Disentangling phylogenetic relations and biogeographic history within the Cucujus haematodes species group (Coleoptera: Cucujidae).

Recent progress in the taxonomy of flat bark beetles (Cucujidae), specifically, in the genus Cucujus, has revealed great diversity in subtropical Asia, but the seemingly well-known temperate and boreal taxa need further attention because of their conservation status. Here, we used an integrative approach using morphology, DNA, and species distribution modelling to disentangle phylogenetic relations, verify the number of species, and understand the historical biogeography of Palearctic and Nearctic Cucujus beetles, particularly the C. haematodes species group. Species distinctiveness was supported for C. cinnaberinus, but present-day C. haematodes turned out to be a species complex made up of separate lineages in the western, middle and eastern parts of its Palearctic range. Cucujus muelleri was a member of that complex, being sister to Asian C. haematodes. Moreover, C. haematodes caucasicus was found to be phylogenetically closely related to Italian C. tulliae, and both to be sister to European C. haematodes. North American C. clavipes clavipes and C. c. puniceus resulted to be enough divergent to be considered different species. Interestingly, western American C. puniceus turned out to be closely related to the C. haematodes complex, whereas eastern American C. clavipes constituted a separate lineage, being distantly related to both C. puniceus and C. cinnaberinus. These patterns suggest former trans-continental connections among the ancestors of extant flat bark beetle species. Moreover, a divergent lineage of C. cinnaberinus was found in Calabria, which should be regarded at the very least as a subspecies. The ancestor of C. hameatodes group originated in mid-Miocene, and next, ca. 6.2 Mya, a line leading to C. cinnaberinus had split. Speciation of the American lineages occurred during Pliocene (4.4 Mya for C. clavipes and 3.3 Mya for C. puniceus). Species classified as C. haematodes, C. tulliae and C. muelleri, as well as distinct lineages within C. cinnaberinus split during mid Pleistocene (ca. 1.5 Mya). A comparison of species climatic requirements and their present distribution allowed to identify glacial refugia in south-eastern areas of North America (C. clavipes), south-western areas of North America (C. puniceus), and the Mediterranean and Caspian Sea Basins (European Cucujus species), or south-eastern areas of Asia and the foothills of the central Asian mountains (eastern C. haematodes). Subsequent climatic changes in the Holocene forced these beetles to move their ranges northwards along the coasts of the Pacific (C. puniceus) or Atlantic (C. clavipes), north-eastwards to central, northern, and eastern Europe (C. cinnaberinus and European C. haematodes) or Siberia (Asian C. haematodes). The combined use of molecular, morphological and climatic data allows a comprehensive understanding of the phylogenetic relations and past distributions of Cucujus beetles, highlighting the complexity of C. haematodes species group evolution.

The Origin of Isolated Populations of the Mountain Weevil, Liparus glabrirostris-The Flagship Species for Riparian Habitats.

Liparus glabrirostris is one of the largest European weevils, and it has been recently proposed as the flagship species for threatened riparian habitats in the mountains. For effective conservation of its populations (and associated habitats), it is crucial to understand its history, contemporary distribution, genetic diversity and predict changes in the range, including its highly isolated populations on the Baltic coast. Here, we examined numerous populations of L. glabrirostris across almost the entire species range using phylogeography and species niche modeling (SNM) approaches. Analyses of mtDNA and nucDNA markers revealed the existence of 2 major mitochondrial lineages generally separated between 1) the Alpine region and 2) the Bohemian Massif, the Carpathians, and the Baltic coast areas. Genetic diversity in nuclear genes was more complicated with no clear division between populations. The origin of Baltic populations was derived from the Carpathians, but there were probably multiple expansion events to the north. SNM suggested the existence of glacial refugia for L. glabrirostris, mainly in the Alps and the Southern Carpathians. Current predictions of species range were found to be generally congruent with zoogeographic data; however, the Baltic coast was not really supported as a suitable area for L. glabrirostris. An important prediction of future distribution (2050-2070 CE) suggests a shrinkage of the L. glabrirostris range and extinction of some of its populations (particularly those isolated on lower altitudes). Based on the aforementioned data, proposals for the protection of this species are proposed, including the designation of several evolutionary units of conservation importance.

Xenotransplantation of human cultured parathyroid progenitor cells into mouse peritoneum does not induce rejection reaction.

INTRODUCTION: Parathyroid progenitor cells devoid of immunogenic antigens were used for human allotransplantation. Although there were many potential reasons for the expiry of transplant activity in humans, we decided to exclude a subclinical form of rejection reaction, and test the rejection reaction in an animal model. MATERIAL AND METHODS: Experiments were carried out on 40 conventional male mice in their third month of life. The animals were housed in groups of 10 per cage in 4 cages with fitted water dispensers and fed a conventional diet based on standard pellet food. They were divided into four groups of 10 animals each, three experimental groups and one control group. Identified progenitor cells were stored in a cell bank. After testing the phenotype, viability, and absence of immunogenic properties, the cells were transplanted into mouse peritoneum cavity. RESULTS: Animals were observed for 9 weeks. At 9 weeks of observation, the mean serum PTH concentration in the experimental groups was 2.0-2.5 pg/ml, while in the control group it did not exceed 1.5 pg/ml. The immunohistochemical assays demonstrated that millions of viable cells with a phenotype identical to the endocrine cells had survived in the peritoneum. Histologic specimens from different internal organs stained for PTH revealed positive cells labelled with anti-PTH Ab in the intestinal lamina, brain, liver, and spleen. CONCLUSIONS: In the present paper we have demonstrated that xenotransplantation may be used as a model for an explanation of the immunogenic properties of cells generated from postnatal organs for regenerative therapy.

Recurrent vulvar melanoma in 35-year-old pregnant women.

Vulvar melanoma represents between 3% and 10% of vulvar neoplasms. We present a case of a 34-year-old pregnant woman presenting with a pigmented lesion on the left labium majus; she reported no family history of melanoma. The histological diagnosis was malignant melanoma, superficial spreading type, with Breslow thickness of 0.9 mm; the excision was complete. Eight months before, an atypical genital nevus was completely excised from a nearby location. The pregnancy was finished by cesarean delivery at term, and 3 months later, another pigmented lesion was noticed near but not within the scars. Partial right vulvectomy was performed, and histological diagnosis was malignant melanoma of superficial spreading type, with Breslow thickness of 0.7 mm. The specimen obtained in the first operation was reviewed, and although histological examination was diagnostic for atypical genital nevus, Vysis Melanoma Fluorescence in situ hybridization Probe Kit revealed increased copy numbers of RREB1, which could be consistent with a diagnosis of malignant melanoma.

Limited congruence in phylogeographic patterns observed for riverine predacious beetles sharing distribution along the mountain rivers.

Riverine predacious beetles (RPB) (Carabidae, Staphylinidae) are highly diverse and numerous elements of riverine ecosystems. Their historical and contemporary distribution and diversity are highly dependent on natural flow regimes and topography of watercourses. Despite broad knowledge of their ecology, data on population genetic diversity and connectivity are lacking. This study aimed to fill this gap in order to solve two principal hypotheses assuming (i) congruence of phylogeographic patterns observed for RPB indicating that they share a common history and the ecological adaptations to the dynamic environment, (ii) genetic structuration of populations according to river basins. The Carpathian populations of four ground beetles and three rove beetles were examined using cytochrome oxidase and arginine kinase sequencing. There are substantial differences in RPB demographic history and current genetic diversity. Star-like phylogeny of Bembidion and complex haplotype networks of Paederus/Paederidus, with some haplotypes being drainage-specific and others found in distant populations, indicate a general lack of isolation by distance. Signs of recent demographic expansion were detected for most RPB with the latest population collapse for some rove beetles. To some extent, migration of examined species has to be limited by watersheds. Observed phylogeographic patterns are essential for correctly understanding RPB meta-population functioning.

[Is there any point in pharmacological prophylaxis of PDPH (post-dural puncture headache) after spinal anaesthesia for Caesaren section?]. / Czy celowe jest stosowanie farmakoprofilaktyki w popunkcyjnym bólu glowy po cieciu cesarskim w znieczuleniu podpajeczynówkowym?

PURPOSE OF THE STUDY: To assess the effectiveness of postoperatively applied pharmacological prophylaxis and the impact of demographic parameters (age, height, weight), gestational age, parturients' morbidity (hypertension, motion sickness), postoperative fluid resuscitation, applied anaesthetic technique (spinal needle type and diameter, patient's positioning, choice of intervertebral space for puncturing dura, a dose of local anaesthetic) on the incidence of PDPH after spinal anaesthesia for Caesarean section. MATERIAL AND METHODS: There were analyzed 182 mothers who delivered by Caesarean section under spinal anaesthesia. Postoperative management included fluid administration 2500 ml daily and i.v. antibiotic prophylaxis (control group, n = 560). The consecutive groups of patients were administered antibiotic and fluids in dose as mentioned above, and additionally oral caffeine 3 x 200 mg (n = 40); caffeine plus magnesium 2 x 1 g daily i.v. (n = 42) or caffeine plus magnesium plus aminophylline 250 mg i.v. once daily (n = 40). Incidence of PDPH was analyzed in all the groups of patients. RESULTS: The incidence of PDPH was lower after usage of thin spinal needles (Spinokan 27G), but statistical significance was p = 0.07. The other analyzed factors did not affect the incidence of PDPH. None of the applied pharmacoprophylactic methods appeared to be efficacious. The volume of administered within 18 hours postoperatively crystalloids was larger in the group of patients with multifactorial pharmacoprophylaxis (p = 0.04), probably due vasodilatation caused by synergistic effect of magnesium and aminophylline; explanation of this phenomenon is arguable, however. CONCLUSIONS: Neither prophylactic administration of caffeine, magnesium or aminophylline, nor postoperative fluid administration, did not influence the incidence of PDPH.

[Why the severity-of-illness scoring systems applied in severely ill patients are not in common use?]. / Dlaczego skale oceny ciezko chorych pacjentów nie sa powszechnie stosowane?

PURPOSE OF THE STUDY: To compare predicted death rate (PDR) numbers, computed in commonly used severity-of-illness and prognostic scoring systems (Portsmouth-POSSUM, SAPS 2, MPM 2, MPM for cancer patients, LODS, ODIN i TRIOS) on the first and on the third postoperative days with the mean PDR calculated from the scales. Assessment of the mean PDR values. Analysis of the main risk factors that affect postoperative mortality. MATERIAL AND METHODS: There were analyzed 187 cases of non-survivors and 100 cases of survivors treated in surgical wards at University Hospital in Kraków. In each case there were compared groups of patients with defined pathological syndromes (sepsis, thromboembolism, left-heart failure, respiratory tract infections, trauma, oncology, multiorgan failure and haemorrhage) with PDR calculated in seven severity-of illness and prognostic scoring systems on the first and on the third postoperative day and mean PDR computed from seven PDR numbers. There was used calculation of OR (odds ratio) with 95% CI (confidence interval) and the Pearson product moment correlation coefficient. RESULTS: The main risk factors of early deaths (that occurred within the first 3 postoperative days) in the group of nonsurvivors (n = 187) were: emergencies (p < 0.001), perioperative haemorrhage (p < 0.002), and trauma (p = 0.02). The late deaths (that occurred > 3 postoperative days) were caused by repeated surgery (p < 0.001), oncology (p = 0.019), then comorbidities (p = 0.025) and sepsis (p = 0.072). The Pearson product moment correlation coefficients for mean PDR computed on the 1st and 3rd postoperative day were respectively -0.4517 and -0.4012. None of the scales showed good discriminant characteristics in patients with cardiovascular diseases and pneumonia. In all scoring systems, except of the MPM for cancer patients and TRIOS, the PDR values correlated significantly with the preoperative ASA group assessment. CONCLUSIONS: There is no commonly used severity-of-illness scoring system that could properly evaluate intensive care unit patients. Discriminative abilities of the scoring systems do not present any unique features that might affect selection of one of them. The mean PDR value computed from available scales is a reasonable descriptive and prognostic alternative.

[Prediction of survival of the postoperative patients based on selected severity-of-illness scoring systems]. / Przewidywanie przezycia pacjentów pooperacyjnych w oparciu o wybrane skale oceny ryzyka.

PURPOSE OF THE STUDY: To compare and evaluate preoperative assessment in ASA scale to predicted death rate (PDR) numbers, computed in commonly used severity-of-illness and prognostic scoring systems (Portsmouth-POSSUM, SAPS 2, MPM 2, MPM for cancer patients, LODS, ODIN i TRIOS) on the first and on the third postoperative days. Evaluation of the mean PDR calculated from the scales. MATERIAL AND METHODS: There were analyzed 187 cases of non-survivors and 100 cases of survivors of 187 patients treated in surgical intensive care unit at University Hospital in Kraków. In each case PDR was calculated in seven severity-of illness and prognostic scoring systems on the first and on the third postoperative day and compared to the ASA group and mean PDR computed from seven PDR numbers. Discrimination and calibration characteristics of the scoring systems was analyzed as area under receiver operating characteristic curves (AUROC) and predictive values. RESULTS: Length of hospital stay was shorter in survivors (16.6 days) as compared to nonsurvivors (25.3 days); similarly the time period between the hospital admittance and surgery was shorter in survivors (1.6 days vs 7.4 days). There were almost twice more frequent repeated surgical procedures in nonsurvivors (45.4% vs 26%). The mean ASA scale in non-survivors was 3.74 and 3.20 in survivors (p < 0.001). The mean PDR computed from seven scoring systems on the first postoperative day was 55.2 in non-survivors vs 21.2 in survivors (p < 0.001) and on the third postoperative day was 64.1 vs 32.3 (p < 0.001). The best discriminative properties, calculated as AUROC, showed: mean PDR computed from the used scoring systems on the first postoperative day (0.859), then ODIN (0.847), MPM2 (0.833), Portsmouth-POSSUM (0.83) and mean PDR computed on the third postoperative day (0827). CONCLUSIONS: There is none severity-of-illness nor prognostic scoring system that could be commonly used in intensive care unit patients. There are discrepancies in predicted death rate (PDR) cal. culated in each of available risk models in population of intensive care unit patients. The mean PDR value computed from available scales could be a reasonable descriptive and prognostic alternative.

The influence of surgery of cervical intraepithelial neoplasia (CIN) and cervical carcinoma on quality of life.

UNLABELLED: The aim of the study was to determine to what extent cervical intraepithelial neoplasia and cervical cancer surgery affect a woman's mental state and how does it affect her interpersonal relationships, sexual activity, family life, and her professional and social activity. The clinical material consisted of 153 women aged 20 and 47, who were diagnosed and treated by the Chair of Gynaecology and Obstetrics, Jagiellonian University Medical College in Kraków between 2006 and 2010, and were confirmed to have CIN3 and cervical carcinoma stage IA. An oryginally constructed survey form consisting of 108 questions and divided into 5 research stages was implemented. H.J. Eysenck's Personality Questionnaire, and Physical and Mental State Questionnaire KS-40. RESULTS: The diagnosis generated a change in the patients' self-images: prior to the diagnosis, 74.6% considered themselves to be completely healthy, whereas after the diagnosis was given 40.5% of respondents had the feeling of illness, and 33.3% of the moderately illness. CONCLUSIONS: The diagnosis of CIN and microinvasive cervical cancer, and surgical procedure, invokes a feeling of being unwell in a woman who previously felt completely healthy, and significantly impedes quality of life. The diagnostic-therapeutic management induces general anxiety, worry about preservation of the generative organ, sexual intercourse, fertility, changes in the dynamics of the family and in the professional field, as well as changes in interpersonal relationships.

[Evaluation of the recurrence and residual lesions incidence after loop electroexcisional procedure and cold knife conisation]. / Ocena wystepowania nawrotów lub zmian rezydualnych po wycieciu zmiany przy pomocy petli elektrycznej o wysokiej czestotliwosci i konizacji szyjki macicy.

The aim of this paper was the evaluation of the recurrence and residual lesions of cervical intraepithelial neoplaisa (CIN) incidence after LEEP (loop electro excisional procedure) and cold knife conisation. The clinical material was 210 women aged 22-65 years of life referred to the Department of Gynecology and Oncology Jagiellonian University Medical College in Krakow, Poland, the period in 2000- 2005 years, with initial cytological pap diagnosis-HSIL. (high grade squamous intraepithelial lesion-HSIL) according to The Bethesda System. The study group was 115 women with colposcopically visible lesions, which was qualified to the LEEP procedure. The controls were 95 women, preoperatively diagnosed based on colposcopically directed biopsy of the ectocervix and cervical canal curettage. In all cases the recurrence of cervical dysplasia and residual disease of cervical intraepithelial neoplasia incidence were analyzed. The follow-up period was 5 years with Pap smear and colposcopy every 3 months, for the first 2 years and every 6 months in subsequent 3 years. In case of recurrence which was diagnosed within first 6 months the residual disease was assumed rather than recurrence one. Data were statistically analyzed. We conclude that the therapeutical effect depends on CIN (cervical intraepithelial neoplasia) localization within cervix, because in case of cervical canal localization the recurrence and residual disease percentage is significantly higher in comparision to the ectocervix localization. This is why the colposcopic precise localization of the lesion within cervix is of the great importance. The free margins of the removed tissue speciemen are also the important prognostic factor. Most of the recurrence are diagnosed within the first year after initial procedure and does not depend on the margins involvement.

The role of mRNA E6/E7 HPV high oncogenic risk expression in colposcopy of cervical intraepithelial neoplasia (CIN).

UNLABELLED: The aim of this paper is the evaluation of colposcopy and mRNA E6/E7 HPV detection--as the marker of persistent human papilloma virus (HPV) infection in the triage of abnormal Pap smears and in the assessment of cervical intraepithelial neoplasia progression risk. The clinical material consisted of 85 women, participating the national cervical cancer screening in the period of April 2010, and October 2010, reffered to the Outpatient Clinic of Gynecologic Oncology and Female Genital Tract Neoplasms Prophylaxy of the Jagiellonian University Medical College in Krakow, Poland. All subjects were offered gynecological evaluation, Pap smear, colposcopy, DNA HPV (Hybrid Capture2, Qiagen) and mRNA E6/E7 testing (NulciSens, Biomerieux). In case of positive tests colposcopically directed cervical biopsy with histopathologic evaluation were performed. RESULTS: The presence of mRNA E6/E7 HPV transcripts correlated with high grade squamous intraepithelial lesions, statistically significantly. There was statistically difference between colposcopic, histologic concordance comparing to mRNA E6/E7 HPV colposcopic histologic concordance (p < 0.001). CONCLUSIONS: The presence of mRNA E6/E7 HR HPV may be assumed as specific marker of high grade cervical lesions. The combination of mRNA E6/E7 HR HPV ewith colposcopic evaluation increases the colposcopy concordanece with final histologic findings.

The effect of nitric oxide synthase and arginine on the color of cooked meat.

In previous studies, it has been suggested that the NO-synthase enzyme may be responsible for color formation in fermented sausages. Thus, this is the first study in which the aim was to analyze the effects of direct NO-synthase and arginine application to meat on its color after heating. Myoglobin forms as well as the presence of NO-myoglobin were investigated. The color of the meat and myoglobin forms present in the samples were mainly affected by pH differences, caused by a HEPES buffer or arginine. None of the variants demonstrated a bright pink color as in the case of the heated nitrite-cured sample. Based on analysis of the absorption spectra, it can be concluded that there is some evidence of nitroso-complex formation. Therefore, it is probable that optimizing the pH/time/temperature conditions for NO-synthase activity would allow to obtain a desirable color effect. NO-synthase could be used as an alternative curing ingredient.

Expression of vascular endothelial growth factors VEGF- C and D, VEGFR-3, and comparison of lymphatic vessels density labeled with D2-40 antibodies as a prognostic factors in vulvar intraepithelial neoplasia (VIN) and invasive vulvar cancer.

OBJECTIVE: The aim of this study was to compare the immunohistochemical expression of vascular endothelial growth factors VEGF-C and D, as well as the expression of VEGFR-3 in VIN and vulvar invasive cancer and to compare the density of lymphatic marker D2-40 antibody in both groups, and to compare them with different clinicopathologic features. MATERIALS & METHODS: The study was performed using tissue material and clinical data from 100 women diagnosed with VIN and 100 women diagnosed with invasive vulvar cancer. RESULTS: No significant differences were found in the expression of VEGF-C and -D or VEGFR-3 between those patients with VIN and those with invasive vulvar cancers. Weak expression of VEGF-C was confirmed only in two cases of the analyzed series; in all cases, expression of VEGF-D and VEGFR-3 was observed. The strongest expression of VEGF-D and VEGFR-3 was observed in the group of invasive cancers. The highest density of lymphatic vessels per 2 mm was observed in VIN. In the cancer group, small lymphatic vessels with a narrow oval lumen were observed. Moreover, in two cases of vulvar cancer, the presence of intratumoral lymphatic vessels was observed. CONCLUSIONS: These results suggest that lymphangiogenesis begins at the preinvasive stage of vulvar carcinogenesis and suggests the important role of VEGF-C, VEGF-D, VEGFR-3 and LV (D2-40) as prognostic factors in the process of carcinogenesis in the vulvar area.

[The risk factors in elderly intensive care unit (ICU) patients admitted after non-traumatic haemorrhagic shock]. / Czynniki ryzyka u chorych w podeszlym wieku leczonych w oddziale intensywnej terapii z powodu wstrzasu krwotocznego nie-pourazowego.

Haemorrhage into the digestive tract lumen in elderly patients leads directly to multiorgan instability and failure. Analysis of 68 ICU patients, treated in 2007-2008 proved interdependence between presenting co-existing diseases, including reduction of vital organ reserve, and multiorgan dysfunction. Each patient was evaluated consecutively according to four commonly accepted severity-of-illness scoring systems (severity models): SAPS2, LODS, MODS and POSSUM. The assessment was displayed in numbers (predicted death rate, PDR) and in binary system of survivors (60%) and non-survivors (40%). The last group was divided into two subgroups: a/. those, who survived (their average PDR calculated in SAPS 2 on admittance was 22.3 vs after surgery on ICU was 25.1, and respectively computed in LODS on admittance was 17.4 vs after surgery on ICU was 21.4), and b/. those, who died shortly after hospital admittance, or following surgery in the ICU (their average PDR calculated on admittance in SAPS2 was 34.8 vs after surgery on ICU was 62.3, and respectively computed in LODS on admittance was 30.0 vs after surgery on ICU was 57.2). In POSSUM average PDR calculated for survivors was 61.6 vs for 85.4 in non-survivors. The difference was also noticed during collecting points in severity scoring systems: in MODS for non-survivors (3.3 on admittance vs 7.5 calculated in ICU after surgery), and in LODS (5.8 vs 9.5, respectively), p<0.001. The main risk factors were systolic blood pressure < 90 mmHg, HR > 140/min, Glasgow Coma Scale < 12, urine output < 20ml/ h, Hb < 8.5 g/L, creatinine > 350 micromol/l, paO2 < 60 mmHg, INR > 2,2, catecholamine i.v. administration > 1 h, mechanical ventilation > 48h, surgery < 2h following patients hospital admittance. In non-survivor group there were more than two co-existing diseases in the 3rd or 4th degree of advancement (p<0.004).

Phylogeography and morphological evolution of Pseudechiniscus (Heterotardigrada: Echiniscidae).

Tardigrades constitute a micrometazoan phylum usually considered as taxonomically challenging and therefore difficult for biogeographic analyses. The genus Pseudechiniscus, the second most speciose member of the family Echiniscidae, is commonly regarded as a particularly difficult taxon for studying due to its rarity and homogenous sculpturing of the dorsal plates. Recently, wide geographic ranges for some representatives of this genus and a new hypothesis on the subgeneric classification have been suggested. In order to test these hypotheses, we sequenced 65 Pseudechiniscus populations extracted from samples collected in 19 countries distributed on 5 continents, representing the Neotropical, Afrotropical, Holarctic, and Oriental realms. The deep subdivision of the genus into the cosmopolitan suillus-facettalis clade and the mostly tropical-Gondwanan novaezeelandiae clade is demonstrated. Meridioniscus subgen. nov. is erected to accommodate the species belonging to the novaezeelandiae lineage characterised by dactyloid cephalic papillae that are typical for the great majority of echiniscids (in contrast to pseudohemispherical papillae in the suillus-facettalis clade, corresponding to the subgenus Pseudechiniscus). Moreover, the evolution of morphological traits (striae between dorsal pillars, projections on the pseudosegmental plate IV', ventral sculpturing pattern) crucial in the Pseudechiniscus taxonomy is reconstructed. Furthermore, broad distributions are emphasised as characteristic of some taxa. Finally, the Malay Archipelago and Indochina are argued to be the place of origin and extensive radiation of Pseudechiniscus.

Sarcopenia-The Impact on Physical Capacity of Liver Transplant Patients.

Optimizing patients' condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = -0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.

PEComa-A Rare Liver Tumor.

PEComa (perivascular epithelioid cell tumor) is a rare liver tumor. Decisions regarding patient management are currently based on a few small case series. The aim of this study was to report the clinicopathological features of PEComa in order to provide guidance for management, complemented by our own experience. This retrospective observational study included all patients with PEComa who underwent surgical treatment in two departments between 2002 and 2020. A total of 20 patients were diagnosed with PEComa following histopathological examination. The age of the patients ranged from 21 to 73 years. The majority of patients were women (85%). In most patients, the tumors were incidental. In diagnostic studies, PEComas with high arterial vascularization have been described. Liver resection was the treatment of choice. There was only one postoperative complication. During histopathological evaluation, tumors were composed mostly of epithelioid cells, rarely with spindle cell components, thick-walled vessels, and adipocytes in different proportions. Melanocytic markers (HMB45, MelanA) and at least one smooth muscle marker were expressed in all tumors. Features suggestive of malignancy were found in three cases. In conclusion, PEComa is a rare liver tumor that is usually diagnosed incidentally. In radiological studies, tumors with high arterial vascularization are observed. Liver resection is the treatment of choice.

Analysis of Patients With Incidental Perihilar Cholangiocarcinoma: An Old and a Persistent Burden for Liver Transplantation.

BACKGROUND: Selected patients with unresectable perihilar cholangiocarcinoma (p-CCA) are now considered as candidates for liver transplant, provided they fulfill a strict perioperative treatment and staging protocol. The aim of this study was to examine the outcomes of patients after liver transplant with incidental p-CCA found in the liver explants. METHODS: A cohort of 10 patients with incidental p-CCA after liver transplant in the period between 1994 and 2019 was included in this retrospective analysis. All patients with this diagnosis were scheduled for transplant because of primary sclerosing cholangitis. The primary and secondary endpoints comprised patient's death and tumor recurrence, respectively, assessed over a 5-year postoperative period. RESULTS: Patient median age was 35 years (range, 32-42 years). Median size of the tumor was 3.0 cm (range, 2.5-4.0 cm). Five patients (50%) had metastases to local lymph nodes. Overall survival was 100%, 37.5%, and 18.8% after the first, third, and fifth postoperative year, respectively, with median survival of 21 months. Patient age (P = .827), R1 resection status (P = .144), tumor diameter (P = .432), and presence of lymph node metastases (P = .663) were not significantly associated with overall survival. Recurrence-free survival was 60.0% after the first postoperative year and 22.5% after the third and fifth postoperative years, with median recurrence-free survival of 13.6 months. No significant predictors of tumor recurrence were found. CONCLUSIONS: Incidental p-CCA in patients with primary sclerosing cholangitis undergoing liver transplant is associated with universally very high risk of postoperative tumor recurrence and short expected survival.

Hepatic Epithelioid Hemangioendothelioma: A Rare Disease With Favorable Outcomes After Liver Transplantation.

BACKGROUND: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor with indolent behavior in terms of malignancy. The treatment of choice is either resection in the case of resectable lesions or liver transplantation (LT) for the disseminated intrahepatic form. The aim of this study was to investigate the outcomes of patients with HEHE treated by LT. MATERIAL AND METHODS: There were 18 patients with HEHE who underwent LT between 2002 and 2018 included in this retrospective study. The study group was comprised of young recipients (median age of 39 years) and mainly women (15 of 18; 83.3%). Two recipients had concomitant tumors of epithelioid hemangioendothelioma in the liver and lungs prior to LT. The survival probability was calculated using the Kaplan-Meier estimator. RESULTS: According to histopathological data, none of the patients had a macrovascular invasion. In 4 patients (22.2%), the disease had spread to the hilar lymph nodes. The maximum diameter of the tumor in the studied group was 18 cm. The survival probability after 1, 5, and 15 years was 94.0%, 82.6%, and 41.3%, respectively. No disease recurrence was observed during a median follow-up of 65.9 months. CONCLUSION: Liver transplantation provides favorable outcomes for selected patients with a hepatic form of epithelioid hemangioendothelioma.

Unsatisfactory Long-term Results of Liver Transplant in Patients With Intrahepatic Cholangiocarcinoma.

BACKGROUND: Cholangiocarcinoma is the primary liver tumor forming from the biliary epithelium. Two major subtypes of this disease are distinguished because of the initial location: the extra- and intrahepatic form. The latter disease is currently a controversial indication for liver transplant (LT). The aim of this study was to evaluate the outcomes of LT of patients with intrahepatic cholangiocarcinoma. METHODS: Based on postoperative histopathologic examination of the explanted liver, 8 patients with intrahepatic cholangiocarcinoma were identified from all LT recipients in the period between 1994 and 2019 and included in this retrospective cohort study. Four of the patients received transplants with a preoperative diagnosis of hepatocellular carcinoma; the remaining tumors were incidental findings. Patient survival was the primary outcome measure. RESULTS: Six recipients had solitary lesion with a maximum tumor diameter of 6 cm. The median carbohydrate antigen 19-9 concentration prior to LT was 52.3 U/mL. The overall survival was 75.0%, 37.5%, and 25% after the first, third, and fifth year, respectively, with a median survival of 18 months. Age (P = .758), carbohydrate antigen 19-9 (P = .282), largest tumor size (P = .862), and the sum of the number of lesions and diameter of the largest tumor (P = .530) were not significantly associated with overall survival. Recurrence-free survival was 71.4% after 1 year and 28.6% after 3 and 5 years. Correspondingly, no significant predictors of worse recurrence-free survival were found. CONCLUSIONS: Intrahepatic cholangiocarcinoma remains associated with a very high risk of recurrence and dismal survival after LT irrespective of macroscopic disease burden.