Changes in natural killer cell activity after surgery and predictors of its recovery-failure.

BACKGROUND AND OBJECTIVES: We evaluated the changes in natural killer cell activity (NKA) during the entire treatment period of patients with resectable biliopancreatic cancers and investigated the predictors of the failure of recovery of NKA after surgery. METHODS: A total of 202 patients who underwent curative resection for biliopancreatic cancer were enrolled in the study. NKA levels were measured six times during the treatment period. We investigated whether there was any difference in postoperative NKA recovery according to the period-by-time NKA value. RESULTS: NKA decreased after surgery (mean, 40 pg/ml) compared to the NKA value at admission (200.2 pg/ml), then began to increase from 3 weeks after surgery (139.7 pg/ml) and rose to normal NKA levels at 5 weeks (217.1 pg/ml). The pattern of NKA changes was distinct according to the NKA values at admission. In multivariate analysis, NKA values of less than 250 pg/ml at admission (odds ratio = 5.898, p = 0.044) were a predictor of NKA recovery failure 5 weeks after surgery. CONCLUSIONS: NKA rapidly decreased after curative surgery for biliopancreatic cancer and recovered to normal levels about 5 weeks later. Clinicians should be aware and cautious that patients with low NKA at admission may fail to recover NKA postoperatively.

A life where concealment and exposure coexist-The antiretroviral therapy adherence of people living with HIV infection: A phenomenological study.

AIM: The aim of this study is to identify the nature and structure of the real world experiences of people living with HIV infection and adhering to antiretroviral therapy (ART). DESIGN: Giorgi's phenomenological method was applied. METHODS: Data collection was conducted from 1 November 2016-1 September 2017. A total of six participants participated in the study. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to report this study. RESULTS: The findings show that the structure of the experience of people living with HIV and adhering to ART is composed of six essential common constituents: (a) ART adherence has become a prerequisite for a normal life; (b) Endless adjustments responding to a sensitive body; (c) Dosing Time becomes the framework of the day; (d) Dosing time needing to coincide with the availability of confidential dosing space; (e) Classification of Relationships-those who know of my taking antiretroviral drugs and those who do not; and (f) Recognition of the multiple relationships affecting ART. CONCLUSION: Adhering to ART is experienced by people infected with HIV not only as a process they want to hide, but also a critical lifeline that stabilizes their lives. That is, their day-to-day living is split into a double life reflecting their coexisting need for concealment and exposure. IMPACT: Although much existing literature focuses on the adherence to medication, this study reveals the meaning of ART in the context of viewing the patient as an independent subject. Contrary with what people living with HIV want, they are at risk of external exposure during the process of treatment. This study highlights the need for nurses to communicate with patients about the strategies they need to meet the challenges they face.

Changes in total lymphocyte count and neutrophil-to-lymphocyte ratio after curative pancreatectomy in patients with pancreas adenocarcinoma and their prognostic role.

BACKGROUND AND OBJECTIVES: To assess the prognostic significance of postoperative changes in immune status represented by total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) in resectable pancreatic cancer. METHODS: Patients who underwent curative pancreatectomy for pancreatic adenocarcinoma were divided into high and low groups according to cut-off values of TLC, and NLR measured preoperatively, immediately after surgery, and 1 or 6 months after surgery. Oncologic outcomes were compared between the two groups at different times, and prognostic roles of TLC and NLR were evaluated. RESULTS: Of 193 patients, the median follow-up time was 22 months, and median survival was 18 months. Their immunologic status deteriorated within 3 to 4 days after the operation and recovered after that. At 1 and 6 months postoperatively, overall survival rates were significantly lower in the group with high NLR (>2.535 and >3.21, respectively) and low TLC (<1.66 × 109 and <1.62 × 109 /L, respectively). In multiple regression analyses, elevated NLR at postoperative 1 and 6 months and decreased TLC at postoperative 1 month were significant prognosis predictors. CONCLUSIONS: Changes in immune status such as decreased TLC and elevated NLR at postoperative 1 and 6 months are effective prognostic predictors after curative pancreatectomy in patients with pancreatic adenocarcinoma.

A Simplified Mortality Score Using Delta Neutrophil Index and the Thrombotic Microangiopathy Score for Prognostication in Critically Ill Patients.

BACKGROUND: This study was conducted to assess the prognostic value of a simplified mortality score (SMS) using the delta neutrophil index (DNI) and thrombotic microangiopathy (TMA) score, both easily obtained from the complete blood count, to identify critically ill patients at high risk of death. METHODS: This was a retrospective study performed in the medical ICU at Yonsei University College of Medicine from June 2015 to February 2016. The primary end point was 28-day all-cause mortality. Participants were divided into two groups: a training (n = 232) and a test (n = 57) set. We used Cox proportional-hazards analysis, Harrell's C index, and Kaplan-Meier survival analysis to derive the SMS and test its internal validity. RESULTS: We enrolled 289 patients. The 28-day mortality rate was 31.1% (n = 90). Nonsurvivors had higher APACHE II, SOFA, and TMA scores, and DNI. The SMS, derived by Cox proportional-hazards analysis, consisted of age, sex, DNI, and TMA score. We assigned a weighted point to each variable in the SMS, as follows: age + 11 if male + (2 × DNI) + (61 [TMA = 1], 76 [TMA = 2], 74 [TMA = 3], 26 [TMA = 4], 99 [TMA = 5]). Nonsurvivors had a higher median SMS than survivors, and the Harrell's C index was 0.660. Analysis of survival by risk group according to SMS (low, intermediate, high risk) showed a significant difference among these three groups (P < 0.001). We then investigated this SMS in the test set to determine internal validity; the results were similar to those of the training set. CONCLUSIONS: The SMS is a more rapid, simple prognostic score for predicting 28-day mortality and stratifying risk than the APACHE II or SOFA scores. However, external validation using a larger sample is needed.

20-Hydroxyeicosatetraenoic Acid (20-HETE) Modulates Canonical Transient Receptor Potential-6 (TRPC6) Channels in Podocytes.

The arachidonic acid metabolite 20-hydroxyeicosatetraenoic acid (20-HETE) regulates renal function, including changes in glomerular function evoked during tubuloglomerular feedback (TGF). This study describes the cellular actions of 20-HETE on cultured podocytes, assessed by whole-cell recordings from cultured podocytes combined with pharmacological and cell-biological manipulations of cells. Bath superfusion of 20-HETE activates cationic currents that are blocked by the pan-TRP blocker SKF-96365 and by 50 µM La(3+), and which are attenuated after siRNA knockdown of TRPC6 subunits. Similar currents are evoked by a membrane-permeable analog of diacylgycerol (OAG), but OAG does not occlude responses to maximally-activating concentrations of 20-HETE (20 µM). Exposure to 20-HETE also increased steady-state surface abundance of TRPC6 subunits in podocytes as assessed by cell-surface biotinylation assays, and increased cytosolic concentrations of reactive oxygen species (ROS). TRPC6 activation by 20-HETE was eliminated in cells pretreated with TEMPOL, a membrane-permeable superoxide dismutase mimic. Activation of TRPC6 by 20-HETE was also blocked when whole-cell recording pipettes contained GDP-ßS, indicating a role for either small or heterotrimeric G proteins in the transduction cascade. Responses to 20-HETE were eliminated by siRNA knockdown of podocin, a protein that organizes NADPH oxidase complexes with TRPC6 subunits in this cell type. In summary, modulation of ionic channels in podocytes may contribute to glomerular actions of 20-HETE.

Effects of loco regional treatments before living donor liver transplantation on overall survival and recurrence-free survival in South Korean patients with hepatocellular carcinoma.

BACKGROUND: We evaluated the effects of pre-transplant locoregional treatment on survival in living donor liver transplantation (LDLT), and the most accurate method for predicting survival after LDLT in patients who received pre-transplant locoregional treatment. METHODS: From December 2003 to December 2012, 234 patients underwent LDLT for hepatocellular carcinoma (HCC) at our transplant center. We retrospectively reviewed 86 patients newly diagnosed with HCC and who received pre-transplant locoregional treatments at our hospital. RESULTS: Of the 33 patients with HCC initially beyond the Milan criteria, 12 experienced successful down-staging after locoregional treatments, and the 5-year recurrence-free survival was 81.8%, which was comparable to those in patients with HCC initially within the Milan criteria. A bad responder according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) [HR, 4.874 (1.059-22.442), p = 0.042], and increased AFP levels [HR 4.002 (1.540-10.397), p = 0.004] during pre-transplant locoregional treatments were independent risk factors for HCC recurrence after LDLT in multivariate analysis. CONCLUSIONS: Liver transplantation may be considered after successful down-staging in patients with HCC initially beyond the Milan criteria. The mRECIST and serum AFP level changes are better selection criteria for LDLT in patients who have received locoregional treatments.

Predictive factors of impaired quality of life in Korean patients with inactive inflammatory bowel disease: association with functional gastrointestinal disorders and mood disorders.

BACKGROUND AND AIM: Inflammatory bowel disease is a chronic and relapsing inflammatory disorder of the intestine and has a great effect on patients' health-related quality of life (HRQOL). Some patients in remission are known to show functional gastrointestinal disorders (FGIDs) and mood disorders (MDs), which may also negatively impact HRQOL. The aim of this study was to evaluate predictors of impaired HRQOL in inactive inflammatory bowel disease (IBD) patients. METHODS: Patients presenting a long-standing remission during the previous year completed questionnaires of EuroQol, Rome III criteria for FGID, and Hospital Anxiety and Depression Survey. Demographic data including age, sex, employment status, education, smoking, and location of residence were also collected. RESULTS: Among the 513 patients with IBD, 226 (Crohn's disease 107 and ulcerative colitis 119, age 39.01±15.63, male 141) defined in remission were enrolled. Overall, 147 (65.0%) had at least 1 FGID with irritable bowel syndrome being the most common disorder (36.3%). Anxiety and depression were identified in 27.4% and 33.6%, respectively. Participants with FGID or MD had a significantly lower HRQOL status than those without disorders (P<0.01). Among various demographic and clinical variables, aged 40 or older [odds ratio (OR), 2.342; 95% confidence interval (CI), 1.195-4.590; P=0.01], irritable bowel syndrome (OR, 3.932; 95% CI, 1.937-7.982; P<0.01), and anxiety (OR, 2.423; 95% CI, 1.067-5.502; P=0.03) were significant independent predictors of impaired HRQOL in inactive IBD patients. CONCLUSIONS: FGID and MD are common in Korean quiescent IBD patients. Appropriate management should be administered according to age of patients and presence of concomitant FGID and MD to improve patients' HRQOL.

Accuracy of EUS for detection of intraductal papillary mucinous tumor of the pancreas.

BACKGROUND: Patients with intraductal papillary mucinous tumors of the pancreas (IPMT) present with symptoms similar to those of chronic pancreatitis. This study assessed the accuracy of EUS for detection of IPMT and identified features that discriminate IPMT from chronic pancreatitis. METHODS: EUS accuracy for detecting IPMT was determined with characteristic findings by endoscopic retrograde pancreatography as the reference standard. To determine EUS features characteristic of IPMT, EUS images from patients with IPMT were compared with those from patients (similar age, gender) with chronic pancreatitis. RESULTS: Thirty-eight patients (23 men, 15 women; age range 40-90 years) with IPMT were identified between 1994 and 2001. For EUS, the sensitivity was 86%, specificity 99%, positive predictive value 78%, and negative predictive value 99% for detection of IPMT. When compared with patients with chronic pancreatitis, the EUS features of dilation of pancreatic duct (89% vs. 42%, p < 0.0001), cysts (45% vs. 11%, p = 0.002), and pancreatic atrophy (32% vs. 3%, p = 0.002) were more common, whereas parenchymal features of chronic pancreatitis were less common with IPMT (21% vs. 97%, p < 0.0001). By multivariate analysis, the presence of no more than one parenchymal feature of chronic pancreatitis suggested the diagnosis of IPMT (odds ratio 43.84; 95% CI [4.13, 465.74]). CONCLUSIONS: EUS may be useful in the initial evaluation of patients suspected to have IPMT. Paucity of parenchymal features of chronic pancreatitis is important in differentiating IPMT from other causes of chronic pancreatitis.