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Abstract Genetic variants associated with increased liver fat and volume have been reported, but whether physical activity (PA) can attenuate the impact of genetic susceptibility to these traits is poorly understood. We aimed to investigate whether higher PA modify genetic impact on liver-related traits in the UK Biobank cohort. PA was self-reported, while magnetic resonance images were used to estimate liver fat (n = 27,243) and liver volume (n = 24,752). Metabolic dysfunction-associated liver disease (MASLD) and chronic liver disease (CLD) were diagnosed using ICD-9 and ICD-10 codes. Ten liver fat and eleven liver volume-associated genetic variants were selected and unweighted genetic-risk scores for liver fat (GRSLF) and liver volume (GRSLV) were computed. Linear regression analyses were performed to explore interactions between GRSLF/ GRSLV and PA in relation to liver-related traits. Association between GRSLF and liver fat was not different among lower (β = 0.063, 95% CI 0.041–0.084) versus higher PA individuals (β = 0.065, 95% CI 0.054–0.077, p interaction = 0.62). The association between the GRSLV and liver volume was not different across different PA groups (p interaction = 0.71). Similarly, PA did not modify the effect of GRSLF and GRSLV on MASLD or CLD. Our findings show that physical activity and genetic susceptibility to liver-related phenotypes seem to act independently, benefiting all individuals regardless of genetic risk.

Artificial intelligence (AI) advances and the rapid adoption of generative AI tools, like ChatGPT, present new opportunities and challenges for higher education. While substantial literature discusses AI in higher education, there is a lack of a systems approach that captures a holistic view of the structure and dynamics of the AI transformation of higher education institutions (HEIs). To fill this gap, this article develops a causal loop diagram (CLD) to map the causal feedback mechanisms of AI transformation in a typical HEI. We identify important variables and their relationships and map multiple reinforcing and balancing feedback loops accounting for the forces that drive the AI transformation and its impact on value creation in a typical HEI. The model shows how, motivated by AI technology advances, the HEI can invest in AI to improve student learning, research, and administration while dealing with academic integrity problems and adapting to job market changes by emphasizing AI-complementary student skills. We explore model insights, scenarios, and policy interventions and recommend that HEI leaders become systems thinkers to manage the complexity of the AI transformation and benefit from the AI feedback loops while avoiding policy traps that may lead to decline. We also discuss the notion of HEIs influencing the direction of AI and directions for future research on AI transformation and the sustainability of HEIs. [ABSTRACT FROM AUTHOR]

Cell line development (CLD) represents a complex but highly critical process during the development of a biological drug. To shed light on this crucial workflow, a team of BioPhorum members (authors) has developed and executed surveys focused on the activities and effort involved in a typical CLD campaign. An average of 27 members from different companies that participate in the BioPhorum CLD working group answered surveys covering three distinguishable stages of a standard CLD process: (1) Pre‐transfection, including vector design and construction; (2) Transfection, spanning the initial introduction of vector into cells and subsequent selection and analysis of the pools; and (3) Single Cell Cloning and Lead Clone Selection, comprising methods of isolating single cells and confirming clonal origin, subsequent expansion and screening processes, and methods for identifying and banking lead clones. The surveys were very extensive, including a total of 341 questions split between antibody and complex molecule CLD processes. In this survey review, the authors interpret and highlight responses for antibody development and, where relevant, contrast complex molecule development challenges to provide a comprehensive industry perspective on the typical time and effort required to develop a CHO production cell line. [ABSTRACT FROM AUTHOR]

Background: The branched-chain amino acids (BCAAs) to tyrosine (Tyr) ratio (BTR) test is used to evaluate the progression of chronic liver disease (CLD). However, the differences across sex, age, body mass index (BMI) and etiologies are still unclear. Methods: We retrospectively reviewed data from 2,529 CLD cases with free amino acids (FAAs) in peripheral blood from four hospitals and 16,421 general adults with FAAs data from a biobank database. In total, 1,326 patients with CLD (covering seven etiologies) and 8,086 healthy controls (HCs) were analyzed after exclusion criteria. We investigated the change of BTR in HCs by sex, age and BMI and then compared these to patients divided by modified ALBI (mALBI) grade after propensity score matching. Results: BTR is significantly higher in males than females regardless of age or BMI and decreases with aging in HCs. In 20 types of FAAs, 7 FAAs including BCAAs were significantly decreased, and 11 FAAs including Tyr were significantly increased by mALBI grade in total CLD. The decreasing timings of BTR were at mALBI grade 2b in all CLD etiologies compared to HCs, however in chronic hepatitis C (CHC), chronic hepatitis B (CHB) and alcoholic liver disease (ALD), BTR started to decrease at 2a. There was a positive correlation between BCAAs and albumin among parameters in BTR and mALBI. The correlation coefficients in PBC, ALD and MASLD were higher than those of other etiologies. Conclusions: BTR varies by sex and age even among healthy adults, and decreasing process and timing of BTR during disease progression is different among CLD etiologies. [ABSTRACT FROM AUTHOR]

Patients with chronic liver disease (CLD) experience health‐related quality of life (HRQoL) and patient‐reported outcomes (PROs) impairments. We assessed and identified predictors of HRQoL and PROs in CLD patients from Saudi Arabia (SA), Turkey and Egypt. Patients enrolled in Global Liver Registry™ with chronic hepatitis B (CHB), chronic hepatitis C (CHC) and non‐alcoholic fatty liver disease (NAFLD) or non‐alcoholic steatohepatitis (NASH) were included. Clinical data and PRO questionnaires (FACIT‐F, CLDQ and WPAI) were compared across countries. Linear regression identified PRO predictors. Of the 4014 included patients, 26.9% had CHB, 26.9% CHC and 46.1% NAFLD/NASH; 19.2% advanced fibrosis. Compared across countries, CHB patients were younger in Egypt (mean age [years] 41.2 ± 11.4 vs. 45.0 ± 10.3 SA, 46.1 ± 12.0 Turkey), most often employed in SA (64.8% vs. 53.2% Turkey) and had the lowest prevalence of obesity in Turkey (26.7% vs. 37.8% SA, 38.5% Egypt). In SA, CHB patients had lowest prevalence of fibrosis and comorbidities (all p <.01). There was a higher frequency of males with NAFLD/NASH in SA (70.0% vs. 49.6% Turkey, and 35.5% Egypt). Among NAFLD/NASH patients, CLDQ‐NAFLD/NASH scores were highest in SA (mean total score: 5.3 ± 1.2 vs. 4.8 ± 1.2 Turkey, 4.1 ± 0.9 Egypt, p <.01). Independent predictors of worse PROs included younger age, female sex, advanced fibrosis, non‐hepatic comorbidities and lack of regular exercise (all p <.05). Clinical presentation and PRO scores of CLD patients vary across SA, Turkey and Egypt. Impairment of HRQoL is associated with demographic factors, lack of regular exercise, advanced fibrosis and non‐hepatic comorbidities. [ABSTRACT FROM AUTHOR]

Background: The term "chronic liver disease" (CLD) refers to a long-term, permanent alteration in the structure of the liver that may result in consequences including cirrhosis and early mortality. A potential contributing element to the pathophysiology of chronic liver disorders and the development of complications in cirrhosis is the dysfunction of the intestinal epithelial barrier. One indicator of intestinal permeability is zonulin. Objective: This study aimed to assess serum zonulin levels in CLD with and without cirrhosis in pediatrics. Patients and methods: The study population consisted of 40 children with CLD with cirrhosis, 40 children with CLD without cirrhosis and 20 apparently healthy children serving as a control group. Serum levels of zonulin was determined. Results: The main finding of the current study was that serum zonulin levels were significantly higher in CLD with cirrhosis patients than in CLD without cirrhosis patients or healthy controls (p < 0 001). The median of serum zonulin levels in CLD with cirrhosis patients, CLD without cirrhosis patients, and healthy controls were 264.24, 8.24 and 39.69 ng/mL respectively. Conclusion: Serum zonulin levels were significantly increased in liver cirrhosis patients. [ABSTRACT FROM AUTHOR]

Background: Chronic liver disease (CLD) and its complications are becoming a major public health problem. The relation between trace elements and chronic liver disease has been studied in recent times. Objectives of the study: To study the levels of various trace elements like copper and zinc in cases of CLD and to compare and correlate them with healthy controls. Materials and methods: This was an observational case control study conducted in department of Medicine of KIMS Koppal for a duration of 18 months. A total of 100 subjects were prospectively included in the study (50 cases of CLD and 50 matched controls). The concentration of trace elements like serum zinc and copper were measured in all subjects and correlated. Results: There was significant reduction in the levels of zinc whereas copper levels were significantly increased in chronic liver disease. Conclusion: The functions of trace elements like coper and zinc have a dual role. In normal levels, they are important for stabilization of the cellular structures, but in deficiency states may stimulate alternate pathways and cause diseases. These trace elements have clinical significant and these can be estimated using different analytical method. [ABSTRACT FROM AUTHOR]

Objective: Fetal magnetic resonance imaging (MRI) is broadly used as a method for assessing prognosis in congenital diaphragmatic hernia (CDH). In addition to the extent of lung hypoplasia, determined by measuring the lung volume, cardiac impairment due to pulmonary hypertension and left cardiac hypoplasia is decisive for the prognosis. The percentage area of left ventricle (pALV) describes the percentage of the inner area of the left ventricle in relation to the total area, whereas the mediastinal shift angle (MSA) quantifies the extent of cardiac displacement. The prognostic value of pALV and MSA should be evaluated in terms of survival, the need for extracorporeal membrane oxygenation (ECMO) therapy, and the development of chronic lung disease (CLD). Methods: In a total of 122 fetal MRIs, the MSA and pALV were measured retrospectively and complete outcome parameters were determined regarding survival for all 122 subjects, regarding ECMO therapy in 109 cases and about the development of CLD in 78 cases. The prognostic value regarding the endpoints was evaluated using logistic regression and ROC analysis. Results: The MSA was significantly higher in children who received ECMO therapy (p = 0.0054), as well as in children who developed CLD (p = 0.0018). ROC analysis showed an AUC of 0.68 for ECMO requirement and 0.77 with respect to CLD development. The pALV showed a tendency towards higher levels in children who received ECMO therapy (p = 0.0824). The MSA and the pALV had no significant effect on survival (MSA: p = 0.4293, AUC = 0.56; pALV: p = 0.1134, AUC = 0.57). Conclusions: The MSA determined in fetal MRI is a suitable prognostic parameter for ECMO requirement and CLD development in CDH patients and can possibly be used as a supplement to the established parameters. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic liver disease (CLD) have a higher risk of mortality when infected with severe acute respiratory syndrome coronavirus 2. Although the fibrosis-4 (FIB-4) index, aspartate aminotransferase-to-platelet ratio index (APRI), and albumin-bilirubin grade (ALBI) score can predict mortality in CLD, their correlation with the clinical outcomes of CLD patients with coronavirus disease 2019 (COVID-19) is unclear. This study aimed to investigate the association between the liver severity and the mortality in hospitalized patients with non-cirrhotic CLD and COVID-19. Methods: This retrospective study analyzed 231 patients with non-cirrhotic CLD and COVID-19. Clinical characteristics, laboratory data, including liver status indices, and clinical outcomes were assessed to determine the correlation between liver status indices and the mortality among patients with non-cirrhotic CLD and COVID-19. Results: Non-survivors had higher levels of prothrombin time-international normalized ratio (PT-INR), alanine aminotransferase, aspartate aminotransferase, and high-sensitivity C-reactive protein (hs-CRP) and lower albumin levels. Multivariable analysis showed that ALBI grade 3 (odds ratio (OR): 22.80, 95% confidence interval (CI) [1.70-305.38], p = 0.018), FIB-4 index ≥ 3.25 (OR: 10.62, 95% CI [1.12-100.31], p = 0.039), PT-INR (OR: 19.81, 95% CI [1.31-299.49], p = 0.031), hs-CRP (OR: 1.02, 95% CI [1.01-1.02], p = 0.001), albumin level (OR: 0.08, 95% CI [0.02-0.39], p = 0.002), and use of vasopressors (OR: 4.98, 95% CI [1.27-19.46], p = 0.021) were associated with the mortality. Conclusion: The ALBI grade 3 and FIB-4 index = 3.25, higher PT-INR, hsCRP levels and lower albumin levels could be associated with mortality in non-cirrhotic CLD patients with COVID-19. Clinicians could assess the ALBI grade, FIB-4 index, PTINR, hs-CRP, and albumin levels of patients with non-cirrhotic CLD upon admission. [ABSTRACT FROM AUTHOR]

Oxygen therapy is widely used in the community for patients with chronic hypoxaemia. Although only a small proportion of those are children, more and more paediatric patients are prescribed home oxygen for a variety of indications, most commonly for chronic lung disease related to premature birth. Chronic hypoxaemia in children is diagnosed using pulse oximetry, a method that has limitations, but alternative tests are rarely required. Whilst there are clear advantages in therapy with oxygen outside the hospital setting, clinicians need to be aware of potential impact on family life, housing, school attendance and travel. The process of prescribing is standardised in the UK, and it is crucial for clinicians to understand risks and equipment used to deliver oxygen in the community. Regular follow up is important and input from community-based professionals is hugely beneficial. Some children on long-term oxygen therapy may be able to wean and eventually stop therapy. This process can be supported by a structured protocol. New technologies such as remote monitoring may further improve the care of children with chronic conditions that require long term oxygen therapy. [ABSTRACT FROM AUTHOR]

Chronic liver disease (CLD) affects a significant portion of the global population, leading to a substantial number of deaths each year. Distinct forms like non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (ALD), though they have different etiologies, highlight shared pathologies rooted in oxidative stress. Central to liver metabolism, mitochondria are essential for ATP production, gluconeogenesis, fatty acid oxidation, and heme synthesis. However, in diseases like NAFLD, ALD, and liver fibrosis, mitochondrial function is compromised by inflammatory cytokines, hepatotoxins, and metabolic irregularities. This dysfunction, especially electron leakage, exacerbates the production of reactive oxygen species (ROS), augmenting liver damage. Amidst this, nuclear factor erythroid 2-related factor 2 (NRF2) emerges as a cellular protector. It not only counters oxidative stress by regulating antioxidant genes but also maintains mitochondrial health by overseeing autophagy and biogenesis. The synergy between NRF2 modulation and mitochondrial function introduces new therapeutic potentials for CLD, focusing on preserving mitochondrial integrity against oxidative threats. This review delves into the intricate role of oxidative stress in CLD, shedding light on innovative strategies for its prevention and treatment, especially through the modulation of the NRF2 and mitochondrial pathways. [ABSTRACT FROM AUTHOR]

Depression is a complex and prevalent mental illness. Cherry leaf is a traditional Chinese herbal medicine, which has confirmed to exert a certain antidepressant effect, but its potential neural regulation mechanism is not clear. This paper aims to investigate the improved action of cherry leaf decoction (CLD) on chronic unpredictable mild stress (CUMS) rats and its potential neural regulation mechanism by verifying the role and function of NMDAR regulatory target α2δ-1 in depression due to CUMS. Male SD rats were subjected to random stressors persisting for 5 weeks to establish the CUMS depression rat model. CLD could effectively alleviate depression-like behaviors of CUMS rats in behavioral tests including sucrose preference test, forced swimming test, tail suspension test and open field test. After the administration of the CLD, the expression of corticotropic-releasing hormone (CRH) in the hypothalamus was inhibited. Moreover, the levels of CRH, adrenal cortical hormone (ACTH) and corticosterone (CORT) in serum also decreased significantly. CUMS upregulated the expressions of α2δ-1, N-methyl-d-aspartate receptor 1 (NR1), NR2A and NR2B, and enhanced the binding ability to of α2δ-1 and NR1, which were reversed by CLD. The results demonstrated that CLD could ameliorate depression-like behaviors due to CUMS, which was related to the fact that CLD down-regulated α2δ-1 level and interfered with α2δ-1 binding to NR1, thereby reducing NMDAR expression and ultimately inhibiting HPA axis activity.

Background: Brucellosis is a serious public health problem distributed worldwide. Jordan has one of the highest incidences of brucellosis globally, mostly caused by infection with Brucella melitensis, which is associated with small, ruminant animals such as sheep. Sheep are an important livestock species in Jordan where there is a high value is placed on keeping animals at home. The incidence of human brucellosis rapidly increased following the Syrian conflict, in association with the resettlement of displaced people. Methods: A systems thinking (ST) approach was applied to develop a model to explain the dynamics of brucellosis in Jordan. A causal loop diagram (CLD) was developed to visualize and conceptualize interactions and feedback between several factors involved in sheep husbandry, animal and human health, and livestock trading systems. The CLD was constructed using information from published literature, historical governmental reports, policy documents and media coverage regarding brucellosis in Jordan. Semi-structured, in-depth interviews with diverse stakeholders were conducted to elicit information on their understanding of critical factors associated with brucellosis. Results: The CLD demonstrated that brucellosis transmission in Jordan is driven by sheep husbandry practices like livestock movement/trading and the management of symptomatic animals (those suffering abortion). Five dimensions were identified to be associated with brucellosis transmission: human infection; consumers; traders and markets; and livestock infection and control. Conclusion: The development of a CLD to explain brucellosis transmission in Jordan provides a better understanding of and reveals the multi-sectoral nature of the problem. The need for a multi-sectoral approach for effective brucellosis management in Jordan is clear from the five dimensions identified. [ABSTRACT FROM AUTHOR]

The Content Based Image Retrieval (CBIR) system is a framework for finding images from huge datasets that are similar to a given image. The main component of CBIR system is the strategy for retrieval of images. There are many strategies available and most of these rely on single feature extraction. The single feature-based strategy may not be efficient for all types of images. Similarly, due to a larger set of data, image retrieval may become inefficient. Hence, this article proposes a system that comprises of two-stage retrieval with different features at every stage where the first stage will be coarse retrieval and the second will be fine retrieval. The proposed framework is validated on standard benchmark images and compared with existing frameworks. The results are recorded in graphical and numerical form, thus supporting the efficiency of the proposed system.

Introduction: Despite the clinical relevance and potential implications of anaemia in CLD, the available evidence regarding the association between anaemia and the severity of liver disease remains inconsistent and limited. Method: A cross sectional study was done among 116 CLD patients to address this research gap by investigating the prevalence, Etiology, and clinical implications of anemia among patients with CLD. Result: Out of total 116 patients, 57.8% had anemia. Among patients with anaemia, there were 56 males and 11 females. 71.2% (48) had mild anaemia, compared to 20.1% (14) and 20.1% (14) who had moderate and severe anaemia, respectively. 31 out of 67 (46.3%) were classified as CPS A and CPS B, and only 5 (7.4%) were classified as CPS C. When comparing patients with and without anaemia, the mean MELD points were 12.1 and 9.5, respectively. Conclusion: there was association found between anaemia and the severity of chronic liver disease, as indicated by higher MELD, and a higher proportion of patients in the more severe Child-Pugh scores categories with anaemia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Poractant administration with thin catheter is gradually gaining popularity compared to the INSURE technique. However, there is little evidence to use thin catheters for administration of beractant. With this background, we compared the effect of beractant administration with INSURE vs thin catheter in preterm infants less than 34 weeks with RDS on death/chronic lung disease (CLD). METHODS: This prospective cohort study was conducted in a tertiary NICU where inborn preterm infants≤34 weeks with RDS receiving beractant by INSURE or thin catheter were studied over two epochs- Epoch1– INSURE (Jan 2020–Oct 2020) & Epoch 2– Surfactant through thin catheter (Nov 2020–July 2021).The primary outcome was occurrence of death/CLD. Procedure related complications like transient bradycardia/desaturation, pneumothorax, failure of procedure, rates of other outcomes like failure of CPAP within 72hr, duration of invasive mechanical ventilation/ CPAP support, oxygen supplementation, other major neonatal morbidities & mortality were evaluated as secondary outcomes. RESULTS: The combined outcome of death/CLD was significantly lower in the thin catheter epoch (RR 0.56, 95% CI 0.34-0.90, p = 0.012). When analyzed independently for death/CLD, we found significantly lower number of deaths in the thin catheter epoch (RR 0.44, 95% CI 0.23-0.83, p = 0.008). Number of infants who failed CPAP within 72 hrs of life was lower in thin catheter epoch (RR 0.59, 95% CI 0.41-0.85, p = 0.003). Transient bradycardia/desaturation was higher during thin catheter technique (RR 4.17, 95% CI 2.22-7.69, p < 0.001). Incidence of severe IVH was lower with thin catheter technique (RR 0.13, 95% CI 0.02-0.98, p = 0.034). CONCLUSION: Beractant administration by thin catheter reduces combined outcome of death/CLD. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis (OP) has become an increasingly recognized complication among patients with chronic liver disease (CLD). Objective: This study aimed to determine the prevalence of osteoporosis among patients with CLD and to identify the risk factors associated with osteoporosis in these patients. Materials and Methods: One hundred patients who visited Basrah Gastroenterology and Hepatology Hospital between February 2020 and December 2021 with assessed osteoporosis. Using dual energy X-ray absorptiometry (DEXA), bone density was evaluated. The severity of liver disease, smoking, alcohol use, demographic, biochemical characteristics were all taken while assessing the risk factors for osteoporosis. Results: Of the 100 patients (male/female: 44%/56%, mean age (46 ± 11.5), 50% had CLD diagnoses, 50% did not. Of the 50 patients with CLD, 20 patients had OP(40%), while four patients (8%) of the 50 patients without CLD had OP. Twentyfour (24%) of the total patients who undertook the DEXA study showed OP, while seventy-six (76%) did not. Twenty of the twenty-four individuals with OP had CLD (84%) while just four (16%) did not. Child-Pugh A made up 26% of CLD patients, Child-Pugh B 30%, while Child-Pugh C 44%. In this study, osteoporosis and osteopenia were present at rates of 24% and 31% respectively. OP and CLD appeared to be related in a very substantial way (p 0.001). CLD was identified as an independent predictor of OP by multivariate logistic regression analysis (OR (95% CI):9.09(2.18-37.93), p=0.0 Conclusion: It was determined that OP and CLD are significantly correlated. People with CLD were more likely to develop OP. As a result, routine follow-up of these individuals may require biochemical and bone mineral density (BMD) monitoring. [ABSTRACT FROM AUTHOR]

Prediction accuracy of constant life diagrams (CLDs) for fiber‐reinforced plastics varies with the stacking, tensile/compression dominated failure, input S–N curves, the complexity of the plot, and so forth. The article's authors propose a modified piecewise linear CLD and compare its prediction accuracy with traditional piecewise and 2‐segment anisomorphic CLD. The constant amplitude fatigue life data for three different carbon fiber reinforced polymer composites multidirectional laminates that is (+45, −45, +45, and −45)2S, (+45, −45, 0, and 90)2S, and (0, 90, 0, and 90)2S were generated at five different stress ratios (R = σmin/σmax) that is, R = 0.1 and 0.5 (T–T), −1 and critical stress ratio (T–C), and 5 (C–C). The proposed modified Piecewise linear CLD considers the critical stress ratio (UCS/UTS) as a definite input node. The prediction accuracy of the proposed CLD and others was evaluated using additional fatigue testing at random stress ratios and stress levels. The proposed CLD showed the highest prediction accuracy compared to Piecewise or Anisomorphic CLD. The non‐linear CLD plotted using single S‐N curve data may save time and effort but achieving absolute accuracy will ultimately depend on the stacking sequence. [ABSTRACT FROM AUTHOR]

Background and Aims: Liver fibrosis leading to chronic liver disease (CLD) is a major cause of morbidity, mortality and health‐care expenditure worldwide. The "gold standard" for diagnosis and staging of liver fibrosis is histological analysis of liver tissue obtained by liver biopsy, an invasive procedure. Therefore, there is the need to identify noninvasive and inexpensive markers for diagnosis and staging of liver fibrosis. This study aimed at evaluating the correlation of hyaluronic acid (HA) and 25‐hydroxyvitamin D (25‐OH vitamin D) serum levels as markers of fibrosis with histologically staged and graded liver biopsies obtained from CLD patients. Methods: This was a case‐control study involving 40 CLD patients requiring liver biopsies and 40 controls. Liver biopsies were staged to determine the degree of fibrosis. Serum levels of 25‐OH vitamin D and HA were determined using ELISA. Statistical analyses were performed to determine differences in HA and 25‐OH vitamin D levels between controls and patients as well as to correlate the biomarkers with the stages of fibrosis. Results: CLD patients showed significant (p < 0.001) increase in the levels of AST, ALT, GGT, compared to the controls. Patients also had significantly (p < 0.001) lower serum 25‐OH vitamin D and higher HA (p < 0.001) levels compared to the controls. Additionally, 25‐OH vitamin D levels of the CLD patients were significantly different across the stages of liver fibrosis likewise serum HA levels. Furthermore, 25‐OH vitamin D levels inversely correlated with the severity of liver fibrosis. A significant negative correlation (r = −0.33, p < 0.05) between CLD patients' HA and 25‐OH vitamin D were found. Conclusion: CLD patients had significantly reduced serum 25‐OH vitamin D and higher HA. Both markers correlated with the degree of liver fibrosis. These findings have major clinical translatable implication in the use of vitamin D supplementation in the management of CLD in Ghana. [ABSTRACT FROM AUTHOR]

Background: Subclinical myopathy is an earlier stage that can be easily managed to prevent or delay the associated complications and progression to evident myopathy. Objective: To evaluate subclinical manifestations and distribution of muscle affection in diabetes mellitus (DM), chronic liver disease (CLD) and chronic kidney disease (CKD). Patients and Methods: The study includes 60 patients who were classified into 3 equal groups: Group 1 included diabetes mellitus cases, group 2 included chronic liver disease cases, group 3 included chronic kidney disease cases and another 20 normal individuals as control who were age- and sex-matched (Group 4). The study was conducted at Outpatient Clinic and Inpatient Neurology Department at Mansoura University Hospitals. Four groups were subjected to Electromyography, Magnetic resonance imaging and laboratory investigations. Results: There was statistically significant difference between the studied groups regarding the CK (creatine kinase) and LDH (lactate dehydrogenase) levels. The CK level was higher in CLD and CKD groups than in DM and control groups but within upper normal level. The pattern of myopathy in DM cases was more in proximal than distal muscles at upper and lower limbs. In CLD cases, the myopathic pattern at upper and lower limbs were close in proportions. The pattern of myopathy in CKD cases was more in proximal than distal muscles at upper and lower limbs. The distribution of myopathic pattern in control group was 5%. Conclusion: Subclinical myopathy isn't uncommon in DM, CLD and CKD. CK level is high in CLD and CKD patients but within normal upper limit that need further follow up for diagnosis of myopathy. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. It has been shown that up to 50% of patients with chronic HCV infection experience neuropsychiatric issues. Objective: This study aimed to evaluate the cognitive impairment, extrapyramidal signs and their effects on patients' quality of life. Patients and Methods: The study included 60 untreated patients (20 chronic hepatitis, 40 patients with liver cirrhosis) and 20 healthy controls matched for age, sex, and educational level. Cirrhotic patients were graded according to the Child-Pugh classification. Patients underwent a thorough clinical and neurological evaluation, liver function tests, hepatitis markers, abdominal ultrasonography, psychometric tests and auditory p300 evoked potentials. Unified Parkinson's Disease Rating Scale (UPDRS) and chronic liver disease questionnaire (CLDQ) were used. Results: Patients had significant cognitive impairment that became greater with increased severity of liver disease. The extrapyramidal manifestations were absent in chronic hepatitis while present in cirrhotics and their frequencies were increased with cirrhotic severity (P~0.001). P300 latency was delayed in patients with and without extrapyramidal signs. Quality of life measured by CLDQ was significantly lower in all patients than controls (P~ 0.001), and became worse with increased severity of liver disease except worry increased in chronic hepatitis. Conclusion: Patients with HCV infection had cognitive impairment, which increased with chronic liver disease (CLD) severity. Extrapyramidal signs were absent in chronic hepatitis patients, while, present in cirrhotics and increased with increasing severity of cirrhosis. Cognitive impairment was not attributed to the extrapyramidal affection. The CLD and cognitive impairment had negative impact on the quality of life. [ABSTRACT FROM AUTHOR]

Chronic liver disease (CLD) affects a significant portion of the global population, leading to a substantial number of deaths each year. Distinct forms like non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (ALD), though they have different etiologies, highlight shared pathologies rooted in oxidative stress. Central to liver metabolism, mitochondria are essential for ATP production, gluconeogenesis, fatty acid oxidation, and heme synthesis. However, in diseases like NAFLD, ALD, and liver fibrosis, mitochondrial function is compromised by inflammatory cytokines, hepatotoxins, and metabolic irregularities. This dysfunction, especially electron leakage, exacerbates the production of reactive oxygen species (ROS), augmenting liver damage. Amidst this, nuclear factor erythroid 2-related factor 2 (NRF2) emerges as a cellular protector. It not only counters oxidative stress by regulating antioxidant genes but also maintains mitochondrial health by overseeing autophagy and biogenesis. The synergy between NRF2 modulation and mitochondrial function introduces new therapeutic potentials for CLD, focusing on preserving mitochondrial integrity against oxidative threats. This review delves into the intricate role of oxidative stress in CLD, shedding light on innovative strategies for its prevention and treatment, especially through the modulation of the NRF2 and mitochondrial pathways.

Tadelle Amanuel, Banjaw Zelalem Department of Biomedical Sciences, Jimma University, Jimma City, EthiopiaCorrespondence: Tadelle Amanuel, Email newaman09@yahoo.com; amanuel.muluneh@ju.edu.etBackground: Liver disease affects the electrophysiology of the heart. ECG abnormalities, especially QT interval prolongation are common in CLD. Heart rate affects QT interval, so QT interval is reported as corrected QT interval (QTc). The mechanism of QTc interval prolongation in patients with CLD is related to dysfunction of the autonomic nervous system.Objective: To assess QT interval prolongation among patients with chronic liver disease.Methods: The semi-structured questionnaire, ECG machine, automatic serum analyzer, and centrifuge were data collection instruments. Serum HDL, total proteins, albumin, bilirubin, electrolytes, triglycerides, total cholesterol, and fasting glucose were measured during data collection. LDL cholesterol was calculated. Prothrombin time was measured and INR was calculated. The severity of liver diseases was determined by the child Pugh classification (CTP score), so patients were classified by CTP score (class A, class B, or class C).Results: Twenty-seven (32.5%) were males and 56 (67.5%) were females. Thirty-nine (47%) patients were in child class B and 44 (53%) patients were in child class C. However, no patients were in child class A. Among all male CLD patients, 14 (35.9%) were in child class B and 13 (29.5%) were in child class C. Among all female patients, 25 (64.1%) were in child class B and 31 (70.5%) were in child class C. 52 (94.5%) of the patients had QT prolongation, 49 (89.1%) of the patients had QTc prolongation. Among QT prolongation, 24 (61.5%) was in Child B, 28 (63.6%) was in Child C, and among QTc prolongation, 6 (15.4%) was in Child B, 43 (97.7%) was in Child C. The independent factors significantly associated with QT interval prolongation in this study were systolic hypotension (p = 0.003) and overweight (p = 0.018).Conclusion: QT and QTc prolongation was observed. The prolongation also was increased especially when the disease is more advanced like in child C.Keywords: CLD, Q-T interval, child-Pugh classification

Flooding has been a recurrent problem in the Indonesian capital, especially in the northern part of Jakarta, along the Jakarta shore. The floods were caused by a number of sources. According to Renald et al. (2016), there are four critical factors in designing disaster-prone cities in Indonesia, namely spatial management, disaster adaptation, disaster mitigation, and technology innovation. Therefore, the development of infrastructure in Jakarta has started to use these four elements, by applying the concept of environmentally friendly drainage, specifically the concept of eco-drainage. This study aims to understand the general picture through the cause-and-effect relationship between all flood components. This study used a qualitative approach and was conducted using a dynamic system method to describe the Causal Loop Diagram (CLD) model, which provides information between interrelated variables and forms a complex system Rifaldi et al. (2021). The model generated from the dynamic system can be used for scenario analysis by showing how the interactions between the components that make up the structure of the system and the effects of feedback loops affect. The CLD model shown shows that the use of eco-drainage will directly affect the condition of 2 (two) other variables, both of which will lead to one main variable. The proposed settlement scenarios will result in policy and technical recommendations. This CLD model shows that the interaction between variables is very dynamic and affects each other massively and holistically. Combining dynamic system processes with SMWW can potentially improve the expected results in engineering and provide an alternative scenario.

Abstract Background and Aims Liver fibrosis leading to chronic liver disease (CLD) is a major cause of morbidity, mortality and health‐care expenditure worldwide. The “gold standard” for diagnosis and staging of liver fibrosis is histological analysis of liver tissue obtained by liver biopsy, an invasive procedure. Therefore, there is the need to identify noninvasive and inexpensive markers for diagnosis and staging of liver fibrosis. This study aimed at evaluating the correlation of hyaluronic acid (HA) and 25‐hydroxyvitamin D (25‐OH vitamin D) serum levels as markers of fibrosis with histologically staged and graded liver biopsies obtained from CLD patients. Methods This was a case‐control study involving 40 CLD patients requiring liver biopsies and 40 controls. Liver biopsies were staged to determine the degree of fibrosis. Serum levels of 25‐OH vitamin D and HA were determined using ELISA. Statistical analyses were performed to determine differences in HA and 25‐OH vitamin D levels between controls and patients as well as to correlate the biomarkers with the stages of fibrosis. Results CLD patients showed significant (p

Deficiency-oriented attitudes are still common occurrences despite growing emphasis on linguistic and cultural diversity. Promoting inclusivity in learning, Herrera (2016) proposed “biography-driven instruction” emphasizing the power of students’ assets. Though her work was intended for young learners’ biliteracy, I argue that the tenets can be used as a framework for more equitable adult ESL instruction to build on learners’ “funds of knowledge” (Moll et al., 1992) and “cultural wealth” (Yosso, 2016). In this article, I theorize an “autobiographydriven instruction” approach where L2 writing instruction can foster inclusivity through life writing by acknowledging diverse linguistic and cultural backgrounds as assets, drawing from rich lived experiences, and tapping into multi-competencies. Drawing from the work in translanguaging and life writing, this article problematizes the deficiency-based assumptions, argues for life writing practices, and provides a practical look into the theorized autobiographydriven instruction. I detail how this approach can help students take a more active role in their learning and inevitably leads to amplifying diverse voices and inclusivity in ESL by learners (1) choosing the content they write about, (2) practicing a variety of the life writing genres, and (3) sharing their personal stories to create empathy and build rapport. [ABSTRACT FROM AUTHOR]

Oxygen plays a key role in supporting life on our planet. It is particularly important in higher eukaryotes where it boosts bioenergetics as a thermodynamically favorable terminal electron acceptor and has important roles in cell signaling and development. Many human diseases stem from either insufficient or excessive oxygen. Despite its fundamental importance, we lack methods with which to manipulate the supply of oxygen with high spatiotemporal resolution in cells and in organisms. Here, we introduce a genetic system, SupplemeNtal Oxygen Released from ChLorite (SNORCL), for on-demand local generation of molecular oxygen in living cells, by harnessing prokaryotic chlorite O2-lyase (Cld) enzymes that convert chlorite (ClO2 2) into molecular oxygen (O2) and chloride (Cl2). We show that active Cld enzymes can be targeted to either the cytosol or mitochondria of human cells, and that coexpressing a chlorite transporter results in molecular oxygen production inside cells in response to externally added chlorite. This first-generation system allows fine temporal and spatial control of oxygen production, with immediate research applications. In the future, we anticipate that technologies based on SNORCL will have additional widespread applications in research, biotechnology, and medicine. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is a serious public health problem distributed worldwide. Jordan has one of the highest incidences of brucellosis globally, mostly caused by infection with Brucella melitensis, which is associated with small, ruminant animals such as sheep. Sheep are an important livestock species in Jordan where there is a high value is placed on keeping animals at home. The incidence of human brucellosis rapidly increased following the Syrian conflict, in association with the resettlement of displaced people. Methods: A systems thinking (ST) approach was applied to develop a model to explain the dynamics of brucellosis in Jordan. A causal loop diagram (CLD) was developed to visualize and conceptualize interactions and feedback between several factors involved in sheep husbandry, animal and human health, and livestock trading systems. The CLD was constructed using information from published literature, historical governmental reports, policy documents and media coverage regarding brucellosis in Jordan. Semi-structured, in-depth interviews with diverse stakeholders were conducted to elicit information on their understanding of critical factors associated with brucellosis. Results: The CLD demonstrated that brucellosis transmission in Jordan is driven by sheep husbandry practices like livestock movement/trading and the management of symptomatic animals (those suffering abortion). Five dimensions were identified to be associated with brucellosis transmission: human infection; consumers; traders and markets; and livestock infection and control. Conclusion: The development of a CLD to explain brucellosis transmission in Jordan provides a better understanding of and reveals the multi-sectoral nature of the problem. The need for a multi-sectoral approach for effective brucellosis management in Jordan is clear from the five dimensions identified.

HIV-1 envelope glycoprotein (Env) interacts with cellular receptors and mediates virus entry into target cells. Blocking Env-receptor interactions represents an effective interventional strategy for developing HIV-1 entry inhibitors. We previously designed a panel of CD4-linker-DC-SIGN (CLD) constructs by fusing the extracellular CD4 and DC-SIGN domains with various linkers. Such CLDs produced by the prokaryotic system efficiently inhibited HIV-1 infection and dissemination in vitro and ex vivo. In this study, following the construction and identification of the most promising candidate with a linker of 8 Gly4Ser repeats (named CLD), we further designed an improved form (named CLDmut) by back mutating Cys to Ser at amino acid 60 of CD4. Both CLD and CLDmut were produced in mammalian (293F) cells for better protein translation and modification. The anti-HIV-1 activity of CLD and CLDmut was assessed against the infection of a range of HIV-1 isolates, including transmitted and founder (T/F) viruses. While both CLD and CLDmut efficiently neutralized the tested HIV-1 isolates, CLDmut demonstrated much higher neutralizing activity than CLD, with an IC50 up to one log lower. The neutralizing activity of CLDmut was close to or more potent than those of the highly effective HIV-1 broadly neutralizing antibodies (bNAbs) reported to date. Findings in this study indicate that mammalian cell-expressed CLDmut may have the potential to be used as prophylaxis or/and therapeutics against HIV-1 infection. [ABSTRACT FROM AUTHOR]

Introduction: Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide. A non-synonymous single nucleotide polymorphism (SNP) of the transmembrane 6 superfamily member 2 (TM6SF2) gene is associated with non-alcoholic fatty liver disease. SNPs of the TM6SF2 gene play an important role in the pathogenesis of HCC in alcoholic cirrhosis, but there are limited data regarding other possible etiologies. We aimed to evaluate the role of the rs58542926 polymorphism in the development of HCC in Egyptian chronic liver disease (CLD) patients. Material and methods: A total of 120 participants, including 40 HCC patients, 40 CLD patients, and 40 healthy controls, were selected. Real-time polymerase chain reaction (RT-PCR) was used to detect the TM6SF2 rs58542926 polymorphism. Results: There were no significant differences among the three studied groups regarding age (p = 0.06) and gender (p = 0.75). Frequencies of the CT, TT, CT + TT genotypes and the T allele were significantly higher in HCC patients than in the CLD and control groups (p < 0.001, p = 0.005, and p < 0.001, respectively). CLD patients with the CT genotype had a significantly increased risk of HCC development (OR = 4.67, 95% CI: 1.67-12.90). Patients with the TT genotype had a significantly increased risk of HCC (OR = 9.33, 95% CI: 1.72-50.61). Moreover, the T allele was correlated with an increased risk of HCC (OR = 5.44, 95% CI: 2.09-14.17) compared to the C allele. Conclusions: The TM6SF2 rs58542926 genotype is associated with an increased risk of HCC in the Egyptian population. [ABSTRACT FROM AUTHOR]

Small interfering RNAs (siRNAs) are widely studied for their highly specific gene silencing activity. However, obstacles remain to the clinical application of siRNAs. Attaching conjugates to siRNAs can improve their stability and broaden their application, and most functional conjugates of siRNAs locate at the 3′-terminus of the sense or antisense strand. In this work, we found that conjugating a group at the 5′-terminus of the antisense strand via phosphodiester was practicable, especially when the group was a flexible moiety such as an alkyl linker. When conjugating a bulky ligand, such as cRGD, the length of the 5′-phosphodiester linker between the ligand and the 5′-terminus of the antisense strand was the key in terms of RNA interference (RNAi). With a relative longer linker, the conjugates showed potency similar to siRNA. A highly efficient transfection system composed of a neutral cytidinyl lipid (DNCA) and a gemini-like cationic lipid (CLD) was employed to deliver siRNAs or their conjugates. The cRGD conjugates showed superior targeting delivery and antitumor efficacy in vivo and also selective cellular uptake in vitro. This unity of encapsulation and conjugation strategy may provide potential strategies for siRNA-based gene therapy.

Introduction: The current Covid19 pandemic has overgrown, as reported statistics show. It causes multiple effects in human life, which one a majority of them doing all activities from home that increase the domestic waste production. The inadequate conventional handling management and a large amount of waste generated thrown away by open dumping. Methods: This study was carried out with a descriptive qualitative approach to describe all information of a good understanding in implementing a waste management system in Bekasi Regency. Mapping and identifying all the waste management process variables were then arranged dynamically using the Causal Loop Diagram (CLD) techniques. Results and Discussion: It should be noted that the variables influence many other variables because the policies applied have much influence on other environments. In the formed CLD in this study, the Covid19 pandemic variable will directly affect 3 (three) other variables such as public consumption patterns, economic conditions, and waste volume. The limited land and high costs were the problems that will hinder the success in waste management in Bekasi Regency. Conclusion: The CLD model shows that the waste management process did not get much attention from the community and managers during this pandemic. The thing that is not being overseen is the increase in the volume of domestic waste because most people choose to work from home, school holidays, and many outside activities are reduced. This CLD model shows that it is necessary to immediately improve waste management so that all waste that enters the landfill can be appropriately processed.

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Chronic liver disease (CLD) is one of the leading causes of disability-adjusted life years in many countries. A recent understanding of nuclear bile acid receptor pathways has increased focus on the impact of crosstalk between the gut, bile acids, and liver on liver pathology. While conventionally used in cholestatic disorders and to dissolve gallstones, the discovery of bile acids' influence on the gut microbiome and human metabolism offers a unique potential for their utility in early and advanced liver diseases because of diverse etiologies. Based on these findings, preclinical studies using bile acid-based molecules have shown encouraging results at addressing liver inflammation and fibrosis. Emerging data also suggest that bile acid profiles change distinctively across various causes of liver disease. We summarize the current knowledge and evidence related to bile acids in health and disease and discuss culminated and ongoing therapeutic trials of bile acid derivatives in CLD. In the near future, further evidence in this area might help clinicians better detect and manage liver diseases. [ABSTRACT FROM AUTHOR]

Liver transplantation (LT) is the second most common solid organ transplantation worldwide. LT is considered the best and most definitive therapeutic option for patients with decompensated chronic liver disease (CLD), hepatocellular carcinoma (HCC), acute liver failure (ALF), and acute-on-chronic liver failure (ACLF). The etiology of CLD shows wide geographical variation, with viral hepatitis being the major etiology in the east and alcohol-related liver disease (ALD) in the west. Non-alcoholic fatty liver disease (NAFLD) is on an increasing trend and is expected to be the most common etiology on a global scale. Since the first successful LT, there have been radical changes in the indications for LT. In many circumstances, not just the liver disease itself but factors such as extra-hepatic organ dysfunction or failures necessitate LT. ACLF is a dynamic syndrome that has extremely high short-term mortality. Currently, there is no single approved therapy for ACLF, and LT seems to be the only feasible therapeutic option for selected patients at high risk of mortality. Early identification of ACLF, stratification of patients according to disease severity, aggressive organ support, and etiology-specific treatment approaches have a significant impact on post-transplant outcomes. This review briefly describes the indications, timing, and referral practices for LT in patients with CLD and ACLF. [Display omitted] • liver transplant success for cirrhosis and ACLF increased over time with improved quality of life. • LT domain has expanded with consideration of MELD exceptions, special indication, and better critical care hepatology. • Prioritisation for urgent, emergent conditions and optimization of sick patients including ACLF during the transplant window, are unmet needs. [ABSTRACT FROM AUTHOR]

• This study applied systems thinking methods to understand the risk factors contributing to distracted driving in Australia. • The developed STAMP control structure model revealed a concerning lack of appropriate control and feedback mechanisms for managing driver distraction. • The findings highlight the importance of collaboration, communication, and clear regulations to define expectations and responsibilities for all stakeholders. Distracted driving is a significant threat to road safety worldwide, contributing to fatal crashes and injuries. Current countermeasures have shown limited efficacy, necessitating a more comprehensive approach to address driver distraction. This research adopts systems thinking methods to understand the complexities of managing driver distraction in the Australian road transport system. This research includes two studies that aimed to (1) develop a Causal Loop Diagram (CLD) to identify the interrelated variables influencing distracted driving (study 1), (2) create and validate a System Theoretic Accident Model and Process (STAMP) control structure model to identify the actors, control and feedback mechanisms involved in managing driver distraction, and (3) determine who creates and manages risk factors related to distracted driving (study 2). To develop the CLD, the research team used two group modelling processes and SME workshops for validation. The STAMP control structure model was created by modifying a road safety control structure to fit the distracted driving context and its validation using a modified Delphi technique. The CLD included many variables that contribute to distracted driving, including societal pressures, access to driving technologies, distracting passengers, work-related pressures, and social media use. The STAMP control structure model identified 146 actors involved in the management of driver distraction, with 74 unique control mechanisms and 47 unique feedback mechanisms currently used for managing distracted driving. Mapping stakeholders identified in the STAMP control structure onto the CLD, identified 24 stakeholders who influence the risk factors associated with driver distraction and 29 stakeholders involved in managing them, emphasizing distinct roles between the creators and managers of these risk factors. By applying systems thinking-based methods, the two studies conducted in this research project provided insights into driver distraction and its management. This research contributes to road safety efforts and provides useful insights to policymakers, researchers, and practitioners in addressing distracted driving and improving road safety. [ABSTRACT FROM AUTHOR]

Chronic liver disease (CLD) presents as jaundice and abdominal distention. It has significant morbidity and mortality. CLD is often associated with cirrhosis of the liver and causes of CLD vary from infection to metabolic diseases. Here we present a case of a 7-year-old female who presented with abdominal distention and shortness of breath. Her liver function tests were not normal. An enlarged liver was found on ultrasound and computed tomography scan showed moderate ascites with heterogeneous nodular enhancement on the liver surface. Workup for Wilson disease, viral infections, and autoimmune causes was found to be negative. There was no evidence of metabolic diseases. Biopsy of the liver showed evidence of cirrhosis. No evidence of esophageal varices was found. Supportive management for CLD was started. The case highlights the importance of detailed workup for identification of the cause which can be difficult in a resource-limited setting.

Background: The severity of liver dysfunction in chronic liver disease is often estimated with Child-Pugh (CTP) classification or model for end-stage liver disease (MELD) score. The albumin-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction, which is simple and more objective. Aims and Objective: The present study was aimed to retrospectively compare the performance of ALBI score with Child-Pugh score for predicting the mortality in patients with chronic liver disease. Materials and Methods: Data of patients with chronic Liver disease irrespective of etiology were retrospectively reviewed. Child Pugh score and ALBI score were calculated for the patients and results from ROC curves were analysed. Results: Study conducted on 299 patients of chronic liver disease, age distribution was between 20-85 years with mean age of patients being 45.7+/-10.94 years, sex ratio male: female is 265:34 with mortality rate of 19.73%.The area under curves of ROC of ALBI and Child pugh are 0.586 and 0.549 respectively. Conclusion: Ability of ALBI score for predicting mortality was comparable with that of Child Pugh score but Child pugh score of more than 10 has got better performance of predicting mortality as compared to ALBI score.

Chronic liver disease (CLD) and advanced heart failure (HF) often co-exist with coagulopathy and hematologic abnormalities being major concerns in this cohort. Perioperative outcomes of patients undergoing LVAD implantation can be affected by coagulopathy, associated with a higher International Normalized Ratio (INR) and cytopenias, as well as pre-operative use of antiplatelet therapy and systemic anticoagulation. Our study is aimed at evaluating the in-hospital mortality and clinical outcomes of patients with CLD who underwent LVAD implantation compared to patients who underwent LVAD implantation without CLD. The National Inpatient Sample Database was queried from 2012 to 2017 for relevant International Classification of Diseases (ICD)-9 and ICD-10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with chronic liver disease and those without, who underwent LVAD implantation. A total of 22,955 patients underwent LVAD implantation, 2200 of which had CLD. There was no difference in mean age between those with and without CLD (52.8 ± 14.2 vs. 55.7 ± 15.4 years old, p < 0.001), and 23.7% of patients were female. The proportion of patients with CLD undergoing LVAD implantation trended downward between 2012 and 2017 (average annual growth rate: "−14.8%"). In-hospital post-LVAD outcomes revealed: all-cause inpatient mortality (14.8% vs. 11.1%), major bleeding (34.3% vs. 30.2%), transfusion of platelets (18.0% vs. 14.0%), subarachnoid hemorrhage (1.6% vs. 0.7%) and hospital length of stay were greater in patients with CLD (p < 0.001 for all values). LVAD thrombosis (6.6% vs. 9.4%) and postoperative ischemic stroke (3.4% vs. 6.1%) occurred less in patients with CLD (p < 0.001 for both). There were no statistically significant differences in occurrence of post-LVAD gastrointestinal bleeding and transfusion of fresh frozen plasma or packed red blood cells (p > 0.05 for all). Using a multivariate logistic regression model to adjust for confounding factors, CLD was predictive of increased in-hospital all-cause mortality in patients undergoing LVAD implantation (adjusted odds ratio: 1.29, 95% confidence interval [CI]; 1.06 to 1.56, p = 0.010). LVAD implantation in patients with chronic liver disease was associated with increased mortality and post-LVAD major bleeding with increased utilization of platelet products yet comparable thrombotic complications. Further studies are needed to evaluate the balance and pathophysiology of bleeding risks when compared to thrombosis, as well as predictors in patients with chronic liver disease. • The prevalence of CLD in patients undergoing LVAD implantation was 9.6% and trended downward with an average annual growth rate of -14.8% between 2012 to 2017. • Patients with CLD had increased in-hospital all-cause mortality, more postoperative: major bleeding, occurrences of postoperative subarachnoid hemorrhage and platelet transfusions. • On the other hand, the CLD cohort had less postoperative thrombotic events; and similar rates of post-operative gastrointestinal bleeding, length of stay and cost of hospitalization. • These findings remained significant, even when adjusting for confounding factors such as age, gender, race, hypertension, diabetes mellitus, coronary artery disease, anemia, alcohol use and chronic kidney disease. • To our knowledge, this is the largest analysis associating worsened outcomes in patients receiving LVAD for End stage Heart Failure with pre-existing CLD. [ABSTRACT FROM AUTHOR]

Particular racial/ethnic and class groups remain underrepresented within gifted and talented education (GATE). However, students who are culturally and linguistically diverse (CLD) or gifted and disabled are also underrepresented but are often excluded from analysis. A cross-sectional design was to evaluate gifted enrollment data gathered by the Office for Civil Rights (OCR). Proportional representation in GATE enrollment assessed students' race/ethnicity, English Language Learner (ELL) status, and disability status under the Individuals with Disabilities Education Act (IDEA). A one-sample z test of proportions rendered statistically significant disproportionality across all groups evaluated. Results indicate the issue driving disproportionality lies within the theory of intelligence used to measure giftedness in Western school systems and calls for correctly diagnosing the GATE systems' underlying inequities. [ABSTRACT FROM AUTHOR]

Aim of the study: To determine the correlation of the endoscopic findings with portal Doppler and ultrasound (USG) in children with suspected portal hypertension (PHT). Material and methods: Eighty children with extrahepatic portal vein obstruction (EHPVO) and chronic liver disease (CLD) were included in this retrospective study conducted over a period of 1 year. All patients underwent upper gastrointestinal (GI) endoscopy and Doppler. Results: The etiology was EHPVO in 30 (37.5%) patients, biliary atresia in 12 (15%), Budd-Chiari syndrome in 11 (13.7%), Wilson's disease in 10 (12.5%), idiopathic CLD in 8 (10%), autoimmune hepatitis in 4 (5%), glycogen storage disease (GSD) in 3 (3.8%), non-alcoholic liver disease (NAFLD) in 1 (1.3%) and systemic lupus erythematosus (SLE) in 1 (1.3%) patient. Fifty-three (66.25%) patients had esophageal varices on endoscopy, of whom 3 (3.8%) had associated gastric varices. Portal hypertensive gastropathy (PHG) was present in 30 (37.5%) patients, of whom 10 (12.5%) had severe PHG. Forty-one (51.3%) patients had PHT on Doppler (κ correlation 0.43). Kappa correlation was 0.43 in patients with biliary atresia, 0.31 in Budd-Chiari syndrome, 0.23 in idiopathic CLD, 0.21 in CLD, and 0.05 in Wilson's disease. All (100%) EHPVO patients and 39 (78%) CLD patients had PHT on USG. Endoscopic findings of PHT were seen in 24 (80%) EHPVO patients and 29 (58%) CLD patients. All patients with EHPVO had cavernous transformation of the portal vein on Doppler. For patients with CLD, the common Doppler findings were collaterals seen in 35 patients and reversal of flow in 12 patients. Conclusions: Doppler ultrasound followed by endoscopy should be used to diagnose PHT in children. In children with biliary atresia, Doppler ultrasound may miss changes of PHT. [ABSTRACT FROM AUTHOR]

Chronic liver disease (CLD) is a progressive deterioration of liver functions for more than six months, which includes synthesis of clotting factors, other proteins, detoxification of harmful products of metabolism and excretion of bile. The chronic liver disease represents a continuous and progressive process of hepatic fibrosis, liver tissue architectural distortion, and regeneration nodule formation. While fibrosis is usually irreversible, but it can be reversible in the initial stage of development. The transition time point of reversible fibrosis to irreversible fibrosis is still not completely understood.[1] Sleep disturbances, particularly daytime sleepiness and insomnia, are common problems reported by patients suffering from liver cirrhosis. Poor sleep negatively impacts patients' quality of life and cognitive functions and increases mortality. Although sleep disturbances can be an early sign of hepatic encephalopathy (HE), many patients without HE still complain of poor quality sleep.[2] Progressive muscle relaxation is based upon the simple practice of tensing, or tightening, one muscle group at a time followed by a relaxation phase with release of the tension and improves sleep quality among patients with CLD. [ABSTRACT FROM AUTHOR]