Notes

Cytotoxicity, metabolism compound inhibitory, and anti-inflammatory effect of Lentinula edodes fermented using probiotic lactobacteria.
Defibrotide has an acceptable safety profile with an improved response in severe/very severe SOS compared with historical controls, mainly in pediatric patients. Use of defibrotide for prophylaxis may improve prognosis of patients at high risk of complications due to endothelial damage such as those who receive a second transplant. SOS has an important impact on the HSCT long-term survival, as can be concluded from our study.
The epidemiology of hepatitis B virus (HBV) infection differs between Asians and non-Asians, but little is known regarding the effect of ethnicity on outcomes of HBV-related hepatocellular carcinoma (HCC). We aim to characterize the presentation and survival outcomes in Asian and non-Asian patients with HBV-related HCC.

We analyzed the baseline characteristics and long-term survival of 613 Asian and 410 non-Asian patients with HBV-related HCC from three US and one Spanish centre.

Overall, non-Asian patients were more likely to have HIV or hepatitis C co-infection, cirrhosis, decompensated liver disease and advanced BCLC stage (all P≤.04). Compared with Asians, non-Asians were more likely to be listed for transplantation (P<.0001) and undergo HCC treatment with curative intent (P=.003). Propensity-score matching on HCC diagnosis year, gender and age was performed to balance the two groups for survival analysis and yielded 370 pairs of patients. Selleckchem Poziotinib There was no significant difference in survival overall (P=.43) and among patients with cirrhosis (P=.57). Among patients without cirrhosis, non-Asians had poorer 5-year survival compared with Asians (37.6% vs 53.7%, P=.01), and was associated with poorer survival after adjusting for age, gender, diabetes, alcohol, co-infections, diagnosis date, antiviral therapy, BCLC stage and HCC treatment (adjusted HR 2.01 [95% CI 1.07-3.74], P=.03).

Among HBV-related HCC patients, non-Asians presented with more advanced BCLC stage compared to Asians. Non-Asian ethnicity was independently associated with twice the risk of mortality among patients without cirrhosis, but not among those with cirrhosis. Additional studies are needed to clarify this disparity.
Among HBV-related HCC patients, non-Asians presented with more advanced BCLC stage compared to Asians. Non-Asian ethnicity was independently associated with twice the risk of mortality among patients without cirrhosis, but not among those with cirrhosis. Additional studies are needed to clarify this disparity.
This study focused on comparing the applicability and efficacy of the World Health Organization (WHO) growth standards and the China growth charts in diagnosing malnutrition and indicating nutritional interventions in preterm infants.

Six hundred and eighty-three preterm infants were involved and their anthropometric data were collected. The proportion of weight and head circumference less than the 10
percentile (P
), weight less than the 25
percentile (P
), and weight for length greater than the 90
percentile (P
) identified by the WHO growth standards and the China growth charts were compared.

At corrected age (CA) 1~<2 months (m), the proportion of head circumference <P
assessed by the WHO growth standards was higher than that assessed by the China growth charts by approximately 4.4% in boys and 6.6% in girls. During infancy, both boys and girls had lower proportions of weight <P
and weight <P
with the WHO growth standards than with the China growth charts 5.1% and 5.6%, respectively, for weight <P
and 7.0% and 8.8%, respectively, for weight <P
. For boys older than CA 1 m and for girls older than CA 3 m, the proportion of weight-for-length >P
assessed by the WHO growth standards was greater than that assessed by the China growth charts.

Compared with the China growth charts, the WHO growth standards can further reduce the number of diagnoses of abnormal physical growth, are more helpful in avoiding overnutrition interventions, and are more sensitive in the early detection of delayed head circumference growth.
Compared with the China growth charts, the WHO growth standards can further reduce the number of diagnoses of abnormal physical growth, are more helpful in avoiding overnutrition interventions, and are more sensitive in the early detection of delayed head circumference growth.
To assess the benefits and safety of early human fibrinogen concentrate in postpartum haemorrhage (PPH) management.

Multicentre, double-blind, randomised placebo-controlled trial.

30 French hospitals.

Patients with persistent PPH after vaginal delivery requiring a switch from oxytocin to prostaglandins.

Within 30minutes after introduction of prostaglandins, patients received either 3g fibrinogen concentrate or placebo.

Failure as composite primary efficacy endpoint at least 4g/dl of haemoglobin decrease and/or transfusion of at least two units of packed red blood cells within 48hours following investigational medicinal product administration. Secondary endpoints PPH evolution, need for haemostatic procedures and maternal morbidity-mortality within 6±2weeks after delivery.

437 patients were included 224 received FC and 213 placebo. At inclusion, blood loss (877±346ml) and plasma fibrinogen (4.1±0.9g/l) were similar in both groups (mean±SD). Failure rates were 40.0% and 42.4% in the fibrinogen and placebo groups, respectively (odds ratio [OR]=0.99) after adjustment for centre and baseline plasma fibrinogen; (95%CI 0.66-1.47; P=0.96). No significant differences in secondary efficacy outcomes were observed. The mean plasma FG was unchanged in the Fibrinogen group and decreased by 0.56g/l in the placebo group. No thromboembolic or other relevant adverse effects were reported in the Fibrinogen group versus two in the placebo group.

As previous placebo-controlled studies findings, early and systematic administration of 3g fibrinogen concentrate did not reduce blood loss, transfusion needs or postpartum anaemia, but did prevent plasma fibrinogen decrease without any subsequent thromboembolic events.

Early systematic blind 3g fibrinogen infusion in PPH did not reduce anaemia or transfusion rate, reduced hypofibrinogenaemia and was safe.
Early systematic blind 3 g fibrinogen infusion in PPH did not reduce anaemia or transfusion rate, reduced hypofibrinogenaemia and was safe.
Inhalation of welding fume may cause pulmonary disease known as welder's lung. At our centre we came across a number of welders with systemic iron overload and prolonged occupational history and we aimed at characterizing this novel clinical form of iron overload.

After exclusion of other known causes of iron overload, 20 welders were fully evaluated for working history, hepatic, metabolic and iron status. MRI iron assessment was performed in 19 patients and liver biopsy in 12. We included 40 HFE-HH patients and 24 healthy controls for comparison.

75% of patients showed lung HRCT alterations; 90% had s-FERR>1000ng/mL and 60% had TSAT>45%. Liver iron overload was mild in 8 and moderate-severe in 12. The median iron removed was 7.8g. Welders showed significantly lower TSAT and higher SIS and SIS/TIS ratio than HFE-HH patients. Serum hepcidin was significantly higher in welders than in HFE-HH patients and healthy controls. At liver biopsy, 50% showed liver fibrosis that was mild in four, and moderate-severe in two. Liver staging correlated with liver iron overload.

Welders with prolonged fume exposure can develop severe liver iron overload. The mechanism of liver iron accumulation is quite different to that of HFE-HH suggesting that reticuloendothelial cells may be the initial site of deposition. We recommend routine measurement of serum iron indices in welders to provide adequate diagnosis and therapy, and the inclusion of prolonged welding fume exposure in the list of acquired causes of hyperferritinemia and iron overload.
Welders with prolonged fume exposure can develop severe liver iron overload. The mechanism of liver iron accumulation is quite different to that of HFE-HH suggesting that reticuloendothelial cells may be the initial site of deposition. We recommend routine measurement of serum iron indices in welders to provide adequate diagnosis and therapy, and the inclusion of prolonged welding fume exposure in the list of acquired causes of hyperferritinemia and iron overload.
Physiologic reserve is an important prognostic indicator. Due to its complexity, no single test can measure an individual's physiologic reserve. Frailty is the phenotypic expression of decreased reserve and portends poor prognosis. Both subjective and objective tools have been used to measure one or more components of physiologic reserve. Most of these tools appear to predict pre-transplant mortality, but only some predict post-transplant survival.

Incorporation of these measures of physiologic reserve in the clinical and research settings including prediction models will be reviewed and the applicability to patient related outcomes discussed.

Commonly used tools, in patients with cirrhosis, that have been associated with clinical outcomes were reviewed.

The strength of subjective tools lies in low cost, wide availability and quick assessments at bedside. A disadvantage of these tools is the manipulative capacity, restricting their value in allocation processes. The strength of objective tests lies in objective measurements and the ability to measure change. The disadvantages include complexity, increased cost, and limited accessibility.

Heterogeneity in definitions and tools used has prevented further advancement or a clear role in transplant assessment. Consistent use of objective tools including six-minute walk test, gait speed, liver frailty index or short physical performance battery are recommended in clinical and research settings.
Heterogeneity in definitions and tools used has prevented further advancement or a clear role in transplant assessment. Consistent use of objective tools including six-minute walk test, gait speed, liver frailty index or short physical performance battery are recommended in clinical and research settings.
Sepsis is common in cirrhosis and is often a result of immune dysregulation. Specific stimuli and pathways of inter-cellular communications between immune cells in cirrhosis and sepsis are incompletely understood. Immune cell-derived extracellular vesicles (EV) were studied to understand mechanisms of sepsis in cirrhosis.

Immune cell-derived EV were measured in cirrhosis patients [Child-Turcotte-Pugh (Child) score A, n=15; B n=16; C n=43 and Child-C with sepsis (n=38)], and healthy controls (HC, n=11). In vitro and in vivo functional relevance of EV in cirrhosis and associated sepsis was investigated.

Monocyte, neutrophil and hematopoietic stem cells associated EV progressively increased with higher Child score (P<.001)and correlated with liver disease severity indices (r
>0.3, P<.001), which further increased in Child C sepsis than without sepsis(P<.001); monocyte EV showing the highest association with disease stage [P=.013; Odds ratio-4.14(1.34-12.42)]. A threshold level of monocyte EV early stratification of sicker patients.
To create a personalised machine learning model for prediction of severe adverse neonatal outcomes (SANO) during the second stage of labour.

Retrospective Electronic-Medical-Record (EMR) -based study.

A cohort of 73868 singleton, term deliveries that reached the second stage of labour, including 1346 (1.8%) deliveries with SANO.

A gradient boosting model was created, analysing 21 million data points from antepartum features (e.g. gravidity and parity) gathered at admission to the delivery unit, and intrapartum data (e.g. cervical dilatation and effacement) gathered during the first stage of labour. Deliveries were allocated to high-risk and low-risk groups based on the Youden index to maximise sensitivity and specificity.

SANO was defined as either umbilical cord pH levels ≤7.1 or 1-minute or 5-minute Apgar score ≤7.

The model for prediction of SANO yielded an area under the receiver operating curve (AUC) of 0.761 (95% CI 0.748-0.774). A third of the cohort (33.5%, n=24721) were allocated to a high-risk group for SANO, which captured up to 72.
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