Differences in Hepatic Expression of Iron, Inflammation and Stress-Related Genes in Patients with Nonalcoholic Steatohepatitis

Abstract: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. We have previously shown that hepatic reticuloendothelial system (RES) iron deposition is associated with an advanced degree of nonalcoholic steatohepatitis (NASH) in humans. In this study, we aimed to determine differentially expressed genes related to iron overload, inflammation and oxidative stress pathways, with the goal of identifying factors associated with NASH progression. Seventy five patients with NAFLD were evaluated for their biochemical parameters and their liver tissue analyzed for NASH histological characteristics. Gene expression analysis of pathways related to iron homeostasis, inflammation and oxidative stress was performed using real-time PCR. Gene expression was compared between subjects based on disease status and presence of hepatic iron staining. We observed increased gene expression of hepcidin (HAMP) (2.3 fold, p = 0.027), transmembrane serine proteinase 6 (TMPRSS6) (8.4 fold, p = 0.003), signal transducer and activator of transcription 3 (STAT3) (5.5 fold, p = 0.004), proinflammatory cytokines; IL-1β (2.7 fold, p = 0.046) and TNF-α (3.8 fold, p = 0.001) in patients with NASH. TMPRSS6, a negative regulator of HAMP, is overexpressed in patients with NASH and HIF1α (hypoxia inducible factor-1) is downregulated. NAFLD patients with hepatic iron deposition exhibited higher hepcidin expression (3.1 fold, p = 0.04) but lower expression of cytokines. In conclusion, we observed elevated hepatic HAMP expression in patients with NASH and in NAFLD patients who had hepatic iron deposition, while proinflammatory cytokines displayed elevated expression only in patients with NASH, suggesting a regulatory role for hepcidin in NAFL to NASH transition and in mitigating inflammatory responses.

Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases

Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n=13), cardiovascular diseases (n=8), and diabetes (n=6). Intervention strategies included instructional education/counseling (n=20), workplace environmental change (n=6), physical activity (n=10), use of technology (n=10), and incentives (n=13). Self-reported data (n=21), anthropometric measurements (n=17), and laboratory tests (n=14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

Cost-effectiveness of varicocele surgery in the era of assisted reproductive technology / 亚洲男科学杂志(英文版)

The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when. Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy of varicocele repair as well as cost-effectiveness of repair compared to immediate microTESE in azoospermic men and assisted reproductive technology in men with suboptimal semen parameters will be reviewed.

Moresby food isn’t good: food security, nutritional information and adherence to antiretroviral therapy in Papua New Guinea

The relationship between HIV (human immunodeficiency virus), food security and nutrition has become increasingly important to practitioners, policy makers and people living with HIV. In this paper we describe for the first time the connection between HIV and antiretroviral therapies, the extent of nutritional counselling for HIV-positive people and food security in Papua New Guinea (PNG). A total of 374 HIV-positive people who were over the age of 16 and who had been on antiretroviral therapy (ART) for more than two weeks were recruited from six provinces, using a non-probability, convenience sampling methodology. A subsample of 36 participants also completed an in-depth qualitative interview. Participants received nutritional advice when beginning ART which focused on three main domains, of which the first two were the most frequently mentioned: what foods to avoid; what foods to eat; and how frequently to eat. 72% of the sample reported that they had experienced an increase in their appetite. Of those who reported that their appetite had increased on ART 33% reported that they did not have enough food to satisfy hunger. People who lived in the capital city, Port Moresby, within the Southern Region of PNG, had significantly more difficulty with food security than those who lived in other regions of the country. Not having enough food was the third most commonly recorded reason for non-adherence to ART. Responses to the HIV epidemic in Papua New Guinea must also begin to address the phenomenon of food insecurity for people with HIV, in particular those who are receiving antiretroviral therapies and who live in the urban areas.

Mortality & clinical characteristics of hospitalized adult patients with HIV in Pune, India.

BACKGROUND & OBJECTIVE: In India, data regarding mortality and clinical characteristics of hospitalized HIV-infected patients are sparse, which may limit the effectiveness of new hospital-based HIV programmes providing antiretroviral therapy (ART). The objective of our study was to determine mortality and clinical characteristics of hospitalized HIV-infected individuals in a high HIV prevalence region of India. METHODS: A retrospective chart review was done of known HIV-infected adults admitted to the Medical Service of a large, public hospital in Pune, India, from January 2002 to November 2003. RESULTS: A total of 655 HIV-infected patients were identified; 489 (74.7%) were male and 4 (0.6%) were on ART. The most common illnesses reported were tuberculosis (55.8%), diarrhoea (4.2%), and alcoholic liver disease (3.7%) . The inpatient mortality was 172 (26.3%). The most common causes of death of the 172 people were tuberculosis (52.9%) and cryptococcal meningitis (7.6%). In multivariate analysis, factors associated with increased mortality were male sex (adjusted odds ratio (AOR) 1.92, 95% CI: 1.08-3.41), haemoglobin level < 7 g/dl (AOR 2.75, 95% CI:1.23-6.14), length of stay < 2 days (OR 5.78, 95%, CI: 1.82-18.4), and cryptococcal meningitis (OR 4.44, 95% CI:1.19-16.6). INTERPRETATION & CONCLUSION: In the era prior to widespread ART, a high inpatient mortality of 26 per cent was found among hospitalized HIV-infected individuals. Thus, while hospitalization is an important access and referral point for HIV care and treatment, earlier identification of HIV-infected persons must occur to ensure they will optimally benefit from the government's ART programme.

Complementary and alternative medicine in developmental disabilities.

Developmental disabilities (DD) are defined as a diverse group of severe chronic conditions due to mental and/or physical impairments. Individuals with developmental disabilities have difficulty with major life activities including language, mobility, and learning. Developmental disabilities can begin anytime during development--from prenatal up to 22 years of age, and the disability usually lasts throughout a person's lifetime. Autism spectrum disorders, cerebral palsy, mental retardation, and attention deficit hyperactivity disorder are common conditions falling within the definition of developmental disabilities. Complementary and alternative medicine (CAM) is becoming increasingly utilized in the general population for treatment of everything from the common cold to complex and chronic medical conditions. This article reviews the prevalence of different types of CAM used for various developmental disabilities.

Luxação congênita do quadril: uma abordagem inicial / Congenital hip dislocation: an initial approach

O objetivo do presente estudo foi identificar e analisar as publicações científicas acerca da Luxação Congênita do Quadril (LCQ) através de uma pesquisa bibliográfica. Foram encontrados 41 artigos e constatou-se pela análise que apesar da diversidade e dos distintos parâmetros utilizados pelos autores, as complicações da patologia resultam da deficiência da detecção e do diagnóstico tardio. Considera-se que o conhecimento dessa patogenia pela enfermeira possa contribuir com os cuidados e acompanhamento aos portadores, além do treinamento de seus familiares.

Depoimentos de enfermeiras hospitalares da década de 80: subsídios para a compreensäo da enfermagem atual / Declarations of registered nurses from the 1980s: elements to comprehend nursing today

Este estudo é parte de um projeto mais amplo que visa resgatar aspectos significativos relacionados à evoluçÝo da assistência de enfermagem nas décadas de 50 a 90. Este resgate é feito através da técnica de depoimentos orais de enfermeiras em exercício e aposentados, no contexto de um Hospital escola do interior paulista. O presente estudo particulariza os resultados obtidos, referentes à decada de 80. Como resultado evidencia-se o esforço empreendido pelos enfermeiros na luta pelo reconhecimento e prestígio da profissäo, as transformaçöes intensas e profundas aos novos papéis da enfermeira enquanto líder e membro da equipe médica.

Evoluçäo da enfermagem no contexto do hospital-escola: depoimentos de enfermeiros representantes da década de 70 / Nursing evolution at university hospitals: declarations of nurses who worked in the 1970s

Este estudo é parte de um projeto mais amplo que visa resgatar aspectos significativos relacionados à evoluçäo da assistência de enfermagem nas décadas de 50 a 90. Este resgate é feito através da técnica de depoimentos orais de enfermeiros em exercício e aposentados, no contexto de um Hospital-Escola do interior Paulista. O presente estudo particulariza os resultados obtidos, referentes à decada de 70. Como resultado evidencia-se o esforço empreendido pelos enfermeiros na luta pelo reconhecimento e prestígio da profissäo, as tranformaçöes intensas e profundas aos novos papéis da enfermeira enquanto líder da equipe e membro da equipe médica.

AIDS numa comunidade de Londrina: populaçäo consciente ou desinformada? / Acquired immunodeficiency syndrome in a Londrina's comunity: a conscient population or a bad-informed population?

Considerando que a AIDS tornou-se um dos mais importantes problemas de saúde pública dos tempos atuais em face do grande aumento dos índices mundiais relativos a esta doença, foi avaliado o nível de conscientizaçäo da populaçäo de Londrina, mais especificamente na área de abrangência da Unidade Básica de Saúde "Dr. Newton L. Câmara - Vila Casoni", visando verificar nesta regiäo, o nível de conscientizaçäo da populaçäo situada na faixa etária dos 13-40 anos, além de levantar conhecimentos naquela comunidade, com relaçäo à prevençäo da AIDS. Os resultados obtidos revelam que existe preocupaçäo por parte da populaçäo, sendo satisfatórios os níveis de conscientizaçäo e prevençäo relativos à AIDS