Hasil untuk "Medicine (General)"

Lulu Jia, Qing Yang, Hanchen Jiang et al.

Abstract Background The P53-mutated Hepatocellular Carcinoma (HCC) is an aggressive variant associated with vascular endothelial growth factor (VEGF) overexpression and increased microvascular density. This study aimed to develop an MRI-based deep learning model for predicting P53-mutated HCC. Methods A total of 312 HCC patients who underwent gadolinium-enhanced MRI and were pathologically confirmed between January 2018 and December 2023 were retrospectively enrolled. Participants were randomly divided into training and test dataset at an 8:2 ratio. We developed an EfficientNetV2-based deep learning model, constructing arterial phase (AP) model, portal venous phase (VP), T2-weighted imaging (T2WI), hepatobiliary phase (HBP) single-sequence model, and combined models to predict P53 mutation status. Model performance was evaluated using the area under the curve (AUC), accuracy, sensitivity, specificity, precision, and F1 score as metrics. Differences in AUC values were compared using Delong’s test. Results A total of 312 pathologically confirmed HCC patients (age: 56 ± 9 years; male = 240) were included, with a training dataset (n = 249) and test dataset (n = 63).Among single-sequence models, the HBP model demonstrated superior diagnostic performance (AUC = 0.715) compared to T2WI, AP, and VP models. The multiphase combined model (T2WI + AP + VP) significantly outperformed single-sequence models, achieving AUCs of 0.982 (95% CI: 0.959–1.000) in the training dataset and 0.914 (95% CI: 0.819–1.000) in the test dataset. However, incorporating the HBP sequence into the combined model (T2WI + AP + VP + HBP) did not further improve diagnostic performance (P > 0.05). Advances in knowledge The combined model incorporating AP, VP, T2WI, and HBP sequences demonstrated numerically highest performance in predicting P53-mutated HCC.

Hubert Daisley, Oneka Acco, Martina Daisley et al.

The vasa vasorum of the large pulmonary vessels is involved in the pathology of COVID-19. This specialized microvasculature plays a major role in the biology and pathology of the pulmonary vessel walls. We have evidence that thrombosis of the vasa vasorum of the large and medium-sized pulmonary vessels during severe COVID-19 causes ischemia and subsequent death of the pulmonary vasculature endothelium. Subsequent release of thrombi from the vasa interna into the pulmonary circulation and pulmonary embolism generated at the ischemic pulmonary vascular endothelium site, are the central pathophysiological mechanisms in COVID-19 responsible for pulmonary thromboembolism. The thrombosis of the vasa vasorum of the large and medium-sized pulmonary vessels is an internal event leading to pulmonary thromboembolism in COVID-19.

Osamu Yamada, Shih-Wei Chiu, Toru Nakazawa et al.

Abstract Background In recent years, alternative monitoring approaches, such as risk-based and remote monitoring techniques, have been recommended instead of traditional on-site monitoring to achieve more efficient monitoring. Remote risk-based monitoring (R2BM) is a monitoring technique that combines risk-based and remote monitoring and focuses on the detection of critical data and process errors. Direct data capture (DDC), which directly collects electronic source data, can facilitate R2BM by minimizing the extent of source documents that must be reviewed and reducing the additional workload on R2BM. In this study, we evaluated the effectiveness of R2BM and the synergistic effect of combining R2BM with DDC. Methods R2BM was prospectively conducted with eight participants in a randomized clinical trial using a remote monitoring system that uploaded photographs of source documents to a cloud location. Critical data and processes were verified by R2BM, and later, all were confirmed by on-site monitoring to evaluate the ability of R2BM to detect critical data and process errors and the workload of uploading photographs for clinical trial staff. In addition, the reduction of the number of uploaded photographs was evaluated by assuming that the DDC was introduced for data collection. Results Of the 4645 data points, 20.9% (n = 973, 95% confidence interval = 19.8–22.2) were identified as critical. All critical data errors corresponding to 5.4% (n = 53/973, 95% confidence interval = 4.1–7.1) of the critical data and critical process errors were detectable by R2BM. The mean number of uploaded photographs and the mean time to upload them per visit per participant were 34.4 ± 11.9 and 26.5 ± 11.8 min (mean ± standard deviation), respectively. When assuming that DDC was introduced for data collection, 45.0% (95% confidence interval = 42.2–47.9) of uploaded photographs for R2BM were reduced. Conclusions R2BM can detect 100% of the critical data and process errors without on-site monitoring. Combining R2BM with DDC reduces the workload of R2BM and further improves its efficiency.

Thao Nguyen, Toshiaki Yoshikawa, Yusuke Ito et al.

Summary: Chimeric antigen receptor (CAR) T cell therapy often causes serious toxicities, such as cytokine release syndrome (CRS), mainly due to interleukin-6 (IL-6) secreted by monocyte lineage cells. Here, we describe a protocol to generate anti-CD19 CAR T cells and quantify human monocyte-derived IL-6 cocultured with CAR T cells and target tumor cells in vitro. We further describe a protocol to generate a humanized mouse model and evaluate CAR T cell-associated plasma IL-6 levels in vivo.For complete details on the use and execution of this protocol, please refer to Yoshikawa et al.1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Yuchen Xiao, Chien-Chen Chou, Garth Rees Cosgrove et al.

Summary: Cognitive control involves flexibly combining multiple sensory inputs with task-dependent goals during decision making. Several tasks involving conflicting sensory inputs and motor outputs have been proposed to examine cognitive control, including the Stroop, Flanker, and multi-source interference task. Because these tasks have been studied independently, it remains unclear whether the neural signatures of cognitive control reflect abstract control mechanisms or specific combinations of sensory and behavioral aspects of each task. To address these questions, we record invasive neurophysiological signals from 16 patients with pharmacologically intractable epilepsy and compare neural responses within and between tasks. Neural signals differ between incongruent and congruent conditions, showing strong modulation by conflicting task demands. These neural signals are mostly specific to each task, generalizing within a task but not across tasks. These results highlight the complex interplay between sensory inputs, motor outputs, and task demands underlying cognitive control processes.

Bienvenido Rodríguez-Lezcano, Doris Jeanlouis, Daniella Agnes Malulu et al.

Background: dementia has now become a major cause of death, leading to disability and dependence. Objective: to characterize clinical and epidemiological variables in patients with dementia in Seychelles, from July 2018 to August 2019. Methods: an observational, descriptive, longitudinal study was performed in a universe of 257 patients treated at the dementia clinic of Victoria Hospital, Seychelles, in the time period stated above. The variables evaluated included: age group, sex, associated risk factors, type of dementia, marital status and educational level. For the clinical evaluation and diagnosis of dementia, Mini-Cog, Lawton and Brody tests and the Katz Independence Index were used. The data were analyzed according to descriptive statistics. Results: 47.08 % of the universe was diagnosed with dementia, the mean age was 78.61 years. Those aged 80 and over represented 58.68 % and marked female predominance (61.98 %). Sedentarism (84.30 %), high blood pressure (69.42 %) and alcohol intake (65.28 %) as associated risk factors and vascular dementia (39.66 %) and Alzheimer’s disease (38.01 %) were more frequent. Primary education predominated (52.07 %). Married (35.54 %) and widowed as marital status prevailed (32.23 %). Conclusions: clinical and epidemiological variables were characterized in Seychelles patients with dementia, which generally resemble those reported in the international literature.

Anouk Francine Jacqueline Geraets, Andreas Heinz, Andreas Heinz

Oral health remains a global health problem. Mental health has been linked to oral health behavior. However, studies among adolescents in high-income countries are limited. This study aimed to investigate the association between adolescent mental health and well-being with regular toothbrushing. We used data from the 2018 Luxembourg Health Behavior in School-Aged Children study (n = 7,561; n = 3,896 [51.5%] girls; mean [standard deviation] age = 14.9 [2.1] years). Multiple logistic regression analyses were performed to assess the associations of self-reported stress levels, life-satisfaction, somatic health complaints, and psychological health complaints with regular toothbrushing (≥2 daily). Analyses were adjusted for gender, age, family affluence, family structure, migration background, daily sugar consumption, smoking behavior, and general health. 70.5% of the adolescents regularly brushed their teeth. Adolescents who reported higher levels of stress (odds ratio [OR], 95% confidence interval [CI]; 0.97 [0.95;0.99] per one-point increase), low life-satisfaction (OR = 0.92 [0.89;0.95] per one-point increase), and psychological health complaints (OR = 0.95 [0.91;0.99] per complaint) were less likely to regularly brush their teeth. No association was found between somatic health complaints and regular toothbrushing (OR = 1.00 [0.94;1.06] per complaint). Adolescents with poor mental health and well-being are less likely to regularly brush their teeth and may have an increased risk for oral diseases. Interventions focused on lifestyle modification in adolescents with mental health problems should include regular toothbrushing to prevent dental caries and other oral diseases.

Muhammad Shoaib, Abdul Raziq, Qaiser Iqbal et al.

<h4>Objective</h4>Although community practices towards disposal of expired and unused medications vary globally, the phenomenon is neglected specifically in developing countries. We, therefore, aimed to assess the disposal practices of unused and expired pharmaceuticals among the general public in Quetta city, Pakistan.<h4>Methods</h4>A questionnaire-based, cross-sectional survey was conducted among 830 respondents in Quetta city, Pakistan. A pre-validated, structured questionnaire was used for data collection. Data were coded and analyzed by Statistical Package for Social Science (SPSS) version 26. Both descriptive and inferential statistics were sued and p<0.05 was taken as significant.<h4>Results</h4>Almost 87% of the respondents had unused medicines at their homes and reusing the medications was the purpose of medicine storage (50%). Medicines were mostly kept in refrigerators (36.0%) followed by bedrooms (28.8%). Fifty percent of the respondents never checked the expiry date before using the medications. The procedure to dispose of nearly expired or expired medicines was unknown to 88% of the respondents and for those reasons, medicines were disposed either in household trash or flushed in the toilet or sink. Interestingly, medicines were kept at home even after being expired by 27% of the respondents. Income was associated with reason of storing medicines (p = 0.004; φc = 0.402) while educational status had significant associations with storage of medications (p = 0.002; φc = 0.399), reading about storage instructions (p = 0.008; φc = 0.452) and checking expiry date before purchasing and using the medicines (p = 0.007; φc = 0.114 and p = 0.001; φc = 0.100) respectively.<h4>Conclusion</h4>Improper storage and disposal of unused and expired medications is a common practice among study respondents and raised serious concerns. Findings of the current study call upon immediate development and implementation of the strategies to promote awareness and strengthen the pharmaceutical waste management program at the societal level.

Massimiliano Leigheb, Alessandro de Sire, Matteo Colangelo et al.

Sarcopenia is a skeletal muscle disorder characterized by reduced muscle mass, strength, and performance. Muscle ultrasound can be helpful in assessing muscle mass, quality, and architecture, and thus possibly useful for diagnosing or screening sarcopenia. The objective of this study was to evaluate the reliability of ultrasound assessment of tibialis anterior muscle in sarcopenia diagnosis. We included subjects undergoing total or partial hip replacement, comparing measures with a healthy control group. We measured the following parameters: tibialis anterior muscle thickness, echogenicity, architecture, stiffness, skeletal muscle index (SMI), hand grip strength, and sarcopenia related quality of life evaluated through the SarQoL questionnaire. We included 33 participants with a mean age of 54.97 ± 23.91 years. In the study group we found reduced tibialis anterior muscle thickness compared to the healthy control group (19.49 ± 4.92 vs. 28.94 ± 3.63 mm, <i>p</i> < 0.05) with significant correlation with SarQoL values (r = 0.80, <i>p</i> < 0.05), dynamometer hand strength (r = 0.72, <i>p</i> < 0.05) and SMI (r = 0.76, <i>p</i> < 0.05). Moreover, we found reduced stiffness (32.21 ± 12.31 vs. 27.07 ± 8.04 Kpa, <i>p</i> < 0.05). AUC measures of ROC curves were 0.89 predicting reduced muscle strength, and 0.97 predicting reduced SMI for tibialis anterior muscle thickness, while they were 0.73 and 0.85, respectively, for muscle stiffness. Our findings showed that ultrasound assessment of tibialis anterior muscle might be considered a reliable measurement tool to evaluate sarcopenia.

Natanael de Carvalho Bruno, Patricia Morais Mattar, André Teixeira Pontes

Radioactive materials are used for medical purposes, to avoid greenhouse gas effect in energy production plants, food and other products sterilization, research and sophisticated measurement technologies. Transport of radioactive material involves a range of actors each one having specific responsibilities for safety. Through Management System, consignors and carriers fulfil objective evidences that safety requirements are met in practice, while compliance assurance programs allow regulatory bodies and/or competent authorities to demonstrate to society that public, workers and environment are protected. According to IAEA, safety has to be achieved and maintained through an effective management system. This system should integrate all elements of management so that requirements for safety are established and applied consistently with other requirements, including those related to human performance, quality and security, and so that safety is not committed by other requirements or demands. CNEN, the Brazilian Regulatory Body for the safe transport of radioactive materials, adopt international standards to establish safety requirements deemed relevant for protection of health and minimization of danger to life and property, and to provide for the application of these standards. Seeking for continuous improvement, the adherence of the practices adopted by Transport Safety Unit (TSU) against the recommendations from the IAEA was assessed. This assessment led to the elaboration of proposals for improvement as well as the identification of good practices. The methodology used to perform this assessment was the SARIS methodology, developed by the IAEA. This paper will describe the most relevant findings of this study.

Jana Riehl, Ramesh Rijal, Leonie Nitz et al.

The abundant homohexameric AAA + ATPase p97 (also known as valosin-containing protein, VCP) is highly conserved from Dictyostelium discoideum to human and a pivotal factor of cellular protein homeostasis as it catalyzes the unfolding of proteins. Owing to its fundamental function in protein quality control pathways, it is regulated by more than 30 cofactors, including the UBXD protein family, whose members all carry an Ubiquitin Regulatory X (UBX) domain that enables binding to p97. One member of this latter protein family is the largely uncharacterized UBX domain containing protein 9 (UBXD9). Here, we analyzed protein-protein interactions of D. discoideum UBXD9 with p97 using a series of N- and C-terminal truncation constructs and probed the UBXD9 interactome in D. discoideum. Pull-down assays revealed that the UBX domain (amino acids 384–466) is necessary and sufficient for p97 interactions and that the N-terminal extension of the UBX domain, which folds into a β0-α–1-α0 lariat structure, is required for the dissociation of p97 hexamers. Functionally, this finding is reflected by strongly reduced ATPase activity of p97 upon addition of full length UBXD9 or UBXD9261–573. Results from Blue Native PAGE as well as structural model prediction suggest that hexamers of UBXD9 or UBXD9261–573 interact with p97 hexamers and disrupt the p97 subunit interactions via insertion of a helical lariat structure, presumably by destabilizing the p97 D1:D1’ intermolecular interface. We thus propose that UBXD9 regulates p97 activity in vivo by shifting the quaternary structure equilibrium from hexamers to monomers. Using three independent approaches, we further identified novel interaction partners of UBXD9, including glutamine synthetase type III as well as several actin-binding proteins. These findings suggest a role of UBXD9 in the organization of the actin cytoskeleton, and are in line with the hypothesized oligomerization-dependent mechanism of p97 regulation.

Jannigje G. Kers, Egil A.J. Fischer, J. Arjan Stegeman et al.

In the short life of broiler chickens, their intestinal microbiota undergoes many changes. To study underlying biological mechanisms and factors that influence the intestinal microbiota development, longitudinal data from flocks and individual birds is needed. However, post-mortem collection of samples hampers longitudinal data collection. In this study, invasively collected cecal and ileal content, cloacal swabs collected from the same bird, and boot sock samples and cecal droppings from the litter of the broilers’ poultry house, were collected on days 0, 2, 7, 14 and 35 post-hatch. The different sample types were evaluated on their applicability and reliability to characterize the broiler intestinal microbiota. The microbiota of 247 samples was assessed by 16S ribosomal RNA gene amplicon sequencing. Analyses of α and β measures showed a similar development of microbiota composition of cecal droppings compared to cecal content. Furthermore, the composition of cecal content samples was comparable to that of the boot socks until day 14 post-hatch. This study shows that the value of non-invasive sample types varies at different ages and depends on the goal of the microbiota characterization. Specifically, cecal droppings and boot socks may be useful alternatives for cecal samples to determine intestinal microbiota composition longitudinally.

N. Zanjari, Sh. Namjoo, D.M. Aminzadeh et al.

Aims: In the world, many elderly people are cared by informal caregivers. Caring for elderly people with a special condition such as veterans can affect the mental health of caregivers. Therefore, the aim of this study was to investigate the relationship between self-efficacy and depression among the family caregivers of chemical warfare elderly veterans. Instruments & Methods: This cross-sectional descriptive-analytical study carried out among 142 family caregivers of chemical warfare elderly veterans in Sardash in 2018. The subjects were selected using purposive sampling method. The data were collected through Center for Epidemiological Study of Depression Scale (CES-D) and Sherer’s General Self-Efficacy (GSES) and were analyzed by SPSS 21 software using Chi square, Pearson correlation, multiple linear regression, and logistic regression tests. Findings: The prevalence of depression among caregivers was 52.8%. The subjects in the age group of 41-50 years old, high economic status, born in the village and with self-efficacy had lower depression. Also, the dimension of “intention of behavior” had the highest effect on the change in the depression score. Moreover, caregivers who had higher self-efficacy (OR=0.918; CI=0.859-0.981) and higher age (OR=0.932; CI=0.875-0.993) were less depressed, and caregivers who had high economic status were less depressed (OR=0.267; CI=0.065-0.948). Conclusion: Family caregivers of chemical warfare elderly veterans with higher self-efficacy, higher age and, high economic status are less depressed.

Lutfi, M.D., Tengku Puspa Dewi

Introduction.Silent spontaneous rupture of the uterus at the second trimester of gestation was very rare. In this case was accompaniedby extrusion of an intact amniotic sac and normal fetal heart rate base line. Silent uterine rupture can be very difficult to diagnose, as the clinical features of uterine rupture, including abdominal pain, vaginal bleeding, maternal hypovolemic shock or hemorrhage, may be absent.Very few cases have been reported in literature. CasePresentation.Wereport a case of silent spontaneous uterine ruptureat 27-28 Weeks of Gestation.Patient had history of two prior cesarean sections with the last C-sections has uterine rupture. The residents were misdiagnosis silent spontaneous rupture with condition of dyspepsia. She underwent cesarean subtotal hysterectomy and deliveredalive infant. She had a good postoperative recovery and was discharged on postoperative day 3. Conclusion.Silent spontaneous rupture of the uterus at second trimester of gestation with extrusion of an intact amniotic sac is rare.For this case even there were no sign of acute abdomen and shock but only sign of dyspepsia. We have to think about the risk of Rupture uterine imminens. A high index of suspicion and good imagingduring pregnancy are important in making this diagnosis.   Keywords: uterine rupture, dyspepsia, cesareanhysterectomy

Práxedes Isabel Rincón Socha, Lilia Del Riesgo Prendes, Milcíadez Ibáñez Pinilla et al.

Introdução: a hipoxemia secundária a complicações fetais ou obstétricas é causa de asfixia perinatal e lesão cerebral no recém-nascido; 15 a 20% destas crianças morrem durante o período neonatal e 25% dos que sobrevivem, apresentam déficit neurológicos permanentes. Objetivo: determinar fatores de risco anteparto, intraparto e fetais associados ao diagnóstico de asfixia perinatal nos recém-nascidos do serviço de neonatologia do Hospital Universitário Mayor Mederi de Bogotá, nos anos 2010-2011. Materiais e métodos: estudo retrospectivo de casos e controles pareado por data de nascimento, com uma relação 1:5 (51:306). Os casos de asfixia perinatal se diagnosticaram segundo os critérios da Academia Americana de Pediatria e o Colégio Americano de Ginecologia e Obstetrícia. As associações se avaliaram com a prova de Chi-quadrado de Mantel e Haenszel ou o Teste de Fisher para dados pareados, com or e intervalo de con ança do 95%. A análise multivariada se realizou com um modelo de regressão logística condicional. Resultados: fatores de risco com associação significativa: Anteparto: antecedentes patológicos maternos e primigestação. Intraparto: desprendimento prematuro de placenta, hemorragia do terceiro trimestre, oligo-hidrâmnios, taquicardia fetal, monitoramento fetal intraparto anormal, expulsivo prolongado, febre materna, corioamnionite, convulsões maternas e bradicardia fetal. Fetais: idade gestacional por Ballard igual ou <36semanas, via do nascimento instrumentado, líquido amniótico hemorrágico ou tingido de mecónio, circular de cordão, peso ao nascer igual ou <2500 gramas. Os sublinhados e a síndrome hipertensiva associado à gravidez se encontraram significativos na análise multivariada. Conclusões: o reconhecimento e controle temporão dos fatores de risco deve contribuir a diminuir a probabilidade de asfixia perinatal nos recém-nascidos.

Safira Nadifa, Achadiyani Achadiyani, Hartati Purbo Dharmadji et al.

Background : Clinical manifestation of Systemic Lupus Erythematosus (SLE) may be varies in attacking various body tissue and organ system. Anti-dsDNA is the important antibody in determining diagnosis and prognosis of SLE. This study was conducted to explain the characteristics of antidsDNA and organ system involved in SLE patients. Method:  We used quantitative descriptive analysis methods. Data were collected from medical records of SLE patients who came to Dr. Hasan Sadikin Bandung General Hospital Rheumatology Clinic from September to November 2016. Using categorical descriptive research equation, we found that total minimum samples were 67 subjects. Data observed included the level of anti-dsDNA antibody and clinical manifestation of organ system involved. Result: From 67 samples, there were 65 females which accounted for 97% of the research subjects. Distribution of organ system involved in our subjects was musculoskeletal (29%), mucocutaneous (27%), hematologic (21%), kidney (15%), neuropsychiatry (4%), lung involvement (4%) and cardiovascular (0%). Organ system involved related with strong positive anti-dsDNA were mucocutaneous (21,6%), hematologic (25%), musculoskeletal (12,5%), kidney (14,3%) and lungs (20%). Conclusion:  The most frequent organ system involved in SLE patients at our setting was musculoskeletal. The common organ involvement related with strong positive antidsDNA were mucocutaneous, musculoskeletal, and hematologic. Keywords: anti-dsDNA, involvement of organ system, clinical manifestation, systemic lupus erythematosus

Steffen Ducheyne

Como complemento al relato de John L. Heilbron, argumentaré que aunque la etiqueta ‘física experimental’ se puede usar legítimamente para describir algunos aspectos de la obra de Petrus van Musschenbroek (1692-1761), la comprensión de la ‘physica’ de este último se ha de entender dentro de un marco más amplio en el que las consideraciones teológicas, filosóficas, y teleológicas continuaron desempeñando una función importante. En primer lugar, me centraré en la concepción de van Musschenbroek en el ámbito de la ‘physica’ y en especial en su concepto de una ley de la naturaleza. Se verá que, al radicalizar algunos aspectos de las ideas metodológicas de Isaac Newton, van Musschenbroek ya no se considera la física como la disciplina que descubre las causas de efectos, como hizo Newton, sino como la disciplina que estudia los efectos de causas desconocidas. Además, se verá que van Musschenbroek pensaba que las leyes de la naturaleza están supeditadas a la libre voluntad de Dios y que son cognoscibles debido a la bondad de Dios. En segundo lugar, argumentaré que para van Musschenbroek la física, junto con la teleología, tenía claras repercusiones físico-teológicas. En el camino, por primera vez discutirá su posición en relación con el principio de razón suficiente.

Fatemeh Atabaki pasdar, Alireza Khooei, Alireza Fazel et al.

Background: Differential diagnosis between complete hydatidiform mole, partial hydatidiform mole and hydropic abortion, known as hydropic placentas is still a challenge for pathologists but it is very important for patient management. Objective: We analyzed the nuclear DNA content of various types of hydropic placentas by flowcytometry. Materials and Methods: DNA ploidy analysis was performed in 20 non-molar (hydropic and non-hydropic spontaneous abortions) and 20 molar (complete and partial moles), formalin-fixed, paraffin-embedded tissue samples by flow cytometry. The criteria for selection were based on the histopathologic diagnosis. Results: Of 10 cases histologically diagnosed as complete hydatiform mole, 9 cases yielded diploid histograms, and 1 case was tetraploid. Of 10 partial hydatidiform moles, 8 were triploid and 2 were diploid. All of 20 cases diagnosed as spontaneous abortions (hydropic and non-hydropic) yielded diploid histograms. Conclusion: These findings signify the importance of the combined use of conventional histology and ploidy analysis in the differential diagnosis of complete hydatidiform mole, partial hydatidiform mole and hydropic abortion.

N Ataei, B Safaian, A Madani et al.

&quot;nUrinary tract infection (UTI) may lead to irreversible changes in renal parenchyma. Early diagnosis using scintigraphy with technetium-99m-labeled dimercaptosuccinic acid (DMSA) scan and early treatment may decrease or prevent development of renal parenchymal lesions. The aim of this study was to assess the occurrence of renal parenchymal lesion in children admitted with a first-time symptomatic UTI and to evaluate the relation between renal parenchymal damage and severity of vesicoureteral reflux (VUR). A total of 102 children with first time acute pyelonephritis (APN) were enrolled in the study. All children studied with DMSA scan and ultrasonography (US). Voiding cystourethrography (VCUG) was performed in 98 children when urine culture became negative. Changes on the DMSA scan and US were found in 178 (88%) and 5 (2.4%) out of 203 renal units during the acute phase, respectively. All abnormal renal units on US showed severe parenchymal involvement on DMSA. We also found significant correlation between severity of VUR and abnormal US results on kidneys. Of 40 kidneys with reflux, 38 (95%) were found to have abnormal renal scan. Among 155 kidneys with non-refluxing ureters 132 (85.2%) revealed parenchymal changes on renal cortical scintigraphy. Kidneys with moderate to severe reflux were more likely to have severe renal involvement. We found a high incidence of renal parenchymal changes in children with APN. Additionally, renal involvement was significantly higher in children with moderate to severe reflux. When there are high-grade VUR and female gender, the risk of renal parenchymal involvement is higher.

Khaldoun Almhanna, Richard Kim, Sujith Kalmadi

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, and it is responsible for up to one million deaths annually. Although multiple risk factors for HCC have been identified, and despite preventive measures, the incidence of HCC continues to rise to epidemiologic proportions in the United States. In general, tumor resection and orthotopic liver transplantation are the treatment with the best outcome; however, HCC is generally diagnosed late in its course when patients are not eligible for curative treatment options. HCC is a relatively Chemo-refractory tumor secondary to heterogeneity of the tumor and the high rate of multidrug resistant gene expression. There are no standard treatments for HCC, multiple palliative treatment modalities have been used for patients with unresectable disease. None of these modalities have shown any superiority; and the retrospective nature of these available data has confounded any reasonable conclusions. Different institutions use different treatment schema dependent on the center expertise. Sorafenib, a tyrosine kinase inhibitor, has recently demonstrated a survival advantage in metastatic HCC, and if approved by the FDA, might become the standard of care. In this article we will review the rationale behind the currently available treatment options for HCC.