The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study.

INTRODUCTION: Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS: Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS: In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION: These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.

Decision-to-delivery interval and neonatal outcomes for category-1 caesarean sections during the COVID-19 pandemic.

General anaesthesia is known to achieve the shortest decision-to-delivery interval for category-1 caesarean section. We investigated whether the COVID-19 pandemic affected the decision-to delivery interval and influenced neonatal outcomes in patients who underwent category-1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre-COVID-19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID-19 pandemic (1 April 2020-1 July 2020) (post-COVID-19 group). Primary outcome measures were: decision-to-delivery interval; number of caesarean sections achieving decision-to-delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5-min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre- and post-COVID-19 groups (risk ratio 0.48 (95%CI 0.37-0.62); p < 0.0001). Compared with the pre-COVID-19 group, the post-COVID-19 group had an increase in median (IQR [range]) decision-to-delivery interval (26 (18-32 [4-124]) min vs. 27 (20-33 [3-102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision-to-delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre- and post-COVID-19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision-to-delivery interval observed during the COVID-19 pandemic did not adversely affect neonatal outcomes.

Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes.

OBJECTIVES: The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3 mg/dl or by ≥50% in <48 h from a stable value within 3 months. The baseline SCr may influence AKI risk and patient outcomes. The objective of this study is to determine in cirrhosis whether the baseline SCr has any effect on the in-hospital AKI course and patient survival. METHODS: North American Consortium for the Study of End-Stage Liver Disease is a consortium of tertiary-care hepatology centers prospectively enroling non-elective cirrhotic inpatients. Patients with different baseline SCr levels (≤0.5, 0.51-1.0, 1.01-1.5, >1.5 mg/dl) were evaluated for the development of AKI, and compared for AKI outcomes and 30-day survival. RESULTS: 653 hospitalized cirrhotics (56.7±10years, 64% men, 30% with infection) were included. The incidence of AKI was 47% of enrolled patients. Patients with higher baseline SCr were more likely to develop AKI, with significantly higher delta and peak SCr (P<0.001) than the other groups, more likely to have a progressive AKI course (P<0.0001), associated with a significantly reduced 30-day survival (P<0.0001). Multivariate logistic regression showed that the delta SCr during an AKI episode to be the strongest factor impacting AKI outcomes and survival (P<0.001), with a delta SCr of 0.70 mg/dl having a 68% sensitivity and 80% specificity for predicting 30-day mortality. CONCLUSIONS: Admitted cirrhotic patients with higher baseline SCr are at higher risk for in-hospital development of AKI, and more likely to have AKI progression with reduced survival. Therefore, such patients should be closely monitored and treated promptly for their AKI.

Synthon Approach to Structure Models for the Bayerite-Derived Layered Double Hydroxides of Li and Al.

The Br- ion intercalated layered double hydroxide (LDH) of Li and Al obtained from the bayerite-Al(OH)3 precursor crystallizes in a structure different from that of the gibbsite-Al(OH)3 derived counterpart. Additionally, it undergoes temperature- and humidity-induced reversible interpolytype transformations. The dehydrated LDH (T ≈ 120 °C) adopts a structure of hexagonal symmetry (space group P3̅1m) and comprises a stacking of the metal hydroxide layers arranged one above another. On cooling and rehydration, the LDH adopts a structure of monoclinic symmetry with a stepwise increase in the stacking angle, ß. Using the structural synthon approach, based on the systematic elimination of the principal symmetry elements of the hexagonal crystal, structure models were generated for each of the two hydration steps (relative humidity ∼50%, >70%) and the structures refined (space group C2/m). The refined structures show that the interpolytype transitions are a result of rigid translations of successive metal hydroxide layers relative to one another by translation vectors (1/6, 0, 1) and (1/3, 0, 1), respectively.

Layered Double Hydroxides: Proposal of a One-Layer Cation-Ordered Structure Model of Monoclinic Symmetry.

Layered double hydroxides are obtained by partial isomorphous substitution of divalent metal ions by trivalent metal ions in the structure of mineral brucite, Mg(OH)2. The widely reported three-layer polytype of rhombohedral symmetry, designated as polytype 3R1, is actually a one-layer polytype of monoclinic symmetry (space group C2/m, a = 5.401 Å, b = 9.355 Å, c = 11.02 Å, ß = 98.89°). This structure has a cation-ordered metal hydroxide layer defined by a supercell a = √3 × a0; b = 3 × a0 (a0 = cell parameter of the cation-disordered rhombohedral cell). Successive layers are translated by (1/3, 0, 1) relative to one another. When successive metal hydroxide layers are translated by (2/3, 0, 1) relative to one another, the resultant crystal, also of monoclinic symmetry, generates a powder pattern corresponding to the polytype hitherto designated as 3R2. This structure model not only removes all the anomalies intrinsic to the widely accepted cation-disordered structure but also abides by Pauling's rule that forbids trivalent cations from occupying neighboring sites and suggests that it is unnecessary to invoke rhombohedral symmetry when the metal hydroxide layer is cation ordered. These results have profound implications for the correct description of polytypism in this family of layered compounds.

3HP preventive treatment among children and adolescents with HIV and child household contacts of TB patients.

INTRODUCTION: India's National TB Elimination Programme plans to roll out short-course TB preventive therapy (TPT) using 3 months of rifapentine and isoniazid (3HP). Understanding the feasibility and safety of children in programmatic settings is critical for widespread implementation. We present the findings of a targeted scale-up of 3HP among children and adolescents living with HIV (CALHIV) and child household contacts (>2 to <6 years) of pulmonary TB patients (CHHC). METHODS: Between December 2021 and July 2023, eligible CALHIV and CHHC participants were given weekly dosages of 3HP for 3 months at antiretroviral therapy (ART) and TB clinics, respectively, of a public hospital in Pune, India. RESULTS: Of 97 children screened, 91 initiated 3HP (32 CALHIV and 59 CHHC). The median age of CALHIV was 14 years; 66% were male and on dolutegravir-based ART. The median age of CHHC was 4 years; 47% were males. Thirty-one (97%) CALHIV and 56 (95%) CHHC completed 3HP without dolutegravir dose adjustment. None of the child participants discontinued 3HP due to adverse events. No child participant developed TB during 1 year of follow-up post-3HP. CONCLUSION: Our study provides evidence of the uptake and feasibility of the planned nationwide rollout of 3HP.

INTRODUCTION: Le programme national indien d'élimination de la tuberculose prévoit de mettre en place un traitement préventif de courte durée contre la tuberculose (TPT) en utilisant trois mois de rifapentine et d'isoniazide (3HP). Il est essentiel de comprendre la faisabilité et la sécurité des enfants dans le cadre des programmes pour pouvoir les mettre en œuvre à grande échelle. Nous présentons les résultats d'une extension ciblée de la 3HP parmi les enfants et les adolescents vivant avec le VIH (CALHIV, pour l'anglais « children and adolescents living with HIV ¼) et les enfants contacts familiaux (>2 à <6 ans) de patients atteints de tuberculose pulmonaire (CHHC, pour l'anglais « child household contacts ¼). MÉTHODES: Des doses hebdomadaires de 3HP ont été administrées pendant 3 mois aux participants éligibles CALHIV et CHHC dans les cliniques de thérapie antirétrovirale (ART) et de tuberculose, respectivement, d'un hôpital public de Pune, en Inde, entre décembre 2021 et juillet 2023. RÉSULTATS: Sur 97 enfants dépistés, 91 ont initié 3HP (32 CALHIV et 59 CHHC). L'âge médian des CALHIV était de 14 ans ; 66% étaient de sexe masculin et sous ART à base de dolutegravir. L'âge médian des CHHC était de 4 ans ; 47% étaient des hommes. Trente et un (97%) CALHIV et 56 (95%) CHHC ont terminé l'étude 3HP sans ajustement de la dose de dolutégravir. Aucun des enfants participants n'a interrompu le traitement 3HP en raison d'effets indésirables. Aucun enfant participant n'a développé de tuberculose au cours de l'année de suivi post-3HP. CONCLUSION: Notre étude fournit des preuves de l'adoption et de la faisabilité de la mise en œuvre prévue de 3HP à l'échelle nationale.

Polytypism in sulfate-intercalated layered double hydroxides of Zn and M(III) (M = Al, Cr): observation of cation ordering in the metal hydroxide layers.

The as-precipitated sulfate-intercalated layered double hydroxide of Zn and Al crystallizes in the structure of the 3R1 polytype. On hydrothermal treatment, this 3R1 polytype transforms into the somewhat rare 3H and 3R2 polytypes at different temperatures. Observation of the 3R2 polytype distinct from the 3R1 polytype is evidence for the lack of cation ordering in the [Zn-Al-SO4] system. The layered double hydroxide of Zn and Cr (polytype, 1H) on hydrothermal treatment in mother liquor yields a cation-ordered phase also having the structure of the 1H polytype. Direct evidence of cation ordering is found by the appearance of weak supercell reflections corresponding to a = √3 × a(o) (a(o) is the a parameter of the cation-disordered phase). The same precursor under other conditions yields the cation-disordered 3R1 polytype. In this work, the structures of both the cation-ordered and the cation-disordered phases with similar states of hydration are refined and compared.

Combined orthodontic and surgical correction of an adolescent patient with thin palatal cortex and vertical maxillary excess.

This paper describes the treatment of a male patient aged 14 years who presented with a skeletal class I, vertical maxillary excess, marked increase in overjet, thin palatal cortex and a gummy smile. Considering the severity of his malocclusion and its impact severity on his psychosocial well being, he was managed with a combined approach of Fixed Orthodontic therapy and Orthognathic surgery, even though his growth was not complete. Records of Pre treatment, Post treatment and three years in retention were analyzed and the functional and esthetic results were found to be fairly stable.

Anion exchange reaction potentials as approximate estimates of the relative thermodynamic stabilities of Mg/Al layered double hydroxides containing different anions.

Coatings of hydrotalcite-like nitrate-intercalated Mg/Al layered double hydroxides are electrochemically deposited on a Pt electrode by electrogeneration of base by reduction of a mixed metal nitrate aqueous solution. As-prepared coatings are stable to workup and function as rugged electrodes. The voltammetric response generated by anion exchange of intercalated nitrate for dissolved anions from solution under equilibrium conditions is employed to estimate the thermodynamic stabilities of the Mg/Al layered double hydroxides comprising different anions relative to the nitrate-containing phase. Among monovalent anions, the most stable is the fluoride-containing LDH (ΔG° = -48.7 kJ mol(-1)) relative to the nitrate-containing LDH. The stability in aqueous phase decreases as F(-) > Cl(-) > Br(-) > NO(2)(-) > NO(3)(-), whereas, among divalent anions, SO(4)(2-) (ΔG° = -8.7 kJ mol(-1)) > CO(3)(2-) (ΔG° = 14.3 kJ mol(-1)). The results of monovalent ions match well with the Miyata series, whereas the divalent anion series is at variance with the commonly held belief that carbonate-LDHs are more stable than sulfate-LDHs.

Polytypism in the lithium-aluminum layered double hydroxides: the [LiAl2(OH)6]+ layer as a structural synthon.

The [LiAl(2)(OH)(6)](+) layer obtained from gibbsite-Al(OH)(3) belongs to the layer group symmetry P-312/m. This layer satisfies the defining characteristics of a synthon in that it predicts all the polymorphic modifications of the layered double hydroxides of Li and Al. The various possible ways of stacking these layers can be derived by the systematic elimination of the principal symmetry elements comprising the layer group. This approach yields the complete universe of possible structures. When the 3 axis of the layer is conserved in the stacking, the resultant crystal adopts the structure of the 1H, 2H, or 3R polytypes (H, hexagonal; R, rhombohedral). When the 3 axis is destroyed and the 2/m axis is retained, the crystal adopts monoclinic symmetry and crystallizes in the structures of the 1M(1) or 1M(2) (M, monoclinic) polytypes; the two polytypes differ only in their translational component. Experimentally, gibbsite-based precursors yield the 2H polytype, and bayerite-based precursors yield the 1M polytype. Faulted structures incorporating differently oriented 1M(1) motifs or a mixture of 1M(1) and 1M(2) motifs are also obtained. These stacking faults result in cation disorder along the c axis and produce signature effects on the line shapes of select reflections in the powder X-ray diffraction patterns. This symmetry-guided approach is general and can be extended to other classes of layered solids.

Spectroscopic and theoretical investigation on the origin of color in jarosites.

This work aims to understand the origin of the electronic spectra of Fe3+ (d5), Cr3+ (d3), and V3+ (d2) containing jarosites. The electronic spectrum of the Fe-jarosite is currently assigned to spin forbidden transitions. This work shows that the spectra essentially arise due to the tetragonal distortion of the coordination symmetry of the Fe3+ ion in the jarosite crystal, and thereby obviates the need for invoking spin forbidden transitions. The absorption spectra of Cr- and V-jarosite are also assigned to transitions predicted for the tetragonal distortion of the metal ion coordination. The electronic term symbols are worked out using the correlation diagram and Tanabe-Sugano diagram for orbital splitting for all three systems employing ab initio and DFT methods. The bandgaps were computed and corroborated with the experimentally measured values to support the low symmetry at the metal center.

Secondary and tertiary structure modeling reveals effects of novel mutations in polycystic liver disease genes PRKCSH and SEC63.

Polycystic liver disease (PCLD) is characterized by intralobular bile duct cysts in the liver. It is caused by mutations in PRKCSH, encoding hepatocystin, and SEC63, encoding Sec63p. The main goals of this study were to screen for novel mutations and to analyze mutations for effects on protein structure and function. We screened 464 subjects including 76 probands by direct sequencing or conformation-sensitive capillary electrophoresis. We analyzed the effects of all known and novel mutations using a combination of splice site recognition, evolutionary conservation, secondary and tertiary structure predictions, PolyPhen, and pMut and sift. We identified a total of 26 novel mutations in PRKCSH (n = 14) and SEC63 (n = 12), including four splice site mutations, eight insertions/ deletions, six non-sense mutations, and eight missense mutations. Out of 48 PCLD mutations, 13 were predicted to affect splicing. Most mutations were located in highly conserved regions and homology modeling for two domains of Sec63p showed severe effects of the residue substitutions. In conclusion, we identified 26 novel mutations associated with PCLD and we provide in silico analysis in order to delineate the role of these mutations.

Homogeneous precipitation by formamide hydrolysis: synthesis, reversible hydration, and aqueous exfoliation of the layered double hydroxide (LDH) of Ni and Al.

Homogenous precipitation by formamide hydrolysis results in the formation of a formate-intercalated layered double hydroxide (LDH) of Ni(II) and Al(III). The formate-LDH is sensitive to the atmospheric humidity and reversibly exchanges its intercalated water with atmospheric moisture. The hydration/dehydration cycle is complete within a narrow range of 0-30% relative humidity with significant hysteresis and involves a randomly interstratified intermediate phase. When immersed in water, the formate ion grows its hydration sphere (osmotic swelling), eventually leading to the exfoliation of the metal hydroxide layers into lamellar particles having in-plane dimensions of 100-200 nm and a thickness of 9-12 nm. These nanoplatelets restack to thicker tactoids again upon evaporation of the dispersion. The intercalated formate ion can be exchanged with nitrate ions in solution but not with iodide ions. These observations have implications for many applications of LDHs in the area of carbon dioxide sorption and catalysis.

Polytypism, disorder, and anion exchange properties of divalent ion (Zn, Co) containing bayerite-derived layered double hydroxides.

Incorporation of Zn(2+) into bayerite results in the formation of a cation-ordered layered double hydroxide (LDH) of monoclinic symmetry in which about half the vacancies of Al(OH)(3) are occupied by Zn(2+) giving rise to positively charged layers. Charge compensation takes place by the incorporation of sulfate ions in the interlayer region. Structure refinement reveals that the adjacent layers in the crystal are related by a 2(1) axis (we call it 2M(1) polytype) with sulfate coordinating in the D(2d) symmetry in the interlayer region. Another polytype in which adjacent layers are related by a 2-fold axis (2M(2) polytype) can also be envisaged. Faulted crystals arising from intergrowths of the 2M(2) polytype within the 2M(1) structure were also obtained. These bayerite-based LDHs have a distinctly different interlayer chemistry when compared to the better known brucite-based LDHs, in that they have a strong affinity for tetrahedral ions such as SO(4)(2-), CrO(4)(2-), and MoO(4)(2-) and a poor affinity for CO(3)(2-) ions. These observations have implications for the use of LDHs in applications related to chromate sorption.

Electronic transitions in layered hydroxides: Consequences of trigonal distortion of octahedral symmetry.

This work describes the assignment of the electronic spectra of metal ions in D3d coordination symmetry. Layered hydroxides are a class of materials that host transition metal ions such as Ni2+, Co2+, and Cr3+ in D3d coordination symmetry. The electronic spectra of these ions in the layered hydroxides exhibit significant fine structure which is assigned to transitions arising from D3d coordination symmetry. Towards this end, the correlation diagrams- complete or partial, and the resultant Tanabe-Sugano like diagrams for D3d symmetry are obtained from first principles and supported by DFT based computations. The approach engendered here helps in better understanding of the electronic transitions arising due to lower symmetry.

Structure of bayerite-based lithium-aluminum layered double hydroxides (LDHs): observation of monoclinic symmetry.

The double hydroxides of Li with Al, obtained by the imbibition of Li salts into bayerite and gibbsite-Al(OH)(3), are not different polytypes of the same symmetry but actually crystallize in two different symmetries. The bayerite-derived double hydroxides crystallize with monoclinic symmetry, while the gibbsite-derived hydroxides crystallize with hexagonal symmetry. Successive metal hydroxide layers in the bayerite-derived LDHs are translated by the vector ( approximately -1/3, 0, 1) with respect to each other. The exigency of hydrogen bonding drives the intercalated Cl(-) ion to a site with 2-fold coordination, whereas the intercalated water occupies a site with 6-fold coordination having a pseudotrigonal prismatic symmetry. The nonideal nature of the interlayer sites has implications for the observed selectivity of Li-Al LDHs toward anions of different symmetries.

Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis.

BACKGROUND AND AIMS: Risk factors for mortality and re-bleeding following acute variceal haemorrhage (AVH) are incompletely understood. The aim of this study was to determine risk factors for 6-week mortality, and re-bleeding within 5 days in patients with cirrhosis and AVH. METHODS: Kaplan-Meier and Cox proportional hazards regression analyses were used to determine risk factors among 256 patients with AVH entered into a randomised, prospective trial. RESULTS: Thirty-five patients (14%) died within 6 weeks of AVH; 14 deaths (40%) occurred within 5 days. Only the Model for End-stage Liver Disease (MELD) score and units of packed red blood cells (PRBCs) transfused in the first 24 h were associated with 6-week mortality univariately (HR 1.11, p < 0.001; HR 1.22, p < 0.001) and bivariately (HR MELD = 1.10, p < 0.001; HR per unit of PRBCs transfused = 1.15, p = 0.005). Re-bleeding within 5 days occurred in 37 patients (15%); MELD score (p = 0.01) and a clot on a varix (p = 0.05) predicted re-bleeding. Patients with a MELD score > or = 18; both MELD score > or = 18 and > or = 4 units of PRBCs transfused; both MELD score > or = 18 and active bleeding at index endoscopy; and variceal re-bleeding had increased risk of death 6 weeks post-AVH (HR = 7.4, p < 0.001; 11.3, p < 0.001; 9.9, p < 0.001; 10.2, p < 0.001 respectively). CONCLUSIONS: Patients with AVH and MELD score > or = 18, requiring > or = 4 units of PRBCs within the first 24 h or with active bleeding at endoscopy are at increased risk of dying within 6 weeks. MELD score > or = 18 is also a strong predictor of variceal re-bleeding within the first 5 days.

Interaction of Pristine Hydrocalumite-Like Layered Double Hydroxides with Carbon Dioxide.

The layered double hydroxides (LDHs) of Ca2+ and trivalent cations, Al3+ and Fe3+, are single-source precursors to generate supported CaO, which picks up CO2 from the gas phase in the temperature range 350-550 °C. The supports are ternary oxides, mayenite, and Ca2Fe2O5. The uptake capacity of the Fe3+-containing LDH at 1.9 mmol g-1 is two times the capacity of the Al3+-containing LDH. The product of CO2 uptake is calcite CaCO3. It is observed that the intercalated chloride ions reduce the thermal penalty by inducing the early decomposition of CaCO3. In the case of the chloride-intercalated LDHs of Ca2+ and Fe3+, the CaCO3 formed is completely decomposed at 900 °C. This is in contrast with the CaCO3 formed from bare CaO, which shows no sign of decomposition at 900 °C under similar conditions. This work shows that the hydrocalumite-like LDHs are candidate materials for CO2 mineralization.

Experimental demonstration of interference avoidance protocol (transmission scheduling) in O-CDMA networks.

We experimentally demonstrate a transmission scheduling algorithm to avoid congestion collapse in O-CDMA networks. Our result shows that transmission scheduling increases the performance of the system by orders of magnitude.