Prognostic value of Ishak fibrosis stage: Findings from the hepatitis C antiviral long-term treatment against cirrhosis trial

Studies of the prognostic value of Ishak fibrosis stage are lacking. We used multi-year follow-up of the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial to determine whether individual Ishak fibrosis stages predicted clinical outcomes in patients with chronic hepatitis C. Baseline liver biopsy specimens from 1050 patients with compensated chronic hepatitis C who had failed combination peginterferon and ribavirin were reviewed by a panel of expert hepatopathologists. Fibrosis was staged with the Ishak scale (ranging from 0 = no fibrosis to 6 = cirrhosis). Biopsy fragmentation and length as well as number of portal tracts were recorded. We compared rates of prespecified clinical outcomes of hepatic decompensation and hepatocellular carcinoma across individual Ishak fibrosis stages. Of 1050 biopsy specimens, 25% were fragmented, 63% longer than 1.5 cm, 69% larger than 10 mm 2 , and 75% had 10 or more portal tracts. Baseline laboratory markers of liver disease severity were worse and the frequency of esophageal varices higher with increasing Ishak stage ( P < 0.0001). The 6-year cumulative incidence of first clinical outcome was 5.6% for stage 2, 16.1% for stage 3, 19.3% for stage 4, 37.8% for stage 5, and 49.3% for stage 6. Among nonfragmented biopsy specimens, the predictive ability of Ishak staging was enhanced; however, no association was observed between Ishak stage and outcomes for fragmented biopsy specimens because of high rates of outcomes for patients with noncirrhotic stages. Similar results were observed with liver transplantation or liver-related death as the outcome. Conclusion : Ishak fibrosis stage predicts clinical outcomes, need for liver transplantation, and liver-related death in patients with chronic hepatitis C. Patients with fragmented biopsy specimens with low Ishak stage may be understaged histologically. (H EPATOLOGY 2010;51:585–594.)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64929/1/23315_ftp.pd

Effect of substitution of Mn3+ by other trivalent cations on the colossal magnetoresistance and related properties of the manganates:La0.7A0.3Mn1−xMxO3 La_{0.7}A_{0.3}Mn_{1-x}M_{x}O_{3} (A = Ca, Sr, Pb; M = Al, Cr, Fe, Co)

Investigations of the manganates of the general formula La(0.7)A(0.3)Mn(1-x)M(x)O(3) with A = Ca, Sr, or Pb and M = Al, Cr, Fe, or Co in the x range 0.00-0.20 have shown that the ferromagnetic T-c and the insulator-metal transition temperature, T-p, generally decrease with increase in x, accompanied by an increase in the resistivity at T-p The value of the saturation magnetization and, hence, the saturation moment also decrease with increase in x. The magnitude of magnetoresistance is generally smaller in the Fe and Co substituted systems when A = Pb. However, with A Sr, we find enhanced colossal magnetoresistance in the 50-250 K range when x = 0.1 for M Fe and Co. Interestingly, these systems exhibit a nearly flat resistivity curve over this temperature rang

Detection and visualization of dural pulsation for spine needle interventions

© 2015, CARS. Purpose: Epidural and spinal anesthesia are common procedures that require a needle to be inserted into the patient’s spine to deliver an anesthetic. Traditionally, these procedures were performed without image guidance, using only palpation to identify the correct vertebral interspace. More recently, ultrasound has seen widespread use in guiding spinal needle interventions. Dural pulsation is a valuable cue for finding a path through the vertebral interspace and for determining needle insertion depth. However, dural pulsation is challenging to detect and not perceptible in many cases. Here, a method for automatically detecting very subtle dural pulsation from live ultrasound video is presented. Methods: A periodic model is fit to the B-mode intenstity values through extended Kalman filtering. The fitted frequencies and amplitudes are used to detect and visualize dural pulsation. The method is validated retrospectively on synthetic and human video and used in real time on an interventional spinal phantom. Results: This method was capable of quickly identifying subtle dural pulsation and was robust to background noise and motion. The pulsation visualization reduced both the normalized path length and number of attempts required in a mock epidural procedure. Conclusion: This technique is able to localize the dura and help find a clear needle trajectory to the epidural space. It can be run in real time on commercial ultrasound systems and has the potential to improve ultrasound guidance of spine needle interventions