Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis

Purpose

Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA.

Materials and Methods

A total of 304 patients with HA admitted to our institution between July 2009 and June 2011 were enrolled consecutively. Patients with complications defined as acute liver failure (ALF) were evaluated, and mortality was defined as death or liver transplantation.

Results

The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. Based on receiver operating characteristics (ROC) analysis, a MELD ≥23.5 was significantly more predictive than a SIRS score ≥3 (area under the ROC: 0.940 vs. 0.742, respectively). In addition, of patients with a MELD score ≥23.5, King''s College Hospital criteria (KCC) and SIRS scores were predictive factors associated with death/transplantation in multivariate analysis.

Conclusion

MELD and SIRS scores ≥23.5 and ≥3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scores ≥3 were valuable in predicting mortality of patients with a MELD ≥23.5.     

Development of a radiopaque,long-term drug eluting bioresorbable stent for the femoral-iliac artery

Tubular tissues exist in various forms purported for blood supply, waste secretion, etc. to aid proper function and maintenance of the human body. Under pathological conditions, however, these tissues may undergo stenosis. A major surgical treatment for stenosis is to implant a medical device called a stent which aims to expand the narrowed tissue and maintain its patency. Most stents are currently made from metals; despite their high mechanical strength, however, interactions with the host tissue often results in restenosis and stent fracture. To solve these problems, a bioresorbable stent (BRS) is proposed as a next generation stent. In this study, a rotating rod combined 3D printing system was developed to fabricate various types of BRSs. In addition, we confirmed that a 1.5 year long-term release of paclitaxel is possible using polymeric materials. Moreover, a stent loaded with contrast powder was fabricated and was successfully viewed under fluoroscopy. The stent was then implanted in the iliac arteries of pigs and no adverse events were observed for up to 8 weeks.

A radiopaque, long-term drug eluting bioresorbable stent is developed for the treatment of femoral-iliac artery. The prepared materials are printed on a pre-designed rotating rod. The fabricated stent can be adapted for various clinical cases.     

Attitudinal concordance toward uptake and disclosure of genetic testing for cancer susceptibility in patient–family member dyads

Decisions for cancer susceptibility genetic testing (CSGT) uptake and dissemination of results occur within the family context. A national survey was performed with 990 patient–family member dyads (participation rate:76.2%), with paired questionnaires examining attitudes toward CSGT uptake and disclosure of results in response to a hypothetical scenario in which a reliable CSGT was available for the specific cancer a patient was being treated. While most patients and family members responded they would uptake or recommend CSGT if available, concordance between the dyads was poor for both patient's testing (agreement rate 77.5%, weighted κ = 0.09) and first‐degree relatives' testing(agreement rate 78.0%, weighted κ = 0.09). Most patients (93.2%) and family members (92.9%) indicated that patients should disclose positive CSGT results to family members, with dyadic agreement of 89.1% (κ = 0.15). However, there were substantial disagreement regarding when disclosure should take place, who should make the disclosure (the patient or the health care professionals), and to whom the results should be disclosed. Patients and family members may hold different attitudes toward CSGT uptake of and disclosure of results within the family. Our findings reinforce the need for a family system approach to incorporate perspectives of patients as well as their family members.     

Hydrophobic resin treatment of hydrothermal autohydrolysate for prebiotic applications

The production of a high-value xylooligosaccharide (XOS) prebiotic product from lignocellulosic autohydrolysate requires processing for the removal of non-carbohydrate components such as lignin and furfural. In this research, the nature of XOS dissolved in autohydrolysate is evaluated including the XOS degree of polymerization (DP) distribution and potential covalent association between XOS and lignin (LCC). The impact of these factors on the yield of XOS during treatment of Miscanthus autohydrolysate with hydrophobic resin is assessed. Over 30% of the XOS in autohydrolysate was found to be likely associated with lignin (“tied” XOS), all of which was removed during hydrophobic resin treatment along with over 90% of the dissolved lignin. However, loss of dissolved XOS during resin treatment was found to not be due solely to XOS association with lignin. Over 50% of the “free,” non-lignin-associated XOS was also removed by resin treatment. Interaction between “free” XOS and the hydrophobic resin was found to be highly dependent on DP with higher DP XOS being removed far more readily than low DP XOS. Over 80% of dissolved “free” XOS with a DP of six and above (X6+) was removed from autohydrolysate during treatment while only 17% of xylose (X1) was removed. Efforts to understand the interaction between the hydrophobic resin and XOS and to improve the recovery of XOS during hydrophobic resin treatment are presented.

∼30% of xylooligosaccharides (XOS) in autohydrolysate are likely bonded to lignin “tied,” contributing to loss during resin purification. Loss of “free” XOS depends on DP.     

Notch1 is an important mediator for enhancing of B‐cell activation and antibody secretion by Notch ligand

The roles of Notch1 and Notch2 in T‐cell function have been well studied, but the functional roles of Notch in B cells have not been extensively investigated, except for Notch2 involvement in peripheral marginal zone B‐cell differentiation. This study examined the roles of Notch1 in murine primary B cells. During B‐cell activation by B‐cell receptor ligation, Notch1 was up‐regulated while Notch2 was not. In addition, Notch1 up‐regulation itself did not contribute to the further activation of B cells, but the Notch ligand was important for Notch1‐mediated further B‐cell activation. Moreover, Notch1 deficiency significantly decreased B‐cell activation and antibody secretion under the presence of Notch ligand. These data suggest that Notch1 is an important mediator for enhancing B‐cell activation and antibody secretion by Notch ligand.     

Capacitive Measurement of ECG for Ubiquitous Healthcare

The technology for measuring ECG using capacitive electrodes and its applications are reviewed. Capacitive electrodes are built with a high-input-impedance preamplifier and a shield on their rear side. Guarding and driving ground are used to reduce noise. An analysis of the intrinsic noise shows that the thermal noise caused by the resistance in the preamplifier is the dominant factor of the intrinsic noise. A fully non-contact capacitive measurement has been developed using capacitive grounding and applied to a non-intrusive ECG measurement in daily life. Many ongoing studies are examining how to enhance the quality and ease of applying electrodes, thus extending their applications in ubiquitous healthcare from attached-on-object measurements to wearable or EEG measurements.     

Surgeon Custom-Made Iliac Branch Device to Salvage Hypogastric Artery during Endovascular Aneurysm Repair

Endovascular salvage of the hypogastric artery using iliac branch device (IBD) during endovascular aortic aneurysm repair (EVAR), offers less invasive alternative solution to surgery to prevent pelvic ischemia. We have performed the first Korean surgeon custom-made IBD for this purpose to overcome the limitation of unavailability of the devices in Korea. Four patients with abdominal aortic aneurysm with bilateral common iliac artery aneurysm (CIAA) were treated using custom-made IBDs from October 2013 to December 2013. IBD was created in back table before EVAR operation using TFLE Zenith iliac limb stent graft (Cook Inc.). Three V12 (Atrium, Inc.) one Viabahn (Gore, Inc.) were used for bridging between IBD and target hypogastric artery. With this modification of IBD procedure, exteriorize the guide wire without snare device is possible which offers another benefit in terms of reducing medical costs comparing to commercial IBD. All operations were successful without any device related complications or postoperative endoleaks. During the mean follow up of 3 months, all IBD were patent without clinical complications. Surgeon custom made IBD is feasible and useful to preserve pelvic perfusion especially in the situation of limited commercial IBD availability in many countries. Long-term follow-up is needed to evaluate stent graft patency and IBD-related complications.