Incidence of HCC in chronic hepatitis C patients with advanced hepatic fibrosis who achieved SVR following DAAs: A prospective study

Liver cirrhosis is an important risk factor for hepatocellular carcinoma. The reported annual incidence of HCC is about 3%‐8% in CHC cirrhotic patients. Based on the Cochrane systematic review, there was no clear evidence, on the long‐term clinical effects of DAAs in patients achieving SVR, as regard liver cirrhosis‐related HCC incidence. The aim of the study was to determine the incidence of HCC in chronic hepatitis C patients genotype IV with liver cirrhosis and advanced liver fibrosis after achieving SVR following DAA treatment in a prospective large cohort of HCV patients with long follow‐up. This was a prospective observational cohort study including 2372 CHC patients with advanced liver fibrosis or cirrhosis receiving DAA therapy in outpatient clinics at the Egyptian Liver Research Institute and Hospital since January 2015. Liver fibrosis was assessed using transient elastography. Abdominal ultrasonography and AFP measurement were done at baseline and follow‐up visits every 6 months, in addition to triphasic abdominal MSCT when needed. Patients were followed up after achieving SVR12 for at least 12 months. HCC developed in 109 cases during the follow‐up period (mean 23.60 ± 8.25 months). Overall HCC incidence was 2.338/100 PY, 95% CI = 1.942‐2.814. In patients with cirrhosis, the incidence of HCC was 2.917/100 PY, 95% CI = 2.407‐3.535, while in patients with advanced liver fibrosis the incidence of HCC was 0.664/100 PY, 95% CI = 0.333‐1.326. In conclusion, the incidence of HCC was reduced in chronic hepatitis C genotype 4 patients with liver cirrhosis (F4) and advanced hepatic fibrosis (F3) who achieved SVR following DAA therapy.     

Willingness score obtained after a short CPAP trial predicts CPAP use at 1 year

Purpose

To predict continuous positive airway pressure (CPAP) adherence at 1 year.

Methods

We followed consecutive OSA patients scheduled for CPAP initiation for 1 year. Patients completed a self-efficacy questionnaire (5 = low, 25 = high score) before CPAP initiation. After CPAP initiation, we enquired about patients’ satisfaction in CPAP trial and their eagerness and willingness to continue CPAP therapy (0 = unsatisfied, uneager, or refused CPAP; 100 = satisfied, eager, or willing to continue CPAP treatment).

Results

Of the 580 patients we followed, 377 continued CPAP therapy beyond 1 year. A low willingness score (<50) was expressed by 77 patients but only 7 of them used CPAP >4 h daily at 1 year, yielding a specificity of 97 % in predicting CPAP failure. At 1 year, patients with a self-efficacy score >20, expressed prior to CPAP initiation, used CPAP more often than the patients with a score <20 (average use 4.4?±?2.2 h vs. 3.7?±?2.3 h, p?<?0.001).

Conclusions

A low score of willingness to continue CPAP therapy after a short trial predicts CPAP failure and poor CPAP adherence at 1 year.     

Modelling,Analysis, and Optimization of the Effects of Pulsed Electrophoretic Deposition Parameters on TiO2 Films Properties Using Desirability Optimization Methodology

Titanium dioxide thin films immobilized over treated stainless steel were prepared using the pulsed electrophoretic deposition technique. The effects of process parameters (deposition time, applied voltage, initial concentration, and duty cycle) on photocatalytic efficiency and adhesion properties were investigated. To optimize the multiple properties of the thin film, a response surface methodology was combined with a desirability optimization methodology. Additionally, a quadratic model was established based on response surface analysis. The precision of the models was defined based on the analysis of variance (ANOVA), R², and the normal plot of residuals. Then, a desirability function was used to optimize the multiple responses of the TiO₂ thin film. The optimum values of applied voltage, catalyst concentration, duty cycle, and deposition time were 4 V, 16.34 g/L, 90% DC, and 150 s, respectively. Under these conditions, the decolorization efficiency of tested dye solution reached 82.75%. The values of critical charges L_C1, L_C2, and L_C3 were 5.9 N, 12.5 N, and 16.7 N, respectively.     

Ultrasound Effect on Neural Differentiation of Gingival Stem/Progenitor Cells

Dental pulp loss due to caries or pulpitis can affect the longevity of teeth. Dental pulp tissue engineering necessitates the use of progenitor cells that has the potential to differentiate into neural, vascular and odontoblasts like cells. Previous reports have shown that human gingival progenitor cells (HGPCs) can be differentiated into different cell types; however neural differentiation of these cells, to the best of our knowledge, has not been reported. Low intensity pulsed ultrasound (LIPUS) has been reported to enhance cell differentiation. The aims of this study were (1) to explore the potential neural differentiation of HGPCs and (2) to investigate the effect of LIPUS on the differentiation of HGPCs when incubated under neuroinductive conditions. The HGPCs were isolated from human interdental papilla proximal to the premolar teeth that were extracted for orthodontic purpose. The HGPCs were induced to differentiate into neural lineage using a neuroinductive culture medium. HGPCs were divided into four groups; control group, neuro-induction (NI) group, ultrasound group (LIPUS), and a combined NI+LIPUS group. HGPCs were harvested for immunostaining and q-PCR after 1 day. Immunostaining for neuron specific antigens and q-PCR suggested that HGPCs can be differentiated into neural lineage and that selected neurodifferentiation markers can be enhanced by LIPUS.     

Occurrence of longitudinal stent compression before stent deployment: Two case studies

Several recent reports have described the occurrence of longitudinal stent deformation(LSD, defined as the distortion or shortening of a stent along the longitudinal axis), following its successful deployment. However, few reports have described LSD prior to any stent deployment. This previously unrecognized complication is the result of modifications to stent design. It has been noted that the new-generation stent platforms have a reduced number of connectors, which in turn causes a reduction in longitudinal stent strength. To corroborate previous findings by our lab and others(Vijayvergiya et al, 2013), we describe here two cases of LSD prior to stent deployment that occurred due to crushing of the proximal stent edge by the guide catheter while attempting to withdraw the crimped stent. In addition, we discuss the associated risk factors, such as the length of the stent, and specific management strategies, including technical guidelines and use of fluoroscopic guidance for maneuvering the stent during the procedure.     

Wilson disease: copper deficiency and iatrogenic neurological complications with zinc therapy

A 17‐year‐old female was diagnosed with Wilson disease and commenced on oral zinc therapy. She re‐presented 6 months later with a fall and had classical signs of subacute combined degeneration of the spinal cord confirmed on nerve conduction studies, as a result of zinc‐induced copper deficiency. After 6 months of copper therapy, she made a complete recovery with no residual neurological deficits. Early detection of zinc‐induced copper deficiency and stringent follow‐up mechanisms are crucial. Early initiation of copper replacement may both limit and completely reverse neurological deficits.     

Plexiform hypoglossal schwannoma of the tongue and the submandibular region

ABSTRACT: Hypoglossal schwannomas usually develop in the intracranial portion of the brain. Incidence of hypoglossal schwannomas of the submandibular region is extremely rare. A 27-year-old patient presented to us with hypoglossal schwannoma of the tongue and the submandibular region. The tumor was excised intraorally combined with submandibular approach. Histopathologic examination revealed a plexiform schwannoma (a rare variant).     

Detection of vertical root fractures using digitally enhanced images: reverse‐contrast and colorization

Abstract – Root fracture diagnosis is a clinical difficulty that in most cases can only be detected through radiography. The objective of this study was to compare the diagnostic accuracy of two types of digitally enhanced images (reverse‐contrast and colorization) with original digital radiographies in detecting experimental root fractures. Two hundred extracted single‐rooted human teeth were endodontically instrumented and then divided in two groups, one control group and one test group, including fractured teeth. Vertical root fractures were experimentally made in the fractured group. The digital image of each tooth was taken, using the paralleling technique. There were three groups of images: (i) original, (ii) reverse contrast, and (iii) colorized. Three experienced dental specialists examined the images with no prior knowledge of the distribution of the root fractures. Two‐way analysis of variance was used to assess the differences in accuracy, sensitivity, and specificity of each technique in detecting root fractures. Cohen’s kappa coefficients were calculated to investigate the degree of interobserver agreement. The accuracy, sensitivity, and specificity of original images were 67.4%, 66.7%, and 68%, respectively; these amounts were 61.5%, 61%, and 65.5% in reverse contrast images and 66.4%, 70.7%, and 62% in colorized digital radiography. The original images had the best inter observer kappa coefficients (between 0.45 and 0.55). The results showed that the accuracy of original images is better than reverse contrast and colorized images. Use of reverse‐contrast and colorization digital images in root fracture detection should be regarded as an adjunct to other diagnostic methods not as a highly critical diagnostic aid.