Clinical outcome of patients infected with hepatitis C virus infection on survival after primary liver transplantation under tacrolimus

In 1994, as a result of both programme evaluations which identified students' fears and apprehensions about their practical ability, and a review of the literature on skill acquisition, experiential skills teaching was resumed within the faculty. Having invested considerable finance into the reconstruction of a skills centre to teach skills, it is now imperative that its use be formally evaluated. Part of the evaluative process includes a review of the empirical literature on the acquisition of psychomotor skills in nursing. This paper summarizes this review.     

Sediment Delivery Assessment for a Transboundary Mediterranean Catchment: The Example of Nestos River Catchment

Nestos River flows through Bulgaria and Greece and discharges into the North Aegean Sea. Its total catchment area is around 6,200 km², while the mean annual precipitation and runoff are 680 mm and 40 m³/s, respectively. The Hellenic part of the catchment has undergone a substantial hydroelectric development, since two dams associated with major hydropower pumped-storage facilities are in operation. The main objective of the paper is to assess the expected sediment delivery of Nestos R. at the uppermost Thisavros reservoir site. This has been carried out by implementing the Universal Soil Loss Equation in a GIS environment for determining the mean annual soil erosion in conjunction with a suspended sediment measurement program (114 measurements in total) accomplished between 1965 and 1983 adjacent to the dam site. The sediment discharge rating curve between sediment and river discharges in a power form has been constructed using five alternative techniques, namely (a) the linear regression of the log-transformed variables, (b) the same as (a) but with the Ferguson correction, (c) different ratings for the dry and wet seasons of the year, (d) the nonlinear regression, and (e) the broken line interpolation that utilizes different rating parameters for two discharge classes. It is shown that the mean annual sediment yield is almost equal for all rating curve formulations and varies between 178.5 t km⁻² and 203.4 t km⁻² and the highest value results from the broken line interpolation method. Accordingly, the sediment delivery ratios vary slightly between 17% and 19% of the upstream soil erosion.     

Water demand management: implementation principles and indicative case studies

Current practices for the efficient use and management of water resources are based on the conjunctive application of water supply and demand measures. Even though options for the augmentation of water supply are widely analysed and assessed, water demand management remains an open field for study, as it is highly dependent on the socio‐economic features of a region and has a site‐specific character. This paper summarizes the guiding principles of demand management and presents some successful application examples of demand management measures from regions that cover a wide range of socioeconomic and environmental conditions in an effort to identify the critical factors for the efficient planning and implementation of demand management plans.     

Acute hepatic allograft rejection: incidence, risk factors, and impact on outcome

Hepatic allograft rejection remains an important problem following liver transplantation, and, indeed, complications related to the administration of immunosuppressive therapy remain a predominant cause of posttransplantation morbidity and mortality. The Liver Transplantation Database (LTD) was used to study a cohort of 762 consecutive adult liver transplantation recipients and determined the incidence, timing, and risk factors for acute rejection. We also evaluated the impact of histological severity of rejection on the need for additional immunosuppressive therapy and on patient and graft survival. Four hundred ninety (64%) of the 762 adult liver transplantation recipients developed at least one episode of rejection during a median follow-up period of 1,042 days (range, 336-1,896 days), most of which occurred during the first 6 weeks after transplantation. Multivariate analysis revealed that recipient age, serum creatinine, aspartate transaminase (AST) level, presence of edema, donor/recipient HLA-DR mismatch, cold ischemic time, and donor age were independently associated with the time to acute rejection. An interesting observation was that the histological severity of rejection was an important prognosticator: the use of antilymphocyte preparations was higher, and the time to death or retransplantation was shorter, for patients with severe rejection. Findings from this study will assist in decision-making for the use of immunosuppressive regimens and call into question whether complete elimination of all rejection or alloreactivity is a desirable goal in liver transplantation.     

Dynamic behavior of hepatitis C virus in chronically infected patients receiving liver graft from infected donors

We studied the outcome of hepatitis C virus (HCV) infection in 14 patients with end-stage HCV-related liver disease who received HCV-positive liver allografts. Viral sequences specific for donor and recipient were established by direct sequencing of PCR products from the NS5 region and by single-strand conformation polymorphism. Within a few months after transplantation the donor strain took over the recipient strain in 8 patients while in 6 patients it was the recipient strain which ultimately prevailed. Donor and recipient were infected by identical genotypes in 6 donor/recipient pairs and by different genotypes in the remaining 8 pairs. Subtype 1b and type 1 (1a + 1b) became the predominant strains in all recipient/donor pairs in which they were present. Patients retaining their own strain were found to have significantly more active liver disease than those infected by the donor strain. We show that HCV superinfection and overtake phenomena occur in humans and suggest that genotypes 1b and 1 (1a + 1b) may possess replicative advantages over other genotypes. Furthermore, we provide evidence of the existence of interference preventing simultaneous continuous infection even by the same genotype strains. The development of active liver disease associated with recipient strain infection and mild or no disease associated with infection from the donor suggests various pathogenic abilities of different HCV strains.     

Gestational diabetes mellitus enhances arachidonic and docosahexaenoic acids in placental phospholipids

In previous studies, we reported that neonates of women with gestational diabetes mellitus (GDM) have reduced blood levels of arachidonic acid (AA) and docosahexaenoic acid (DHA) that were unrelated to maternal status. Since both AA and DHA are selectively transferred from maternal to fetal circulation by the placenta, we have investigated whether the FA composition of the placenta is altered by GDM. Thirty-six women, 11 with and 25 without GDM, were recruited from Newham General Hospital, London. The women with GDM had higher levels of di-homo-γ-linolenic (P<0.05), docosate-traenoic (n-6 DTA; P<0.0001), docosapentaenoic n-6 (P<0.005), total n-6 (P<0.005), docosapentaenoic (n-3 DPA; P<0.005), and total n-3 (P<0.01) FA, as well as higher levels of AA (P<0.05) and DHA (P<0.01), in placental choline phosphoglycerides (CPG) compared with the healthy women who served as controls. Similarly, the women with GDM had elevated n-6 DTA (P<0.005), AA, total n-6 metabolites (P<0.05), DHA, total n-3 metabolites, and total n-3 FA (P<0.005) in ethanolamine phosphoglycerides (EPG). In contrast to CPG and EPG, the placental TG of the women with GDM had higher linoleic acid (P<0.05) and lower AA, n-6 metabolites, and n-3 DPA (P<0.01). The placenta is devoid of desaturase activity, and it is thought to be reliant on maternal circulation for both AA and DHA. Hence, the enhanced levels of the two FA in the placenta of the GDM group suggests that these FA are taken up from the maternal circulation and retained after esterification into phosphoglycerides instead of being transferred to the fetus. Further study is needed to elucidate the mechanism involved and the effect of the phenomenon on postnatal growth and development of the offspring.     

Evaluating the land use patterns of medium-sized Hellenic cities

Land use morphology has profound effects both on city functions and peri-urban areas. They can either lead to conflicts with negative side effects or generate positive synergies. This study focuses on land use spatial configurations and interprets the interactions among them. In order to evaluate spatial planning policies, the measurement of urban land use patterns is considered to play an important role in the urban development process and deserves further attention. A comparative analysis of the land use patterns of the medium-sized Hellenic cities is attempted, there are also used using pre-existing metrics, some new data from the European Environment Agency Urban Atlas 2006 geodataset and population and construction census data concerning the last decade from the national Hellenic Statistical Authority data set. The Larger Urban Zones of the medium-sized Hellenic cities are chosen as a suitable study level based both on population size and socio-spatial procedures. The results provide interesting information about the diversification among medium-sized cities, while some particularities concerning urban procedures appear to emerge for some of them. Many discussion points arise from this study concerning the data availability, the method, the functional city area delineation and the Larger Urban Zones definition.     

Adult heart transplantation under tacrolimus (FK506) immunosuppression: histopathologic observations and comparison to a cyclosporine-based regimen with lympholytic (ATG) induction

BACKGROUND: Tacrolimus (FK506) is an effective immunosuppressant for human heart transplantation, but information about its effects on cardiac allograft and nonallograft kidney and liver histopathologic study is limited. METHODS: We therefore reviewed 1145 endomyocardial biopsy specimens and eight autopsy results from 80 heart transplant recipients who received tacrolimus as baseline immunosuppression. These were compared with 619 endomyocardial biopsy specimens and four autopsy results from 51 patients treated with cyclosporine-based immunosuppression with lympholytic induction (CLI) by use of rabbit anti-thymocyte globulin. Twenty-one histologic features including the International Society for Heart and Lung Transplantation histopathologic grade were retrospectively assessed without knowledge of the treatment regimen. The lymphocyte growth index on biopsy specimens obtained from these patients was also compared. RESULTS: In general, there were no qualitative differences in the histopathologic appearance of various allograft syndromes between tacrolimus- and CLI-treated patients. Thus histopathologic criteria used to diagnose various graft syndromes are applicable under tacrolimus immunosuppression. However, early (between 10 and 30 days) after transplantation, biopsy specimens from patients treated with tacrolimus showed a significantly higher percentage of inflamed fragments (p = 0.02), the inflammation tended to be more severe (p = 0.09), and the rejection grade tended to be slightly higher (p = 0.08). In contrast, during the late transplantation period (275 to 548 days), biopsy specimens from patients treated with CLI showed a significantly higher percentage of inflamed fragments (p = 0.03), more severe inflammation (p = 0.03), higher rejection grades (p = 0.01), and a higher frequency of Quilty lesions (p = 0.05). Although overall freedom from any grade 3A or higher rejection was greater in the CLI-treated arm, tacrolimus was successfully used to treat refractory rejection in three patients from the CLI-treated arm. Concern has been raised in the literature about the possibility of tacrolimus being a direct hepatotoxin and an accelerant of allograft obliterative arteriopathy. However, no evidence to support either of these contentions was detected in this patient population. In contrast, tacrolimus is clearly nephrotoxic, although similar to cyclosporine in this regard. CONCLUSIONS: Tacrolimus is an effective immunosuppressive drug for heart transplantation. The cardiac allograft histopathologic study of patients treated with tacrolimus immunosuppression does not significantly differ from those given conventional, cyclosporine-based triple therapy with lympholytic induction.     

Role of splenectomy in human liver transplantation under modern-day immunosuppression

Between January 1987 and October 1991, 1466 patients underwent consecutive Orthotopic Liver Transplantation (OLTx) at the University of Pittsburgh. Forty of these patient's had concomitant splenectomy with OLTx. These patients were compared to 147 randomly selected OLTx patients without splenectomy within the same time period. One-year patient and graft survival (PS and GS) were lower in splenectomized (Splx) patients compared to nonsplenectomized (non-Splx) patients (59% vs 86% PS, 55% vs 80% GS, respectively). One-month and one-year patient mortality in the Splx group was higher than in the non-splx patients (20% vs 3.4%, P < 0.001 for one month; 40% vs 14.3%, P = 0.003 for one year, respectively). One-month and one-year sepsis-related mortality was also high in Splx patients (17.5% vs 2.7%, P = 0.0022, for one month, and 30% vs 11.5%, P = 0.0043, for one year, respectively). We conclude that concomitant splenectomy with OLTx has a significantly higher patient mortality mainly due to its septic complications and, at present, unless there is a specific indication for a splenectomy, the routine addition of this procedure to liver allograft surgery would not be recommended.     

Monitoring urban sprawl using simulated PROBA-V data

Urbanization proceeds currently at a rapid pace and the impact on natural ecosystems cannot be neglected. Consequently, it is important to be able to monitor the expansion of urban areas. Yet the process of extracting them from satellite imagery is not trivial. Urban is a non-uniform class with spectral proximity to barren land. In this article, a method for extracting urban areas from medium-resolution Earth observation data is presented. The information source is simulated data of the PROBA-V sensor. Visual and near-infrared bands are classified by the adaptive neuro-fuzzy inference system (ANFIS) neuro-fuzzy classifier into urban and non-urban classes. The method can overcome the main difficulty in similar efforts, i.e. the extensive commission errors of barren to the class urban. The main novelty relies on exploiting annual spectral variability of each land-use class at the pixel level. The basic assumption is that urban and barren areas may have similar spectral values but they have different phenological cycles. The overall accuracy obtained by the classification is 91.57% with a Cohen’s kappa coefficient (khat) of 0.84. Sufficient correlation at the city level is also achieved. Change detection is also possible in terms of hot-spot identification, however marginally suitable for medium-sized cities.