Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis

BACKGROUND AND AIMS: The natural history of subclinical hepatic encephalopathy (SHE) is unknown. The present study was conducted to study the prevalence and the natural history of SHE in patients with cirrhosis of the liver. METHODS: One hundred and sixty-five patients with cirrhosis of the liver were studied. A total of nine psychometric tests (trail making and Wechsler adult intelligence scale-performance (WAIS-P) tests) were administered. Subclinical hepatic encephalopathy was present if two or more psychometric tests were abnormal. Seventy-two patients (SHE 40, without SHE 32) also underwent serial psychometric testing on follow-up visits at 6-8 week intervals. RESULTS: Subclinical hepatic encephalopathy was present in 103 (62.4%) patients. The number and figure connection, block design and picture completion tests were the most useful in the detection of SHE. Severity of SHE, as assessed by the number of abnormal tests, was greater in patients with more severe liver disease. During follow up, SHE tended to persist or worsen in patients with poorer liver function. Although other clinical complications were similar in different groups, overt hepatic encephalopathy developed more commonly in those patients who had SHE at entry compared to those who did not (22.6 vs 5.6%, P = 0.044). Among the patients with SHE, the development of overt hepatic encephalopathy was more common in patients with Child's score of > 6 than with Child's score of 相似文献   

Hepatopulmonary syndrome: An update

Hepatopulmonary syndrome (HPS) is characterized by defects in oxygenation caused by intra-pulmonary vasodilation occurring because of chronic liver disease, portal hypertension, or congenital portosystemic shunts. Clinical implications of portal hypertension are very well-known, however, awareness of its effect on multiple organs such as the lungs are less known. The presence of HPS in chronic liver disease is associated with increased mortality. Medical therapies available for HPS have not been proven effective and definitive treatment for HPS is mainly liver transplantation (LT). LT improves mortality for patients with HPS drastically. This article provides a review on the definition, clinical presentation, diagnosis, and management of HPS.     

A case study of Fe2TaZ (Z = Al,Ga, In) Heusler alloys: hunt for half-metallic behavior and thermoelectricity

We have computed the electronic structure and transport properties of Fe₂TaZ (Z = Al, Ga, In) alloys by the full-potential linearized augmented plane wave (FPLAPW) method. The magnetic conduct in accordance with the Slater–Pauling rule classifies them as non-magnetic alloys with total zero magnetic moment. The semiconducting band profile and the density of states in the post DFT treatment are used to estimate the relations among various transport parameters such as Seebeck coefficient, electrical conductivity, thermal conductivity, and figure of merit. The Seebeck coefficient variation and band profiles describe the p-type behavior of charge carriers. The electrical and thermal conductivity plots follow the semiconducting nature of bands along the Fermi level. The overall measurements show that semi-classical Boltzmann transport theory has well-behaved potential in predicting the transport properties of such functional materials, which may find the possibility of their experimental synthesis for future applications in thermoelectric technologies.

Crystal structure in conventional unit cell for Fe₂TaZ (Z = Al, Ga, In) in Fm$\bar{3}$m configuration.     

Diagnostic accuracy of transient elastography in diagnosing clinically significant portal hypertension in patients with chronic liver disease: a systematic review and meta-analysis

Purpose

Liver stiffness measurement using transient elastography (TE-LSM) is a promising noninvasive alternative to hepatic venous pressure gradient (HVPG) for diagnosing clinically significant portal hypertension (CSPH). However, previous studies have yielded conflicting results. We evaluated the correlation between TE-LSM and HVPG and the performance of TE-LSM in diagnosing CSPH (HVPG?≥?10 mmHg).

Methods

We conducted a systematic review and meta-analysis by searching PubMed and Scopus databases for relevant literature evaluating the clinical usefulness of TE for diagnosing CSPH in patients with chronic liver disease.

Results

Twenty-six studies (4337 patients with valid TE and HVPG) met our inclusion criteria. The median correlation coefficient of TE with HVPG was 0.70 (range 0.36–0.86). The weighted mean of optimal cut-off of liver stiffness value for diagnosing CSPH was 22.8 kPa (95% CI 22.7–23.0 kPa). The summary sensitivity and specificity were 79% (95% CI 74–84%) and 88% (95% CI 84–91%), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.91 (95% CI 0.88–0.93) according to the bivariate model. One limitation of the study was significant heterogeneity in the results of summary sensitivity and specificity (I² 83 and 74%, respectively). The heterogeneity could be explained by the variable liver stiffness cut-offs used in studies. The meta-regression plot revealed that as the optimal cut-off increased, the sensitivity decreased, the specificity increased, and vice versa.

Conclusions

Liver stiffness measurement using TE correlates well with HVPG, and a liver stiffness cut-off value of 22.8 kPa shows a high accuracy for diagnosing CSPH. Thus, use of TE should be integrated into clinical practice for noninvasive diagnosis of CSPH.

     

Numbness Following Total Knee Arthroplasty: Role of Incision Length And Position - A Randomized Study

BackgroundOne of the symptoms annoying patients after total knee replacement (TKR) is numbness around the operative scar. Some studies have shown that altering the incision in terms of placement or length may decrease the incidence of numbness. It still remains unknown whether numbness affects patient-reported outcomes.MethodsWe conducted a randomized study to compare a short-length incision (n = 50) and a lateral exit incision (n = 50) with a standard midline TKR incision (n = 50) in terms of the incidence of numbness and its progress over 1 year of follow-up. Our secondary objective was to look at the involved zone, area of numbness, and secondary symptoms. We also looked at patient-reported outcome in terms of satisfaction in all groups using a visual analog scale and Forgotten Joint Score.ResultsAt 3 months postoperatively, the incidence of numbness was least in the lateral exit group: 46.2% as compared to midline (62%) and short (58.3%), but the difference was not significant (p = 0.07). At 6 months, the short incision group had a significantly lower incidence (8%) of residual numbness as compared to 30% in the other two groups (p = 0.003). At 1 year, most patients recovered sensation loss and had similar function.ConclusionsPlacement or length of an incision did not significantly affect the incidence of numbness; however, the short incision led to early recovery of numbness. At 1 year of follow-up, most patients did not complain of loss of sensation and had similar functional outcome.     

Synthesis of microtubule-interfering halogenated noscapine analogs that perturb mitosis in cancer cells followed by cell death

We have previously identified the naturally occurring non-toxic antitussive phthalideisoquinoline alkaloid, noscapine as a tubulin-binding agent that arrests mitosis and induces apoptosis. Here we present high-yield efficient synthetic methods and an evaluation of anticancer activity of halogenated noscapine analogs. Our results show that all analogs display higher tubulin-binding activity than noscapine and inhibit proliferation of human cancer cells (MCF-7, MDA-MB-231 and CEM). Surprisingly, the bromo-analog is ∼40-fold more potent than noscapine in inhibiting cellular proliferation of MCF-7 cells. The ability of these analogs to inhibit cellular proliferation is mediated by cell cycle arrest at the G₂/M phase, in that all analogs except 9-iodonoscapine, caused selective mitotic arrest with a higher efficiency than noscapine followed by apoptotic cell death as shown by immunofluorescence and quantitative FACS analyses. Furthermore, our results reveal the appearance of numerous fragmented nuclei as evidenced by DAPI staining. Thus, our data indicate a great potential of these compounds for studying microtubule-mediated processes and as chemotherapeutic agents for the management of human cancers.     

Comparison of single-segment and double-segment Intacs for keratoconus and post-LASIK ectasia

PURPOSE: To evaluate the efficacy of single-segment Intacs and compare with double-segment Intacs in subjects with post-LASIK ectasia and keratoconus. DESIGN: Retrospective comparative analysis. METHODS: setting: Boxer Wachler Vision Institute, Beverly Hills, California, USA. study population: Thirty-seven eyes of 28 patients with keratoconus and post-LASIK ectasia classified into two groups: single-segment group (17 eyes, 11 patients) and double-segment group (20 eyes, 17 patients). Both groups were matched for age, visual acuity (uncorrected, UCVA; best spectacle-corrected, BSCVA), refractive error (sphere, cylinder, spherical equivalent), and keratometry (K) value (flat, steep, average) by t test for equality of means. intervention: Single- or double-segment Intacs procedure with axis of incision for insertion in the steep axis of manifest refraction. main outcome measure: Improvement of acuity, refractive error, K values, and inferior-superior (I-S) ratio. RESULTS: There was more improvement in UCVA in the single-segment group (nine lines) than the double-segment group (2.5 lines), P < .01; in BSCVA in the single-segment group (2.5 lines) than the double-segment group (<1 line), P < .01; in steep K values in the single-segment group (2.76 diopters +/- 2.68) than the double-segment group (0.93 diopters +/- 2.01), P = .02; and in I-S ratio in the single-segment group (9.51 +/- 7.49) than the double-segment group (4.22 +/- 4.82), P = .01; and greater cylinder decrease after Holladay vector analysis in the single-segment group (5.69 diopters +/- 3.10) than the double-segment group (1.58 diopters +/- 3.09), P < .01. CONCLUSIONS: Single-segment Intacs improved both UCVA and BSCVA by differential flattening of inferior meridian and steepening of superior meridian as reflected by change in I-S ratio.