Acute variceal bleeding portends poor outcomes in patients with acute-on-chronic liver failure: a propensity score matched study from the APASL ACLF Research Consortium (AARC).

BACKGROUND AND AIMS: Limited data exist regarding outcomes of acute variceal bleeding (AVB) in patients with acute-on-chronic liver failure (ACLF), especially in those with hepatic failure. We evaluated the outcomes of AVB in patients with ACLF in a multinational cohort of APASL ACLF Research Consortium (AARC). METHODS: Prospectively maintained data from AARC database on patients with ACLF who developed AVB (ACLF-AVB) was analysed. This data included demographic profile, severity of liver disease, and rebleeding and mortality in 6 weeks. These outcomes were compared with a propensity score matched (PSM) cohort of ACLF matched for severity of liver disease (MELD, AARC score) without AVB (ACLF without AVB). RESULTS: Of the 4434 ACLF patients, the outcomes in ACLF-AVB (n = 72) [mean age-46 ± 10.4 years, 93% males, 66% with alcoholic liver disease, 65% with alcoholic hepatitis, AARC score: 10.1 ± 2.2, MELD score: 34 (IQR: 27-40)] were compared with a PSM cohort selected in a ratio of 1:2 (n = 143) [mean age-44.9 ± 12.5 years, 82.5% males, 48% alcoholic liver disease, 55.7% alcoholic hepatitis, AARC score: 9.4 ± 1.5, MELD score: 32 (IQR: 24-40)] of ACLF-without AVB. Despite PSM, ACLF patients with AVB had a higher baseline HVPG than without AVB (25.00 [IQR: 23.00-28.00] vs. 17.00 [15.00-21.75] mmHg; p = 0.045). The 6-week mortality in ACLF patients with or without AVB was 70.8% and 53.8%, respectively (p = 0.025). The 6-week rebleeding rate was 23% in ACLF-AVB. Presence of ascites [hazard ratio (HR) 2.2 (95% CI 1.03-9.8), p = 0.026], AVB [HR 1.9 (95% CI 1.2-2.5, p = 0.03)], and MELD score [HR 1.7 (95% CI 1.1-2.1), p = 0.001] independently predicted mortality in the overall ACLF cohort. CONCLUSION: Development of AVB confers poor outcomes in patients with ACLF with a high 6-week mortality. Elevated HVPG at baseline represents a potential risk factor for future AVB in ACLF.

Harmonia sedecimnotata (F.): Predatory potential, biology, life table, molecular characterization, and field evaluation against Aphis gossypii Glover.

The ladybird beetle, Harmonia sedecimnotata (F.) was studied in biology, life table, consumption rates, molecular characterization, and field evaluation. The net reproductive rate (R0), based on the age-stage and two-sex life table, was 43.2 eggs/individual. The female adults lived longer (68.1 d) than the male adults (62.9 d). The rate of consumption increased with progress in each stage of development. Compared to the other larval stages of the predator, the fourth stadium consumed most quantities of Aphis gossypii Glover nymphs (Hemiptera: Aphididae) (200.4). Both female (2214.6) and male (1792.4) consumed more prey (nymphs) than larvae. The net rate of consumption was 1458.92 nymphs of melon aphids. There was no variation in the sequences of the two nucleotides out of 583 bp, H sedecimnotata China (EU392410) and India (MG720024). Our investigations demonstrated that inoculative release of 30 or 40 or 50 adults per 100 m2 attained high reduction of aphids (>90%). Thus, it may be recommended the release rate of 40 adults per 100 m2 to suppress the eggplant aphid population. H. sedecimnotata is therefore one of the most promising biological control agents for cotton aphids that can be achieved for instant control through an inoculative release of adults.

Medialization of the vocal cord with fat injection.

A simple way of obtaining a smooth paste of fat for injection for medialization of the vocal cord has been described.

Photochemical decontamination of red blood cell concentrates with the silicon phthalocyanine PC 4 and red light.

Various approaches are being developed for virus inactivation of red blood cell concentrates (RBCC) in order to increase the safety of the blood supply. We have been studying the silicon phthalocyanine Pc 4 for this purpose, a photosensitizer activated with red light. Pc 4 targets the envelope of pathogenic viruses such as HIV. To protect RBC during the process two main approaches are used: (i) inclusion of quenchers of reactive oxygen species produced during the treatment. Tocopherol succinate was found to be most effective for this purpose; (ii) formulation of Pc 4, a lipophilic compound, in liposomes that reduce its binding to RBC but not to viruses. As a light source we used a light emitting diode array emitting at 670-680 nm. An efficient mixing device ensures homogenous light exposure during treatment of intact RBCC. Treatment of 50 ml RBCC with 5 microM Pc 4 and 18 J/cm(2) light results in the inactivation of > or = 5.5 log(10) HIV, > or = 6.3 log(10), VSV and > or = 5 log(10) of PRV and BVDV. The relative sensitivities of these viruses based on the slope of virus kill versus light dose are 1.0, 1.25, 1.5 and 1.9 for HIV, VSV, PRV and BVDV, respectively. To achieve the same level of virus inactivation in 350 ml RBCC, the light dose needed is 40 J/cm(2). HIV actively replicating in CEM cells is as sensitive as cell-free and HIV in latently infected cells is 3-4 times more sensitive. Parasites that can be transmitted by blood transfusion (P. falciparum and T. cruzi) are even more sensitive than viruses. Following treatment, RBCC can be stored for 28 days at 4 degrees C with haemolysis below 1%. Previous studies under less favourable conditions showed that baboon RBC circulated with an acceptable 24 hr recovery and half-life. Genetic toxicological studies of Pc 4 with or without light exposure (mutagenicity in bacteria, mammalian cells in vitro and clastogenicity in vivo) were negative. We conclude that a process using Pc 4 and red light can potentially reduce the risk of transmitting pathogens in RBCC.

Prior knowledge of obstetric gestational age and possible bias of Ballard score.

OBJECTIVE: To determine whether prior knowledge of obstetric estimate of gestational age creates a bias in assignment of gestational age by the Ballard assessment score. METHODS: The Ballard assessment score was done on 82 infants weighing less than 2500 g by two examiners, one who had prior knowledge of best obstetric gestational age estimate and the other who was masked to that information. Obstetric gestational age was correlated with masked and unmasked score. Statistical analysis used Spearman rank correlation test, plotting the measurement means against the measurement differences, chi2, Wilcoxon signed-rank test, analysis of variance, and Student t test. Significance was assumed at P < .05. RESULTS: There was high reliability (r = 0.84-0.86) between obstetric gestational age estimates (33.3 +/- 3.0 weeks) and the gestational age derived from masked (34.3 +/- 3.0 weeks) and unmasked (34.0 +/- 3.0 weeks) Ballard scores. The mean difference between unmasked scores and gestational age was 1.38 +/- 1.15 weeks and that between masked scores and obstetric gestational age was 1.40 +/- 1.15 weeks, a nonsignificant difference. There was no significant difference in the number of cases with 100% agreement between masked and unmasked scores and obstetric gestational age or in the number of cases in which the score (masked or unmasked) differed by more than 2 weeks from obstetric gestational age. This study had over 99% power to detect a 1-week difference between the accuracy of masked and unmasked scores. CONCLUSION: Prior knowledge of obstetric gestational age did not bias the Ballard assessment score.

Fasciolopsis buski (giant intestinal fluke)--a case report.

A girl, aged 20 years presented with diarrhoea, vomiting, pain abdomen and loss of weight, the routine Stool examination revealed Fasciolopsis buski (giant intestinal fluke) in large numbers. Despite treatment with Praziquantel, she died after three days.

Auditory brain stem response in young and old guinea pigs.

OBJECTIVE: To characterize age-related auditory changes in genetically similar guinea pigs. BACKGROUND: In humans and animals, changes in hearing are known to occur with age. METHODS: Brain stem-evoked responses were measured in genetically similar guinea pigs that ranged 6-36 months in age. Changes in hearing and the input/output function curve were determined. RESULTS: Threshold shift with increase in age was seen. Marked reduction in amplitude of response with increasing age was also demonstrated. No change was seen in latency or interpeak interval. CONCLUSIONS: In genetically similar guinea pigs, age-related changes in threshold occurred. Latency and interpeak intervals remained unchanged. Amplitude of response decreased substantially after 12 months of age to a greater extent than predicted by threshold shifts alone. This phenomenon appears important in understanding the pathophysiology of age-related hearing loss.

Triple-drug therapy of Helicobacter pylori infection in duodenal ulcer disease.

OBJECTIVE: To evaluate the efficacy of triple-drug therapy for Helicobacter pylori infection and the effect of its eradication on relapse of ulcer in patients with duodenal ulcer (DU) disease. METHODS: Patients with uncomplicated DU who were H. pylori-positive on urease test or histology were given triple-drug therapy (metronidazole, tetracycline, colloidal bismuth subcitrate). Ulcer healing and H. pylori status were assessed one month after completion of therapy. Those with healed ulcers were followed up endoscopically for ulcer recurrence at 3-month intervals for one year or more. RESULTS: Fifty seven of 60 consecutive DU patients (95%) who were H. pylori-positive were taken up for the study; 46 patients (36 men; median age 40 years, range 13-70) completed the study. Thirty one of them (67%) eradicated H. pylori and had healed ulcers at one month post therapy; of 15 patients with persistent H. pylori infection, ulcers healed in 12 (p = ns). After an average follow up of 11 months, 8 of 12 H. pylori-positive patients had relapse of DU compared to 5 of 31 (16%) H. pylori-negative patients (p < 0.01). CONCLUSIONS: Triple-drug therapy was effective and safe for H. pylori infection, the lower rate of eradication observed compared to results elsewhere probably being related to bacterial resistance. Eradication of H. pylori was associated with healing of ulcers, resolution of antral gastritis and a significant fall in the rate of ulcer relapse.

Labyrinthectomy in the elderly.

This study involved elderly patients with Meniere's disease with incapacitating vertigo. Several of these patients underwent surgery for relief of symptoms that was tailored to the individual's general health and degree of physical activity. Factors that might affect postoperative rehabilitation and recovery were considered, including vision, vertebrobasilar ischemia, proprioception (such as neuropathy resulting from diabetes), and basal ganglia disease. The postoperative results of this tailored approach have been completely satisfactory.

Use of medication data to validate an association in community-based symptom prevalence studies.

A chemical spill from an oil refinery in Texas City, Texas, exposed the community to more than 40,000 lbs (18,144 kg) of highly toxic and corrosive hydrofluoric acid. A symptom prevalence study indicated an association between symptom reports, most notably breathing symptoms, and hydrofluoric acid exposure. Although verification of self-reported symptoms by checking medical records or performing clinical tests is theoretically possible, it is not a feasible alternative in dealing with an entire community. Open-ended data on medication use collected in the prevalence study were coded by organ system and analyzed by cross-classification techniques and log linear models. Results showed that the reported use of medication for hydrofluoric acid-related problems was associated with the exposure; medication use for problems unrelated to hydrofluoric acid exposure was uniform across the exposure categories. Moreover, medication use was significantly associated with the severity of breathing-related problems for each exposure category. Medication use, however, may have been under-reported because it seems difficult to conjure up the names of medications that were not taken or medications not taken recently may not be recalled. Nonetheless, open-ended medication data may be a useful surrogate approach to validating an association between an exposure and health outcomes.

In vivo incorporation of [2-14C]mevalonic acid into rat brain complex glycolipids: characterization of glycosylsterols in mammalian brain.

The in vivo incorporation of [2-14C]mevalonate into complex glycolipids of rat brain was investigated. Results indicated that the majority of the incorporated radioactivity was found to be in cholesterol. Analysis of neutral glycolipid and ganglioside fractions revealed that there were selected radioactive bands co-migrating to known glycolipids and gangliosides and the hydrolysis of which released the radioactive cholesterol. These results indicated the existence of glycosylsterols in the rat central nervous system.

Luetic endolymphatic hydrops: diagnosis and treatment.

Luetic endolymphatic hydrops (LEH) is an effectively treatable disorder that requires astute clinical judgment to suspect, confirm, and treat. We provide a review of the literature as well as recommendations regarding the clinical management of LEH with discussion of several illustrative cases. We also give an overview of laboratory testing for the diagnosis and monitoring of the infectious process. Ultimately, the control of the otologic symptoms in LEH requires acumen on the part of the clinician.

The use of microwave oven for the rapid hydrolysis of bile acid methyl esters.

An efficient and convenient procedure for the hydrolysis of bile acid methyl esters is described. This is achieved by the addition of aqueous lithium hydroxide in methanol/dioxane/tetrahydrofuran (or dimethylformamide) in the microwave oven. Under these conditions the formates as well as the acetate derivatives prepared under microwave irradiation conditions were also hydrolyzed, and the desired bile acids were isolated in 86-94% yield. All these reactions were completed in the microwave oven within 45-60 s.

Potentiation of cochlear hair cell loss by acoustic stimulus and gentamicin in the guinea pig.

We explored the possibility of synergism between a pure-tone stimulus and gentamicin in causing cochlear injury by analyzing hair cell loss. Guinea pigs receiving daily injections of gentamicin (200 mg/kg body wt.) for 1 week were exposed to a 2 kHz tone (95 dB SPL, 2 hours daily). Surface preparations of the spiral organ were studied by phase contrast microscopy, and the extent of hair cell loss in the entire organ of Corti was recorded in cytocochleograms. Gentamicin by itself was slightly ototoxic, damaging the innermost row of outer hair cells, whereas exposure to sound alone caused no hair cell loss. Combined antibiotic and acoustic exposure produced extensive cochlear damage. A few animals showed massive hair cell degeneration and collapse of the organ of Corti, except in the apical turn. The site of damage was possibly determined by the frequency of the sound stimulus. Thus, an intermittent tonal stimulus such as that used in the present experiment can be harmless by itself, but causes injury to cochlear hair cells in guinea pigs when administered in combination with gentamicin.

Surgical inferences from study of temporal bones with glomus jugulare tumor.

Over the past few years, considerable advances have been made in the surgical treatment of glomus jugulare tumors. The long-term results of such surgery for cure of these tumors has yet to be established, however. We have reviewed the temporal bones of two patients who had glomus jugulare tumors. Such study provides a special opportunity to evaluate the major critical areas of involvement of these tumors, which bears on the long-term results of surgery, and is important in developing treatment to cure these benign, though aggressive, tumors.