Difficulties of familes in caring for children and adolescents with mental disorders: an integrative review / Dificultades de las familias en la atención a niños y jóvenes con trastorno mental: una revisión integral / Dificuldades das famílias no cuidado à criança e ao adolescente com transtorno mental: uma revisão integrativa

Objective To identify the difficulties of families with children and/or adolescents with mental disorder. Method This is an integrative review. In December 2013, an electronic search was performed on Latin American Caribbean Literature on Health Sciences databases (LILACS) and on Electronic Medicus Index of the National Library of Medicine (MEDLINE) indexed in the Health Virtual Library (BVS) using a combination of descriptors and boolean operators as follows: mental disorders and child or adolescent and caregivers and/not health staff. Results 557 studies were identified, of which 15 were selected for this study. The findings indicated difficulties related to the care for or to interaction with children/adolescents with mental disorder. Conclusion The studies revealed difficulties related to everyday practices of care and feelings expressed during care practices, as well as in relationships with children or adolescents with mental disorder.

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Objetivo Identificar las dificultades de las familias con niños y/o adolescentes con desórdenes mentales. Método Se trata de una revisión integradora. Una búsqueda electrónica se realizó en diciembre de 2013, en la base de datos de la literatura caribeña Latinoamericano de Ciencias de la Salud (LILACS) y en el Índice de Electronic Medicus de la Biblioteca Nacional de Medicina (MEDLINE) indexados en la Biblioteca Virtual en Salud (BVS), utilizando combinación de descriptores y operadores booleanos transtornos mentales and niño and adolescentes and cuidadores and/not personal de salud. Resultados Se identificaron 557 estudios, de los cuales 15 fueron considerados para este estudio. Los hallazgos indican dificultades relacionadas con la atención o estar con los niños o adolescentes con trastornos mentales. Conclusión Se evidenciaron las dificultades relacionadas con las prácticas cotidianas y con los sentimientos durante la atención de quien vive con un niño o adolescente con trastornos mentales.
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Objetivo Identificar as dificuldades das famílias de crianças ou adolescentes com transtornos mentais. Método Trata-se de uma revisão integrativa realizada nas bases de dados da Literatura Latino-Americana do Caribe em Ciências da Saúde (LILACS) e no Index Medicus Eletrônico da National Library of Medicine (MEDLINE) indexadas na Biblioteca Virtual em Saúde (BVS) utilizando a combinação dos descritores e operadores booleanos transtornos mentais and criança or adolescente and cuidadores and/not pessoal de saúde, em dezembro de 2013. Resultados Foram identificados 557 estudos, dos quais 15 foram selecionados para este estudo. Os achados evidenciaram dificuldades relacionadas ao cuidado ou convívio com crianças ou adolescentes com transtorno mental. Conclusão Foram evidenciadas dificuldades relacionadas às práticas cotidianas e aos sentimentos manifestos durante o convívio e o cuidado de crianças ou adolescentes com transtornos mentais.
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Expansion of peripheral and intratumoral regulatory T-cells in hepatocellular carcinoma: A case-control study.

Background: Hepatocellular carcinoma (HCC) is notorious for poor prognosis with limited therapeutic options. A better understanding of the role of regulatory T-cells (Tregs) in HCC is important for design of immunotherapy based clinical protocol. The objective of the present study was to evaluate the presence of Tregs in tumor microenvironment in patients with HCC compared to chronic hepatitis (CH). Materials and Methods: The frequency of CD4 + CD25 + Treg cells was evaluated from peripheral blood (PB) of 28 patients of HCC and 30 controls including CH cases and healthy donors using flowcytometry. Intratumoral Treg were also analyzed in tissue samples from 17 HCC cases and 15 CH cases. In addition the expression of FOXP3 and CTLA-4 was also studied by RT-PCR. Results: Frequency of CD4 + CD25 + cells in the PBMCs of HCC cases was significantly higher than in HC (10.8 ± 7.64 vs 3.05 ± 1.30, P < 0.005) and CH patients (2.88 ± 1.92, P < 0.005). Also Treg population was significantly higher in HCC tumor microenvironment compared to CH biopsies (15.8 ± 5.32 vs 5.51 ± 3.40, P < 0.05). Expression of FOXP3 and CTLA-4 was also significantly higher in HCC patients ( P < 0.05) compared to CH group. Conclusions: We provide evidence of an increased population of Treg not only in the PB but also in tumor microenvironment of HCC patients, suggesting association of enhanced Treg activity with poor immune responses to tumor antigens. These findings may in future play a significant role in designing immunotherapeutic approaches in HCC.

Changes of CD4(+) CD25 (+) regulatory T cells in peripheral blood in patients with hepatocellular carcinoma before and after TACE / 华中科技大学学报（医学）（英德文版）

This study investigated the changes of CD4(+) CD25(+) regulatory T cells (Tregs) in peripheral blood of patients with hepatocellular carcinoma before and after transcatheter arterial chemoembolization (TACE). The proportion of CD4(+) CD25(+) Tregs among CD4(+) T lymphocytes in peripheral blood of 33 patients with hepatocellular carcinoma was determined by flow cytometry before, 1 week and 1 month after TACE. And 25 healthy volunteers served as control. One month after TACE, the patients were divided into two groups: 22 in group A, who were in stable condition or getting better; and 10 in group B, who were deteriorating. One patient died and was excluded. The results showed that the percentage of CD4(+)CD25(+) Tregs among CD4(+) T lymphocytes did not significantly change in the 33 patients 1 week after TACE as compared with that before TACE, however, the difference was significant (P<0.01) between the patients with hepatocellular carcinoma and the healthy subjects. The percentage of CD4(+) CD25(+) Tregs among CD4(+) T lymphocytes in group A 1 month after TACE was decreased significantly in comparison with that before and 1 week after TACE (P<0.01), whereas, that in group B was increased significantly 1 month after TACE (P<0.01). It was concluded that patients with hepatocellular carcinoma had a higher proportion of CD4(+)CD25(+) Tregs in peripheral blood. TACE did not significantly affect the level of CD4(+) CD25(+) Tregs within short time (such as 1 week). The proportion of CD4(+)CD25(+) Tregs in peripheral blood 1 month after TACE was related to the prognosis of hepatocellular carcinoma.

Solitary Extramedullary Plasmacytoma of the Liver without Systemic Monoclonal Gammopathy

Extramedullary plasmacytoma of the liver is a very rare tumor. Although a few cases of extramedullary plasmacytoma of the liver have been reported, we could not find any report on truly localized extramedullary plasmacytoma of the liver in the literature. The patient was a 63-yr-old man who exhibited a solitary liver mass on dynamic computed tomography and magnetic resonance imaging. Histologically, the tumor was composed of mature plasma cells with mild atypia. Immunohistochemistry demonstrated monoclonal IgG and Kappa light chain expression. Bone marrow examination revealed no abnormalities. There was no evidence of a monoclonal protein in the serum and urine, lytic bone lesions, anemia, renal insufficiency, and hypercalcemia. The patient was treated with 5,000 cGy of radiotherapy, and the tumor disappeared 6 months after treatment.

Utilization of antihepatocyte clone OCH1E5 (Hep Par 1) in histological evaluation of liver tumors.

Diagnosis of hepatocellular carcinoma (HCC) is not always easy on simple hematoxylin and eosin (H&E) stain. The diagnostic problems arise when tumor shows pseudoglandular, pleomorphic or clear cell differentiation. Various tumors markers have been described with varying sensitivity and specificity. Monoclonal antibody Hep Par 1 (OCH1E5) which is specific for hepatocytes offers great help in separation of these tumors. The aim of the present study was to determine utility of Hep Par 1 (OCH1E5) in differentiating HCC from metastatic tumors and cholangiocarcinoma. Total of 62 cases of liver tumors obtained from biopsies, resected or autopsy specimens were included in the study. Slides having representative sections were subjected to immunohistochemistry with monoclonal antibody Hep Par 1 (Dako Corp) using avidin biotin technique with primary antibody dilution of 1:40. Adjacent nontumorous hepatocytes were taken as positive control. Slides were examined by experienced pathologist without any information of clinical or H&E diagnosis. Cases were considered positive for Hep Par 1 if tumor cells showed cytoplasmic brown colored granules. The intensity and distribution (diffuse/ focal) of immunoreactivity was noted. Subsequently immunohistochemistry results were correlated with histology and clinical diagnosis. Hep Par 1 antibody was positive in 26 (42 %) and negative in 36 (58 %) liver tumors. On correlating with H&E sections, out of 26 positive cases, 25 (89.2%) were HCC and one was the case of metastasis of mucin secreting adenocarcinoma. From 36 tumors with negative staining 3 were cases of HCC, 27 metastatic adenocarcinomas and 6 cholangiocarcinomas. Only one case of liver metastasis of mucin secreting adenocarcinoma showed positivity. None of the cases of cholangiocarcinoma showed positivity for Hep Par 1. The three HCCs which did not take up staining for Hep Par 1 were 2 cases of moderately differentiated HCC having pseudoglandular pattern and a case of well differentiated HCC with trabecular arrangement. In 11(44%) cases staining was diffuse while in 14 (56%) it was focal but intense. Hep Par 1 is a useful marker in differentiating HCC from metastaic tumors and cholangiocarcinoma with sensitivity and specificity of 89 % and 97 % respectively and positive predictive value of 96 %. However one should be aware of limitations of immunohistochemistry.

Clinical associations and prognostic significance of serum anti-p53 antibodies in Thai patients with hepatocellular carcinoma.

Mutations of the p53 gene have been reported to be of prognostic significance in hepatocellular carcinoma (HCC). However, the clinical associations and prognostic value of anti-p53 antibodies, known to be products of the host immune response to these mutations, have been controversial. Serum anti-p53 antibodies were measured in 121 Thai patients diagnosed with HCC using a specific enzyme-linked immunosorbent assay (ELISA) kit. The clinical/pathological characteristics of the patients were compared with respect to the presence of serum anti-p53 antibodies. Cox regression analysis was performed to assess factor interaction and association with survival. Anti-p53 antibodies were detected in 13.2% (16 of 121) of our patients. There were no differences between groups with regard to age, sex, viral markers (HBsAg or anti-HCV), severity of liver disease and tumor advancement. The median survival rates for patients positive and negative for anti-p53 antibodies were 4.0 and 3.0 months, respectively (p = 0.443, by log-rank test). Multivariate analysis demonstrated that an advanced Okuda stage, lack of therapy and presence of portal vein thrombosis were independent factors related to the prognosis of the patients. Nonetheless, the presence of anti-p53 antibodies did not constitute a predictive variable associated with a poorer prognosis. Serum assay of anti-p53 antibodies, although rapid and easily performed, may not be suitable as an alternative to molecular detection of mutations in assessing tumor advancement and prognosis of patients with HCC.

Inhibition of HBsAg secretion from Alexander cell line by Phyllanthus amarus.

Alexander cell line, an human hepatocellular carcinoma derived cell line which has the property of secreting HBsAg in the supernatant was used to study the antiviral property of phyllanthus amarus. Aquous extract of Phyllanthus amarus was evaluated for its in vitro ability to inhibit HBsAg secretion on a dose dependent manner. It was seen that P. amarus at 1mg/ml concentration on a single dose inhibited the secretion of HBsAg for a period of 48 hours. This experiment proved the anti hepatitis B virus property of P. amarus at cellular level and further confirmed its beneficial use in the treatment of acute and chronic hepatitis B and healthy carriers of HBV.

Anticuerpos contra el virus de la hepatitis C en pacientes con hepatopatías y en sujetos a riesgo: comunicación preliminar / Antibodies against hepatitis C virus in patients with liver diseases and in risk subjects: preliminary report

El reciente descubrimiento de un componente antigénico del virus causante de la Hepatitis No-A No-B post-transfusional, hizo posible caracterizar dicho agente el cual se ha denominado Virus de la Hepatitis C y permitió detectar un anticuerpo presente en personas infectadas (anti-VHC) utilizando el antígeno C-100 derivado de una región no estructural del genoma viral. El objetivo del presente trabajo es determinar en nuestro medio la frecuencia con que se presenta el anticuerpo descrito detectado mediante técnica de inmunoensayo enzimatico ELISA, utilizando el Kit comercial de Ortho Diagnostic Systems Inc. Los resultados obtenidos fueron los siguientes: Personal de Salud (médicos, enfermeras y personal del laboratorio): 102 personas estudiadas, dos positivas (1,96%), 16 pacientes en hemodiálisis crónica: 6 positivos (33%); 20 sujetos con anticuerpos contra el virus de la inmunodeficiencia humana confirmado mediante técnicas de Western blot: 7 positivos (35,4%). De 10 pacientes con hepatitis crónica Antígeno de superficie negativos, siete (70%) resultaron positivos para anti-VHC; de 25 pacientes con cirrosis hepática: 12 positivos (48%), de 2 pacientes con hepatocarcinoma 1 positivo (50%). Se constató además una frecuente asociación de anticuerpo anti-core total contra el virus B en los pacientes con hepatopatías. Losresultados sugieren que el virus C puede estar jugando un papel etiológico importante en pacientes con afecciones hepáticas en nuestro medio

Serological makers in hepatocellular carcinoma (HCC)

A conscientizacao de que hepatopatas cronicos devem realizar exames de imagens ou determinacao de marcadores sericos periodicamente a cada 3-6 meses, objetiva a realizacao de diagnostico precoce do carcinoma hepatocelular. Tem o objetivo de identificar lesoes menores que 3 cm, as quais, quando convenientemente ressecadas, podem oferecer melhores niveis de sobrevida tardia. A realizacao de ultra-sonografia do figado, pelas suas caracteristicas de baixo custo e facil execucao, tem papel importante nesta programacao. A tomografia computadorizada, ressonacia magnetica e a arteriografia hepatica devem ser realizadas quando da utilizacao de outros metodos complementares na tentativa de definicao mais precisa. Objetivamente, quanto aos marcadores sericos, a fosfatase alcalina e especifica, mas pouco sensivel para o diagnostico dos pequenos carcinomas hepatocelulares, enquanto que a concentracao plasmatica de gama-GT esta elevada em 100 por cento das lesoes avancadas, comportamento incerto nas lesoes pequenas. Talvez o uso de isoenzimas da gama-GT possa, no futuro, fornecer respostas mais objetivas. A *-L fucosidase, sabe-se hoje, e um marcador util, com 75 por cento de sensibilidade e 90 por cento de especifidade. A partir de 1981, tem se utilizado, em alguns centros, glutation S. transferase como marcador tumoral, ...

Evolución alejada en portadoras asintomáticos HBsAg(PA-HBsAg) en un área de baja prevalencia de hepatocarcinoma

Data provided by 51 voluntaru blood donnors identified as asymptomatic HBsAg carriers five to ten years (x = 7.5 years) before their inclusion in the study are analysed towards their long-term evolution. HBsAg clearance was estimated 2.5% yearly and 83.9% of those remaining positive showed the classical non-replicative serological pattern,; another 12.9% were negative for both HBeAg - Anti HBe (serovonversion window?), one of them presenting raised ASATALAT levels and enhanced histological activity (lobular chronic hepatitis). Neither alpha-fetoprotein seric levels (RIA) nor liver ultrasonography demonstrated hepato cellular carcinoma suspicion signs in 35 HBsAg positive cases to this methods; ASAT-ALAT levels raised over two fold the normal superior limit ion only 11.4%, and neither agressive chronic liver disease nor hepatocyte dissplasia was showed in 17 biopsed cases (70.6% normal; 23.6% chronic reactive or chronic persistent hepatitis; 5.8% chronic liobular hepatitis). One out of five patients biopsed with a seven years interval showed histologic worsening

High prevalence of delta virus infection in Thai intravenous drug abusers.

The prevalence of antibodies to delta virus (anti-delta) in the selected groups of hepatitis B surface antigenemia population was investigated. The subjects were 84 intravenous drug abusers; 20 chronic hepatitis, 12 cirrhosis, 6 primary hepatocellular carcinoma and 46 asymptomatic healthy carriers. Anti-delta was detected in 65.48% of intravenous drug abusers, 11.11% of chronic active hepatitis and 8.33% of cirrhosis cases. None of asymptomatic carriers had anti-delta. In addition, 51 acute icteric hepatitis B patients who were positive for HBs Ag and 20 IV drug abusers positive for anti-HBc only (HBsAg and anti-HBs negative) were negative for anti-delta.

Estudios inmunohistoquímicos en hepatocarcinomas / Immunohistochemical studies in hepatocarcinomas

Se estudiaron 18 hepatocarcinomas en los que se investigó mediante el método de peroxidasa-antiperoxiadasa la presencia de alfa-1-antitripsina (A1AT), alfa feto proteína (AFP) y el antígeno de superficie de la hepatitis B (HBsAg) en el tejido tumoral y del parénquima hepático no neoplásico. Se halló positividad para A1AT en 13 casos (72 por ciento), siendo la tinción citoplasmática de tipo globular o difusa. La AFP fue positiva en 4 casos (22%) en forma globular. Todos los casos positivos para AFP lo fueron también para A1AT. La presencia de HBsAg fue detectada en dos casos (11%) en el citoplasma de las células tumorales. De los 8 casos en que contaba con parénquima hepático no neoplásico, en 2 se observó positividad difusa para A1AT. Este trabajo demuestra la alta frecuencia de positividad de A1AT en carcinomas hepatocelulares. Si bien no se trata de un marcador tumoral específico es de ayuda diagnóstica en un tumor histológicamente compatible con esta neoplasia. La AFP es mucho más específica aunque la frecuencia con que fue hallada es mucho menor. La positividad para HBsAg es un dato más sobre la posible vinculación etiológica entre el virus de la hepatitis B y el desarrollo de estos tumores