Secondary prevention of atherosclerosis, especially before the onset of symptoms, appears desirable and could be possible with a serum marker detecting atherosclerosis. Circulating, shedded forms of adhesion molecules may serve as such because their expression is upregulated in atherosclerotic plaques. In 52 patients with peripheral arterial vascular disease (Fontaine class IIa, 7 patients; class IIb, 29 patients; and class III, 16 patients), the extent of atherosclerosis was evaluated on the basis of angiograms of a large portion of the arterial system. The area diseased by atherosclerosis was determined by the percentage of vessel wall irregularities of the following calculated segments: aorta (distal from the kidney arteries), common iliac artery, external iliac artery, common femoral artery, lateral circumflex femoral artery, and popliteal artery. The maximal surface area that could exhibit atherosclerotic changes was 250 cm2. The serum concentration of circulating vascular cell adhesion molecule-1 (VCAM-1) correlated with the extent of atherosclerosis (r = .8, P < .001). In contrast, circulating intercellular adhesion molecule-1, E-selectin, P-selectin, and thrombomodulin (as markers for endothelial cell damage) did not correlate with the extent of atherosclerosis. Furthermore, circulating VCAM-1 could be used to indicate stages of atherosclerosis with a high degree of statistical significance. The potential bias of factors such as age, diabetes mellitus, hypercholesterolemia, arterial hypertension, renal failure, and history of myocardial infarction on the correlation of circulating VCAM-1 with the extent of atherosclerosis could be excluded by multivariate analysis. These findings suggest an important role of VCAM-1 in atherosclerosis and may serve as the basis for further evaluation of circulating VCAM-1 as a potential serum marker for atherosclerosis.
BackgroundHistorical data indicate that surgical resection may benefit select patients with metastatic gastric and gastroesophageal junction cancer. However, randomized clinical trials are lacking. The current RENAISSANCE trial addresses the potential benefits of surgical intervention in gastric and gastroesophageal junction cancer with limited metastases.MethodsThis is a prospective, multicenter, randomized, investigator-initiated phase III trial. Previously untreated patients with limited metastatic stage (retroperitoneal lymph node metastases only or a maximum of one incurable organ site that is potentially resectable or locally controllable with or without retroperitoneal lymph nodes) receive 4 cycles of FLOT chemotherapy alone or with trastuzumab if Her2+. Patients without disease progression after 4 cycles are randomized 1:1 to receive additional chemotherapy cycles or surgical resection of primary and metastases followed by subsequent chemotherapy. 271 patients are to be allocated to the trial, of which at least 176 patients will proceed to randomization. The primary endpoint is overall survival; main secondary endpoints are quality of life assessed by EORTC-QLQ-C30 questionnaire, progression free survival and surgical morbidity and mortality. Recruitment has already started; currently (Feb 2017) 22 patients have been enrolled.DiscussionIf the RENAISSANCE concept proves to be effective, this could potentially lead to a new standard of therapy. On the contrary, if the outcome is negative, patients with gastric or GEJ cancer and metastases will no longer be considered candidates for surgical intervention.Trial registrationThe article reports of a health care intervention on human participants and is registered on October 12, 2015 under ClinicalTrials.gov Identifier: NCT02578368; EudraCT: 2014–002665-30.
The aim of this study is to investigate the effects of anxiety, depression, and coping on quality of life in patients after liver transplantation. Patients were asked to fill out a postal survey. Two hundred thirty-six of 375 patients (63%) who entered the study returned the questionnaires, and 186 of these patients could be included in the assessment. Anxiety and depression were surveyed using the Hospital Anxiety and Depression Scale; health-related quality of life, using the 36-Item Short-Form Health Survey; and coping strategies, using the Freiburg Questionnaire on Coping With Illness. In terms of physical and mental dimensions of health-related quality of life, psychosocial factors are far more relevant in liver transplant recipients than purely somatic factors, such as the number of posttransplantation complications or length of hospital stay. Through multiple regression analysis, we were able to account for 51% of the variance in the physical dimension of health-related quality of life and 58% of the variance in the mental dimension. Physical factors of depression, age, and employment and mental factors of anxiety and depression were significant for predicting healthrelated quality of life after liver transplantation. Depressive coping, anxiety, and depression, as well as aspects of the social environment, contribute considerably to determine well-being and health-related quality of life of patients after liver transplantation. O ver the past 15 years, liver transplantation has proven to be the treatment of choice in patients with terminal liver disease. The 1-year survival rate is approximately 80%; after 8 years, 61% of patients are still alive. 1 From the physician's point of view, it is necessary to optimize therapy with immunosuppressants and minimize complications with medical treatment. Diabetes mellitus, malignancies, weight gain, and, particularly, non-Hodgkin's lymphomas have been observed, in addition to increased rates of hypertension. Furthermore, the likelihood of fractures increases after transplantation. 2,3 These associated diseases, along with the transplantation procedure itself and changes in the patient's surroundings, exert considerable influence on a patient's quality of life.Previous investigations into quality of life in transplant recipients focused primarily on the relation between medical treatment and transplantation, i.e., type of immunosuppression, duration and severity of illness, and course of the transplantation (revisions, retransplantation, rejection responses), in addition to effects of these factors on patients' quality of life. 4,5 Posttransplantation health-related quality of life is impaired by disease severity and previous transplantations. 6 A controlled study found no difference in quality of life or psychiatric outcomes between patients who underwent liver transplantation because of alcoholic liver disease and those who underwent liver transplantation because of other chronic liver diseases. 7 Previous results indicated that lung, heart, and liver transplant re...
Summary Aging of the population and improvements in diabetes therapy have led to an increased number of older pancreas transplant candidates. The aim of our retrospective study was to evaluate pancreas transplantation (PT) outcomes in patients ≥50 years, as limited data exist in these patients. We analyzed 398 consecutive pancreas transplant patients from June 1994 to June 2009 for different outcomes (patient/graft survival, rejection rate, and surgical complications) between the age groups ≥50 years (n = 69) and <50 years (n = 329). Donor and recipient characteristics were similar except for recipient age (54.0 vs. 38.8 years), BMI (24.6 vs. 22.9 kg/m2), and duration of diabetes mellitus (36.0 vs. 27.7 years). One‐, 5‐, and 10‐year patient and graft (kidney/pancreas) survival were not significantly different between the groups with patient survival rates reaching 84% and pancreas graft survival up to 67% after 10 years. Surgical complications such as relaparotomy rate (34% vs. 33%) or pancreas graft thrombosis (14% vs. 11%) as well as 1‐year rejection rates (35% vs. 31%) were not significantly different. PT in selected patients aged ≥50 years resulted in survival comparable with that of younger patients. In conclusion, advanced age should no longer be considered as an exclusion criterion for PT. However, good medical assessment and careful patient selection are necessary.
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