup sympathetic/parasympathetic modulation was assessed by power spectral analysis. At week 6, PH status was confirmed by echocardiography, and rats were randomized to vehicle or treatment (both n=12). At the end-of-study, echocardiography was repeated, with additional RV pressure-volume measurements, along with lung, RV histological and protein analyses. Results -PAH-patients with lower RVEF (<41%) had a significantly reduced HRR in comparison to patients with higher RVEF. In PAH RV-samples, α-7nAchR was increased and AchE activity was reduced versus controls. No difference in m2AchR expression was observed. Chronic PYR-treatment in PH-rats normalized the cardiovascular autonomic function, demonstrated by an increase in parasympathetic activity and baroreflex sensitivity. PYR improved survival, increased RV contractility, and reduced RV stiffness, RV hypertrophy, RV fibrosis, RV inflammation, as well as RV α-7nAchR and m2AchR expression. Furthermore, PYR reduced pulmonary vascular resistance, RV afterload and pulmonary vascular remodeling, which was associated with reduced local and systemic inflammation. Conclusions -RV dysfunction is associated with reduced systemic parasympathetic activity in PAH-patients, with an inadequate adaptive response of the cholinergic system in the right ventricle. Enhancing parasympathetic activity by PYR improved survival, RV function and pulmonary vascular remodeling in experimental-PH.

PMID: 29167228 [PubMed - as supplied by publisher]

Airway transplantation of adipose stem cells protects against bleomycin-induced pulmonary fibrosis.

PubMed Lung Transplant - Fri, 11/24/2017 - 13:45

Airway transplantation of adipose stem cells protects against bleomycin-induced pulmonary fibrosis.

J Investig Med. 2017 Nov 21;:

Authors: Llontop P, Lopez-Fernandez D, Clavo B, Afonso Martín JL, Fiuza-Pérez MD, García Arranz M, Calatayud J, Molins López-Rodó L, Alshehri K, Ayub A, Raad W, Bhora F, Santana-Rodríguez N

Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with poor prognosis. Adipose-derived stem cells (ADSC) have demonstrated regenerative properties in several tissues. The hypothesis of this study was that airway transplantation of ADSC could protect against bleomycin (BLM)-induced pulmonary fibrosis (PF). Fifty-eight lungs from 29 male Sprague-Dawley rats were analyzed. Animals were randomly divided into five groups: a) control (n=3); b) sham (n=6); c) BLM (n=6); d) BLM+ADSC-2d (n=6); and e) BLM+ADSC-14d (n=8). Animals received 500 µL saline (sham), 2.5 UI/kg BLM in 500 µL saline (BLM), and 2×10(6) ADSC in 100 µL saline intratracheally at 2 (BLM+ADSC-2d) and 14 days (BLM+ADSC-14d) after BLM. Animals were sacrificed at 28 days. Blinded Ashcroft score was used to determine pulmonary fibrosis extent on histology. Hsp27, Vegf, Nfkβ, IL-1, IL-6, Col4, and Tgfβ1 mRNA gene expression were determined using real-time quantitative-PCR. Ashcroft index was: control=0; sham=0.37±0.07; BLM=6.55±0.34 vs sham (P=0.006). BLM vs BLM+ADSC-2d=4.63±0.38 (P=0.005) and BLM+ADSC-14d=3.77±0.46 (P=0.005). BLM vs sham significantly increased Hsp27 (P=0.018), Nfkβ (P=0.009), Col4 (P=0.004), Tgfβ1 (P=0.006) and decreased IL-1 (P=0.006). BLM+ADSC-2d vs BLM significantly decreased Hsp27 (P=0.009) and increased Vegf (P=0.006), Nfkβ (P=0.009). BLM+ADSC-14d vs BLM significantly decreased Hsp27 (P=0.028), IL-6 (P=0.013), Col4 (P=0.002), and increased Nfkβ (P=0.040) and Tgfβ1 (P=0.002). Airway transplantation of ADSC significantly decreased the fibrosis rate in both early and established pulmonary fibrosis, modulating the expression of Hsp27, Vegfa, Nfkβ, IL-6, Col4, and Tgfβ1. From a translational perspective, this technique could become a new adjuvant treatment for patients with IPF.

PMID: 29167193 [PubMed - as supplied by publisher]

Growth rates of pulmonary metastases after liver transplantation for unresectable colorectal liver metastases.

PubMed Liver Transplant - Fri, 11/24/2017 - 13:45

Growth rates of pulmonary metastases after liver transplantation for unresectable colorectal liver metastases.

Br J Surg. 2017 Nov 23;:

Authors: Grut H, Solberg S, Seierstad T, Revheim ME, Egge TS, Larsen SG, Line PD, Dueland S

Abstract
BACKGROUND: The previously reported SECA study demonstrated a dramatic 5-year survival improvement in patients with unresectable colorectal liver metastases (CLM) treated with liver transplantation (LT) compared with chemotherapy. The objective of this study was to assess whether immunosuppressive therapy accelerates the growth of pulmonary metastases in patients transplanted for unresectable CLM.
METHODS: Chest CT scans from 11 patients in the SECA study resected for 18 pulmonary metastases were reviewed retrospectively. Tumour diameter, volume and CT characteristics were registered and tumour volume doubling time was calculated. Findings in the SECA group were compared with those of a control group consisting of 12 patients with non-transplanted rectal cancer resected for 26 pulmonary metastases. Disease-free survival (DFS) and overall survival (OS) after first pulmonary resection were determined.
RESULTS: Median doubling time based on tumour diameter and volume in the SECA and control groups were 125 and 130 days (P = 0·658) and 110 and 129 days (P = 0·632) respectively. The metastases in both groups were distributed to all lung lobes and were mostly peripheral. Median DFS after LT in the SECA group and after primary pelvic surgery in the control group was 17 (range 6-42) and 18 (2-57) months respectively (P = 0·532). In the SECA group, estimated 5-year DFS and OS rates after first pulmonary resection were 39 and 51 per cent respectively.
CONCLUSION: Patients treated by LT for unresectable CLM have a good prognosis following resection of pulmonary metastases. Doubling time did not appear to be worse with the immunosuppression used after LT.

PMID: 29168565 [PubMed - as supplied by publisher]

PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art.

PubMed Liver Transplant - Fri, 11/24/2017 - 13:45

PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art.

Minim Invasive Ther Allied Technol. 2017 Nov 23;:1-6

Authors: Cazzato RL, Garnon J, Shaygi B, Koch G, Tsoumakidou G, Caudrelier J, Addeo P, Bachellier P, Namer IJ, Gangi A

Abstract
Positron emission tomography/computed tomography (PET/CT) represents an emerging imaging guidance modality that has been applied to successfully guide percutaneous procedures such as biopsies and tumour ablations. The aim of the present narrative review is to report the indications, advantages and disadvantages of PET/CT-guided procedures in the field of interventional oncology and to briefly describe the experience gained with this new emerging technique while performing biopsies and tumor ablations.

PMID: 29168421 [PubMed - as supplied by publisher]

Potential Effect of Recombinant Thrombomodulin on Ischemia-Reperfusion Liver Injury in Rats.

PubMed Liver Transplant - Fri, 11/24/2017 - 13:45

Potential Effect of Recombinant Thrombomodulin on Ischemia-Reperfusion Liver Injury in Rats.

Hepatol Res. 2017 Nov 23;:

Authors: Kimura K, Yoshizumi T, Inokuchi S, Itoh S, Motomura T, Mano Y, Toshima T, Harada N, Harimoto N, Ikegami T, Soejima Y, Maehara Y

Abstract
BACKGROUND: Liver ischemia-reperfusion (I/R) injury is a severe complication of liver surgery. However, the responsible molecular mechanism remains unclear. High-mobility group box 1 (HMGB1) is released from the nuclei of cells and behaves as a damage-associated molecular pattern. The aim of this study is to reveal the roles of HMGB1 and the effects of recombinant thrombomodulin in I/R liver injury.
METHODS: Rats underwent partial hepatic ischemia followed by reperfusion, and changes in HMGB1 were assessed. Recombinant thrombomodulin (rTM) was used as an inhibitor of HMGB1.
RESULTS: In rats with I/R injury, the HMGB1 level significantly decreased in the liver tissue and significantly increased in the serum after surgery (P < 0.001 for both). No difference in the HMGB1 level in the hepatocytes was observed between the rTM (-) group and rTM (+) group after surgery. Conversely, the serum HMGB1 level was significantly lower in the rTM (+) group than rTM (-) group after surgery (P < 0.001). The levels of tumor necrosis factor-alpha and interleukin-6 in the liver tissue 24 hours after surgery were significantly lower in the rTM (+) group than rTM (-) group (P < 0.001). The plasma alanine aminotransferase level at 24 hours after surgery of the rTM (+) group was significantly decreased after surgery compared with that of the rTM (-) group (P < 0.001). The necrotic area of the liver tissue 24 hours after surgery was significantly smaller in the rTM (+) group than rTM (-) group (P < 0.001).
CONCLUSIONS: rTM can serve as a treatment for I/R liver injury by inhibiting HMGB1.

PMID: 29168258 [PubMed - as supplied by publisher]

In vivo therapeutic potential of Inula racemosa in hepatic ischemia-reperfusion injury following orthotopic liver transplantation in male albino rats.

PubMed Liver Transplant - Fri, 11/24/2017 - 13:45

In vivo therapeutic potential of Inula racemosa in hepatic ischemia-reperfusion injury following orthotopic liver transplantation in male albino rats.

AMB Express. 2017 Nov 22;7(1):211

Authors: Wang Z, Geng L, Chen Z, Lin B, Zhang M, Zheng S

Abstract
Hepatic ischemia-reperfusion (I/R) injury mainly occurs following hepatic resection and liver transplantation and cause severe liver damage, organ injuries, and dysfunction. Pro-inflammatory cytokines that promote injury are released when kupffer cell activates after getting induced by I/R. Repercussions of oxidative stress and cardiac function against isoproterenol based myocardial infarction are caused by flavonol glycosides which are found in high concentrations in Inula racemosa (Ir).The root was deemed to have analgesic and anti-inflammatory effects, and no report has been published about the liver-protective activity against hepatic I/R. Therefore, the present study was aimed to understand the therapeutic impact of Ir in hepatic I/R injury. Male albino, Wistar strain rats were used and were grouped into four total phenolic content, free radical scavenging activity and serum enzymes were determined. Histopathological and immunohistochemical analysis were also carried out. Inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin (IL-6) and protein expression of p53, bax, and bcl-2 were determined. The administration of extracts of Ir significantly increased total phenolic and free radical scavenging activity. Altered cellular morphology, cytokines and aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were returned to near normal level. IL-6 and TNF-α levels were reduced more than 25% following treatment. Also, the protein expression of p53, bax, and bcl-2 were also returned to near normal level. Taking all these data together, it is suggested that the extracts of Ir may be a potential therapeutic agent for providing several beneficial effects in hepatic I/R injury.

PMID: 29168056 [PubMed]

Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer.

PubMed Liver Transplant - Fri, 11/24/2017 - 13:45

Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer.

Transl Gastroenterol Hepatol. 2017;2:83

Authors: Lucatelli P, Argirò R, Bascetta S, Saba L, Catalano C, Bezzi M, Levi Sandri GB

Abstract
Cone-beam CT (CBCT) application to the field of trans-arterial chemoembolization has been recently the focus of several researches. This imaging modality is performed with a rotation of the C-arm around the patient, without needs of patient repositioning. Datasets are immediately processed, obtaining volumetric CT-like images with the possibility of post-processing and reconstruction of images. Dual phase CBCT recently introduced in clinical practice consists in a first arterial acquisition followed by a delayed acquisition corresponding to a venous phase. The introduction of this feature has overcome the limit of single-phase acquisitions, allowing lesions characterization. Moreover these recent advantages have several intra-procedural implications. Detailed technical and acquisition parameters will be widely exposed in this review with particular attention to: catheter positioning, acquisition delay, injection parameters, patient positioning and contrast dilution. Comparison with standard of practice second line imaging [multidetector computer tomography (MDCT) and MDCT/arteriography] demonstrate the capability of detecting occult nodules providing some clinical implications thus potentially identifying a sub set of patients with aggressive disease behaviour. Other intra-procedural advantages of dual phase CBCT usage consist in a better tumor feeder visualization, reduction of proper DSA and fluoroscopic time, suggestion the presence of an extrahepatic parasitic feeder thus resulting in a more accurate treatment. Finally, the volumetrical intraprocedural evaluation of accumulation of embolic agent has proved to be correlate with treatment response if compared with MRI.

PMID: 29167830 [PubMed]

Hepatocellualr cancer and liver transplantation: from the tower of babel towards a uniform language.

PubMed Liver Transplant - Fri, 11/24/2017 - 13:45

Hepatocellualr cancer and liver transplantation: from the tower of babel towards a uniform language.

Transl Gastroenterol Hepatol. 2017;2:82

Authors: Lerut PJ

PMID: 29167829 [PubMed]

Hepatocellular cancer and recurrence after liver transplantation: what about the impact of immunosuppression?

PubMed Liver Transplant - Fri, 11/24/2017 - 13:45

Hepatocellular cancer and recurrence after liver transplantation: what about the impact of immunosuppression?

Transl Gastroenterol Hepatol. 2017;2:80

Authors: Lerut J, Iesari S, Foguenne M, Lai Q

Abstract
Liver transplantation (LT) has originally been designed to treat hepatobiliary malignancies. The initial results of LT for hepatocellular cancer (HCC) were, however, dismal this mainly due to the poor patient selection procedure. Better surgical and perioperative care and, especially, the refinement of selection criteria led to a major improvement of results, making HCC nowadays (again!) one of the leading indications for LT. This evolution is clearly shown by the innumerable reports aiming to further extend inclusion criteria for LT in HCC patients. Nonetheless, the vast majority of papers only deals with morphologic (tumour diameter and number) and (only recently) biologic (tumour markers and response to locoregional treatment) parameters to do so. Curiously enough, the role of both the immune competent state of the recipient as well as the impact of both immunosuppression (IS) type and load has been very poorly addressed in this context, even if it has been shown for a long time, based on both basic and clinical research, that they all play a key role in the outcome of any oncologic treatment and in the development of de novo as well as recurrent tumours. This chapter aims to give, after a short introductive note about the currently used inclusion criteria of HCC patients for LT and about the role of IS in carcinogenesis, a comprehensive overview of the actual literature related to the impact of different immunosuppressive drugs and schemes on outcome of LT in HCC recipients. Unfortunately, up to now solid conclusions cannot be drawn due to the lack of high-level evidence studies caused by the heterogeneity of the studied patient cohorts and the lack of prospectively designed and randomized studies. Based on long-term personal experience with immunosuppressive handling in LT some proposals for further clinical research and practice are put forward. The strategy of curtailing and minimising IS should be explored in the growing field of transplant oncology taking thereby into account the immunological privilege of the liver allograft. These strategies will become more and more compelling when further extending the indications in which adjuvant chemotherapy will probably become an inherent part of the therapeutic scheme of HCC liver recipients.

PMID: 29167827 [PubMed]

First Polish analysis of the treatment of advanced heart failure in children with the use of BerlinHeart EXCOR mechanical circulatory support.

PubMed Heart Transplant - Fri, 11/24/2017 - 13:45

First Polish analysis of the treatment of advanced heart failure in children with the use of BerlinHeart EXCOR mechanical circulatory support.

Kardiol Pol. 2017 Nov 23;:

Authors: Pawlak S, Przybylski R, Skalski J, Śliwka J, Kansy A, Grzybowski A, Wierzyk A, Białkowski J, Maruszewski B, Zembala M

Abstract
BACKGROUND: The treatment of advanced heart failure in children and infants poses a serious management problem. Heart failure in that patient group is usually of congenital etiology. The treatment schedules for pediatric patients are in most cases adapted from the guidelines for treatment of adults. Up to 2009, the treatment of that extremely difficult group of patients was limited to pharmacological therapy and occasional heart transplantations. Constantly increasing problems with recruiting donors, especially for the pediatric group, contribute to the fact that mechanical support with the use of ventricular assist devices is for many children the only chance to survive the period of waiting for a heart donor.
AIM: The aim of the study was to analyze the results of treatment of circulatory support in Poland and assessment of the advisability of this method for treatment of children with severe heart failure.
METHODS: This method of treatment of pediatric patients is currently used in three Polish centers. From December 28th, 2009 to August 1st, 2015, 27 implantations of Berlin Heart EXCOR mechanical circulatory support system were performed in children aged from 1 month to 16 years (10 patients below 1 year of age; 37%). Left ventricular assist devices were implanted to 21 patients, whereas the remaining children received biventricular support. The most common reason for using this method was heart failure developed in the course of cardiomyopathy. In one case, heart failure after Fontan operation was the indication.
RESULTS: The duration of the circulatory support period ranged from 6 to 1215 days. It was followed by successful heart transplantations in 10 patients (37%), in 5 (18.1%) it resulted in regeneration of the heart, enabling explantation of the device, whereas three children are still waiting for transplantations. Nine children (33%) died during the therapy because of thromboembolic complications.
CONCLUSIONS: As it follows from our data, circulatory support utilizing the Berlin Heart system is an effective and promising method used as a bridge to cardiac transplantation, or regeneration of the myocardium in pediatric patients. In the group of the youngest and the most difficult patients, the method requires close cooperation of the medical and nursing personnel.

PMID: 29168549 [PubMed - as supplied by publisher]

The prognostic significance of frailty compared to peak oxygen consumption and B-type natriuretic peptide in patients with advanced heart failure.

PubMed Heart Transplant - Fri, 11/24/2017 - 13:45

The prognostic significance of frailty compared to peak oxygen consumption and B-type natriuretic peptide in patients with advanced heart failure.

Clin Transplant. 2017 Nov 23;:

Authors: Moayedi Y, Duero Posada JG, Foroutan F, Goldraich LA, Alba AC, MacIver J, Ross HJ

Abstract
Frailty assessment has become an integral part of the evaluation of potential candidates for heart transplantation and ventricular assist device (HTx/VAD). The impact of frailty, as a heart failure risk factor or to identify those who will derive the greatest benefit with HTx/VAD remains unclear. The aim of this study was to evaluate the independent prognostic relevance of frailty assessment from peak oxygen consumption (peak VO2 ) or B-type natriuretic peptide (BNP) on mortality in patients referred for advanced heart failure therapies. Frailty was measured using a modified Fried frailty criteria. In 201 consecutive patients, during a median follow up of 17.5 months (IQR 11-29.2), there were 25 (12.4%) deaths. One year survival was 100%, 94%, and 78% in non-frail, pre-frail and frail patients, respectively (log rank p = 0.0001). Frailty was associated with a two-fold increase risk of death (HR 2.01, p<0.0001, 95% CI 1.42 -2.84). When adjusted for BNP or peak VO2 , frailty was not associated with a significant risk of all-cause death. However, when peak VO2 is stratified into two categories (≥12 ml/kg/min vs. < 12 ml/kg/min), frailty was associated with increased mortality in patients with a lower peak VO2 (HR 1.72, p=0.006). This article is protected by copyright. All rights reserved.

PMID: 29168222 [PubMed - as supplied by publisher]

Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension.

PubMed Heart Transplant - Fri, 11/24/2017 - 13:45

Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension.

Circulation. 2017 Nov 22;:

Authors: da Silva Gonçalves Bos D, Van Der Bruggen CE, Kurakula K, Sun XQ, Casali KR, Casali AG, Rol N, Szulcek R, Dos Remedios C, Guignabert C, Tu L, Dorfmuller P, Humbert M, Wijnker PJM, Kuster DWD, van der Velden J, Goumans MJ, Bogaard HJ, Vonk-Noordegraaf A, de Man FS, Handoko ML

Abstract
Background -Beneficial effects of parasympathetic stimulation have been reported in left heart failure, however, whether it would be beneficial for pulmonary arterial hypertension (PAH) remains to be explored. Here, we investigated the relationship between parasympathetic activity and right ventricular (RV) function in PAH-patients, and the potential therapeutic effects of pyridostigmine (PYR), an oral drug stimulating the parasympathetic activity through acetylcholinesterase (AchE) inhibition, in experimental pulmonary hypertension (PH). Methods -Heart rate recovery (HRR) after maximal cardiopulmonary exercise test was used as a surrogate for parasympathetic activity. RV ejection fraction (RVEF) was assessed in 112 PAH-patients. Expression of nicotinic (α-7nAchR) and muscarinic (m2AchR) receptors, and AchE activity were evaluated in RV (n=11) and lungs (n=7) from PAH-patients undergoing heart/lung transplantation and compared with tissue obtained from controls. In addition, we investigated the effects of PYR (40 mg/kg/day) in experimental PH. PH was induced in male rats by SU5416 (25 mg/kg; s.c.) injection followed by 4 weeks of hypoxia. In a subgroup sympathetic/parasympathetic modulation was assessed by power spectral analysis. At week 6, PH status was confirmed by echocardiography, and rats were randomized to vehicle or treatment (both n=12). At the end-of-study, echocardiography was repeated, with additional RV pressure-volume measurements, along with lung, RV histological and protein analyses. Results -PAH-patients with lower RVEF (<41%) had a significantly reduced HRR in comparison to patients with higher RVEF. In PAH RV-samples, α-7nAchR was increased and AchE activity was reduced versus controls. No difference in m2AchR expression was observed. Chronic PYR-treatment in PH-rats normalized the cardiovascular autonomic function, demonstrated by an increase in parasympathetic activity and baroreflex sensitivity. PYR improved survival, increased RV contractility, and reduced RV stiffness, RV hypertrophy, RV fibrosis, RV inflammation, as well as RV α-7nAchR and m2AchR expression. Furthermore, PYR reduced pulmonary vascular resistance, RV afterload and pulmonary vascular remodeling, which was associated with reduced local and systemic inflammation. Conclusions -RV dysfunction is associated with reduced systemic parasympathetic activity in PAH-patients, with an inadequate adaptive response of the cholinergic system in the right ventricle. Enhancing parasympathetic activity by PYR improved survival, RV function and pulmonary vascular remodeling in experimental-PH.

PMID: 29167228 [PubMed - as supplied by publisher]

Reply to Drs. Pageaux et al.: Cognitive demand of eccentric versus concentric cycling.

PubMed Heart Transplant - Fri, 11/24/2017 - 13:45

Reply to Drs. Pageaux et al.: Cognitive demand of eccentric versus concentric cycling.

J Appl Physiol (1985). 2017 Nov 01;123(5):1418

Authors: Nosaka K, Haynes A, Chasland LC, Maiorana A, Naylor LH, Green DJ

PMID: 29167208 [PubMed - in process]

Improvement in Pancreas Transplant Evaluation and Surgical Volume Using a Multidisciplinary Approach.

PubMed Kidney Transplant - Thu, 11/23/2017 - 13:45

Improvement in Pancreas Transplant Evaluation and Surgical Volume Using a Multidisciplinary Approach.

Am J Transplant. 2017 Nov 22;:

Authors: Scalea JR, Sultan S, Lamos E, Bartlett ST, Barth RN

Abstract
Pancreas numbers are down: Pancreas transplantation is the only long-term treatment for diabetes which restores glucose homeostasis, without the risks of hypoglycemia.(1-3) Further, receiving a simultaneous pancreas kidney (SPK) transplant improves life expectancy over kidney transplantation alone.(4,5) Despite this, the total number of pancreas transplants in the United States has decreased since 2006. Experts in the field recently reported that, while this drop in volume is multifactorial, the lack of a steady referral source is partly to blame.(1) This article is protected by copyright. All rights reserved.

PMID: 29166550 [PubMed - as supplied by publisher]

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