Subsets of Inflammatory Cytokine Gene Polymorphisms are Associated with Risk of Carcinogenic Liver Fluke Opisthorchis viverrini-Associated Advanced Periductal Fibrosis and Cholangiocarcinoma

Opisthorchis viverrini infection induces chronic inflammation, and a minor proportion of infected individuals develop advanced periductal fibrosis (APF) and cholangiocarcinoma (CCA). Inflammatory cytokines and/or their gene polymorphisms may link to these biliary pathologies. We therefore investigated associations among cytokine gene polymorphisms and cytokine production in 510 Thai cases infected with O. viverrini who presented with APF+ or APF−, as established by abdominal ultrasonography as well as in patients diagnosed with CCA. Levels of pro-inflammatory and anti-inflammatory cytokines were determined in culture supernatants after stimulation of peripheral blood mononuclear cells (PBMCs) with O. viverrini excretory-secretory (ES) products. Pro-inflammatory cytokines, IL-1β, IL-6, IFN-γ, LT-α, and TNF-α were significantly increased in CCA patients compared with non-CCA (APF− and APF+) cases. Polymorphisms in genes encoding IL-1β-511C/T, IL-6-174G/C, IFN-γ +874T/A, LT-α +252A/G, and TNF-α−308G/A were then investigated by using PCR-RFLP or allele specific-PCR (AS-PCR) analyses. In the CCA cases, LT-α +252A/G and TNF-α−308G/A heterozygous and homozygous variants showed significantly higher levels of these cytokines than the wild type. By contrast, levels of cytokines in wild type of IFN-γ +874T/A were significantly higher than the variants in CCA cases. IFN-γ +874T/A polymorphisms were associated with advanced periductal fibrosis, whereas IL-6 −174G/C polymorphisms were associated with CCA. To our knowledge, these findings provide the first demonstration that O. viverrini infected individuals carrying several specific cytokine gene polymorphisms are susceptible to develop fibrosis and CCA.

A Development of Pain Assessment and Pain Documentation as a Fifth Vital Sign in a University Hospital

Background: Pain assessment and documentation can be used as vital sign for the improvement of postoperative pain management; however, these systems have never been adopted for use at Srinagarind Hospital.Objectives:1.     To develop a systematic postoperative pain assessment and documentation as the fifth vital sign; and,2.     To implement a revised graphic sheet for pain documentation at Srinagarind Hospital.Design:  Descriptive studySetting:  Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversityMethods:  Researchers explored the ward nurses’ attitudes and practices vis-à-vis the pain assessment and documentation in a pilot ward.  Subsequently, systematic pain assessment and documentation using the old graphic sheet, originally developed for recording four other vital signs, were re-designed to include the new sign, tested and revised for its practicality.  The revised graphic sheet was re-tested in two other wards and finally the system was implemented throughout the hospital.Measurement:  Pain assessment tools, frequency of pain documentation and the number of patients assessed before and after the study were recorded.  The ward nurses were asked to give their comments on the practicality of the new system for pain assessment and documentation.Results:  In the pilot ward, misunderstanding regarding the pain assessment tools was found among some ward nurses. The frequency of pain assessment and documentation significantly increased after using the revised graphic sheet (43.2% vs. 57.3%, p=0.039).  The prevalence of no pain assessment also decreased significantly (12.1 vs. 2.2%, p=0.008).  Most of the nurses (87.5%) could complete the pain record form within one minute.  The new system, as reported by 62.5% of the ward nurses, nominally increased their workload.  Re-testing this system in the other two wards increased the number of pain assessments and documentations on the first post-operative day from 67% to 98 %.  The revised graphic sheet was then accepted by the policy makers for use throughout the hospital.Conclusion:  The system of post-operative pain assessment as the fifth vital sign was developed.  A revised graphic sheet was used for pain documentation and accepted for routine use.  The new system increased the number of pain assessments and documentations of post-operative patients.