ABSTRACT
Chronic hepatitis C virus (HCV) infection is associated with fatigue and depression. Cognitive impairments are also reported in a smaller number of HCV-positive patients. Recent studies linked HCV to low-grade inflammation in brain. Here, we test the hypothesis that chronic HCV is associated with 3T-neuroimaging-derived grey matter volume (GMV) and functional connectivity alterations in a sample of chronic HCV (1b), without severe liver disease. Regional GMV and resting-state fMRI-derived eigenvector centrality (EC) were compared between 19 HCV-positive patients and 23 healthy controls (all females, 50-69 and 52-64 years, respectively), controlling for white matter hyperintensities and age. Standard tests were used to assess fatigue, depression and cognitive performance. Also, liver fibrosis stage and viral load were quantified among patients. In comparison with controls, HCV-positive patients had higher scores in fatigue and depression, and worse alertness scores. The groups performed similarly in other cognitive domains. We report higher EC in a cluster in the right anterior superior parietal lobule in patients, while no differences are found in GMV. Post hoc functional connectivity analysis showed increased connectivity of this cluster with primary and secondary somatosensory cortex, and temporal and occipital lobes in patients. Higher mean EC in the superior parietal cluster, adjusted for mean framewise displacement, was associated with better memory and attention performance, but not with fatigue, depression, viral load or level of liver fibrosis, among patients. These results suggest a compensatory mechanism in chronic hepatitis C and explain equivocal results in the literature about cognitive deficits in infected persons. Further studies should define the relation of these connectivity changes to the brain's inflammatory activity.
Subject(s)
Encephalitis/diagnostic imaging , Encephalitis/epidemiology , Gray Matter/diagnostic imaging , Gray Matter/pathology , Hepatitis C, Chronic/complications , Aged , Cognition Disorders/epidemiology , Depression/epidemiology , Encephalitis/pathology , Fatigue/epidemiology , Female , Humans , Liver Cirrhosis/pathology , Magnetic Resonance Imaging , Middle Aged , Viral LoadABSTRACT
Hepatic complications contribute to morbidity and mortality after allogeneic hemopoietic SCT. Liver Doppler ultrasound and elastography represent promising methods for pretransplant risk assessment and early detection of complications. Ultrasound (liver and spleen size, liver perfusion) and elastography (transient elastography (TE); right liver lobe acoustic radiation force impulse imaging (r-ARFI); left liver lobe ARFI (l-ARFI)) were prospectively evaluated in patients with indications for allo-SCT. Measurements were performed before and repeatedly after SCT. Results were compared with the incidence of life-threatening complications and death during the first 150 days after SCT. Of 59 included patients, 16 suffered from major complications and 9 of them died within the follow-up period. At baseline, liver and spleen size, liver perfusion, TE and r-ARFI did not differ significantly between patients with and without severe complications. In contrast, l-ARFI was significantly elevated in patients who later developed severe complications (1.58±0.30 m/s vs 1.37±0.27 m/s, P=0.030). After SCT, l-ARFI values remained elevated and TE showed increasing liver stiffness in patients with complications. The value of conventional liver ultrasound for prediction of severe SCT complications is limited. Increased values for TE and l-ARFI are associated with severe SCT complications and demand further evaluation.
Subject(s)
Abdomen/diagnostic imaging , Elasticity Imaging Techniques/methods , Hematopoietic Stem Cell Transplantation/adverse effects , Liver/diagnostic imaging , Adult , Aged , Allografts , Cohort Studies , Female , Graft vs Host Disease/diagnostic imaging , Humans , Male , Middle Aged , Risk Assessment , Spleen/diagnostic imaging , Ultrasonography, DopplerABSTRACT
Blood in the peritoneal dialysis catheter just before menstruation was regularly observed in 9 of 11 premenopausal women maintained on peritoneal dialysis for end-stage renal failure. Peritoneal bleeding at other times during the menstrual cycle was not seen in any of these patients. Likewise, peritoneal bleeding in men or nonmenstruating women on chronic peritoneal dialysis was exceedingly rare, was not periodic, and usually was due to recognizable causes. These observations suggest that retrograde menstrual bleeding into the peritoneal cavity is the rule rather than the exception in women on peritoneal dialysis and possibly in all menstruating women. Implications of this observation for the pathogenesis of endometriosis and dysmenorrhea are discussed.
Subject(s)
Blood , Kidney Failure, Chronic/therapy , Menstruation , Peritoneal Cavity , Peritoneal Dialysis , Adolescent , Adult , Dysmenorrhea/etiology , Endometriosis/etiology , Female , HumansABSTRACT
A silicone rubber tube with bonded Dacron felt cuffs have been implanted in dogs as a ureteral replacement prosthesis. A one-way valve has also been developed to prevent reflux so the prosthesis may be put into the bladder. The prosthesis has been implanted for periods up to nine months. Although there are some problems associated with the prosthesis, most animals have maintained a normal serum creatinine, sterile urine, and a normal excretory urogram.
