The impact of hepatocellular carcinoma diagnosis on patients' health-related quality of life.

BACKGROUND: Patients with hepatocellular cancer (HCC) are known to have worse health-related quality of life (HRQL) than the general population. However, the change in HRQL from before the diagnosis to after diagnosis remains unknown and is difficult to estimate. We aimed to compare HCC cases with matched controls to evaluate the differences in change in HRQL from before to after HCC diagnosis. METHODS: We performed propensity score-matched analysis using the self-reported HRQL data from the Surveillance, Epidemiology, and End Results registries (SEER) data linked with Medicare Health Outcomes Survey (MHOS) data (1998-2014). Cases were selected as Medicare beneficiaries (aged ≥65 years) who were diagnosed with HCC between their baseline assessment and follow-up assessment. Matched controls were selected from the same data resource and the same time period to include subjects without cancer diagnosis by propensity scores. HRQL was assessed using the Medical Outcomes Study Short Form-36 (SF-36). RESULTS: The study included 62 subjects who developed HCC and 365 matched controls. Compared to their baseline HRQL scores, after diagnosis of HCC, subjects were more likely to report declines in scores related to the mental component of HRQL. When stratified by time since diagnosis, mental component remained significantly lower as the disease advanced. In contrast, only general health aspects of physical health worsened after HCC diagnosis. CONCLUSIONS: Diagnosis of HCC has a profound negative impact on patients' HRQL. Mental health component deteriorated significantly over time. The need of including mental health services within a multidisciplinary HCC care model is clearly evident.

Major Histocompatibility Complex Class I-Related Chain A Alleles and Histology of Nonalcoholic Fatty Liver Disease.

Major histocompatibility complex class I-related chain A (MICA) is a highly polymorphic gene that modulates immune surveillance by binding to its receptor on natural killer cells, and its genetic polymorphisms have been associated with chronic immune-mediated diseases. The progressive form of nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), is characterized by accumulation of fat and inflammatory cells in the hepatic parenchyma, potentially leading to liver cell injury and fibrosis. To date, there are no data describing the potential role of MICA in the pathogenesis of NAFLD. Therefore, our aim was to assess the association between MICA polymorphism and NASH and its histologic features. A total of 134 subjects were included. DNA from patients with biopsy-proven NAFLD were genotyped using polymerase chain reaction-sequence-specific oligonucleotide for MICA alleles. Liver biopsies were assessed for histologic diagnosis of NASH and specific pathologic features, including stage of fibrosis and grade of inflammation. Multivariate analysis was performed to draw associations between MICA alleles and the different variables; P ≤ 0.05 was considered significant. Univariate analysis showed that MICA*011 (odds ratio [OR], 7.14; 95% confidence interval [CI], 1.24-41.0; P = 0.04) was associated with a higher risk for histologic NASH. Multivariate analysis showed that MICA*002 was independently associated with a lower risk for focal hepatocyte necrosis (OR, 0.24; 95% CI, 0.08-0.74; P = 0.013) and advanced fibrosis (OR, 0.11; 95% CI, 0.02-0.70; P = 0.019). MICA*017 was independently associated with a higher risk for lymphocyte-mediated inflammation (OR, 5.12; 95% CI, 1.12-23.5; P = 0.035). Conclusion: MICA alleles may be associated with NASH and its histologic features of inflammation and fibrosis. Additional research is required to investigate the potential role of MICA in increased risk or protection against NAFLD.

Liver Biopsy in Primary Biliary Cholangitis: Indications and Interpretation.

Primary biliary cholangitis is a disease characterized by immune-mediated bile duct destruction, followed by inflammation, scarring, and the development of chronic cholestasis and a slow progression to cirrhosis over the course of years. Liver biopsy has traditionally been used in conjunction with clinical evaluation and serologic autoantibody testing to establish the diagnosis, but it is no longer required in typical cases with positive antimitochondrial antibodies. Biopsy remains essential, however, in antimitochondrial antibody-negative patients or suspected overlap syndrome with autoimmune hepatitis, and if an adequate biopsy is performed precise staging is possible for assessment of prognosis.

Healing of Deep Wound Infection without Removal of Non-Absorbable Dura Mater (Neuro-Patch®): A Case Report.

We report on a female patient who received microvascular decompression due to hemifacial spasm. Neuro-Patch® was used during the operation to repair and replace damaged dura mater. Six days after the operation, the incision wound was found to be infected. Abscesses were present deep in the incision. However, because the artificial dura mater was attached so tightly to the original dura mater, the infection was not able to spread inside the skull. After 3 months of meticulous wound cleaning and drug treatment to promote the growth of granulation tissue, we were able to gradually achieve healing of the infection without having to remove the non-absorbable artificial dura mater. By describing this case and the results of a review of the pertinent literature, we discuss the possibility of recovery of an infection without removal of artificial dura mater.

Gamma Knife Radiosurgery for Glossopharyngeal Neuralgia by Targeting the Medial Cisternal Segment of the Glossopharyngeal Nerve: Report of 3 Cases.

Gamma knife surgery (GKS) is now used as a treatment option for glossopharyngeal neuralgia (GPN). Most authors have selected the distal part of the nerve as the gamma knife target. Here we report on 3 patients with medically intractable GPN who were treated with GKS. All 3 patients had a single shot with a 4-mm collimator which was used to deliver 80 Gy to the 100% isodose line. The GKS targets were the medial cisternal segments of the glossopharyngeal nerve. Patients were investigated prospectively, treated, and then assessed periodically with respect to pain relief and neurological function. Three patients felt pain reduced at 2, 7, and 11 days, respectively. None of them have suffered recurrent pain since becoming pain free. The follow-up after radiosurgery was 25 months, 22 months, and 20 months, respectively. This preliminary experience provides encouraging evidence that choosing the medial cisternal segment of the glossopharyngeal nerve as the target is also an option for the treatment of GPN with stereotactic radiosurgery and is consistent with previous reports. Additional follow-ups and a larger number of patients are needed to demonstrate the long-term safety and effectiveness for this indication.