Non-therapy Group Research Articles

Impact of preoperative antiplatelet / anticoagulant therapy on postoperative bleeding rate in anorectal surgery. Analysis of a high-volume proctologic and pelvic floor clinical center

IntroductionThe aim of the present study is to analyze the impact of preoperative antiplatelet and/or anticoagulant therapy on postoperative bleeding in proctologic surgery. Material and MethodsA retrospective study was conducted on a consecutive series of patients who underwent to proctologic surgery between January 2016-December 2018. The patients were divided in two groups: non-therapy group without any cardiovascular problem and therapy group that received antiplatelet and/or anticoagulant therapy. A sub analysis was carried out stratifying the patients according to the type of preoperative therapy and the type of surgery. ResultsA total of 1832 operated patients were collected; 8.7 % of them received antiplatelet or anticoagulant therapy preoperatively. The postoperative bleeding rate was 2.8 % (2.1 % in the non-therapy group, and 10.1 % in the therapy group). The re-operation rate after bleeding was 1.2 % (1.1 % of non-therapy group, and 3.1 % therapy group). The re-operation rate in patients with postoperative bleeding was 51.4 % and 31.3 % for therapy and non-therapy group, respectively. The interval time between surgery and bleeding, was 7.8 days (non-therapy) and 8.5 days (therapy). Hemorrhoid's surgery showed to have the higher postoperative bleeding rate. The use of DOACs and OAC showed the highest rates of bleeding (20 % vs 36.4 %). ConclusionThe constant increase of patients with antiplatelet/anticoagulant treatment requiring surgery for benign diseases reveals a significant increase the post-operative risk of bleeding. The management of these complex patients needs to be discussed in a multidisciplinary team with the aim to follow shared guidelines but also to customize the approach.

PO-05-061 RIGHT VENTRICULAR SYSTOLIC FUNCTION ON MRI IS RELATED TO APPROPRIATE ICD THERAPY

Right ventricular function is recently referred as an independent predictor of sudden cardiac death (SCD). The purpose of this study was to evaluate the association of right ventricular ejection fraction (RVEF) on magnetic resonance imaging (MRI) and appropriate ICD therapy. Consecutive patients who underwent initial ICD implantation for any diseases except for non-dilated phase hypertrophic cardiomyopathy and channelopathy were retrospectively enrolled from 2012 to 2018 and were followed up on appropriate ICD therapy and death. We enrolled patients who underwent MRI before ICD implantation. RVEF, RV radial strain, RV circumferential strain (RVCS), RV 4 chamber transmural strain and RV 4 chamber longitudinal stain were evaluated to investigate the association with appropriate ICD therapy. RVEF was analyzed on the software (MR Multi-Chamber Wall Motion Tracking, Canon). In total, 97 patients (58.5±14.5 years, 69 males) including 20 ischemic cardiomyopathy were enrolled. Fifty-one patients received an ICD as a secondary prophylaxis. Mean LVEF and RVEF were 37.4±14.5% and 36.2±12.6%, respectively. There was no correlation between RVEF and LVEF (correlation coefficient =0.36). Regarding appropriate ICD therapy events, the best cut-off value of RVEF was 43.0%. The hazard ratio (HR) of low RVEF was 9.601 (95%CI: 1.287-71.6, P=0.027). Secondary prophylactic cohort with low RVEF showed highest incidence of appropriate ICD therapy as shown in the figure. In multivariate analysis about RVEF and RV strain, low RVEF and RVCS were independent predictors of appropriate ICD therapy (RVEF:HR 12.4, 95%CI:1.51-101, P=0.019 and circumferential strain: HR 0.8, 95%CI:0.76-0.98, P=0.021). RVCS in appropriate ICD group (-11.1±4.6%) was lower than RVCS in non-therapy group (-7.0±11.7%). Low RVCS predicted higher incidence of appropriate ICD therapy. Low RVEF was associated with increased appropriate ICD therapy.

The Insignificant Correlation between Androgen Deprivation Therapy and Incidence of Dementia Using an Extension Survival Cox Hazard Model and Propensity-Score Matching Analysis in a Retrospective, Population-Based Prostate Cancer Registry.

Simple SummaryThis study shows the insignificant effect of the duration of androgen-deprivation therapy on the incidence of dementia in patients with prostate cancer from population-based data. We found that, despite an overall lower incidence of dementia in the androgen-deprivation-therapy group compared to the non-therapy group, there were no significant correlations between androgen-deprivation therapy and the prevalence of individual dementia subtypes in patients with prostate cancer. This demonstrates that patients with old age, obesity, regional SEER stage, a history of cerebrovascular disease, and a high Charlson Comorbidity Index were at increased risk for dementia.This study aims to evaluate the effect of androgen-deprivation therapy (ADT) on the incidence of dementia, after considering the time-dependent survival in patients with prostate cancer (PC) using a Korean population-based cancer registry database. After excluding patients with cerebrovascular disease and dementia before or within the 3-month-ADT and those with surgical castration, 9880 (19.3%) patients were matched into ADT and non-ADT groups using propensity-score matching (PSM) among 51,206 patients registered between 2006 and 2013. To define the significant relationship between ADT duration and the incidence of dementia, the extension Cox proportional hazard model was used with p-values < 0.05 regarded as statistically significant. The mean age and survival time were 67.3 years and 4.33 (standard deviation [SD] 2.16) years, respectively. A total of 2945 (9.3%) patients developed dementia during the study period, including Parkinson’s (11.0%), Alzheimer’s (42.6%), vascular (18.2%), and other types of dementia (28.2%). Despite PSM, the PC-treatment subtypes, survival rate, and incidence of dementia significantly differed between the ADT and non-ADT groups (p < 0.05), whereas the rate of each dementia subtype did not significantly differ (p = 0.069). A multivariate analysis for dementia incidence showed no significance of ADT type or use duration among patients with PC (p > 0.05), whereas old age, obesity, regional SEER stage, a history of cerebrovascular disease, and a high Charlson Comorbidity Index were significant factors for dementia (p < 0.05). Insignificant correlation was observed between ADT and the incidence of dementia based on the extension survival model with PSM among patients with PC.

Metastatic Pattern Discriminates Survival Benefit of Type of Surgery in Patients With De Novo Stage IV Breast Cancer Based on SEER Database.

Background: The role of surgery and surgery type in de novo stage IV breast cancer (BC) is unclear.Methods: We carried out a retrospective cohort study that included the data of 4,108 individuals with de novo stage IV BC abstracted from SEER (Surveillance, Epidemiology, and End Results) data resource from 2010 to 2015. The patients were stratified into the non-surgery group, breast-conserving (BCS) surgery group, and mastectomy group. Inverse probability propensity score weighting (IPTW) was then used to balance clinicopathologic factors. Overall survival (OS), as well as the breast cancer-specific survival (BCSS), was assessed in the three groups using Kaplan–Meier analysis and COX model. Subgroups were stratified by metastatic sites for analysis.Results: Of the 4,108 patients, 48.5% received surgery and were stratified into the BCS group (574 cases) and mastectomy group (1,419 cases). After IPTW balance demographic and clinicopathologic factors, BCS and mastectomy groups had better OS (BCS group: HR, 0.61; 95% CI: 0.49–0.75; mastectomy group: HR, 0.7; 95% CI: 0.63–0.79) and BCSS (BCS group: HR, 0.6; 95% CI, 0.47–0.75; mastectomy group: HR, 0.71; 95% CI, 0.63–0.81) than the non-therapy group. Subgroup analyses revealed that BCS, rather than mastectomy, was linked to better OS (HR, 0.66; 95% CI: 0.48–0.91) and BCSS (HR, 0.63; 95% CI: 0.45–0.89) for patients with bone-only metastasis. For patients with viscera metastasis or bone+viscera metastases, BCS achieved similar OS (viscera metastasis: HR, 1.05; 95% CI: 0.74–1.48; bone+viscera metastases: HR, 1.01; 95% CI: 0.64–1.61) and BCSS (viscera metastasis: HR, 0.94; 95% CI: 0.64–1.38; bone+viscera metastases: HR, 1.06; 95% CI: 0.66–1.73) in contrast with mastectomy.Conclusions: Local surgery for patients with distant metastasis (DS) exhibited a remarkable survival advantage in contrast with non-operative management. BCS may have more survival benefits for patients with de novo stage IV BC with bone-only metastasis than other metastatic sites. Decisions on de novo stage IV BC primary surgery should be tailored to the metastatic pattern.

Preemptive Bundle Therapy for Subclinical Pulmonary Hypertension After Liver Transplant.

After liver transplant, veno-occlusive disease and infectious complications may result from subclinical pulmonary hypertension. In this retrospective study, we investigated whether our preemptive bundle therapy was effective for subclinical pulmonary hypertension and extrasinusoidal platelet aggregation after liver transplant. After January 2014, nutrition therapy with glutamine, synbiotics, phosphodiesterase 3 inhibitors, prostaglandin E1, prostaglandin I2, closedloop artificial pancreas, and sivelestat has been used to reduce bacterialtranslocation, vascular endothelial cell damage, and extrasinusoidal platelet aggregation, which is administered as preemptive bundle therapy for all livertransplantrecipients. In this study, we evaluated the prognosis of 84 liver transplant recipients who underwent liver transplants through 2018. Subclinical pulmonary hypertension was evaluated in 49 adult liver transplant recipients with an evaluable main pulmonary artery trunk cross-sectional area using enhanced computed tomography in the acute phase after transplant, with 14 of these patients receiving preemptive bundle therapy. Subclinical pulmonary hypertension was reduced in the preemptive bundle therapy group (n = 14) compared with the nontherapy group (n = 35). The preemptive bundle therapy group showed more rapid recovery of platelet, prothrombin time, and bilirubin levels afterlivertransplant compared with the nontherapy group. The prognosis of patients in the preemptive bundle therapy group was significantly better than in the nontherapy group. Extrasinusoidal platelet aggregation was significantly lower in the preemptive bundle therapy group than in the nontherapy group. Preemptive bundle therapy reduced sinusoidal endothelial cell injury, extrasinusoidal platelet aggregation, and subclinical pulmonary hypertension after liver transplant, resulting in good posttransplant recovery.

Research on the Role of Combined Chemotherapy and Radiotherapy in Patients With N+ Non-Metastatic Metaplastic Breast Carcinoma: A Competing Risk Analysis Model Based on the SEER database, 2000 to 2015.

PurposeDue to the rarity of metaplastic breast carcinoma (MpBC), no randomized trials have investigated the role of combined chemotherapy and radiotherapy (CCRP) in this condition. We aimed to explore and identify the effectiveness of CCRP in patients with regional lymph node metastasis (N+) non-metastatic MpBC.Materials and MethodsData were obtained from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program database. We assessed the effects of CCRP on overall survival (OS), breast cancer-specific survival (BCSS), and breast cancer-specific death (BCSD) using Kaplan-Meier analysis, competing risk model analysis, and competing risk regression mode analysis.ResultsA total of 707 women and 361 death cases were included in the unmatched cohort, of which 76.45% (276/361) were BCSD, and 23.55% (85/361) were non-breast cancer-specific deaths (non-BCSD). Both the ChemT and CCRP groups had better OS (ChemT group: HR: 0.59, 95% CI: 0.45–0.78, P<0.001; CCRP group: HR: 0.31, 95% CI: 0.23–0.41, P<0.001) and BCSS (ChemT group: HR: 0.63, 95% CI: 0.45–0.87, P<0.001; CCRP group: HR: 0.32, 95%CI: 0.22–0.46, P<0.001) than the non-therapy group. Subjects in the CCRP group tended to have significantly lower cumulative BCSD (Gray’s test, P=0.001) and non-BCSD (Gray’s test, P<0.001) than the non-therapy group or ChemT group. In competing risk regression model analysis, subjects in the CCRP group had a better prognosis in BCSD (HR: 0.710, 95% CI: 0.508–0.993, P=0.045) rather than the ChemT group (HR: 1.081, 95% CI: 0.761–1.535, P=0.660) than the non-therapy group.ConclusionOur study demonstrated that CCRP could significantly decrease the risk of death for both BCSD and non-BCSD and provided a valid therapeutic strategy for patients with N+ non-metastatic MpBC.

Progression of Carotid Plaque Among Postmenopausal Asymptomatic Women: A Prospective Observational Population-based Follow-up Study

Introduction: The most frequent underlying mechanism of CVD is universal atherosclerotic vascular disease. Atherosclerosis in the carotid arteries (carotid plaque=CP) are often present without symptoms. Despite this, present of CP has previously been shown to predict future CVD events. Data on progression and development of CP over time remains sparse, especially among women. Simultaneous, more strokes are seen in women than men and along an increasing incidence of CVD due to longer life expectancy of women. This study examines the CP progression of screening-detected CP among postmenopausal women and evaluates adherence to the recommended prophylactic medical therapy after screening-detected CP 6 years ago. Methods: Between 2011 and 2013, a combined cardiovascular screening programme including 1474 60 to77 year-old asymptomatic women (attendance rate 74.3%) was conducted. CP was detected in 601 women (40.8%), who all were recommended prophylactic anti-platelet and lipid-lowering therapy. These 601 women were re-invited to a follow-up screening 6 years after the primary screening. The carotid intima media thickness and plaque progression were examined by ultrasonography. CP was measured from leading edge observed in the lumen echo to its most protruding part within the lumen. The anatomic placements described: common carotid arteries, bulb of the common carotid arteries, internal carotid arteries and external carotid arteries. Positive findings resulted in recommendation of prophylactic medical therapy (75 mg acetylsalicylic acid and 20 mg atorvastatin). Self-reported questionnaires regarding current medication were used to determine whether the participants were adherent to the recommendation concerning prophylactic medical therapy from the primary screening. Results: In total, 559 women (38 died and 4 were lost to follow-up) were invited, and 417 (74.6%) participated. The mean follow-up duration was 5.8 years (SD ±0.33; range 5.3 to 6.7 years). A tendency for plaque progression was observed at all investigated anatomical sites. The largest progression (0.66mm) was seen in the left common carotid artery (from 0.39mm to 1.05mm; p=0.000, 95% CI: 0.38-0.93). When stratifying for +/- prophylactic lipid-lowering therapy during the 6-year period, plaque progression was observed in both groups with a greater progression in the non-therapy group (ex: CP internal carotid; progression with lipid lowering therapy 0.37 mm versus 0.77 mm without lipid lowering therapy). No regression of CP was observed. 248 (59.5%) women had been adherent to the recommended lipid-lowering therapy and 247 (59.2%) to anti-platelet therapy. When combining the women already in prophylactic therapy and women accepting therapy after the follow-up screening, lipid-lowering therapy were accepted by 101 women (prophylactic coverage of 83.9%) and Anti-platelet were accepted by 119 women (prophylactic coverage of 87.8%). Conclusion: CP progressed over time in all examined sites in the carotid artery. Stratifying for lipid-lowering therapy between primary screening and follow-up showed a more prominent CP progression in the non-therapy group compared with the lipid-lowering group. Medication adherence to relevant prophylactic therapy 6 years after CP detection was approximately 60% increasing to approximately prophylactic coverage of 85% after re-scanning. This identified hesitation concerning prophylactic medical therapy needs to be addressed in future studies. Disclosure: Nothing to disclose

EFFECT OF PSYCHOTHERAPY ON DEPRESSED PATIENTS WITH CORONARY ARTERY DISEASE (CAD)

Objectives: To see the effects of psychotherapy in depressed patients withcoronary artery disease (CAD) Methodology: This was a randomized clinical trial conducted in Preventivesection, Cardiology department, Lady Reading Hospital, Peshawar from March2018 to October 2018. Verbal informed consent was taken from patients.Patients from both genders and all ages were included. Patients were randomlyallocated to therapy group and non-therapy group. In therapy group, treatmentplan based on cognitive behavioral therapy techniques, were administered tosubjects. There were six session in total, two every week. The subjects in nontherapygroup received routine care. After completing the sessions, the subjectswere reassessed by PHQ-9 to see improvement in the level of depression. Datais presented as frequency, mean and standard deviation calculated for eachvariable. Paired T test was used to compare continuous data and Chi-square forcategorical variables. Results: A total of 1100 patients with CAD presenting to cardiology departmentwere enrolled. Out of these 1100 patients, 272 post MI patients diagnosed with ofdepression on PHQ- 9 were selected for the study.. A sample of 260 subjects whomet the inclusion criteria was analyzed Therapy group had 125 subjects andnon-therapy group had 135 subjects. Mean age was 57.07±13.07. Males were43% and females 57%. Of total literate were 33%, hypertension was documentedin 52.3 %, diabetes in 31.2%, and Current smokers were 21.2 %. At baseline thePHQ scores were 10.08±1.68 in therapy group and 10.10±1.49 in non-therapygroup respectively (p =0.783). After six sessions of treatment, therapy groupshowed reduction in level of depression PHQ-9 scores to 6.04±0.347 PHQscores were 10.08±1.68 in therapy group and 10.10±1.49 in non-therapygroup (p 0.783) at the baseline (p≤0.001), In non therapy group the level ofdepression did not reduce significantly. Conclusion: Psychotherapy was found to be effective treatment in reducingsymptoms of depression. Key Words: CAD, Depression, PHQ-9, Psychotherapy

Influence of periodontitis and scaling and root planing on insulin resistance and hepatic CD36 in obese rats

The aim of the study was to explore the influence of periodontitis and scaling and root planing (SRP) on insulin resistance and hepatic CD36 in obese rats with periodontitis. Thirty-two specific pathogen free Sprague-Dawley rats were randomly divided into four groups of eight animals each as follows: healthy rats (healthy group), obese rats (obesity group), obese rats with periodontitis (non-therapy group), and obese rats with periodontitis who underwent periodontal SRP (therapy group). Rats were fed with a high-fat diet for 16weeks to build an obesity model. Periodontal inflammation was induced by performing periodontal ligation with Porphyromonas gingivalis. The tissue around the maxillary second molars, bilaterally, were collected. The periodontal attachment level (from the cemento-enamel junction to the bottom of the periodontal pocket) of the second molars was measured in all groups. All rats were subjected to fasting blood glucose, insulin, and serum C-reactive protein tests (CRP). Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR), oral glucose tolerance test (OGTT), and area under the curve (AUC). The liver was excised to detect intrahepatic free fatty acid (FFA) levels and pathologic observation. Real-time quantification PCR, western blot, and immunohistochemistry were applied to detect hepatic CD36 expression. Compared with the obesity group, HOMA-IR, AUC, intrahepatic FFA, and protein expression, and mRNA levels of hepatic CD36 in the non-therapy group were significantly increased (P<0.05). HOMA-IR, AUC, CRP, protein expression, and mRNA levels of hepatic CD36 were all significantly decreased (P<0.05) 2-weeks after SRP. Periodontitis increases insulin resistance while scaling and root planning could improve insulin resistance. Hepatic CD36 regulation may be considered a potential mechanism for this phenomenon.

Nephroprotective effects of enalapril after [177Lu]-DOTATATE therapy using serial renal scintigraphies in a murine model of radiation-induced nephropathy.

BackgroundRadiation-induced nephropathy is still dose limiting in radionuclide therapy of neuroendocrine tumors. We investigated the nephroprotective potential of the angiotensine converting enzyme inhibiting drug enalpril after [177Lu]-DOTATATE therapy in a murine model of radiation-induced nephropathy by renal scintigraphy.At first, the appropriate therapy activity to induce nephropathy was identified. Baseline scintigraphy (n = 12) entailed 12-min dynamic acquisitions after injection of 25 MBq [99mTc]-MAG3, which was followed by radionuclide therapy at four escalating activities of [177Lu]-DOTATATE: group (Gp) 1: 10 MBq; Gp 2: 20 MBq; Gp 3: 40 MBq; Gp 4: 65 MBq. Follow-up [99mTc]-MAG3 scintigraphy was carried out at days 9, 23, 44, and 65. The treatment activity for the intervention arm was selected on the basis of histological examination and declining renal function. In the second part, daily administration by gavage of 10 mg/kg/d enalapril or water (control group) was initiated on the day of radionuclide therapy. Follow-up scintigraphy was carried out at days 9, 23, 44, 65, and 86. We also created a non-therapy control group to detect therapy-independent changes of renal function over time. For all scintigraphies, mean renogram curves were analyzed and the “fractional uptake rate” (FUR; %I.D./min ± SEM) of the tracer by the kidneys was calculated as an index of renal clearance.ResultsAt day 65 of follow-up, no significant change in the FUR relative to baseline (11.0 ± 0.3) was evident in radionuclide therapy groups 1 (11.2 ± 0.5) and 2 (10.1 ± 0.6), but FUR was significantly reduced in groups 3 (8.93 ± 0.6, p < 0.05) and 4 (6.0 ± 0.8, p < 0.01); we chose 40 MBq [177Lu]-DOTATATE (Gp 3) for the intervention study. Here, at the last day of follow-up (day 86), FUR was unaltered in enalapril-treated mice (11.8 ± 0.5) relative to the baseline group (12.4 ± 0.3) and non-therapy group (11.9 ± 0.8), whereas FUR in the control group had undergone a significant decline (9.3 ± 0.5; p < 0.01). Histological examination revealed prevention of kidney damage by enalapril treatment.ConclusionsTreatment with enalapril is effective for nephroprotection during radionuclide therapy with [177Lu]-DOTATATE in mice. Although these results are only limitedly transferable to human studies, enalapril might serve as a promising drug in the mitigation of nephropathy following treatment with [177Lu]-DOTATATE.Electronic supplementary materialThe online version of this article (doi:10.1186/s13550-016-0219-2) contains supplementary material, which is available to authorized users.

Molecular targeting therapy using bevacizumab for peritoneal metastasis from gastric cancer

To clarify the significance of vascular endothelial growth factor (VEGF) in peritoneal metastasis from gastric cancer, using the gastric cancer cell line MKN-45 compared with the high potential peritoneal dissemination gastric cancer cell line MKN-45P. The supernatant of culture medium of MKN-45 cells or MKN-45P cells was collected and the concentrations were measured of various cytokines, matrix metalloproteinases, growth factor and angiogenic factors, including VEGF. We performed an initial pilot study to explore whether bevacizumab, a humanized monoclonal antibody against VEGF, had any suppressive effect on the peritoneal dissemination from gastric cancer in an experimental nude mouse model of peritoneal metastasis. The concentrations of interleukin-6 (IL-6), IL-8, VEGF and matrix metalloproteinase-2 protein in the culture supernatant were each significantly higher than each of those for MKN-45. In the in vivo study, the volume of ascites and the mitotic index were significantly lower in the therapy group than in the non-therapy group. The survival curve of the therapy group was significantly higher than that of the non-therapy group. These results suggested that VEGF was correlated with peritoneal metastasis from gastric cancer. Findings suggested that bevacizumab for inhibiting VEGF could suppress peritoneal dissemination from gastric cancer.

SUBCLINICAL PSYCHOTIC EXPERIENCES AND AFFECTIVE DYSREGULATION IN ADOLESCENTS AND YOUNG ADULTS

Although persistent developmental stuttering is known to affect daily living, just how great the impact is remains unclear. Furthermore, little is known about the underlying mechanisms which lead to a diminished quality of life (QoL). The primary objective of this study is to explore to what extent QoL is impaired in adults who stutter (AWS). In addition, this study aims to identify determinants of QoL in AWS by testing relationships between stuttering severity, coping, functioning and QoL and by testing for differences in variable scores between two AWS subgroups: receiving therapy versus not receiving therapy. A total of 91 AWS filled in several questionnaires to assess their stuttering severity, daily functioning, coping style and QoL. The QoL instruments used were the Health Utility Index 3 (HUI3) and the EuroQoL EQ-5D and EQ-VAS. The results indicated that moderate to severe stuttering has a negative impact on overall quality of life; HUI3 derived QoL values varied from .91 (for mild stuttering) to .73 (for severe stuttering). The domains of functioning that were predominantly affected were the individual's speech, emotion, cognition and pain as measured by the HUI3 and daily activities and anxiety/depression as measured by the EQ-5D. AWS in the therapy group rated their stuttering as more severe and recorded more problems on the HUI3 speech domain than AWS in the non-therapy group. The EQ-VAS was the only instrument that showed a significant difference in overall QoL between groups. Finally, it was found that the relationship between stuttering severity and QoL was influenced by the individual's coping style (emotion-oriented and task-oriented). These findings highlight the need for further research into stuttering in relation to QoL, and for a broader perspective on the diagnosis and treatment of stuttering, which would take into consideration quality of life and its determinants.Learning outcomes: Readers will be able to: (1) Understand how the Wilson and Cleary (1995) model of quality of life could be applied to comprehensively assess the quality of life in adults who stutter, (2) describe how health related quality of life is impaired in adults who stutter, (3) mention affected domains of functioning that are related to health related quality of life impairment in adults who stutter, (4) describe the relationship between stuttering severity, functioning, coping and health related quality of life in adults who stutter, (5) describe differences in stuttering severity, coping style, functioning and health related quality of life between adults who stutter who have registered for therapy and adults who stutter who have not.

Effects of depressive disorder on monocytic expression of CD(40) and plasma IL-8 concentration in senile coronary heart disease patients

To observe the monocytic expression of CD(40) and plasma IL-8 concentration in senile CHD (coronary heart disease) patients with depressive disorder and examine the effects of immunological factors in depressive disorder and CHD. A total of 100 senile CHD patients (> 60 yr old) were divided into 3 group: control group (A, n = 30), depression score ≤ 20 & anxiety score ≤ 6; therapy group (B, n = 35), depression score ≥ 30 & anxiety score ≤ 6, psychological evaluations with HAMD (Hamilton depression rating scale) from Day 1 pre-operation to Day 7 post-operation; non-therapy group (C, n = 35), depression score ≥ 30 & anxiety score ≤ 6. They underwent the same operation: lumbar decompression & fusion, stripping of great saphenous vein and repair of indirect hernia. At Day 1 pre-operation and Day 7 post-operation, 2 ml venous blood was drawn for the detection of monocytic expression of CD(40) and plasma concentration of IL-8 (interleukin-8). Depressive value of Group B at post-operation was lower than that at pre-operation and Group C ((25.1 ± 2.9) vs (33.2 ± 1.4) & (34.2 ± 0.8), P < 0.05); the pre-operative expression of CD(40) of Group A was lower than the other groups ((123 ± 18) vs (197 ± 23) & (204 ± 26), P < 0.05). And Group B at post-operation was lower than Group C ((147 ± 19) vs (212 ± 18), P < 0.05); the pre-operative concentration of IL-8 was lowest in Group A ((85 ± 16) ng/L vs (151 ± 18) ng/L & (164 ± 22) ng/L, P < 0.05). And Group B at post-operation was lower than Group C ((158 ± 19) ng/L vs (197 ± 24) ng/L, P < 0.05). There were significantly positive correlations between depression scores, the expression of CD(40) and the plasma concentration of IL-8. Depressive disorders elevate the monocytic expression of CD(40) and raise the plasma concentration of IL-8 in senile CHD patients. Some immunological factors may play a important role in depressive disorder and CHD.

Quality of life in adults who stutter

Although persistent developmental stuttering is known to affect daily living, just how great the impact is remains unclear. Furthermore, little is known about the underlying mechanisms which lead to a diminished quality of life (QoL). The primary objective of this study is to explore to what extent QoL is impaired in adults who stutter (AWS). In addition, this study aims to identify determinants of QoL in AWS by testing relationships between stuttering severity, coping, functioning and QoL and by testing for differences in variable scores between two AWS subgroups: receiving therapy versus not receiving therapy. A total of 91 AWS filled in several questionnaires to assess their stuttering severity, daily functioning, coping style and QoL. The QoL instruments used were the Health Utility Index 3 (HUI3) and the EuroQoL EQ-5D and EQ-VAS. The results indicated that moderate to severe stuttering has a negative impact on overall quality of life; HUI3 derived QoL values varied from .91 (for mild stuttering) to .73 (for severe stuttering). The domains of functioning that were predominantly affected were the individual's speech, emotion, cognition and pain as measured by the HUI3 and daily activities and anxiety/depression as measured by the EQ-5D. AWS in the therapy group rated their stuttering as more severe and recorded more problems on the HUI3 speech domain than AWS in the non-therapy group. The EQ-VAS was the only instrument that showed a significant difference in overall QoL between groups. Finally, it was found that the relationship between stuttering severity and QoL was influenced by the individual's coping style (emotion-oriented and task-oriented). These findings highlight the need for further research into stuttering in relation to QoL, and for a broader perspective on the diagnosis and treatment of stuttering, which would take into consideration quality of life and its determinants. Learning outcomes: Readers will be able to: (1) Understand how the Wilson and Cleary (1995) model of quality of life could be applied to comprehensively assess the quality of life in adults who stutter, (2) describe how health related quality of life is impaired in adults who stutter, (3) mention affected domains of functioning that are related to health related quality of life impairment in adults who stutter, (4) describe the relationship between stuttering severity, functioning, coping and health related quality of life in adults who stutter, (5) describe differences in stuttering severity, coping style, functioning and health related quality of life between adults who stutter who have registered for therapy and adults who stutter who have not.

The Usefulness of Electrophysiological Test (EPS) for Implantable Cardioverter Defibrillator (ICD) Therapy in Patients with Hypertrophic Cardiomyopathy (HCM)

Background: Patients with HCM are at substantial risk for sudden cardiac death (SCD). There are observational studies that show HCM patients with inducible arrhythmias are at increased risk for SCD, however, the usefulness of EPS, which predicts the necessity of preoperative management for ICD therapy, is not established. Method: In 76 patients with HCM implanted ICD between May 2000 and August 2010 followed for mean (±SD) of 38.3 +⁄− 3.2 months, consists of 50 patients implanted ICD for primary prevention and 26 patients for secondary prevention, 9 patients (18%) in primary prevention group and 10 patients (38%) in secondary prevention group have received appropriate ICD therapies. Arrythmogenic risk was assessed by occurrence of NSVT in Holter ECG and induced Sustained Ventricular tachycardia (SVT) and fibrillation (VF) in EPS. Results: In the primary prevention group, all patients has a history of NSVT on Holter ECG, of which max beats are significantly higher (17.22/8.357 P=0.0017) in therapy group. EPS shows there is no tendency to the occurance of SVT/VF in therapy group (P=0.17). In therapy group, SVT/VF had induced by double ventricular extrastimuli in only 2 patients (25%), triple entricular extrastimuli in 5 patients (62%). In non-therapy group, SVT/VF had induced by double ventricular extrastimuli in 37 patients (51%), triple ventricular extrastimuli in 14 patients (37%). Conclusion: In HCM patients, EPS suggest not to be the prior predictor for the indication of primary ICD implantation.

Treatment Acceptability among Crime Victims

Crime victims receive relevant treatment too seldom and there is uncertainty as to whether those who need the treatment the most are among those who get it. Fifty-two consecutive adult crime victims were offered 10 sessions of psychotherapy within two weeks after an experienced trauma of criminal victimization. Twenty-six accepted and 26 declined the offer. The aim of the study was to explore some of the differences between these two groups. The results show that the therapy group presented a higher incidence of acute stress disorder, more negative scorings regarding immediate reactions (to the crime), more subjective ratings of physical and psychological health (GAF, according to DSM IV), and more psychiatric and trauma-related symptoms as compared to the non-therapy group. A conclusion was that those who needed treatment the most also accepted it. Traumatized people may, due to avoidant strategies, withdraw from potential treatment. Conversely, the therapy group scored higher on the coping style escape-avoidance.

Readiness to adaptively change under three conditions: Clinical, careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self-rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non-therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non-therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.

Suppressive effect of bevacizumab on peritoneal dissemination from gastric cancer in a peritoneal metastasis model

Vascular endothelial growth factor (VEGF) has been reported to enhance vascular permeability and angiogenesis in the abdominal wall, thereby contributing to peritoneal dissemination with malignant ascites. We conducted this experimental study to find out if bevacizumab, a humanized monoclonal antibody against VEGF, had a suppressive effect on peritoneal dissemination from gastric cancer, in an experimental nude mouse model of peritoneal metastasis. Each mouse was treated with a single intraperitoneal (i.p.) injection of bevacizumab. Five mice were killed, and we measured their body weight, the mean number of tumor nodules, and the volume of ascites. We also extracted retroperitoneal tissues for histological examination, to count the frequency of mitosis, and to calculate the mitotic index. Another five mice were monitored until death, and their mean survival duration was calculated. The volume of ascites and the mitotic index were significantly lower in the therapy group than in the nontherapy group (P = 0.042 and P < 0.01, respectively). The survival curve of the therapy group was significantly higher than that of the nontherapy group (P = 0.005). Bevacizumab may suppress peritoneal dissemination from gastric cancer.

Increased oral lichen planus in a chronic hepatitis patient associated with elevated transaminase levels before and after interferon/ribavirin therapy

Oral lichen planus (OLP) is the most frequent oral lesion found in patients with hepatitis C virus (HCV) infection. The aims of this study were to investigate the prevalence of OLP among chronic hepatitis C patients, to clarify the role of HCV in the pathogenesis of OLP, and to assess its relationship to transaminase levels. Two groups of subjects were studied; 277 hepatitis C patients were examined for OLP (Group 1) and 5273 outpatients seeking dental care within 1 year were used as a control (Group 2) to determine the prevalence of OLP in the general population. The dental and hepatic records were collected and analyzed. The prevalences of OLP were 4.7% ( n = 13) in Group 1 and 2.0% ( n = 104) in Group 2 and significantly differed (P = 0.002). All 13 OLP cases occurred in hepatitis C patients who had experienced elevated alanine transaminase levels of > 80 IU/L within the 2 previous years, regardless of whether they were treated with interferon-ribavirin combination therapy or not. There was a strong association between elevated transaminase levels and the development of HCV-related OLP lesions (P = 0.014). Of the 13 OLP patients, two were in the group with a sustained virologic response (SVR) to HCV therapy, two were in the group without an SVR, and nine were in the non-therapy group. The incidence of OLP in hepatitis C patients did not significantly differ between those who showed an SVR to HCV therapy and those who did not respond or did not receive therapy (P = 0.560). We concluded that: (1) elevation of transaminase levels is associated with the detection of HCV-related OLP, and (2) HCV-related OLP can remain unchanged for years after an SVR to HCV therapy. The findings revealed that the role of HCV in OLP pathogenesis is due to host factors induced by HCV rather than a direct cytopathic effect of HCV.

Dynamic flamingo therapy

A long follow up study of one minute unipedal standing therapy 3 times in a day to prevent femoral neck osteoporosis that have started from 1993 was reported. The registration from July 1993 to March 2004 were 86 cases which measured the femoral neck bone mineral density (BMD) according to dual energy x-ray absorptiometry (DXA) (Hologic QDR 1000 and 2000) in a follow-up period. Average age at starting exercise was 67.9 years old. All cases were female who were registered in our university hospital. The result of unipedal exercise evaluated by the femoral neck BMD was described as follows : The increased cases of BMD were 15/24 (62.5%) post exercise 3 months, 15/37 (40.5%) post 6 months, and 12/21 (57.1%) post one year, 8/25 (32%) post 3 years, 7/13 (53.8%) post 5 years and 1/3 (33.3%) post 10 years. We have no fracture cases in which continued exercise in follow-up period. According to a randomized controlled study of unipedal standing balance therapy to clinically defined high-risk elderly individuals a therapy group reduced fall times by a significant difference than non-therapy group. We conclude that unipedal standing therapy is efficacious against femoral neck osteoporosis and fractures.