Perceived stress, optimism-pessimism, psychological adjustment, and death distress of nurses during the COVID-19 pandemic.

OBJECTIVE: the aim of this study is to investigate the relationship between death distress, psychological adjustment, optimism, pessimism and perceived stress among nurses working during the COVID-19 pandemic. METHOD: this study was designed as cross-sectional/cohort. The population of the study involved 408 nurses from Northern Cyprus, which are registered as full members of the Nurse Council. The sample comprised 214 nurses, who volunteered to participate in the study. The study data was collected using a web-based online survey (Demographic form, the Coronavirus Stress Measure, The Optimism and Pessimism Questionnaire, The Brief Adjustment Scale-6, The Death Distress Scale). RESULTS: the results indicated that perceived stress significantly and negatively predicted optimism (ß = -0.21, p < 0.001) and pessimism (ß = 0.38, p < 0.001). Perceived stress had significant and positive predictive effects on psychological adjustment (ß = 0.31, p < 0.001) and death distress (ß = 0.17, p < 0.01). Further analysis results revealed that pessimism mediates the association of stress with psychological adjustment and death distress; however, optimism only mediates the effect of stress on psychological adjustment among nurses. CONCLUSION: a low level of pessimism is effective in strengthening nurses' psychological adjustment skills againt perceived stress and death distress. Nurses should consider behavioral strategies to help reduce the level of pessimism during periods such as pandemics. BACKGROUND: (1) High levels of perceived stress increased higher score of psychological adjustment. (2) Pessimism mediates the association of stress with adjustment and death distress. (3) Optimism only mediates the effect of stress on psychological adjustment among nurses.

Modification of Mediterranean Diet Pyramid from an Island's perspective / Alteração da Pirâmide Alimentar Mediterrânea na perspectiva de uma Ilha

ABSTRACT Objective The present study aimed to determine traditional and local food consumption and adherence to the Mediterranean diet in Cyprus. And also, aimed to improve their adherence to the Mediterranean diet and traditional and local food consumption. From this point, this current study aimed to revise the Cyprus Mediterranean Diet Pyramid, based on the Current Mediterranean Diet Pyramid. Methods The sample size was calculated as a minimum of 386 according to a 95.0% confidence interval, and a 5.0% error. This study was conducted online between November 2020-April 2021 in Cyprus. All volunteers were invited to this study on the national public internet platforms. Participant´s adherence to the Mediterranean diet was determined by the Mediterranean Diet Adherence Screener. Traditional and local food consumption frequencies were determined by a Food Frequency Questionnaire. A novel Cyprus Mediterranean Diet Pyramid was developed with traditional and local food items for Cyprus. The modification was also aimed to safeguard planet health, to increase traditional food consumption and adherence to the Mediterranean diet. Results 1,007 adults (78.0% native islanders/Cypriots) participated voluntarily in the current study. The mean Mediterranean Diet Adherence Screener score was 7.55±2.30 points and only 34.4% had high adherence to the Mediterranean diet. According to their responses, there was a need to increase use of olive oil, vegetables, fruits, fish, and red wine consumption and to decrease red meat and dessert consumption. According to responses to the Mediterranean Diet Adherence Screener and their traditional/local food consumption frequencies an up-to-date Cyprus Mediterranean Diet Pyramid was done hence a national food pyramid for Cyprus. Commonly consumed traditional and local foods were added to the pyramid to facilitate increased adaptation of the Mediterranean diet in the general population. Adequately consumed foods were added to make it more region-specific and rarely consumed foods were added to help to increase consumption. Conclusion This modification is believed to be instrumental to increase Mediterranean diet adaptation, traditional/local food consumption and decrease the impact of nutrition on the planet´s health. And also, this modification can shed light on the development of the other traditional food pyramids.

RESUMO Objetivo Este estudo teve como objetivo determinar o consumo alimentar tradicional e local, bem como a adesão à dieta mediterrânea no Chipre. Também teve como objetivo melhorar a adesão à dieta mediterrânea e ao consumo de alimentos tradicionais e locais. A partir desse ponto, este trabalho atual teve como objetivo revisar a Pirâmide da Dieta Mediterrânea do Chipre, que é baseada na Pirâmide da Dieta Mediterrânea Atual. Métodos O tamanho da amostra foi calculado com um mínimo de 386 de acordo com intervalo de confiança de 95,0% e erro de 5,0%. Este estudo foi realizado online entre novembro de 2020 e abril de 2021 em Chipre. Todos os voluntários foram convidados para esta análise nas plataformas públicas nacionais de internet. A adesão dos participantes à dieta mediterrânea foi avaliada pelo Medidor de Adesão à Dieta Mediterrânea. As frequências de consumo alimentar tradicional e local foram determinadas pelo Questionário de Frequência Alimentar. Foi desenvolvida uma nova Pirâmide da Dieta Mediterrânica de e para o Chipre, com alimentos tradicionais e locais. A modificação teve também como objetivo salvaguardar a saúde do planeta, aumentar o consumo de alimentos tradicionais e a adesão à dieta mediterrânea. Resultados No total de 1.007 adultos (78,0% naturais da ilha/cipriotas) participaram voluntariamente no estudo. A pontuação média obtida no Medidor de Adesão à Dieta Mediterrânea foi de 7,55±2,30 pontos, com apenas 34,4% aderindo fortemente à dieta mediterrânea. De acordo com as suas respostas, houve necessidade de aumentar a utilização de azeite, vegetais, frutas, peixe e vinho tinto, bem como de diminuir o consumo de carnes vermelhas e sobremesas. Com base nas suas respostas ao Medidor de Adesão à Dieta Mediterrânea e as suas frequências de consumo alimentar tradicional/local, foi feita uma pirâmide da Dieta Mediterrânea do Chipre atualizada, ou seja, uma pirâmide alimentar nacional para o Chipre. Alimentos locais e regionais comumente consumidos foram adicionados à pirâmide para aumentar a adesão à dieta mediterrânea. Alimentos consumidos de acordo com as recomendações foram adicionados para torná-los específico da região, e alimentos pouco consumidos foram adicionados para ajudar a aumentar o consumo. Conclusão Acredita-se que esta modificação seja determinante para aumentar a adaptação da dieta mediterrânea e o consumo de alimentos tradicionais e locais, além de diminuir o impacto da nutrição na saúde do planeta. Ainda, essa modificação pode lançar luz sobre o desenvolvimento das outras pirâmides alimentares tradicionais.

CCR5-Δ32 gene variant frequency in the Turkish Cypriot population.

Recent UNAIDS reports (December 2019) indicate that 37.9 million people have been affected by HIV infection around the globe in 2018, of which 1.7 million are cited as new infections. Human immunodeficiency virus-1 (HIV-1) requires both the CD4 receptor, as the primary receptor, and a chemokine co-receptor to gain entry into the cell. In addition to the WT allele for C-C motif chemokine receptor 5 (CCR5-wt), there is another allele with a 32 bp deletion in the protein coding region (CCR5-Δ32). Individuals who are homozygous for the mutant allele are resistant towards M-tropic HIV infections. In the current study, we aimed to determine the CCR5-Δ32 allele frequency in the Turkish Cypriot population with 326 subjects, 141 men (43.1%) and 185 (56.9%) women. The region of the CCR5 gene containing the Δ32 deletion was amplified using flanking primers. The CCR5 gene Δ32 allele frequency was calculated at 3% and only observed in heterozygous individuals. We hope that our current publication could be a point of dialog between the physicians, the government officials and the public set up a more modern and well-structured HIV screening program in an effort to control and hopefully eliminate HIV from the Turkish Cypriot population.

Intestinal ciliates (Alveolata, Ciliophora) in Brazilian domestic horses (Equus caballus L.) and a review on the ciliate communities associated with horses around the world.

The aims of this study were to identify and quantify the gastrointestinal ciliates from Brazilian domestic horses, to compare the data obtained with previous studies and to review data on ciliate communities associated with horses around the world. We used eight domestic horses, kept under extensive management. Fecal samples were obtained immediately after defecation of animals and fixed in 18.5% formaldehyde. We identify 24 species of endosymbiotic ciliates, distributed in two subclasses, two orders, five families and 13 genera. The ciliate composition was similar among the animals analyzed. The family Blepharocorythidae presented the higher prevalence and the family Buetschliidae was observed in greater abundance and density. Among the species identified, Cycloposthium dentiferum was observed for the first time in Central and South America and Bundleia elongata, B. inflata, B. piriformis, B. vorax and Cycloposthium psicauda, were observed for the first time in the American continent. In addition, the species Buissonella tapiri, which was originally discovered in fecal contents of the American tapir (Tapirus terrestris) in Brazil was observed for the first time associated to Equus caballus. The review on the ciliate communities associated with horses around the world demonstrated that the equine ciliates are a very diversified group with representatives in two subclasses, Suctoria and Trichostomatia, totaling 78 species distributed in three orders and six families, having been registered in different equine hosts (Equus asinus, Equus caballus and Equus quagga) and geographic locations (USA, China, Russia, Taiwan, Mexico, Cyprus, Turkey, Kyrgyzstan and Brazil).

Personality beliefs as a predictor of smartphone addiction

Objective The purpose of this study is to determine the relation between smart phone addiction and personality beliefs of university students. Methods A total of 1007 students, 637 females (63.3%) and 370 males (36.7%) participated in the study. "Smart phone addiction scale short form" was used to measure smart phone addiction and "personality beliefs scale" was used to identify personality beliefs. Results According to the performed multiple regression analysis, it was found out that dependent, antisocial, narcissist, histrionic, borderline, paranoid personality, schizoid personality, obsessive compulsive personality, passive-aggressive personality and avoidant personality beliefs predicted smart phone addiction at significant level (R = 0.38, R2 = 0.15, p < 0.001). The mentioned variables explain 15% of the variance. An examination of the t-test shows that dependent personality (t = 5.585, p < 0.001), passive-aggressive personality (t = -4.485, p < .001) and paranoid personality (t = 2.901, p < .01) belief among the mentioned variables are a significant predictor of smart phone addiction. Discussion The obtained results show that dependent, passive-aggressive and paranoid personality beliefs are a significant predictor of smart phone addiction. Research findings are discussed in the light of relevant literature.

Adolescents' cognitive capacity reaches adult levels prior to their psychosocial maturity: Evidence for a "maturity gap" in a multinational, cross-sectional sample.

All countries distinguish between minors and adults for various legal purposes. Recent U.S. Supreme Court cases concerning the legal status of juveniles have consulted psychological science to decide where to draw these boundaries. However, little is known about the robustness of the relevant research, because it has been conducted largely in the U.S. and other Western countries. To the extent that lawmakers look to research to guide their decisions, it is important to know how generalizable the scientific conclusions are. The present study examines 2 psychological phenomena relevant to legal questions about adolescent maturity: cognitive capacity, which undergirds logical thinking, and psychosocial maturity, which comprises individuals' ability to restrain themselves in the face of emotional, exciting, or risky stimuli. Age patterns of these constructs were assessed in 5,227 individuals (50.7% female), ages 10-30 (M = 17.05, SD = 5.91) from 11 countries. Importantly, whereas cognitive capacity reached adult levels around age 16, psychosocial maturity reached adult levels beyond age 18, creating a "maturity gap" between cognitive and psychosocial development. Juveniles may be capable of deliberative decision making by age 16, but even young adults may demonstrate "immature" decision making in arousing situations. We argue it is therefore reasonable to have different age boundaries for different legal purposes: 1 for matters in which cognitive capacity predominates, and a later 1 for matters in which psychosocial maturity plays a substantial role. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The negative effect of mean perfusion pressure on the development of acute kidney injury after transcatheter aortic valve implantation

Abstract Objective: To evaluate the predictive value of mean perfusion pressure (mPP) in the development of acute kidney injury (AKIN) after transcatheter aortic valve implantation (TAVI). Methods: One hundred and forty seven consecutive patients with aortic stenosis (AS) were evaluated for this study and 133 of them were included. Mean arterial pressure (mAP) and central venous pressure (CVP) were used to calculate mPP before TAVI procedure (mPP = mAP-CVP). The occurrence of AKIN was evaluated with AKIN classification according to the Valve Academic Research Consortium-2 recommendations. The patients were divided into two groups according to the receiver operating characteristic (ROC) analysis of their mPP levels (high-risk group and low-risk group). Results: The AKIN prevalence was 22.6% in this study population. Baseline serum creatinine level, glomerular filtration rate, amount of contrast medium, and the level of mPP were determined as predictive factors for the development of AKIN. Conclusion: The occurrence of AKIN is associated with increased morbidity and mortality rates in patients with TAVI. In addition to the amount of contrast medium and basal kidney functions, our study showed that lower mPP was strongly associated with development of AKIN after TAVI.

Morphometric characteristics and seasonal proximity to water of the Cypriot bluntnosed viper Macrovipera lebetina lebetina (Linnaeus, 1758)

Background:The blunt-nosed viperMacrovipera lebetina(Linnaeus, 1758) is a medically important snake species inthe Middle East. Its nominate subspeciesMacrovipera l. lebetinais confined to Cyprus, where it is the only dangerouslyvenomous snake species and heavily pursued. Despite the vipers large size, data on its body mass and sex-specificmorphological differences are scarce. It is commonly believed thatM. l. lebetinaprefers freshwater proximity duringsummer. Hence, we aimed at investigatingM. l. lebetinasex-specific morphological differences and its possibleattraction to freshwater bodies in late summer.Methods:Morphometric characteristics, proximity to water and conservation status ofM. l. lebetinawere investigatedin Paphos district (Cyprus) in 2014, 2015 and 2017. Vipers were caught in different habitats, examined morphologicallyfor metric and meristic characters, and released back into their habitat. Additionally, local people were interviewedabout the conservation situation of the species.Results:Of 38 recorded blunt-nosed vipers, morphological characteristics were collected from 34 (10 adult males, 16adult females, eight unsexed juveniles). Rounded total length (ToL) ranged from 23.5 cm to 133.0 cm and weightbetween 10 g and 1456 g. Adult males significantly exceeded adult females in tail length (TaL), ToL and head length(HL). No significant sex-specific differences were found in snout-vent length (SVL), head width (HW), weight or bodycondition index (BCI), nor for the ratios TaL / SVL, TaL / ToL, HL / SVL or HL / HW. Adult females from late summer(2015) had a significantly lower mean BCI than those from spring (2014).Distances of blunt-nosed vipers to the nearest water bodies (natural and artificial...(AU)

The Negative Effect of Mean Perfusion Pressure on the Development of Acute Kidney Injury after Transcatheter Aortic Valve Implantation.

OBJECTIVE: To evaluate the predictive value of mean perfusion pressure (mPP) in the development of acute kidney injury (AKIN) after transcatheter aortic valve implantation (TAVI). METHODS: One hundred and forty seven consecutive patients with aortic stenosis (AS) were evaluated for this study and 133 of them were included. Mean arterial pressure (mAP) and central venous pressure (CVP) were used to calculate mPP before TAVI procedure (mPP = mAP-CVP). The occurrence of AKIN was evaluated with AKIN classification according to the Valve Academic Research Consortium-2 recommendations. The patients were divided into two groups according to the receiver operating characteristic (ROC) analysis of their mPP levels (high-risk group and low-risk group). RESULTS: The AKIN prevalence was 22.6% in this study population. Baseline serum creatinine level, glomerular filtration rate, amount of contrast medium, and the level of mPP were determined as predictive factors for the development of AKIN. CONCLUSION: The occurrence of AKIN is associated with increased morbidity and mortality rates in patients with TAVI. In addition to the amount of contrast medium and basal kidney functions, our study showed that lower mPP was strongly associated with development of AKIN after TAVI.

HLA-G variability and haplotypes detected by massively parallel sequencing procedures in the geographicaly distinct population samples of Brazil and Cyprus.

The HLA-G molecule presents immunomodulatory properties that might inhibit immune responses when interacting with specific Natural Killer and T cell receptors, such as KIR2DL4, ILT2 and ILT4. Thus, HLA-G might influence the outcome of situations in which fine immune system modulation is required, such as autoimmune diseases, transplants, cancer and pregnancy. The majority of the studies regarding the HLA-G gene variability so far was restricted to a specific gene segment (i.e., promoter, coding or 3' untranslated region), and was performed by using Sanger sequencing and probabilistic models to infer haplotypes. Here we propose a massively parallel sequencing (NGS) with a bioinformatics strategy to evaluate the entire HLA-G regulatory and coding segments, with haplotypes inferred relying more on the straightforward haplotyping capabilities of NGS, and less on probabilistic models. Then, HLA-G variability was surveyed in two admixed population samples of distinct geographical regions and demographic backgrounds, Cyprus and Brazil. Most haplotypes (promoters, coding, 3'UTR and extended ones) were detected both in Brazil and Cyprus and were identical to the ones already described by probabilistic models, indicating that these haplotypes are quite old and may be present worldwide.

Os parietale partitum: Exploring the prevalence of this trait in four contemporary populations.

Os parietale partitum is a variable segmentation of the parietal bone. This manifests as a parietal division in the anteroposterior or superoinferior planes that is separated by an unusual suture and can be complete or incomplete. The existence of parietal divisions was observed and documented more than 260 years ago. The main objectives of this paper are to record the incidence of this rare trait in four modern populations with no previous records of it and provide a review of the literature. Four contemporary skeletal collections from Crete (Greece), Limassol (Cyprus), Coimbra (Portugal) and Salvador (Brazil) were assessed by the authors of this paper for non-metric cranial traits. Out of 711 skulls, only three cases of parietal division were found and all three originated from the Cypriot collection. These three cases were anatomically analyzed, showing that all three cases were adult females and showed unilateral expression of the trait. Two skulls showed superoinferior division, and the third case showed anteroposterior division. Numerous other cranial non-metric traits were found in these three skulls. Based on the cemetery archives, there seems to be no genetic link between the individuals bearing this trait. Further genetic analysis is suggested in order to verify this conclusion.

Physical activity habits in a European sports event: a case study / Hábitos de atividade física em um evento do European Sports: um estudo de caso / Hábitos de actividad física en un evento deportivo europeo: un estudio de caso

The aim of this study is to learn more about the physical activity habits of participants in a popular sporting event such as European Sports Day, which is held simultaneously in five European countries (Spain, Italy, Cyprus, Ireland, and Hungary), and to measure the influence of socio-demographic variables on these habits. This is a cross-sectional study conducted with a sample of 856 participants, stratified by gender, age, and nationality. We statistically analyzed five variables related to physical activity habits: frequency of physical activity practice, places of practice, motives of practice, perceived fitness level, and popular event attendance. Of the participants, 76.8% said they perform physical activity weekly. Fitness/health improvement (34.63%) and entertainment/leisure (26.52%) are the main reasons for the practice of physical activity. Age and nationality are differentiating factors on physical activity habits...

"Hábitos de atividade física em um evento do European Sports: Um estudo de caso."O objetivo deste estudo foi determinar os hábitos dos participantes de um evento popular como o Dia Europeu do Desporto realizado simultaneamente em cinco países europeus (Espanha, Itália, Chipre, Irlanda e Hungria), e medir a influência das variáveis ​​sociodemográficas sobre esses hábitos. Este é um estudo transversal, composto por uma amostra de 856 participantes, estratificada por sexo, idade e nacionalidade. Foram analisados ​​estatisticamente cinco variáveis ​​relacionadas aos hábitos de atividade física: frequência de atividade física, local de práticas, motivações para a prática, nível de condicionamento físico percebido, e frequência de participação em eventos populares. Dos participantes, 76,8% disseram que se envolver em atividade física semanal. Melhorar fitness/saúde (34,63%) e entretenimento (26,52%) foram os principais motivos para a prática de atividade física. Idade e nacionalidade são um fator de diferenciação sobre os hábitos de atividade física...

"Hábitos de actividad física en un evento deportivo europeo: Un estudio de caso." El objetivo de este estudio es conocer los hábitos de actividad física de los participantes en un evento popular como el Día del Deporte Europeo, que se celebra simultáneamente en cinco países europeos (España, Italia, Chipre, Irlanda y Hungría) y medir la influencia de las variables sociodemográficas sobre esos hábitos. Este es un estudio transversal compuesto por una muestra de 856 participantes, estratificados por género, edad y nacionalidad. Se analizaron estadísticamente cinco variables relacionadas con los hábitos de actividad física: frecuencia de práctica de actividad física, lugar de práctica, motivaciones de práctica, nivel de condición física percibido y frecuencia de asistencia a eventos populares. De los participantes, el 76,8% aseguraron que realizaban actividad física semanalmente. Mejorar la condición física/salud (34,63%) y el ocio y entretenimiento (26,52%) son las principales razones para la práctica de actividad física. Edad y nacionalidad son un factor diferenciante sobre los hábitos de actividad física...

Green turtle (Chelonia mydas) foraging and nesting aggregations in the Caribbean and Atlantic: impact of currents and behavior on dispersal.

Although significant amounts of research have been dedicated to increasing the knowledge of the life history of green turtles (Chelonia mydas), large gaps exist in our understanding of juvenile migratory behavior. These gaps can be filled by genetic studies of foraging ground aggregations. Using mitochondrial DNA markers and Bayesian analyses, samples (n = 106) from a foraging aggregation in North Carolina indicated that animals from the east coast of the United States (54%) and Mexico (27%) dominate the composition with the remainder coming from other Caribbean and Atlantic nesting aggregations. These findings prompted a reanalysis of 4 regional foraging aggregations using Bayesian mixed stock analysis, analysis of molecular variance, and diversity measures. Significant regional population structure between northern and southern foraging aggregations in the Caribbean was detected (phiST = 0.27, P = 0.000) in addition to significant nesting aggregation structure (phiST = 0.87, P = 0.000). Haplotype diversity levels were highest at foraging aggregations located within the confluence of major current systems. These findings indicate that both currents and behavior have strong influences on the composition of foraging aggregations. In addition, our results provide evidence of juvenile homing to regional foraging grounds and highlight the difficulties of separating historical and current effects on recruitment patterns at foraging locations.

Cancer and communication: similarities and differences of men with cancer from six different ethnic groups.

This paper reports the communication aspects of a pilot study, which explored the cancer meanings and experiences of six men with cancer and their significant others from different ethnic groups. A case study design was applied using the principles of phenomenology. In-depth semi-structured individual interviews were conducted in participants' own homes, in London, UK. This paper will only deal with the communication aspects of the findings. Ten themes emerged from the comparative analysis of the study's data, with communication as a cross-cutting theme. Further analysis of this theme revealed similarities and differences of the participants' experiences of communicating with health professionals; families or friends; and God/Allah. In addition, similarities and differences in communicating meanings of cancer in different cultures were revealed. The findings revealed similarities in the way that men from these six cultures communicate with health professionals and their families following a diagnosis of cancer, and differences in how they communicated with God/Allah, which depended on their religious beliefs and practices.

Mapping the prevalence of sickle cell and beta thalassaemia in England: estimating and validating ethnic-specific rates.

A range of estimates for sickle cell and beta thalassaemia have been derived for the different ethnic groups living in the U.K., reflecting uncertainty over the true population value in certain countries and the heterogeneity within and between countries of origin comprising the same ethnic group. These were validated against six community screening programmes, with the estimated range correctly predicting the number of affected births observed by the programmes. In England approximately 3000 affected babies (0.47%) carry sickle cell trait and 2800 (0.44%) carry beta thalassaemia trait annually: with approximately 178 (0.28 per 1000 conceptions) affected by sickle cell disease (SCD) and 43 (0.07 per 1000) by beta thalassaemia major/intermedia. Allowing for termination, about 140-175 (0.22-0.28 per 1000) affected infants are born annually with SCD and from 10 to 25 (0.02-0.04 per 1000) with beta thalassaemia major/intermedia. These are the first evidence-based rates for sickle cell and beta thalassaemia for use in the U.K., and should underpin the future planning of services. The long-term solution to monitoring changes in the rates of trait and disease in the population is to introduce a standardized instrument for collecting ethnicity for all community screening programmes.

Safety and feasibility of liver-directed ex vivo gene therapy for homozygous familial hypercholesterolemia.

OBJECTIVE: The purpose of this report was to provide detailed information on the safety and feasibility of surgical procedures associated with the first ex vivo liver-directed gene therapy trial for the treatment of vivo gene therapy for homozygous familial hypercholesterolemia (FH). SUMMARY BACKGROUND DATA: Familial hypercholesterolemia is an autosomal dominant disease in which the gene encoding the low density lipoprotein receptor is defective. Patients homozygous for this mutation have extraordinarily high levels of cholesterol and accelerated atherosclerosis and die prematurely of myocardial infarction. The concept of liver-directed gene therapy was based on the report of normalization of cholesterol levels by orthotopic cardiac/liver transplant in a child with homozygous FH. METHODS: Five patients with homozygous FH were selected for inclusion in this trial. The patients underwent hepatic resection and placement of a portal venous catheter. Primary hepatocytes cultures were prepared from the resected liver and transduced with a recombinant retrovirus encoding the gene for the human low density lipoprotein receptor. The genetically modified cells were then transplanted into the liver through the portal venous catheter. RESULTS: Numerous clinical, laboratory, and radiologic parameters were analyzed. Elevations of the hepatic transaminases and leukocyte counts and a decline in hematocrit count were noted. Transient elevations of the portal pressure were observed during cell infusion. No major perioperative morbidity--specifically, myocardial infarct, perioperative hemorrhage, or portal vein thrombosis--or death occurred as a result of this protocol. CONCLUSION: Liver-directed ex vivo gene therapy can be accomplished safely in humans and is appropriate for selected patients.