Serum Tumor Markers Provide Refined Prognostication in Selecting Liver Transplantation Candidate for Hepatocellular Carcinoma Patients Beyond the Milan Criteria.

OBJECTIVE: To develop and validate a model to predict tumor recurrence after living donor liver transplantation (LDLT) (MoRAL) for hepatocellular carcinoma (HCC) beyond the Milan criteria (MC). BACKGROUND: Some subgroups of HCC exceeding the MC experience substantial benefit from LDLT. METHODS: This multicenter study included a total of 566 consecutive patients who underwent LDLT in Korea: the beyond-MC cohort (n = 205, the derivation [n = 92] and validation [n = 113] sets) and the within-MC cohort (n = 361). The primary endpoint was time-to-recurrence. RESULTS: Using multivariate Cox proportional hazard model, we derived the MoRAL score using serum levels of protein induced by vitamin K absence-II and alpha-fetoprotein, which provided a good discriminant function on time-to-recurrence (concordance index = 0.88). Concordance index was maintained similarly on both internal and external validations (mean 0.87 and 0.84, respectively). At cut off of 314.8 (75th percentile value), a low MoRAL score (≤314.8) was associated with significantly longer recurrence-free (versus > 314.8, HR = 5.29, P < 0.001) and overall survivals (HR = 2.59, P = 0.001) in the beyond-MC cohort. The 5-year recurrence-free and overall survival rates of beyond-MC patients with a low MoRAL score were as high as 66.3% and 82.6%, respectively. The within-MC patients with a high MoRAL score showed a higher risk of recurrence than beyond-MC patients with a low MoRAL score (HR = 2.56, P = 0.035). The MoRAL score was significantly correlated with explant histology. CONCLUSIONS: This new model using protein induced by vitamin K absence-II and alpha-fetoprotein provides refined prognostication. Among beyond-MC HCC patients, those with a MoRAL score ≤314.8 and without extrahepatic metastasis might be potential candidates for LDLT.

Manejo odontológico de paciente con déficit de factor XII: reporte de un caso

El Servicio de Medicina Transfusional del Centro Hospitalario Pereira Rossell es el centro de referencia nacional en el área materno infantil. En el marco del convenio MSP- Facultad de Odontología de la UDELAR, se atienden en este Servicio pacientes con diversas coagulopatías. El déficit de factor XII es una patología de baja prevalencia (1-1000000) y no existe evidenciacientífica que respalde protocolos clínicos de atención a nivel odontológico. Se presenta el caso clínico del paciente NT, portador de esta patología, de alto riesgo con alta actividad de caries, en dentición mixta, a quiense le realizó tratamiento odontológico integral con apoyo del equipo multidisciplinario que trabaja en el Servicio de Hemoterapia del CHPR. (AU) FON

Basic, quantitative and experimental research phases of future ethnobotany with reference to the medicinal plants of South America.

Ethnobotany of the future will encompass what we perceive as three interrelated research phases. Basic ethnobotany includes the compilation and organization of information about biota obtained from indigenous and other peoples, such as obtaining data about useful plants and animals, understanding how peoples manage their environments and learning about their lexicons and classifications. This is what we try to do in the best possible way, directly in the field from original sources. These results can then be organized in many ways once species determinations are completed. They may also be organized using other types of information, the most obvious being chemical, medical and linguistic. Quantitative ethnobotany develops methods to allow quantitative description and to evaluate and analyse primary data sets. Original field research must be sufficiently structured and consistent, for example in relation to forest habitat and composition or to oral exchanges between informant and listener, so that statistical techniques may be used to test proposed hypotheses rigorously. This aspect of ethnobotany is in its infancy, yet it can be broadly utilized to comprehend more meaningfully and usefully ethnobotanically valued plants, particularly in the exceedingly diversified environments of tropical regions where because of community isolation practitioners are still most knowledgeable. Experimental ethnobotany involves the use of biota in search of products for industrial, medical and other purposes. Plant ethnomedicinal findings may set the stage for targeting materials which can be meaningfully analysed for chemical activity using appropriate biodirected assays. This approach in search of new pharmaceuticals is woefully underutilized today to the detriment of human health and a number of new strategies should be considered for future advancements in drug discovery. These aspects of ethnobotany will be evaluated largely in relation to current and future research in South America.

Triterpenoid saponins from Gouania lupuloides.

The stems of Jamaican chawstick, Gouania lupuloides, have yielded two novel 16,17-seco-dammaranoid saponins, designated gouanoside A [4] and gouanoside B [5]. Structural assignments are based on spectroscopic data including 2D nmr experiments on the corresponding aglycones, gouanogenin A [1] and gouanogenin B [3].

Ritualistic use of the holly Ilex guayusa by Amazonian Jívaro Indians.

In Amazonian Peru and Ecuador leaf decoctions of the rainforest holly Ilex guayusa with high caffeine concentrations are used as a morning stimulant. After daily ingestion, ritualistic vomiting by male Achuar Indians, better known as Jívaros, reduces excessive caffeine intake, so that blood levels of caffeine and biotransformed dimethylxanthines do not cause undesirable CNS and other effects. Emesis is learned and apparently not due to emetic compounds.

Analisis de contaminacion de las aguas subterraneas por sistemas de saneamiento basico / Undergroundwater pollution analysis by basic sanitation system

Este trabajo pretende, evaluar los resultados obtenidos a partir de investigaciones sobre la contaminacion de aguas subterraneas causada por sistemas sanitarios de disposicion focal; revisar las publicaciones existentes que atanen a la supervivencia y el transporte de microorganismos y de ciertos compuestos inorganicos (principalmente nitratos), a traves de la zona no saturada y saturada; identificar aquellos factores que afecten el transporte de contaminantes, que puedan usarse para determinar el riesgo de contaminacion de los acuiferos bajo diferentes condiciones hidrogeologicas, y que requieran de mayores investigaciones a fin de definir mejor el riesgo implicito..

Late quaternary environmental history of lake valencia, Venezuela.

Chemical, paleontological, and mineralogical analyses of a 7.5-meter core from the middle of Lake Valencia, Venezuela, have provided information on the paleoclimatic history of this low-elevation, low-latitude site for the last 13,000 years. The data show that dry climates existed in this region from 13,000 years before present (B.P.) until about 10,000 years B.P. The Lake Valencia Basin was occupied by intermittent saline marshes at that time. About 10,000 years B.P., a permanent lake of fluctuating salinity formed and arboreal plant communities replaced the earlier dominant xeric herbaceous vegetation and marsh plants. By 8500 years B.P., Lake Valencia reached moderate to low salinities and discharged water; the modern vegetation became established at that time. After 8500 years B.P., the lake twice ceased discharging as a result of reduced watershed moisture. The second of these drying episodes is still in progress and has been aggravated by human activities in the watershed.