Expression analysis and function of mitochondrial genome-encoded microRNAs.

MicroRNAs (miRNAs) play a significant role in nuclear and mitochondrial anterograde and retrograde signaling. Most of the miRNAs found inside mitochondria are encoded in the nuclear genome, with a few mitochondrial genome-encoded non-coding RNAs having been reported. In this study, we have identified 13 mitochondrial genome-encoded microRNAs (mitomiRs), which were differentially expressed in breast cancer cell lines (MCF-7, MDA-MB-468 and MDA-MB-231), non-malignant breast epithelial cell line (MCF-10A), and normal and breast cancer tissue specimens. We found that mitochondrial DNA (mtDNA) depletion and inhibition of mitochondrial transcription led to reduced expression of mitomiRs in breast cancer cells. MitomiRs physically interacted with Ago2, an RNA-induced silencing complex (RISC) protein, in the cytoplasm and inside mitochondria. MitomiRs regulate the expression of both nuclear and mitochondrial transcripts in breast cancer cells. We showed that mitomiR-5 targets the PPARGC1A gene and regulates mtDNA copy number in breast cancer cells. MitomiRs identified in the present study may be a promising tool for expression and functional analysis in patients with a defective mitochondrial phenotype, including cancer and metabolic syndromes. This article has an associated First Person interview with the first author of the paper.

Health-related quality of life among oral and oropharyngeal cancer patients: An exploratory study.

OBJECTIVES: To comprehensively explore the effect of several sociodemographic-, patient- and tumour-related factors on the health-related quality of life (HRQoL) of oral and oropharyngeal cancer patients. METHODOLOGY: Patients diagnosed with oral and oropharyngeal cancers were included in the present cross-sectional study. Information pertaining to various sociodemographic-, patient- and tumour-related factors was recorded. HRQoL was assessed using standard 12-item Short Form Health Survey version 2 (SF12V2), and oral health-related quality of life (OHRQoL) was assessed by Oral Health Impact Profile-14 (OHIP). RESULTS: A total of 108 patients participated in the present study. Results revealed that nodal metastasis, histological differentiation and pain were significant predictors of OHRQoL, while site, size, stage, histological differentiation and pain were significant predictors of HRQoL. Pain was the single most significant negative determinant of HRQoL that was associated with worst total OHIP (B = 2.01, ß = 0.45, p < .0001), physical (B = -0.88, ß = -0.21, p = .017) and mental (B = -1.00, ß = -0.22, p = .016) component summary scores. CONCLUSIONS: Number of sociodemographic-, patient- and tumour-related factors emerged as significant predictors of HRQoL and OHRQoL. Study results might help in formulating targeted treatment plan, optimising patient care and follow-up.

Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.

PURPOSE: Fatigue, decreased functionality, and impaired quality of life are some of the most common adverse outcomes of chemo-radiotherapy (CRT). Head and neck cancers (HNC) affect more than half a million individuals globally and its treatment takes a heavy toll on the patient, often affecting their speech, swallowing, and respiratory functions, and as a result they often develop fatigue, depression, and physical inactivity. The purpose of this study was to evaluate the effectiveness of exercise-based rehabilitation on functional capacity, quality of life, fatigue, hemoglobin, and platelet counts in patients with HNC on CRT. PATIENTS AND METHODS: A randomized controlled trial was conducted on 148 patients with head and neck cancer undergoing CRT to evaluate the effectiveness of exercise on functional capacity measured by the 6-min walk test, quality of life measured by the Medical Outcomes Survey Short Form 36 v2 questionnaire, fatigue by the NCCN (0-10) scale, hemoglobin, and platelets. The control group received standard physical activity recommendations while the exercise group received a structured exercise program of aerobic and active resistance exercises for a period of 11 weeks. RESULTS: There was a significant improvement in the functional capacity (p < 0.001), quality of life (p < 0.001), and prevention of worsening of fatigue (p < 0.001) in the exercise group. The blood parameters did not show a significant difference between the control group and the exercise group. CONCLUSION: Our results elucidate that an 11-week structured exercise program for HNC patients receiving CRT helps in improving their functional capacity and quality of life. It also prevents deterioration of fatigue levels in the exercise group.

Association of urinary metabolites with radiographic progression of knee osteoarthritis in overweight and obese adults: an exploratory study.

INTRODUCTION: Metabolic factors may contribute to osteoarthritis (OA). This study employed metabolomics analyses to determine if differences in metabolite profiles could distinguish people with knee OA who exhibited radiographic progression. METHODS: Urine samples obtained at baseline and 18 months from overweight and obese adults in the Intensive Diet and Exercise for Arthritis (IDEA) trial were selected from two subgroups (n = 22 each) for metabolomics analysis: a group that exhibited radiographic progression (≥0.7 mm decrease in joint space width, JSW) and an age, gender, and body mass index (BMI) matched group who did not progress (≤0.35 mm decrease in JSW). Multivariate analysis methods, including orthogonal partial least square discriminate analysis, were used to identify metabolite profiles that separated progressors and non-progressors. Plasma levels of IL-6 and C-reactive protein (CRP) were evaluated as inflammatory markers. RESULTS: Multivariate analysis of the binned metabolomics data distinguished progressors from non-progressors. Library matching revealed that glycolate, hippurate, and trigonelline were among the important metabolites for distinguishing progressors from non-progressors at baseline whereas alanine, N,N-dimethylglycine, glycolate, hippurate, histidine, and trigonelline, were among the metabolites that were important for the discrimination at 18 months. In non-progressors, IL-6 decreased from baseline to 18 months while IL-6 was unchanged in progressors; the change over time in IL-6 was significantly different between groups. CONCLUSION: These findings support a role for metabolic factors in the progression of knee OA and suggest that measurement of metabolites could be useful to predict progression. Further investigation in a larger sample that would include targeted investigation of specific metabolites is warranted.

Persistent Trophoblastic Disease at Cesarean Scar.

Pregnancy over the cesarean scar is the rarest cause of ectopic pregnancy and development of persistent trophoblastic disease at the scar site is extremely rare. A high index of suspicion is needed for early diagnosis and management of cesarean scar molar pregnancy. This condition is difficult to diagnose and must be considered in the patient with a history of cesarean section who has persistent vaginal bleeding or symptoms of pregnancy after suction evacuation. Diagnosis can be confirmedby measuring ß Human Chorionic Gonadotropin levels, transvaginal ultrasound with doppler flow evaluation. As this is an uncommon condition, this case report with conservative non surgical approach will add up to its clinical spectrum.

Comparison of Hysterosalpingography and Combined Laparohysteroscopy for the Evaluation of Primary Infertility.

Background Hysterosalpingography (HSG) is a useful screening test for the evaluation of female infertility. Laparoscopy has proven role in routine infertility work up but role of hysteroscopy in an infertile patient with normal HSG for additional information is a subject of debate. Hysteroscopy permits direct visualization of the cervical canal and the uterine cavity and thereby helping in the evaluation of shape, and cavitary lesion. Objective To detect uterine abnormalities in infertile women by various approaches i.e. HSG and hysteroscopy and evaluating the role of combining hysteroscopy with laparoscopy for the evaluation of tubo-uterine factor for primary infertility. Method One twenty eight infertile women were evaluated and HSG was performed as a basic test for evaluation of tubes and uterine cavity. Women were subjected to combined laparoscopic and hysteroscopic examination on evidence of HSG abnormalities. In absence of any HSG abnormality, women were subjected to ovulation induction for three to six months and if they did not conceive during this period they were undertaken for combined laparo-hysteroscopic evaluation. Result The positive predictive value of HSG for detecting the intrauterine abnormalities was 70% among 126 patients where the hysteroscopy could be performed successfully. The diagnostic accuracy of HSG for intrauterine abnormalities revealed false negative rate of 12.96%. The most frequent pathologies encountered by laparoscopy were tubal and/or peritoneal and were found in 68% (87/128) of women. Total 64.06% infertile women had some abnormality on laparoscopy. This detection rate has been increased from 64.06% to 71.86% on including the concomitant hysteroscopy. Conclusion HSG is a good diagnostic modality to detect uterine as well as tubal abnormalities in infertile patient. HSG and hysteroscopy are complementary to each other and whenever the patient is undertaken for diagnostic laparoscopy for the infertility, hysteroscopy should be combined to improve the detection rate of abnormalities especially in communities where there is enormous risk of pelvic infection.

Establishment of invasive and non-invasive reporter systems to investigate American elm-Ophiostoma novo-ulmi interactions.

Dutch elm disease (DED), caused by ascomycete fungi in the Ophiostoma genus, is the most devastating disease of American elm (Ulmus americana) trees. Cerato ulmin (CU), a hydrophobin secreted by the fungus, has been implicated in the development of DED, but its role in fungal pathogenicity and virulence remains uncertain and controversial. Here, we describe reporter systems based on the CU promoter and three reporter proteins (GFP, GUS and LUC), developed as research tools for quantitative and qualitative studies of DED in vitro, in vivo and in planta. A strain of the aggressive species Ophiostoma novo-ulmi was transformed with the reporter constructs using Agrobacterium-mediated transformation and the fungal transformants, namely M75-GFP, M75-GUS and M75-LUC, were examined for mitotic stability after repeated subcultures. The intensity of GFP fluorescence was strong in M75-GFP spores and hyphae, allowing microscopic investigations of spore structure, fungal morphogenesis and fungal development. The interaction of M75-GFP and U. americana callus cells was explored with scanning laser confocal microscopy facilitating qualitative studies on fungal strategies for the invasion and penetration of elm cells. M75-GUS was generated to provide an invasive, yet quantitative approach to study fungal-plant interactions in vitro and in planta. The generation of M75-LUC transformants was aimed at providing a non-destructive quantitative approach to study the role of CU in vivo. The sensitivity, low background signal and linearity of LUC assays all predict a very reliable approach to investigate and re-test previously claimed roles of this CU in fungal pathogenicity. These reporter systems provide new tools to investigate plant-pathogen interactions in this complex pathosystem and may aid in better understanding the development of DED.

Comparative toxicity of carbaryl, carbofuran, cypermethrin and fenvalerate in Metaphire posthuma and Eisenia fetida -a possible mechanism.

To establish the use of Metaphire posthuma as a sensitive test model for ecotoxicological studies, acute toxicity testing of carbaryl, carbofuran, cypermethrin and fenvalerate on Eisenia fetida and Metaphire posthuma were carried out. Two different types of bioassays, contact filter paper toxicity and soil toxicity bioassays were used to determine LC50 values for these insecticides. Among the tested chemicals, carbofuran was the most toxic to both the earthworm species. In paper contact method, 72 h-LC50 values of carbofuran in M. posthuma and E. fetida were found to be 0.08 µg/cm(2) and 1.55 µg/cm(2) respectively while in soil test, 14-d LC50 values were 0.49 mg/kg and 21.15 mg/kg respectively. On comparing the toxicity data of these chemicals for both the earthworm species, M. posthuma was found to be more sensitive than E. fetida. Based on the acute toxicity data, the order of toxicity of insecticides in both the test procedures was carbofuran>cypermethrin>carbaryl>fenvalerate for M. posthuma whereas for E. fetida it was carbofuran>carbaryl>fenvalerate>cypermethrin. Morphological changes also appeared in the organisms exposed to these chemicals which were more pronounced in M. posthuma at lower concentrations than E. fetida in both the test procedures. The results of the present study advocates the use of M. posthuma for ecotoxicity studies, being a more sensitive and reliable model than E. fetida. Based on the data on partial atomic charges, structural features and spectroscopic studies on carbaryl and carbofuran, a possible mechanism of toxicity of carbamate insecticides in earthworm was proposed.

A prospective double blind study comparing the effects of oxytocin and human chorionic gonadotrophin as trigger for ovulation.

This study was undertaken to compare the effect of oxytocin and human chorionic gonadotrophin (hCG) on ovulation and conception. A total of 100 women with anovulatory infertility were allocated into two equal groups to take clomiphene citrate plus hCG or clomiphene citrate plus oxytocin. The size and number of follicles by transvaginal sonography determined the administration of hCG or oxytocin. The serum progesterone concentration was measured to provide evidence for ovulation. The ovulation and pregnancy rate of the two groups were compared. There was no significant difference between the groups with respect to mean number of follicles, mean follicular size and rate of ovulation in three cycles. The rate of pregnancy was higher in the oxytocin group compared with the hCG group (12% vs 4%) but it failed to reach statistical difference (p = 0.140). Mild pain was the only side-effect observed in the two groups. Oxytocin was found to be a viable alternative to hCG for triggering ovulation in infertile patients.

An alternative method for mucosal flap closure during peroral endoscopic myotomy using an over-the-scope clipping device.

Maintaining the integrity of the mucosal flap and the reliable closure of mucosal entry during peroral endoscopic myotomy (POEM) is paramount in preventing leakage of esophageal contents into the mediastinal space. We describe our experience with POEM, the problems encountered with closure of mucosal flaps, and successful closure with over-the-scope clips (OTSC). Two patients with achalasia underwent successful endoscopic myotomy during POEM. During both procedures, the proximal end of the longitudinal mucosal incision was noted to be gaping and completion of the closure with standard clips was unsuccessful. The sides of the flap were approximated using a Twin Grasper followed by placement of OTSC. Closure of the mucosal entry appeared to be complete at the end of the procedures. Esophagram the following day revealed no leaks in either patient. There were no other complications and patients were discharged home after 1 - 2 days of hospital observation. Patients reported complete resolution of achalasia symptoms during follow-up. We propose closure of mucosal incisions during POEM using one to two OTSC as an alternative to described techniques. The use of OTSC may simplify the procedure and result in a more durable (i. e. full-thickness) closure.

Blood transfusion in obstetrics.

Transfusion of blood and blood components is a common practice in obstetric wards but it is not without risk. The incidence of transfusion reactions varies from 4 in every hundred transfusions for non-haemolytic reactions to one in every 40,000 for haemolytic transfusion reactions. The physiological basis of blood transfusion is outlined in this article. Most of the donated blood is processed into components: packed red cells (PRBCs), platelets, and fresh frozen plasma (FFP) or cryoprecipitate. Various alternatives to blood transfusion exist and include autotransfusion, pre-autologous blood storage, use of oxygen carrying blood substitutes and intraoperative cell salvage. Despite the risks associated with transfusions, obstetricians are frequently too aggressive in transfusing blood and blood products to their patients. Acute blood loss in obstetrics is usually due to placenta praevia, postpartum blood loss and surgery related. An early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank is essential. There are no established criteria for initiating red cell transfusions and the decision is purely based on clinical and haematological parameters, which have been discussed along with the general principles of blood transfusion in obstetrics and some practical guidelines.

Atomistic nonlinear carrier dynamics in Ge.

An atomistic technique to successfully demonstrate the ultrafast carrier dynamics in Ge photoconductive samples is reported here. The technique is validated against the experimental findings and with the Drude conductivities. The impact of the various different scattering mechanisms is used to calibrate the experimental results. It is observed that the total scattering rate is not a constant parameter as contrast to Drude model which uses constant scattering rate as the fitting parameter to demonstrate the ultrafast carrier dynamics, but strongly dependent on the applied peak THz field strength. It also contradicts with the relaxation time approximation (RTA) method which uses scattering rate chosen on the empirical basis as the fitting parameter to demonstrate the ultrafast carrier dynamics. On the other hand the limitations and challenges offered by various types of density functional theories (DFT) pose lot of challenges. In current manuscript various types of scattering mechanisms i.e. acoustic, intervalley, Coulomb and impact ionization on the behavior of carrier conductivity are studied in details. The proposed technique has shown capability to extract low and high frequency conductivities accurately which is impossible through the Drude model or DFT based theories. It is observed that the free carrier absorption coefficient depends on the refractive index of the material at low THz frequencies. The solution of Boltzmann transport equation through Monte Carlo technique provides valuable insights for better understanding of ultrafast carrier transportation mechanism. The free carrier absorption spectra are found to be in good agreement with the experimental results at various THz field strengths.

In-vivo Comparison of Planned and Measured Rectal Doses during Cobalt-60 HDR CT-based Intracavitary Brachytherapy Applications of Cervical Cancer Using the PTW 9112 Semiconductor Probe.

BACKGROUND: A semiconductor rectal probe was used to compare planned and measured rectal doses during Co-60 high dose rate (HDR) CT-based intracavitary brachytherapy applications (ICBT) of cervical cancer. MATERIALS AND METHODS: A total of 22 HDR brachytherapy applications were included from 11 patients who were first treated with EBRT to the whole pelvis with a total prescribed dose of 50 Gy in 25 fractions. During each application, a PTW 9112 probe rectal probe having a series of five semiconductor diodes (R1 to R5) was inserted into the patient's rectum and a CT-based HDR ICBT application with a prescribed dose per fraction of 7 or 7.5 Gy to HRCTV was performed. Measurements were carried in water phantom using PTW rectal and universal adaptor plugs. Doses measured in phantom and with patients were compared to those calculated by the treatment planning system. RESULTS: The mean percentage dose difference ΔD (%) between calculated and measured values from phantom study were -5.29%, 1.89%, -2.72%, -4.76, and 0.72% for R1, R2, R3, R4, and R3 diodes, respectively and the overall mean ΔD (%) value with standard deviation (SD) was -2.03%±9.6%. From the patient study, a ΔD (%) that ranged from -19.5% to 24.0%, which corresponded to dose disparities between -0.77 Gy and 0.66 Gy. The median ΔD (%) ranged from 0.4% to 1.3%, or -0.03 to 0.05 Gy, respectively. ΔD (%) values exceeded 10% in approximately 26.4% of measurements (29 out of 110 in 22 applications). The location of Rmax in computed and measured values differs in 5 of 22 applications might be due to possible displacement of rectal probe between simulation and treatment. CONCLUSION: Despite the likely geometrical shift of measuring detectors between insertion and treatment, in-vivo dosimetry is feasible and can be used to estimate the dose to the rectum during HDR ICBT.

Comparison of levonorgestrel and copper releasing intrauterine contraceptive device on body iron stores and menstrual bleeding patterns: experience on Indian women.

INTRODUCTION: The search for an ideal contraceptive device most suited for women of developing countries with anemia poses a challenge. AIM: This study was conducted to compare the effects of levonorgestrel releasing (LNG) and copper releasing (Cu T) intrauterine contraceptive devices (IUCD) on body iron stores and menstrual bleeding patterns. METHODS: Hundred women desiring contraception were divided into two groups of fifty each where either LNG or Cu T 200 IUCD was inserted. Outcome parameters evaluated were change in menstrual bleeding patterns, serum ferritin and hemoglobin level post insertion at three, six and twelve months. Main outcome measures were change in serum ferritin, hemoglobin concentration, menstrual bleeding and spotting days 12 months after insertion. RESULTS: Menstrual bleeding days increased initially at three month for both IUCD's, but by 12 months, mean number of bleeding days reduced from preinsertion 4.96 +/- 1.61 to 3.14 +/- 1.72 days (p < 0.05) in the LNG group while in Cu T number of bleeding days remained higher at 12 months (4.76 +/- 0.96 days) compared to pre-insertion level (4.46 +/- 0.91 days, p = NS). At 12 months, 60% women developed hypomenorrhoea and 20% had amenorrhea in LNG group. Higher (p < 0.05) serum ferritin (24.17 + 5.97 vs. 20.80 + 5.78) and hemoglobin (12.45 + 0.46 vs. 11.95 + 11.042 gm/dl) concentration was noted in the LNG group as compared to Cu T by the end of 1 year. CONCLUSION: LNG reduced the number of menstrual bleeding days and increased the hemoglobin and serum ferritin levels, thus preventing loss of body iron. This may be especially important for women in developing countries like India where decrease in blood loss may improve iron deficient situations.

A study of clinical presentation and delays in management of acute myocardial infarction in community.

To assess the medico social demographics of acute myocardial infarction (AMI) in our community we studied 609 patients presenting between January 2008 to December 2008 with a detailed questionnaire in four centres of UP. Medical attention was sought late (> 6 hours) in 316 (51.6%), thrombolysis was obtained in 45.2% (275) and presentation was atypical in 16.3% (99). 36.2% (221) had pre-monitory symptoms of which 68% (150) ignored the same while of 32% (71) who did seek medical attention 47.9% (37) were brushed away as non-cardiac in origin. 20.3% (46/226) of hypertension, 23.2% (43/185) of diabetes and 83.4% (91/109) of hyperlipidaemia was diagnosed post event. We conclude that at least half of patients with AMI do not get definitive therapy, at least one in 10 patients do not have the classical symptoms, reasonable proportion are unaware of their risk factors, and a good majority have pre-monitory symptoms which get overlooked.

Patterns and determinants of dyslipidaemia in 'Young' versus 'Not so Young' patients of coronary artery disease: a multicentric, randomised observational study in northern India.

AIMS: The aims of the study were to ascertain difference in lipid levels of 'Young' onset of coronary artery disease (CAD) (≤ 45 years) vs. 'Not so Young' onset of CAD (≥ 55 years) among north Indians and also to investigate determinants of 'dyslipidaemia' in CAD patients. METHODS: This was a prospective, multicentric, randomised, observational study carried in eight centres of UP, India. All blood investigations were performed employing a central laboratory. RESULTS: Out of a total 435 patients studied, 218 were in the 'young group' (YG) and 235 were in the 'Not so Young Group' (NSYG). Dyslipidaemia was more common in YG as evident by significantly higher levels of total cholesterol, triglycerides, low- and very low-density lipoprotein cholesterol as compared to NSYG. Diabetes, hypertension, urban lifestyle, and family history of CAD were found to be important determinants of dyslipidaemia in YG. CONCLUSION: We conclude that lipid levels among north Indians are significantly higher in younger patients with CAD when compared with elderly.

A randomized clinical trial to compare the efficacy of different doses of intravaginal misoprostol with intracervical dinoprostone for cervical ripening and labor induction.

OBJECTIVES: To compare the efficacy of 25 vs. 50 microg of intravaginal misoprostol vs. intracervical dinoprostone for cervical ripening and labor induction. MATERIALS AND METHODS: 210 women with Bishop's score <6 were randomized into 3 groups of 70 each to receive 6 hourly doses of either 25 or 50 microg of intravaginal misoprostol or 0.5 mg intracervical dinoprostone to maximum of 3 doses and outcome parameters were compared. RESULTS: Induction to vaginal delivery interval was significantly lower (p < 0.05) for 50 microg (13.8 +/- 6.62 hours) as compared to 25 microg misoprostol (16.4 +/- 7.34 hours) or dinoprostone group (16.3 +/- 7.49 hours). Maximum improvement (p < 0.05) in Bishop's score and minimum oxytocin requirement (p < 0.05) was seen with misoprostol 50 microg. No significant difference was observed for women delivering vaginally within 24 hours (93.8 vs. 89.7 vs. 85.4%), patients delivering after one dose (24.3 vs. 21.4 vs. 20%), cesarean deliveries, fetal outcome, complications like hyperstimulation and fetal heart abnormalities for the 50 vs. 25 microg misoprostol vs. dinoprostone group. CONCLUSION: Intravaginal misoprostol 50 microg administered 6 hourly appears to be most effective as it has least induction to delivery time, has maximum improvement in Bishop's score, least oxytocin requirement without any increase in complication rate.

Cryopreservation of shoot tips and cotyledons of the north american ginseng (Panax quinquefolius l.).

North American ginseng (NAG) (Panax quinqueolius L.) is a medicinal plant in high demand due to its health benefits. Cryopreservation is a good alternative for long-term conservation of NAG germplasm. Pretreatments of shoot tips (0.8-1 mm) and cotyledons (1-2 mm) on sucrose and abscisic acid (ABA) enriched medium were tested to determine the effects on regrowth following cryopreservation in liquid nitrogen. The maximum regrowth (60 percent) following PVS2 vitrification occurred with shoot tips after three weeks of cold acclimation and pretreatment on sucrose (0.3 M) or a combination of ABA (0.1 M) and sucrose in the third week. Cotyledon recovery was best with the combination pretreatment. Shoot tips showed normal development and cotyledons produced embryogenic callus after the cryopreservation process. This is the first report on cryopreservation of shoot tips and cotyledons of Panax species. This cryopreservation protocol provides a safe long-term storage method for important NAG selections and makes it possible to use cryopreservation for improving the security of NAG germplasm.

LiverNet: efficient and robust deep learning model for automatic diagnosis of sub-types of liver hepatocellular carcinoma cancer from H&E stained liver histopathology images.

PURPOSE: Liver cancer is one of the most common types of cancers in Asia with a high mortality rate. A common method for liver cancer diagnosis is the manual examination of histopathology images. Due to its laborious nature, we focus on alternate deep learning methods for automatic diagnosis, providing significant advantages over manual methods. In this paper, we propose a novel deep learning framework to perform multi-class cancer classification of liver hepatocellular carcinoma (HCC) tumor histopathology images which shows improvements in inference speed and classification quality over other competitive methods. METHOD: The BreastNet architecture proposed by Togacar et al. shows great promise in using convolutional block attention modules (CBAM) for effective cancer classification in H&E stained breast histopathology images. As part of our experiments with this framework, we have studied the addition of atrous spatial pyramid pooling (ASPP) blocks to effectively capture multi-scale features in H&E stained liver histopathology data. We classify liver histopathology data into four classes, namely the non-cancerous class, low sub-type liver HCC tumor, medium sub-type liver HCC tumor, and high sub-type liver HCC tumor. To prove the robustness and efficacy of our models, we have shown results for two liver histopathology datasets-a novel KMC dataset and the TCGA dataset. RESULTS: Our proposed architecture outperforms state-of-the-art architectures for multi-class cancer classification of HCC histopathology images, not just in terms of quality of classification, but also in computational efficiency on the novel proposed KMC liver data and the publicly available TCGA-LIHC dataset. We have considered precision, recall, F1-score, intersection over union (IoU), accuracy, number of parameters, and FLOPs as metrics for comparison. The results of our meticulous experiments have shown improved classification performance along with added efficiency. LiverNet has been observed to outperform all other frameworks in all metrics under comparison with an approximate improvement of [Formula: see text] in accuracy and F1-score on the KMC and TCGA-LIHC datasets. CONCLUSION: To the best of our knowledge, our work is among the first to provide concrete proof and demonstrate results for a successful deep learning architecture to handle multi-class HCC histopathology image classification among various sub-types of liver HCC tumor. Our method shows a high accuracy of [Formula: see text] on the proposed KMC liver dataset requiring only 0.5739 million parameters and 1.1934 million floating point operations per second.