Metabolic-associated fatty liver disease and hepatocellular carcinoma: a prospective study of characteristics and response to therapy.

BACKGROUND AND AIM: The rising incidence of hepatocellular carcinoma (HCC) in Australia is related to increasing rates of metabolic-associated fatty liver disease (MAFLD). This study aimed to prospectively characterize the metabolic profile, lifestyle, biometric features, and response to treatment of HCC patients in an Australian population. METHOD: Multicenter prospective cohort analysis of newly diagnosed HCC patients at six multidisciplinary team meetings over a 2-year period. RESULTS: Three hundred and thirteen (313) newly diagnosed HCC patients with MAFLD (n = 77), MAFLD plus other liver disease (n = 57) (the "mixed" group), and non-MAFLD (n = 179) were included in the study. Alcohol-associated liver disease (ALD) (43%) and MAFLD (43%) were the most common underlying liver diseases. MAFLD-HCC patients were older (73 years vs 67 years vs 63 years), more likely to be female (40% vs 14% vs 20%), less likely to have cirrhosis (69% vs 88% vs 85%), showed higher ECOG, and were less likely to be identified by screening (29% vs 53% vs 45%). Metabolic syndrome was more prevalent in the MAFLD and mixed groups. The severity of underlying liver disease and HCC characteristics were the same across groups. While the MAFLD population self-reported more sedentary lifestyles, reported dietary patterns were no different across the groups. Dyslipidemia was associated with tumor size, and those taking statins had a lower recurrence rate. CONCLUSION: Equal to ALD, MAFLD is now the most common underlying liver disease seen in HCC patients in Australia. Future HCC prevention screening and treatment strategies need to take this important group of patients into consideration.

Content and Perceived Utility of Mental Imagery by Older Adults in a Peer-Delivered Physical Activity Intervention.

Imagery interventions intended to increase exercise behavior are rare. The Active Adult Mentoring Program (AAMP) was a randomized controlled trial with imagery content. The purposes of this study were to examine the content and perceived utility of mental imagery with 24 AAMP participants (Mage = 65.00, SD = 8.79 years). Digital recordings of AAMP sessions and post-intervention interviews were content-analyzed. Emergent themes included images of the physical activity context and negative impressions about imagery. Post-intervention interviews revealed that 13 participants reported positive experiences using mental imagery while 9 would not engage in further use. Important implications are discussed.

Individualized piano instruction enhances executive functioning and working memory in older adults.

This study evaluates transfer from domain-specific, sensorimotor training to cognitive abilities associated with executive function. We examined Individualized Piano Instruction (IPI) as a potential cognitive intervention to mitigate normal age-related cognitive decline in older adults. Thirty-one musically naïve community-dwelling older adults (ages 60-85) were randomly assigned to either the experimental group (n = 16) or control group (n = 15). Neuropsychological assessments were administered at three time points: pre-training, following six months of intervention, and following a three-month delay. The experimental group significantly improved performance on the Trail Making Test and Digit Symbol measures as compared to healthy controls. Results of this study suggest that IPI may serve as an effective cognitive intervention for age-related cognitive decline.

Availability of mental health services for older adults: a cross-cultural comparison of the United States and Turkey.

Researchers conducted a cross-cultural study using qualitative methods (based on a phenomenological approach) to explore the availability of mental health services (MHS) for older adults in the United States and Turkey. Using purposive sampling, semi-structured in-depth interviews were conducted with administrators (n=24) from a wide-range of sites (nursing homes, hospice, senior centers) in a rural area of North Central Florida, United States and Ankara, Turkey. Interview questions focused on types of staff employed; integration of MHS with other services provided; community promotion of services; coordination, cooperation and communication with other service providers; and administrators' perceptions of barriers in the provision of MHS for older adults. Interestingly, employing on-site mental health staff was a much more popular practice in Turkey compared to the United States with three times as many Turkish sites having on-site mental health professionals. As anticipated, administrators in both countries cited inadequate funding as the most common barrier to MHS provision. Potential solutions to MHS barriers in both countries are discussed.

Age-related differences in object- and location-based inhibition of return of attention.

Four experiments examined age-related differences in inhibition of return (IOR) of visual attention. Using static stimuli, both young and older adults were slower to detect targets in previously cued objects, showing equivalent IOR. With objects that moved after they had been cued, young adults were slower to detect targets in the cued object (compared with uncued ones), revealing object-based IOR, but older adults were faster to detect targets in such objects, failing to demonstrate object-based IOR. Both age groups were slower to detect targets at the initially cued location (location-based IOR). The results show that age has a differential effect on IOR depending on the frame of reference of the inhibition: Inhibition for objects breaks down with age, but that for location does not. This pattern of results is consistent with the view that there are specific inhibitory deficits in old age.

Box Hill Hospital Intensive Care Unit.

The Unit Profile of the Intensive Care Unit at Box Hill Hospital describes the Unit's history and the progression it has made through the past 26 years. Details are given on the type of patients received and the catchment areas this Unit services. The organisational structure and the educational services available are discussed. The breakdown of staff including the nursing and medical staff and the available ancillary services as stated. The critical care course is described in detail to give an outline of and to promote this tertiary based course. It is also hoped this will encourage other hospitals and tertiary institutions to structure such similar courses to provide a more professional education for nurses.

Wear of polyethylene in total joint replacements. Observations from retrieved PCA knee implants.

Observations of wear damage were performed on 12 retrieved porous coated anatomic (PCA) tibial components, all of which were removed because of excessive polyethylene wear. Density measurements of the remaining polyethylene were obtained as a function of depth from the surface of the components. Comparison to previous results from similar studies of total condylar type knee components and total hip acetabular components revealed distinct differences between the types and severity of damage, emphasizing the influence of design factors on the corresponding wear damage. These results confirm previous conclusions that nonconforming articulating surfaces on thin polyethylene components will be at higher risk of damage than more conforming surfaces on thicker components. It also appears that the high cyclic loads to which polyethylene implants are subjected in vivo are most responsible for the degradation in properties of the material near the articulating surface, although the heat pressing of the articulating surface of the PCA components may contribute to the problem.

The arthroscopic evaluation and characteristics of severe polyethylene wear in total knee arthroplasty.

Four hundred eighty-seven porous-coated anatomic (PCA) total arthroplasties were performed by the same surgeon between January 1982 and December 1989. Forty-three patients developed an effusion, pain, or decreased range of motion after a period of pain-free function. Average time to onset of symptoms was 4.5 years. Joint fluid aspirations were sterile and revealed the presence of high-density polyethylene crystals, best seen under a polarizing microscope. Thirty-three of these patients were arthroscopically evaluated. Extensive polyethylene wear and delamination were identified. Wear was most extensive on the medial tibial plateau. Patellar polyethylene wear was also identified. Substantial femoral component abrasions were present in areas where exposure of the tibial and patellar base plates had occurred. Diffuse granulomatous synovial tissue revealed an extensive foreign-body giant-cell reaction to polyethylene particles. In all patients, temporary symptomatic relief was obtained after arthroscopy. Thirty-two patients have, subsequently, had revision surgery. Intraoperative findings and biopsies at the time of revision confirmed the arthroscopic observations. Arthroscopy allowed the accurate diagnosis of polyethylene wear, provided temporary symptomatic relief, and facilitated preoperative revision planning. Polyethylene wear in PCA total knee replacements was related to patient characteristics (larger, younger, more active patients), nonconforming femotibial articular surfaces, thin polyethylene, heat-pressed polyethylene, and nonrigid mechanical attachment of polyethylene to metal base plate. Younger, more active, larger patients with total knee arthroplasties should be observed closely for evidence of polyethylene wear.

Intracellular pathway of interleukin-2 receptors studied using immunogold electron microscopy.

The fate of internalized interleukin-2 receptors (IL-2R) on proliferating T cell blasts and Lyt-2-/L3T4- thymocytes was studied by immunogold electron microscopy. Immediately following labeling, IL-2R were found in coated pits and with time there was sequential appearance of gold particles in smooth vesicles or endosomes, multivesicular bodies and lysosomes. Thus the IL-2R appears to be a member of cell surface receptors internalized by endocytosis via coated pits.