Search

Chronic hepatitis B (CHB) remains a global healthcare burden. Although the recent developments in the field have led to a reduction in incidence, the morbidity and mortality including liver cirrhosis and hepatocellular carcinoma (HCC) remain a formidable challenge. Advances in understanding the immunopathogenesis of CHB have led to a recent change in clinical categorization. EASL introduced the term hepatitis B 'e' antigen (HBeAg)-negative chronic infection, to replace the historical term 'inactive carrier' disease phase, the commonest CHB phase. Although this disease phase is associated with a favorable prognosis, it is not a truly 'inactive' disease phase with no ostensible liver disease, as inferred by the previous anachronistic terminology, and the risk of spontaneous reactivation and the potential risk of disease progression and HCC development are not negligible. Likewise, the APASL also uses the term "Incidentally Detected Asymptomatic Hepatitis B surface antigen (HBsAg)-positive Subject (IDAHS)", comprising all HBsAg-positive subjects who are incidentally detected during routine tests, without any previous or present symptoms of liver disease. This entity includes HBV infection with varied stages of liver disease. Antiviral treatment is generally reserved for patients with active inflammation and/or at risk of disease progression and HCC development. HBsAg loss is considered an optimal treatment endpoint, and may also be achievable in HBeAg-negative chronic infection and IDAHS. In light of this, and the emerging novel HBV therapies, lowering the treatment threshold and a 'Treat All' approach should now be considered. In this review, we summarize the literature and guidance on HBeAg-negative chronic infection, and we make a concerted effort to present the reasons why the one-dimensional term 'inactive carrier' should be abandoned. [ABSTRACT FROM AUTHOR]

Monolithic, optically transparent silica was synthesized for the first time by a green-chemistry method using tannin as a template. Silver nanoparticles were produced in silica mesopores by the reduction by the remaining tannin. After the removal of tannin, silica was coated with titania, which was transformed into anatase by annealing at 500°C. The obtained nanocomposite demonstrated high photocatalytic activity, which was enhanced by the combination of titania and nanosized silver. [ABSTRACT FROM AUTHOR]

Background: Confronting a once-in-a-century pandemic with COVID-19, tremendous stress has been placed in all walks of life worldwide. Aims: In order to enhance scientific information interflow in the arena of liver diseases in Asia–Pacific region during this difficult time, Asian-Pacific Association for the Study of the Liver (APASL) has taken the initiative to form the APASL COVID-19 Taskforce to formulate a clinical practice guidance in Hepatology, liver-related oncology, transplantation and conduct of clinical trials. Methods: A taskforce with 22 key opinion leaders in Hepatology from 16 countries or administration regions in Asia–Pacific regions was formed and through intense interaction via webinar, this guidance was formulated. Based on scientific data and experiences, recommendations were made in the management of liver injury, liver transplantation, autoimmune diseases, chronic liver diseases, delivery of elective and emergency services and conduct of clinical trials. Conclusions: This is the first consensus clinical guidance synthesized by APASL for our hepatologist and their allied medical personal. [ABSTRACT FROM AUTHOR]

Uniform silver nanoparticles with diameters smaller than 10 nm have been synthesized by the hydrothermal method on micro/nanofibrils of cellulose, which is used as a substrate, in a solution consisting of a water/ethylene glycol (reductant) mixture, a silver salt, poly(vinylpyrrolidone), and silver chloride used as a seed. Cellulose plays the role of an additional mild reductant, which prevents the formed nanoparticles from coalescence and provides the formation of their linear assemblies, in which the density of the nanoparticles and the gaps between them are regulated by varying silver salt concentration in the reaction mixture. Experiments performed with rhodamine 6G dye have shown that the synthesized assemblies of silver nanoparticles exhibit surface-enhanced Raman scattering. The proposed synthesis method may be used for the production of inexpensive sensor elements for surface-enhanced Raman scattering spectroscopy analysis. [ABSTRACT FROM AUTHOR]

Background: Systemic inflammatory response syndrome (SIRS) is associated with an increased risk of hepatic encephalopathy, renal failure, and poor outcome in patients with cirrhosis; however, there is a paucity of studies on this entity for severe alcoholic hepatitis (SAH).Aim: To evaluate SIRS at baseline as a predictor of development of acute kidney injury (AKI) and mortality in patients with SAH.Methods: Consecutive in-patients with SAH (discriminant function ≥ 32) without AKI at baseline were followed up for the development and progression of AKI (AKIN criteria).Results: Of the 365 patients (mean age 45.5 ± 9.5, 356 males), SIRS at baseline was present in 236 (64.6%). AKI developed in 122 (33.4%), of which 50 (40.9%) had progression of AKI. SIRS was associated with bacterial infections in 96 (40.6%) and in 140 (59.3%) occurred in the absence of proven infection microbiologically. The presence of SIRS predicted both AKI development (p < 0.001, OR 2.9, 95% CI 1.7-4.8) and AKI progression (p = 0.002, OR 3.27, 95% CI 1.48-7.21). Resolution of AKI also had a significant inverse association with SIRS (p = 0.001). High MELD score (p = 0.002, HR 1.1, 95% CI 1.02-1.09), in-hospital progression of AKI (p = 0.04, HR 1.54, 95% CI 1.003-2.38), and SIRS (p = 0.004, HR 1.98, 95% CI 1.25-3.1) were significant predictors of 90-day mortality (model 1), while high MELD score (p < 0.001, HR 1.1, 95% CI 1.04-1.12) and bacterial infections (p = 0.001, HR 1.8, 95% CI 1.27-2.6) were independent predictors of mortality in the second multivariate model (model 2).Conclusion: SIRS at admission predicts both the development of AKI and 90-day mortality in patients with SAH. This could definitely have a therapeutic and prognostic implication. [ABSTRACT FROM AUTHOR]

Acute on chronic liver failure (ACLF) is a distinct clinical entity; however, there is still debate in the way it is defined in the East as compared to the West, especially with respect to incorporation of kidney dysfunction or failure in the definition of ACLF. Kidney dysfunction is defined as serum creatinine between 1.5 and 1.9 mg/dl and kidney failure as serum creatinine of more than 2 mg/dl or requirement of renal replacement therapy according to the EASL-CLIF Consortium. Kidney dysfunction or failure is universally present in patients with ACLF according to the definition by the EASL-CLIF Consortium while on the contrary the APASL definition of ACLF does not incorporate kidney dysfunction or failure in its definition. Recently, both the diagnosis and management of renal failure in patients with cirrhosis has changed with the advent of the acute kidney injury (AKI) criteria defined as an abrupt decline in renal functions, characterized by an absolute increase in serum creatinine of 0.3 mg/dl within 48 h or an increase of more than 50 % from baseline, which is known or presumed to have occurred in the previous 7 days. Further, recent studies in patients with cirrhosis have shown the utility of biomarkers for the diagnosis of AKI. The present review covers the pathogenetic mechanisms, diagnosis, prognosis as well as management of AKI in patients with ACLF from both a Western as well as an Eastern perspective. The review identifies an unmet need to diagnose AKI and prevent this ominous complication in patients with ACLF. [ABSTRACT FROM AUTHOR]

Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information. [ABSTRACT FROM AUTHOR]

Background and aims: The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history and mortality of AKI at admission and new-onset AKI in hospitalized patients with ACLF and compared the results with patients with acute decompensation of cirrhosis (ADC). Patients and methods: Consecutive patients with ACLF ( n = 382) and ADC ( n = 451) were prospectively studied. Serial renal and liver functions were recorded and correlated with the disease course and outcome. Results: AKI at admission and new onset AKI in the hospital were not different in patients with ACLF and ADC ( p > 0.05). However, a significant difference in the spectrum of AKI was noted; functional volume-responsive AKI was more common ( p < 0.05) in ADC, while patients with ACLF more frequently had the structural form of AKI ( p < 0.05). Moreover, patients with ADC had significantly less AKI progression ( p < 0.05) and prolonged duration ( p < 0.05), a lower requirement of RRT ( p < 0.05) and also less AKI resolution ( p < 0.05) compared to ACLF patients. Patients with ACLF (versus ADC) had a significantly higher mortality on multivariate analysis. Conclusions: The kidneys are differentially affected in patients with cirrhosis with or without liver failure. Patients with ACLF with AKI have more structural AKI, greater potential for reversibility despite higher progression as well as higher mortality compared to patients with ADC. Prevention and early detection of AKI should be considered in patients with ACLF. [ABSTRACT FROM AUTHOR]

ZrO/TiO/SiO (ZrO up to 6.7 mass%) composites with variable oxide ratios that were fabricated by a template sol-gel method were studied. The morphology was described. The structure was analyzed using scanning electron and confocal laser microscopy, small-angle x-ray scattering, and Raman spectroscopy. It was established that the composites were nanostructured micron-sized tubes of ZrO/TiO/SiO. The microtubes were constructed from nanoparticles with the anatase structure and general formula TiZrO (x = 0-0.05). Changes of Raman spectra were examined as a function of ZrO2 content in the composites and the annealing temperature. The contribution of optical phonon scattering to the ν(E) peak position was determined. The ν(B) peak position and the gyration radius of the nanocrystallites were shown to be related. [ABSTRACT FROM AUTHOR]

Objective We explored the role of personality and pre-treatment contentment with one's face and body in predicting satisfaction following simple aesthetic dental procedures.Methods In a single-centre repeated measures cohort design we examined the extent to which patient personality and baseline satisfaction with one's face and body predict post-treatment satisfaction. Data were collected from 60 patients attending a UK general practice in 2012. Adults (M age = 60.7 ± 12.6 years) receiving simple, routine aesthetic dental treatment participated. Satisfaction with one's face and body was assessed pre- and post-operatively through validated self-report measures.Results Although all participants were more satisfied post-treatment with their body overall (t [59] = 2.78, p <0.004) and with their face in particular (t [59] = 1.83, p <0.035), those scoring highly on neuroticism were generally unhappier both before and after treatment (r range = 0.277-0.360, p <0.05). In multiple regressions, post-operative facial satisfaction (R2 = 0.475, p <0.001) was predicted by pre-operative facial satisfaction (β = 0.616, t = 5.912, p <0.001) and to a lesser extent by neuroticism (β = -0.241, t = 2.248, p <0.001). Baseline happiness with one's body (β = 0.851, t = 11.996, p <0.001) was the sole predictor of post-treatment body satisfaction (R2 = 0.744, p <0.001).Conclusions Psychological variables may be important predictors of satisfaction with dental treatment and the clinical benefits of assessing them pre-operatively should be explored. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Drugs used in the treatment of HE are primarily directed at the reduction of the blood ammonia levels. Rifaximin and lactulose have shown to be effective in HE. We evaluated the efficacy and safety of rifaximin plus lactulose vs. lactulose alone for treatment of overt HE.METHODS:In this prospective double-blind randomized controlled trial, 120 patients with overt HE were randomized into two groups: (group A lactulose plus rifaximin 1,200 mg/day; n=63) and group B (lactulose (n=57) plus placebo). The primary end point was complete reversal of HE and the secondary end points were mortality and hospital stay.RESULTS:A total of 120 patients (mean age 39.4±9.6 years; male/female ratio 89:31) were included in the study. 37 (30.8%) patients were in Child-Turcotte-Pugh (CTP) class B and 83 (69.2%) were in CTP class C. Mean CTP score was 9.7±2.8 and the MELD (model for end-stage liver disease) score was 24.6±4.2. At the time of admission, 22 patients (18.3%) had grade 2, 40 (33.3%) had grade 3, and 58 (48.3%) had grade 4 HE. Of the patients, 48 (76%) in group A compared with 29 (50.8%) in group B had complete reversal of HE (P<0.004). There was a significant decrease in mortality after treatment with lactulose plus rifaximin vs. lactulose and placebo (23.8% vs. 49.1%, P<0.05). There were significantly more deaths in group B because of sepsis (group A vs. group B: 7:17, P=0.01), whereas there were no differences because of gastrointestinal bleed (group A vs. group B: 4:4, P=nonsignificant (NS)) and hepatorenal syndrome (group A vs. group B: 4:7, P=NS). Patients in the lactulose plus rifaximin group had shorter hospital stay (5.8±3.4 vs. 8.2±4.6 days, P=0.001).CONCLUSION:Combination of lactulose plus rifaximin is more effective than lactulose alone in the treatment of overt HE. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a relatively frequent problem, occurring in approximately 20 % of hospitalized patients with cirrhosis. Although serum creatinine (S Cr) is the most commonly used method to determine AKI because of easy availability and low cost, practically it underestimates the extent of kidney injury in patients with chronic liver disease. AKI is defined as an abrupt rise in S Cr of 0.3 mg/dl or more (>26.4 mmol/l) or an increase of 150 % or more (1.5-fold) from baseline. The cause of AKI in cirrhosis is multifactorial and is unique in terms of pathogenesis. The most common causes of AKI in cirrhosis can be subdivided into either functional or structural. The functional group includes volume-responsive (prerenal azotemia) and volume-unresponsive states (hepatorenal syndrome). Volume responsive is the most common type of AKI due to frequent use of diuretics, large volume abdominal paracentesis and gastrointestinal bleeding in patients with liver disease. The structural causes include acute tubular necrosis, tubulointerstitial and glomerular diseases. Patients with decompensated cirrhosis are in a vasodilatory state leading to a decrease in effective arterial blood volume, predisposing to AKI. Therefore, management of AKI depends on the underlying cause, and therapy should be directed toward removal of the cause. The outcome in cirrhosis when patients are on dialysis is very dismal. Every effort should be made to prevent AKI. [ABSTRACT FROM AUTHOR]

Formation conditions are studied for bionanocomposite films prepared by mixing cationic chitosan with negatively charged nanoparticles of a synthetic clay (saponite) followed by gradual increasing of the charge of macromolecules by decreasing the pH of a medium. The data on the swelling of the bionanocomposite films in water are used to determine the stoichiometric ratio between the concentrations of macromolecules and nanoparticles that provides the most intense electrostatic interactions stabilizing the films. Their properties and structure are investigated by means of scanning electron microscopy, dynamic thermomechanical analysis, and small-angle X-ray scattering. The films are shown to occur in a glassy state and undergo a number of phase transitions, the temperatures of which depend on the chitosan-to-saponite concentration ratio. In particular, their glass transition temperature increases from 62 to 175°C when passing to the stoichiometric composition. The bionanocomposite films are found to have a layered structure. The layers are, in turn, composed of highly uniform microsized plates 20-30 nm thick. Small-angle X-ray scattering shows a structural order with a periodicity of 1.78 nm. The structure of the bionanocomposite films is discussed. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease globally and commonly associated with insulin resistance and metabolic syndrome (MS). Peroxisome proliferator-activated receptor-γ (PPARγ) is a transcription factor abundantly expressed in adipocytes and plays a key role in the regulation of adipocyte differentiation, lipid and glucose homeostasis. Pro12Ala variant has been earlier associated with obesity, type 2 diabetes and MS. Aim: The present study aimed to determine the genotype frequencies of the Pro12Ala variant in NAFLD patients and any further association with other phenotype in the patients. Patients and methods: Ninety-eight NAFLD patients and 280 matched controls were genotyped for presence of the Pro12Ala variant. Genomic DNA was extracted and polymerase chain reaction-restriction fragment length polymorphism using Bst-UI was performed for the detection of C-G change at codon 12 position of PPAR γ2 gene. Genotype and allele frequencies were compared between patients and controls. The Hardy-Weinberg equilibrium was tested by comparing expected/observed genotype frequencies by χ test. Results: The frequencies of Pro/Ala genotype were comparable between NAFLD patients and controls. In the controls, 213 (75.7%) were homozygous for the wild-type (Pro/Pro) genotype and 67 (23.9%) were heterozygous (Pro/Ala). In NAFLD patients, genotypic distribution of wild type, heterozygous and homozygous were 63 (64.3%), 34 (34.7%) and 1 (1%), respectively. Heterozygous genotype was found to be significantly higher in the patients ( P = 0.01) . We also analyzed related phenotypic association of the patients with Pro12Ala genotype. We observed that the Pro12Ala (heterozygous) genotype was significantly higher in the patients who had body mass index >25 kg/m ( P = 0.025). Conclusions: Pro12Ala variation of the PPAR γ2 gene is associated with NAFLD and might play a role in the pathogenesis of NAFLD. [ABSTRACT FROM AUTHOR]

Metastasis-associated protein 1 (MTA1), a master chromatin modifier, has been shown to regulate cancer progression and is widely upregulated in human cancer, including hepatitis B virus-associated hepatocellular carcinomas (HCCs). Here we provide evidence that hepatitis B virus transactivator protein HBx stimulates the expression of MTA1 but not of MTA2 or MTA3. The underlying mechanism of HBx stimulation of MTA1 involves HBx targeting of transcription factor nuclear factor (NF)-κB and the recruitment of HBx/p65 complex to the NF-κB consensus motif on the relaxed MTA1 gene chromatin. We also discovered that MTA1 depletion in HBx-expressing cells severely impairs the ability of HBx to stimulate NF-κB signaling and the expression of target proinflammatory molecules. Furthermore, the presence of HBx in HBx-infected HCCs correlated well with increased MTA1 and NF-κB-p65. Collectively, these findings revealed a previously unrecognized integral role of MTA1 in HBx stimulation of NF-κB signaling and consequently, the expression of NF-κB targets gene products with functions in inflammation and tumorigenesis. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Endoscopic biliary drainage is an established mode of treatment for acute cholangitis. We compared the safety and efficacy of 7 Fr and 10 Fr stent placement for biliary drainage in patients with acute cholangitis.Patients and Methods: We recruited 40 patients with severe cholangitis who required endoscopic biliary drainage. Patients were randomized to have either a 7 Fr or a 10 Fr straight flap stent placement during endoscopy. Outcome measures included complications related to endoscopic retrograde cholangiopancreatography (ERCP) and clinical outcome.Results: Of 40 patients, 20 were randomized to the 7 Fr stent group and 20 to the 10 Fr stent group. All patients had biliary obstruction due to stones in the common bile duct. Indications for biliary drainage were: fever >100.4 degrees F (n = 27), hypotension (n = 6), peritonism (n = 10), impaired consciousness (n = 8), and failure to improve with conservative management (n = 13). Biliary drainage was achieved in all patients. Abdominal pain, fever, jaundice, hypotension, peritonism, and altered sensorium improved after a median period of 3 days in both groups. Leukocyte counts became normal after a median time of 4 days in the 7 Fr stent group and 6 days in the 10 Fr stent group. There were no ERCP-related complications. There were no instances of occlusion or migration of stent. The success rates of biliary drainage in cholangitis were not affected by the size of stent used.Conclusions: Biliary drainage by 7 Fr stent or 10 Fr stent is equally safe and effective treatment for patients with severe cholangitis. [ABSTRACT FROM AUTHOR]

Interleukin (IL)-18 plays an important dual role in Th1 polarization and viral clearance, as well as in the development of liver fibrosis. Single-nucleotide promoter polymorphisms influence the transcription of IL-18 mRNA. Promoter polymorphisms are linked to delayed virus clearance and disease susceptibility in many diseases. However, there is no information about their role in hepatitis C virus (HCV) infection. To investigate the association between −607 or −137 polymorphism with susceptibility and severity of HCV infection. Two hundred and four serologically proven patients with chronic HCV infection and 350 matched healthy controls were included in this study. Patients were segregated in 2 groups: group A with mild liver disease and group B with severe liver disease on the basis of histological activity index (HAI ≤5 or >5) and hepatic fibrosis score (≤2 or >2). IL-18 promoter genotyping was performed with sequence-specific primers. There was no significant difference in the frequencies of −607 and −137 allelic distribution in patients and controls. The −607 A/A allele was more common in group A patients with mild liver disease than in patients with severe liver disease on the basis of HAI (38.6% vs. 21%, P = 0.05; odds ratio [OR] = 0.424, confidence interval [CI] = 0.233–0.773; R 2 = 0.631) and stage of fibrosis (38.7% vs. 16.7%, P = 0.008; OR = 0282, CI = 0.134–0.596; R 2 = 0.434). IL-18 promoter polymorphism at −607 position with A/A allele is a potential protective marker, as it is associated with milder liver disease in patients with chronic HCV infection. [ABSTRACT FROM AUTHOR]

Extensive and persistent hepatic fibrosis has for a long time been considered irreversible. Accumulating evidence suggests that liver fibrosis is reversible and that recovery from cirrhosis may be possible. The application of molecular techniques to models of reversible fibrosis are helping to establish the events and processes that are critical to recovery. The problem consists in identifying and eliminating its cause. Although fibrosis in the liver has little functional significance by itself, its severity derives from associated vascular changes. Disappearance of fibrosis can be accompanied by remodeling of vascular changes. However, depending on its duration, the fibrosis may be irreversible. [ABSTRACT FROM AUTHOR]

The hepatic venous pressure gradient (HVPG) clearly reflects portal pressure in cirrhotic portal hypertension. Its relation with variceal bleeding has been well studied. We undertook to study the relation of HVPG to variceal size, Child's status, and etiology of cirrhosis. Patients with cirrhotic portal hypertension with esophageal varices underwent HVPG measurement as part of a prospective evaluation. One hundred seventy-six cirrhotics with varices (M:F, 140:36; mean age, 42.6 +/- 13.4 years), 104 with CLD related to viral etiology, 40 with alcoholic liver disease, 26 cryptogenic with cirrhosis, and 6 with miscellaneous causes of CLD underwent HVPG measurement. The mean HVPG was lower in patients with small varices (n = 77; 14.6 +/- 5.9 mm Hg) than in patients with large varices (n = 99; 19.2 +/- 6.6 mm Hg; P < 0.01). In patients with large varices, the mean HVPG in bleeders (n = 37) was higher than in nonbleeders (n = 62) (21.7 +/- 7.2 vs 17.9 +/- 6.2 mm Hg; P < 0.01). The mean HVPG was significantly higher in Child's B (n = 97; 17.4 +/- 6.9 mm Hg) and C (n = 56; 19.0 +/- 5.7 mm Hg) compared to Child's A cirrhotics (n = 23; 12.2 +/- 5.9 mm Hg; P < 0.01), and Child's C compared to Child's B cirrhotics (P = 0.05). HVPG was higher in alcoholic compared to nonalcoholic cirrhotics (20.8 +/- 7.3 vs 16.4 +/- 6.3 mm Hg; P < 0.05), but this was not significant in multivariate analysis. The HVPG was comparable between hepatitis B- and hepatitis C virus-related cirrhotics (P = 0.8). Cirrhotics with ascites had a higher HVPG than those without ascites (18.5 +/- 5.6 vs 16.6 +/- 7.6 mm Hg; P = 0.02). In multivariate analysis, only Child's status, size of varices, and variceal bleed predicted higher HVPG. HVPG is higher in cirrhotics with large varices and a history of bleed. There is a good correlation between HVPG and large varices, bleeder status, and ascites. A higher HVPG reflects more severe liver disease. The etiology of liver disease did not influence the portal pressure. [ABSTRACT FROM AUTHOR]

A 42 year old female with a body mass index of 47 presented to the general surgical outpatient clinic with a large apron of skin hanging from the anterior abdominal wall. This adversely affected her mobility and was prone to intertrigo. It was also complicated by the presence of a large ventral hernia with propensity for recurrent incarceration. Apronectomy with repair of ventral hernia was performed A novel technique to anchor the heavy apron was employed. The apron was anchored to an overhead steel bar by means of large orthopaedic Steinman’s pins and stirrups. A total of 18.5 kg of skin and soft tissue were removed. The patient had difficulty in weaning off the ventilator and spent 3 weeks in the intensive care unit. There were no other complications. There was marked improvement in her mobility and overall quality of life after the operation. Apronectomy can be safely performed in conjunction with ventral hernia repair. This method of anchoring the apron greatly facilitates an otherwise difficult operation. The number of operators as well as the operating time is reduced. [ABSTRACT FROM AUTHOR]

The authors carried out failure analysis of bent and branched copper-nickel alloy pipelines that had failed in marine environments. These failures were almost always dominated by a brittle stress-corrosion cracking (SCC) mode and could often be attributed to the presence of ammoniacal byproducts in the operating environment. Attempts were made to reproduce the marine-type field failures in the laboratory by testing a Cu-5.37%Ni alloy, similar to the material used in failed pipelines. The tests were performed under slow strain rate test (SSRT) conditions in aqueous ammonia and ammoniacal seawater. Results revealed that the ammonia-induced brittle SCC failures were predominant and reduced the load-bearing capacity of the alloy. The real-life failures are not simple SSRT-type failures. The operating conditions, in addition to the induced residual stresses from manufacturing/processing, subject the system pipes to external forces and widely varying pressures and fluid flow rates. This combination of stresses can produce both static and cyclic stress conditions, similar to a static load coupled with a low-amplitude cyclic load. Tests conducted under superimposed cyclic stresses on prestressed specimens were found to accelerate the stress-corrosion failures in the present copper-nickel alloy in an ammoniacal environment. During the testing process, it was established that chlorides of sodium and magnesium also had a role to play on the ammonia-induced SCC. Further tests were therefore designed, and this paper summarizes test results, which point to the possible mitigation of ammonia-induced SCC in cupronickels by the addition of MgCl2. [ABSTRACT FROM AUTHOR]

The work presented in Part 1 of this article showed that additions of magnesium chloride (MgCl2) to ammonia solutions reduced the tendency of ammonia-induced stress-corrosion cracking (SCC) initiation in a Cu-5%Ni alloy. The present work was undertaken to study the SCC behavior of the test alloy exposed to ammonia in the presence of varying concentrations of MgCl2. The exposure to MgCl2 additions reduced the severity of the ammonia-induced SCC. [ABSTRACT FROM AUTHOR]

The electrophysical characteristics of composite media consisting of finely dispersed T-10 000 ferroelectric ceramics and dielectric fluids are experimentally investigated. Transformer oil, dibutyl phthalate, cyclohexanol, and sulfolane are used as dielectric fluids. The permittivity of compositions ε is directly proportional to that of the fluids. Its dependence on the concentration of the ferroelectric ceramics is nonlinear and is well consistent with the known Nielsen formula up to the concentration of 55 vol %. The permittivity of a 50% composition exceeds by a factor of five that of the fluid. The maximal coefficient of ε increasing approximately equals 20 upon adding two ceramics fractions of different particle sizes to the composition. The specific resistance of compositions decreases as the permittivity of the fluid increases. The concentration dependence of the specific resistance of the T-10 000 ferroelectric ceramics–dibutyl phthalate mixture has a minimum at a concentration of 30–40 vol %. A new mechanism of the surface electric conductance is suggested, which is associated with a decrease in the dissociation energy in the surface layer under the effect of image force. The electric strength of compositions decreases as the permittivity of the fluid increases. The obtained experimental data agree with the bubble model of breakdown ignition. [ABSTRACT FROM AUTHOR]

Injection locked Gunn oscillators have been developed to amplify the upconverted millimeter wave frequencies. They are being used in millimeter wave communication systems at Ka, V and W-Bands respectively. [ABSTRACT FROM AUTHOR]

This paper describes the experimental circuit and measured performance of varactor tuned Gunn oscillator at W-band. The power output of 12.5 dBm has been achieved when packaged GaAs Gunn diode is used. Linear frequency excursion of 150 MHz with power variation of 1 dB has been observed when varactor was given reverse bias from 0 to 20 volts. GaAs hyperabrupt varactor is used in parallel to gunn diode at a distance of odd multiple of λg/2 in waveguide channel. [ABSTRACT FROM AUTHOR]

Association of hepatitis viruses with acute pancreatitis in the setting of nonfulminant viral hepatitis is rare. We report six cases of nonfulminant viral hepatitis complicated by acute pancreatitis, including the first documented case of hepatitis E virus (HEV) associated acute pancreatitis. The other five patients had acute viral hepatitis caused by hepatitis A infection. Besides features of viral hepatitis, the presence of typical abdominal pain, high serum amylase, and ultrasound or CT scan features suggested the diagnosis of acute pancreatitis. This complication generally developed in the initial phase of the hepatitic illness. All of the patients had mild to moderate pancreatitis that recovered uneventfully with conservative treatment. [ABSTRACT FROM AUTHOR]

This study demonstrates that the selective delta receptor antagonists ICI 174864 and naltrindole (NTI) attenuate alcohol intake in a dose-dependent manner, without altering water intake, in rats selectively bred for alcohol preference. ICI 174864 had a very limited duration of action, as evidenced by the fact that suppression of alcohol intake lasted for only an hour following ICI 174864 administration. NTI, when administered in a dose of 10 mg/kg, suppressed alcohol intake by 28%. Increasing the dose of NTI to 15 mg/kg produced a 44% suppression of alcohol intake, but a further increase to 20 mg/kg did not produce greater suppression than was seen with a dose of 15 mg/kg (46% versus 44%, respectively). This suggests that NTI is maximally effective in suppressing alcohol intake at a dose of 15.0 mg/kg. NTI displayed a long duration of action, as evidenced by attenuation of alcohol drinking that lasted for at least 8 h following drug treatment. Administering the maximally effective dose of NTI (15 mg/kg) in two parts, separated by 4 h, served to prolong the duration of action of NTI and produced an attenuation of alcohol intake, but not water intake, that lasted for at least 28 h. The effect of NTI on alcohol intake was not specific for alcohol, as evidenced by the fact that NTI reduced the intake of saccharin solutions with and without alcohol. [ABSTRACT FROM AUTHOR]

Intestinal tuberculosis is still common in developing countries. In 186 patients with intestinal tuberculosis, clinical features, radiological findings and complications were carefully recorded and compared with those from earlier studies with a view to study any possible changes after the liberal use of antitubercular drugs. Sixty two percent of the patients in the present series had had prior exposure to antitubercular drugs. The incidence of systemic symptoms like fever and anorexia, alternating diarrhoea and constipation, peritoneal and lymph node involvements and associated pulmonary lesions were less frequently observed. On the other hand, an indolent and complicated course with intestinal obstruction (47%) and lower gastrointestinal bleeding (5.5%) and frequent colonic involvement (19%) often necessitating surgical intervention appeared to have become more frequent than reported in earlier series. Awareness of these changes in the clinical profile of intestinal tuberculosis should be helpful in the diagnosis and management of the condition. [ABSTRACT FROM AUTHOR]

Background: Infection due to hepatitis B virus (HBV) could be due to wild or mutant (precore or surface) viruses. The prevalence and clinical profile of different viral forms in patients with chronic liver disease has not been established. Methods: One hundred and twenty patients with histologically proven HBV-related chronic liver disease were studied. Patients with dual infection with HCV/HDV/HIV, past history of interferon therapy, or autoimmune hepatitis were excluded. Eighteen (15.5%) patients had the precore mutation (HBsAg +ve, HBeAg -ve/anti-HBe +ve, HBVDNA +ve), and 13 (10.8%) had the surface gene mutations (HBsAg -ve, HBeAg -ve, IgG anti-HBc, and HBV DNA+ve). The remaining 89 (74.2%) patients were infected with wild type HBV. The course of all patients with mutant forms and 41 of those with the wild type form was followed for mean (±SD) of 4.4 ± 2.4 yr. Results: Compared with wild-type-infected patients, those with surface mutation were younger (39.9 ± 14 vs. 30.1 ± 12.4 yr, p < 0.05). Patients with precore mutations had a shorter illness than those with surface mutant (p < 0.01) and wild forms (p < 0.05). Histologically, patients with precore type had more active liver disease than wild type (39% vs. 15%, p < 0.05). Patients with precore mutations were always symptomatic, often presenting with ascites (67%) and jaundice (55%). Patients with surface mutant forms often presented with quiescent cirrhosis (77%) or cirrhosis with hepatoma (15%). Conclusions: One-fourth of HBV-related chronic liver disease in Asian Indians is attributable to mutant HBV forms. The presence of variant viruses alters the natural history of the disease, with the precore variance having a more aggressive course and the surface mutant, a more quiescent but unfavorable course, compared with the wild type. [ABSTRACT FROM AUTHOR]

To objectively determine the incidence of subclinical hepatic encephalopathy (SHE) and the relative sensitivity of different evoked potentials for its detection, 22 nonalcoholic cirrhotics without clinically detectable neurological abnormality and an equal number of matched healthy controls were studied. Of the three evoked potentials, visual evoked potential (VEP) studied by the pattern shift reversal method was not found to be abnormal in any patient. Short latency somatosensory evoked potential (SSEP) was abnormal in one (4.5%) and brain stem auditory evoked potential (BAEP) in nine (41%) patients. There was little advantage of performing both BAEP and SSEP in a patient, since the two together were abnormal in 10 (45.5%) patients, with SSEP adding only one more patient. Interpeak latencies I-III, III-V, and I-V in BAEP test were found to be the most sensitive parameters for the detection of SHE. Our results argue in favor of BAEP as the single investigation of choice for the objective assessment of SHE in patients with cirrhosis of the liver. [ABSTRACT FROM AUTHOR]

Endoscopic sclerotherapy is a well-accepted technique for the treatment of variceal bleeding. It is carried out by injecting a sclerosant into or around a varix. Sclerosants are oily or aqueous chemicals which produce sclerosis, depending on their necroinflammatory and thrombotic properties. The safety and efficacy of various sclerosants bas been evaluated in experimental and human studies. However, due to the presence of a large number of variables, conflicting results have been reported. Based primarily on anecdotal experiences, sodium tetradecyl sulfate, ethanolamine oleate, polidocanol, and alcohol appear to be potent and safe sclerosants. There is great need to perform double-blind trials to identify ideal sclerosant(s) with optimum thrombogenic and minimum necroinflammatory properties. [ABSTRACT FROM AUTHOR]

Development of gastric varices is an important manifestation of portal hypertension. In segmental portal hypertension, gastric varices originate from short gastric and gastroepiploic veins. In generalized portal hypertension, intrinsic veins at cardia participate in the formation of gastric varices. Endoscopy and/or spleno-portovenography and a high index of suspicion are required for the diagnosis of gastric varices. The incidence of gastric varices in patients with portal hypertension has been variably reported (2-70%), probably due to difficulties in diagnosis. In a small proportion of patients with gastric varices, chronic portal-systemic encephalopathy or significant variceal bleeding develops. Gastric varices can be classified, depending on their anatomical location, into gastroesophageal varices (a continuation of esophageal varices) or "isolated" gastric varices (fundal or ectopic varices). This distinction is necessary for management. Whereas surgery is recommended for bleeding fundal varices, in acute bleeding from gastroesophageal varices, sclerotherapy could be attempted successfully. In more than a quarter of patients, gastric varices disappear after obliteration of esophageal varices. Prophylactic sclerotherapy of gastric varices is not recommended. [ABSTRACT FROM AUTHOR]

To compare the efficacy of various psychometric tests in the detection of subclinical hepatic encephalopathy (SHE), cerebral functions were studied in 20 nonalcoholic cirrhotics without overt encephalopathy and in 18 matched healthy controls. Wechsler Adult Intelligence Scale (WAIS) indicated that verbal ability was preserved in all cirrhotics. Of the WAIS performance tests, block design test (BDT) was abnormal in 11 (55%), picture arrangement in 10 (50%), object assembly in eight (40%) and digit symbol in six (30%) patients. Taken together, these tests diagnosed SHE in 14 (70%) patients. Number connection test (NCT) alone, on the other hand, was abnormal in 13 (65%) patients. A combination of NCT and BDT yielded the diagnosis of SHE in 15 (75%) patients. An important measure of the reliability of the diagnosis of SHE was that NCT and BDT were independently abnormal in 10 of these patients. Both NCT and BDT were found easy and quick to administer. In conclusion, our results argue in favor of using a combination of NCT and BDT for a rapid and accurate diagnosis of SHE in patients with cirrhosis of the liver. [ABSTRACT FROM AUTHOR]

Mosaic pattern of gastric mucosa has been reported to be a sensitive and specific criterion for the diagnosis of portal hypertension and an important marker of nonvariceal upper gastrointestinal bleeding. So that the validity of this endoscopic sign could be assessed, 136 patients with portal hypertension, 25 chronic alcoholics without portal hypertension, and 366 controls were carefully endoscoped. Mosaic pattern was significantly (p < 0.01) more common in portal hypertension patients (7.4%) than in controls (1.4%). It was not seen in chronic alcoholics. The incidence of mosaic pattern was 10.9% in cirrhotics, 2.9% in noncirrhotic portal fibrosis, and 5.4% in extrahepatic portal obstruction patients; the differences were not significant. Mosaic pattern was significantly (p < 0.01) more often seen in postsclerotherapy (13.8%) than in presclerotherapy patients (2.6%). Bleeding from nonvariceal causes was uncommon, and was seen in only one patient (0.8%) showing mosaic pattern. Endoscopic gastric biopsies from areas showing mosaic pattern did not reveal any vascular abnormalities. In conclusion, gastric mucosal lesions are not very common in Indian patients with portal hypertension. In our experience, "mosaic pattern" is not a useful diagnostic feature in portal hypertension patients. [ABSTRACT FROM AUTHOR]

Forty-seven patients with esophageal variceal bleeding were randomly allocated to undergo sclerotherapy on a 3 weekly schedule with either 5% ethanolamine oleate (23 patients) or absolute alcohol (24 patients), in an attempt to compare the efficacy and safety of the two sclerosants. Sclerotherapy with absolute alcohol eradicated esophageal varices significantly earlier compared with ethanolamine oleate (12.9 ± 5.2 vs 22.3 ± 8.2 wk, respectively, p < 0.001). The mean number of injection courses and the mean amount of sclerosant required for variceal obliteration was also significantly (p < 0.001) less in the alcohol-injected group. Although the total number of rebleeding episodes were significantly (p < 0.05) less in the alcohol-injected group, the frequency of rebleeding was not significantly different between the two groups (20.8% vs 30.4%, respectively, p > 0.05). Two (8.1%) patients died due to rebleeding in the ethanolamine-injected group, whereas in the alcohol group, none died. There was no significant difference in the frequency of complications with the two sclerosants. Besides the relative ease of rapid injection due to its aqueous nature, alcohol is readily available and relatively economical (total cost of sclerosant per patient; alcohol US $0.50, ethanolamine US $60). In conclusion, absolute alcohol appears to be a useful alternative to 5% ethanolamine oleate as a variceal sclerosant. [ABSTRACT FROM AUTHOR]

Noncirrhotic portal fibrosis is a common cause of portal hypertension in India. We report four families with more than one member afflicted with this disorder. Six of the seven (85.5%) patients in whom HLA studies were carried out were HLA-DR 3 positive. The possibility of an immunogenetic basis of noncirrhotic portal fibrosis should be investigated further. [ABSTRACT FROM AUTHOR]

Chronic venous insufficiency is a debilitating condition. It affects about 0.2% of the population and is very demanding on health resources. In the UK, there are about 100,000 patients with active leg ulcers and treating these patients costs the national health service between £100 and £400,000,000 per anum. This paper reviews the classification, epidemiology, pathophysiology, investigations and treatment of this condition. The etiology of venous ulceration is discussed and the various theories explaining the cause of ulceration examined. The latest research into the condition is reviewed and the relative roles of superficial venous incompetence and deep venous incompetence in the pathophysiology of ulceration is presented. Surgical and non-surgical treatment of the condition including surgical treatment of superficial and deep venous incompetence, compression therapy, and drug therapy is explored. [ABSTRACT FROM AUTHOR]

The glasses doped with the Er3+, Nd3+ ions were synthesized in the oxyfluoride system TeO2-PbO·P2O5-PbF2:МF3 and studied by the IR and Raman spectroscopy (including low-frequency range of spectra), DSC, SAXS and luminescence methods. The role of REE ions in the structure forming, crystallization and luminescent properties of glasses is identified. It was found that the rare-earth element ions enter into the medium range order of glass structure and act as crystallite forming nuclei. The contribution of the Er3+ photoluminescence with emission levels at 524, 530, 545, and 554 nm into the inelastic scattering spectrum of glasses in the system of TeO2-Pb2O5·PbO-PbF2:xErF3 has been revealed. [ABSTRACT FROM AUTHOR]

Computed tomographic (CT) scan findings in patients with cavernous ectasia of the biliary tract (Caroli disease) have been described. Our patient had the isolated form of Caroli disease characterized by saccular dilatation of intrahepatic bile ducts and no evidence of portal hypertension. CT scan of the liver showed tiny dots with strong contrast enhancement within dilated intraheptic bile ducts (the central dot sign). This finding when correlated with sonogram indicated portal radicles surrounded by dilated intrahepatic bile ducts. [ABSTRACT FROM AUTHOR]

Ascorbic acid is utilized during the post-embryonic differentiation of skeletal muscle fibres in chick. While the fibres lose their heterogeneity with regard to ascorbic acid, they continue to exhibit differences in their metabolic rates in terms of the succinate dehydrogenase activity throughout life. [ABSTRACT FROM AUTHOR]

Hypoglycemia is a well known paraneoplastic manifestation of hepatocellular carcinoma. However, hypoglycemia as the first presentation is extremely uncommon. We herein report a case of HCC presenting with severe, uncontrollable hypoglycemia that was managed with percutaneous ethanol injection therapy. [ABSTRACT FROM AUTHOR]

Noncirrhotic portal fibrosis is a common cause of portal hypertension in India. We report the development of noncompressive myelopathy after a lienorenal shunt in a patient with noncirrhotic portal fibrosis. [ABSTRACT FROM AUTHOR]

A response to a letter to the editor concerning various antivirals and immunomodulators which are currently in use for treatment of chronic hepatitis B is presented.