Case report: Haemoperitoneum secondary to acute rupture of primary hepatic angiosarcoma.

INTRODUCTION AND IMPORTANCE: Primary hepatic angiosarcoma (PHA) is a rare and aggressive liver malignancy of endothelial cell origin and is associated with poor outcome. Pre-operative confirmation of the diagnosis is challenging, as clinical and radiological findings are generally non-specific. Very rarely, spontaneous haemoperitoneum may occur due to the spontaneous rupture of previously undiagnosed PHA. CASE PRESENTATION: We describe a case of a 28-year-old male with haemoperitoneum due to the rupture of previously undiagnosed PHA. After failing to respond to the non-operative measures, the patient underwent emergency partial liver resection and recovered without any post-operative complications. Histopathological examination of the specimen confirmed the diagnosis of PHA. Two months after the operation, the patient represented with advanced metastatic disease and disseminated intravascular coagulation (DIC). The patient died one month after discharge. CLINICAL DISCUSSION: A patient with PHA presents a diagnostic challenge due to its rare incidence and non-specific clinical findings. Spontaneous intra-abdominal haemorrhage can occur due to PHA rupture and carries a dismal prognosis. In addition to emergency haemorrhage control, complete surgical resection with clear margins is the definitive treatment to date, however, most cases of PHA are unresectable at diagnosis and recurrence is common even after complete resection. CONCLUSION: PHA is associated with very poor outcomes, due to its rapid progression, early recurrence, and metastatic nature. The median survival is approximately 5 months. Haemoperitoneum secondary to rupture of previously undiagnosed PHA is uncommon and is a poor prognostic indicator. Complete surgical resection of the disease is challenging and there is no established treatment.

The diabetic foot ulcer.

BACKGROUND: Diabetic foot ulcers are associated with significant morbidity and mortality and can subsequently lead to hospitalisation and lower limb amputation if not recognised and treated in a timely manner. OBJECTIVE: The aim of this article is to review the current evidence for preventing and managing diabetic foot ulcers, with the aim to increase clinicians' confidence in assessing and treating these complex medical presentations. DISCUSSION: All patients with diabetes should have an annual foot review by a general practitioner or podiatrist. A three-monthly foot review is recommended for any patient with a history of a diabetic foot infection. Assessment involves identification of risk factors including peripheral neuropathy and peripheral vascular disease, and examination of ulceration if present. It is essential to identify patients with diabetes who are 'at risk' of ulceration, assess for any early signs of skin breakdown, initiate appropriate management to prevent progression and refer the patient if indicated.

Evaluation of the "Eat Better Feel Better" Cooking Programme to Tackle Barriers to Healthy Eating.

We evaluated a 6-week community-based cooking programme, "Eat Better Feel Better", aimed at tackling barriers to cooking and healthy eating using a single-group repeated measures design. 117 participants enrolled, 62 completed baseline and post-intervention questionnaires, and 17 completed these and a 3-4 months follow-up questionnaire. Most participants were female, >45 years, and socioeconomically deprived. Confidence constructs changed positively from baseline to post-intervention (medians, scale 1 "not confident" to 7 "very confident"): "cooking using raw ingredients" (4, 6 p < 0.003), "following simple recipe" (5, 6 p = 0.003), "planning meals before shopping" (4, 5 p = <0.001), "shopping on a budget (4, 5 p = 0.044), "shopping healthier food" (4, 5 p = 0.007), "cooking new foods" (3, 5 p < 0.001), "cooking healthier foods" (4, 5 p = 0.001), "storing foods safely" (5, 6 p = 0.002); "using leftovers" (4, 5 p = 0.002), "cooking raw chicken" (5, 6 p = 0.021), and "reading food labels" (4, 5 p < 0.001). "Microwaving ready-meals" decreased 46% to 39% (p = 0.132). "Preparing meals from scratch" increased 48% to 59% (p = 0.071). Knowledge about correct portion sizes increased 47% to 74% (p = 0.002). Spending on ready-meals/week decreased. Follow-up telephone interviewees (n = 42) reported developing healthier eating patterns, spending less money/wasting less food, and preparing more meals/snacks from raw ingredients. The programme had positive effects on participants' cooking skills confidence, helped manage time, and reduced barriers of cost, waste, and knowledge.).

Community Interventions to Improve Cooking Skills and Their Effects on Confidence and Eating Behaviour.

PURPOSE OF REVIEW: Community-based interventions aiming to improve cooking skills are a popular strategy to promote healthy eating. We reviewed current evidence on the effectiveness of these interventions on different confidence aspects and fruit and vegetable intake. RECENT FINDINGS: Evaluation of cooking programmes consistently report increased confidence in cooking skills in adults across different age groups and settings. The effectiveness of these programmes on modifying eating behaviour is less consistent, but small increases in self-reported consumption of fruit and vegetables are also described. Lack of large samples, randomization and control groups and long-term evaluation are methodological limitations of the evidence reviewed. SUMMARY: Cooking skill interventions can have a positive effect on food literacy, particularly in improving confidence on cooking and fruit and vegetable consumption, with vulnerable, low-socieconomic groups gaining more benefits. Consistency across study designs, delivery and evaluation of outcomes both at short and long terms are warranted to draw clearer conclusions on how cooking programmes are contributing to improve diet and health.

Glymphatic fluid transport controls paravascular clearance of AAV vectors from the brain.

Adeno-associated viruses (AAV) are currently being evaluated in clinical trials for gene therapy of CNS disorders. However, host factors that influence the spread, clearance, and transduction efficiency of AAV vectors in the brain are not well understood. Recent studies have demonstrated that fluid flow mediated by aquaporin-4 (AQP4) channels located on astroglial end feet is essential for exchange of solutes between interstitial and cerebrospinal fluid. This phenomenon, which is essential for interstitial clearance of solutes from the CNS, has been termed glial-associated lymphatic transport or glymphatic transport. In the current study, we demonstrate that glymphatic transport profoundly affects various aspects of AAV gene transfer in the CNS. Altered localization of AQP4 in aged mouse brains correlated with significantly increased retention of AAV vectors in the parenchyma and reduced systemic leakage following ventricular administration. We observed a similar increase in AAV retention and transgene expression upon i.c.v. administration in AQP4-/- mice. Consistent with this observation, fluorophore-labeled AAV vectors showed markedly reduced flux from the ventricles of AQP4-/- mice compared with WT mice. These results were further corroborated by reduced AAV clearance from the AQP4-null brain, as demonstrated by reduced transgene expression and vector genome accumulation in systemic organs. We postulate that deregulation of glymphatic transport in aged and diseased brains could markedly affect the parenchymal spread, clearance, and gene transfer efficiency of AAV vectors. Assessment of biomarkers that report the kinetics of CSF flux in prospective gene therapy patients might inform variable treatment outcomes and guide future clinical trial design.