Relationship of 24-hour ambulatory blood pressure and heart rate with markers of hepatic function in cirrhotic patients

<p>Abstract</p> <p>Background</p> <p>There is evidence that in cirrhotic patients, certain hemodynamic parameters, such as blood pressure and heart rate, are related to the severity of liver disease. This study investigated whether non-invasive 24-hour ambulatory blood pressure and heart rate are more closely associated with markers of liver disease severity than conventional office measurements.</p> <p>Methods</p> <p>Ambulatory patients with cirrhosis underwent office blood pressure and heart rate measurements, 24-hour ambulatory blood pressure monitoring and blood laboratory tests.</p> <p>Results</p> <p>Fifty-one patients (32 men, mean age 57.4 ± 11.3 years) completed the study. Twenty six patients had compensated liver cirrhosis (group A) and 25 patients had more advanced liver disease (group B). Group A and B patients differed significantly both in ambulatory asleep diastolic blood pressure (p < 0.05) and office diastolic blood pressure (p < 0.01), which were lower in more advanced liver disease. Office blood pressure and heart rate correlations were similar to or even stronger than ambulatory ones. Ambulatory blood pressure and heart rate awake-asleep variation (dipping) showed a relatively flat pattern as markers of liver dysfunction were deteriorating. The strongest correlations were found with both ambulatory and office heart rate, which increased as indicators of severity of liver disease were worsening.</p> <p>Conclusions</p> <p>Heart rate seems to be a more reliable marker of ongoing liver dysfunction than blood pressure. Evaluation of blood pressure and heart rate with 24-hour ambulatory measurement does not seem to offer more information than conventional office measurements.</p

STUDY OF THE SECONDARY FAILURE TO ORAL HYPOGLYCEMIC AGENTS IN PATIENTS WITH TYPE II DIABETES MELLITUS. ASSOCIATION WITH CLINICAL AND BIOCHEMICAL INDICES AND THE ANTI-ISLET CELL ANTIBODIES

PATIENTS WITH TYPE II DIABETES MELLITUS WHO DEVELOP SECONDARY FAILURE TO ORAL HYPOGLYCEMIC AGENTS IN COMPARISON WITH THOSE WHO CONTINUE TO BE SUCCESSFULLY CONTROLLED BY ORAL HYPOGLYCEMIC AGENTS HAVE: I) HIGHER PREVALENCE OF POSITIVE ISLET CELL ANTIBODIES. II) REDUCED SECRETORY CAPACITY OF B CELLS. IN PATIENTS WITH SECONDARY FAILURE THOSE WITH POSITIVE ICA I) ARE CHARACTERISED BY SHORTER DIABETES DURATION AND LOWER BODY WEIGHT IN COMPARISON WITH THOSE WITH SECONDARYFAILURE AND ISLET CELL ANTIBODIES NEGATIVE, II) FORM A SPECIAL SUBGROUP WHICHIS CLEARLY DISTINGUISHED FROM ICA NEGATIVE PATIENTS WITH SECONDARY FAILURE BY THE FOLLOWING CHARACTERISTICS: 1) DEVELOPMENT OF DM IN OLDER AGE WITH MILD SYMPTOMS BUT HIGH TITERS OF ISLET CELL ANTIBODIES. 2) LOW BODY WEIGHT. 3) FASTDEVELOPMENT OF SECONDARY FAILURE TO OVAL HYPOGLYCEMIC AGENTS NAMELY 3,3 YEARSAFTER THE DIAGNOSIS OF DM.ΑΣΘΕΝΕΙΣ ΜΕ Σ.Δ. ΤΥΠΟΥ ΙΙ ΟΙ ΟΠΟΙΟΙ ΠΑΡΟΥΣΙΑΖΟΥΝ ΔΕΥΤΕΡΟΠΑΘΗ ΑΣΤΟΧΙΑ ΣΤΑ ΑΝΤΙΔΙΑΒΗΤΙΚΑ ΔΙΣΚΙΑ ΣΥΓΚΡΙΝΟΜΕΝΟΙ ΜΕ ΑΥΤΟΥΣ ΠΟΥ ΕΞΑΚΟΛΟΥΘΟΥΝ ΝΑ ΡΥΘΜΙΖΟΝΤΑΙ ΕΠΑΡΚΩΣ Μ'ΑΥΤΑ ΕΧΟΥΝ: Ι) ΥΨΗΛΟΤΕΡΗ ΣΥΧΝΟΤΗΤΑ ΑΝΙΧΝΕΥΣΕΩΣ ΑΝΤΙΝΗΣΙΔΙΑΚΩΝ ΑΝΤΙΣΩΜΑΤΩΝ(ICA). ΙΙ) ΜΕΙΩΜΕΝΗ ΕΚΚΡΙΤΙΚΗ ΙΚΑΝΟΤΗΤΑ ΤΩΝ Β ΚΥΤΤΑΡΩΝ. ΟΙ ΘΕΤΙΚΟΙ ΣΕ ICA ΑΣΘΕΝΕΙΣ ΜΕ ΔΕΥΤΕΡΟΠΑΘΗ ΑΣΤΟΧΙΑ. Ι) ΧΑΡΑΚΤΗΡΙΖΟΝΤΑΙ ΑΠΟ ΜΙΚΡΟΤΕΡΗ ΔΙΑΡΚΕΙΑ ΔΙΑΒΗΤΗ ΚΑΙ ΧΑΜΗΛΟΤΕΡΟ ΣΩΜΑΤΙΚΟ ΒΑΡΟΣ ΣΕ ΣΧΕΣΗ ΜΕ ΤΟΥΣ ΑΡΝΗΤΙΚΟΥΣ ΣΕ ICA ΑΣΘΕΝΕΙΣ ΜΕ ΔΕΥΤΕΡΟΠΑΘΗ ΑΣΤΟΧΙΑ. ΙΙ) ΑΠΟΤΕΛΟΥΝ ΙΔΙΑΙΤΕΡΗ ΥΠΟΟΜΑΔΑ ΠΟΥ ΔΙΑΧΩΡΙΖΕΤΑΙ ΣΑΦΩΣ ΑΠΟ ΤΟΥΣ ΑΣΘΕΝΕΙΣ ΜΕ ΑΡΝΗΤΙΚΑ ICA ΚΑΙ ΔΕΥΤΕΡΟΠΑΘΗ ΑΣΤΟΧΙΑ ΚΑΙ ΕΧΕΙ ΤΑ ΕΞΗΣ ΧΑΡΑΚΤΗΡΙΣΤΙΚΑ. 1) ΕΜΦΑΝΙΣΗ ΤΗΣ ΝΟΣΟΥ ΣΕ ΜΕΓΑΛΗ ΗΛΙΚΙΑ ΧΩΡΙΣ ΘΟΡΥΒΩΔΗ ΣΥΜΠΤΩΜΑΤΑ. 2) ΧΑΜΗΛΟ ΣΩΜΑΤΙΚΟ ΒΑΡΟΣ. 3) ΕΜΦΑΝΙΣΗ ΔΕΥΤΕΡΟΠΑΘΟΥΣ ΑΣΤΟΧΙΑΣ ΣΤΑ ΑΝΤΙΔΙΑΒΗΤΙΚΑ ΔΙΣΚΙΑ 3,3 ΕΤΗ ΜΕΤΑ ΤΗΝ ΔΙΑΓΝΩΣΗ ΤΟΥ Σ.Δ

Bevacizumab in the treatment of hereditary hemorrhagic telangiectasia

Introduction: Hereditary hemorrhagic telangiectasia (HHT) is a rare multisystem vascular disorder characterized by epistaxis, mucocutaneous telangiectases and visceral arteriovenous malformations predisposing to shunting and hemorrhage. Angiogenesis has been implicated in the pathogenesis of HHT and therefore angiogenesis inhibitors appear to be the most promising agents. A literature search was performed to identify all articles reporting bevacizumab, a recombinant humanized monoclonal antibody that inhibits vascular endothelial growth factor (VEGF). We focused on the HHT pathogenesis, mechanism of action of the drug, its impact on the HHT symptoms and safety profile. Areas covered: Systemic intravenous administration of bevacizumab improves the frequency and intensity of epistaxis, gastrointestinal (GI) bleeding episodes and liver arteriovenous malformations consequences. The safety profile of the systematic administration of the drug appears to be excellent with hypertension as the unique adverse effect reported so far. Its intranasal administration significantly decreases frequency and severity of nosebleeds and blood transfusion requirements. Expert opinion: In the absence of randomized controlled trials in HHT, criteria of selecting patients and formal recommendations for treatment are lacking. For life-threatening epistaxis requiring blood transfusion, topical treatment with bevacizumab may be beneficial. Systemic treatment with bevacizumab is promising in symptomatic patients with organ involvement and life-threatening conditions

Entecavir treatment in HBV-related decompensated cirrhosis

Entecavir monotherapy has now been evaluated in patients with hepatitis B virus (HBV)-related decompensated cirrhosis. Entecavir achieves 1-year HBV DNA undetectability rates in up to 90% of treatment-naive patients in this setting without any case of resistance. Entecavir was generally safe and well tolerated. Lactic acidosis was described almost exclusively in very advanced liver disease (MELD score &gt; 20) and usually subsided with drug discontinuation. After 1 year of entecavir therapy, the Child-Pugh score improved by &gt;= 2 points in up to 50% of patients and decreased mean MELD score by &gt; 2 points. The 1-year survival rates were 84-91%, mainly associated with baseline Child-Pugh or MELD scores. In conclusion, entecavir monotherapy is an excellent treatment option for treatment-naive patients with HBV-related decompensated cirrhosis

Mobiles and Cognition: The Associations Between Mobile Technology and Cognitive Flexibility

Mobile phones hold a rather permeating role in our lives. Their portability and ease of use have turned them to indispensable parts of our everyday activities, since they are steadily connected to the internet, providing a wide range of applications at the same time. However, there has been little research so far, on the way mobile technology habits could be related to alterations in our cognitive functioning. The review presented in this paper, introduces findings of the last decade on the field of cognitive flexibility, some of which, tend to be contradictory at times. Cognitive flexibility is presented through the prism of attention-switching, task–switching and in close relation to working memory and inhibitory control, functions which have been proved to be interrelated. Moving a step forward, an attempt was made to present a more contemporary approach towards cognitive flexibility and the ways it is affected by mobile and advanced information and communication technologies.</p

Resilience and Academic Underachievement in Gifted Students: Causes, Consequences and Strategic Methods of Prevention and Intervention

Extensive research and numerous reviews have been conducted in the last years, concerning gifted students. The present review aims at investigating the special personality traits of the resilient gifted students, targeting to the development of strategic methods of prevention and intervention, to enhance the resilience of those in danger of academic underachievement. Many research questions concerning resilience, stress, adaptation, protective factors, intelligence and connections to mental health emerged through the procedure of the systematic review. The evidence found substantiates that the enhancement of resilience in gifted students, is of major importance to help them overcome difficulties in family, school and social environments, thus resulting to the establishment of good physical and mental health

Russian Icons, 17th–18th c. Non-Destructive, Non-Invasive Diagnostic Methodology for an Integrated Study of Micrographic Triptychs from the Benaki Museum Collection

The study aims to enhance our knowledge of the materials and techniques applied in the making of Russian, portable ecclesiastical paintings produced after the 16th century, and to evaluate a pilot, non-destructive, non-invasive, research methodology proposed for their examination. Based on research relating to the historical background of their production and distribution in the South, the availability of materials and the applied techniques, a non-destructive, non-invasive methodology is exploited to examine three triptychs and two polyptych side panels belonging to the collection of the Benaki Museum. As their small size and excellent state of preservation prohibit sampling, a study scheme based on visual examination, the implementation of a series of spectral imaging techniques (VIS, IRRFC, SWIR, UVL, RTI, X ray) and a non-invasive micro XRF analysis is tested. Fiber and wood-type identification are carried out microscopically. The collected information relates to the making of the frames and the supports, the design, the use of metal foils and pigments, the order of application of paint layers and the rendering techniques. Due to the non-destructive, non-invasive character of the procedure, organic constituents are not thoroughly examined. Use of an expected palette was confirmed, but the modelling proved rather sophisticated. Among the most interesting finds were the use of distinct pigment mixtures for the underpaints of the flesh parts and certain deviations from the expected rendering techniques. The methodology proved very effective in terms of its output, the global approach of the construction technique, the user-friendly application, the low cost and time consumption factors

New Approaches to the Treatment of Chronic Hepatitis B

The currently recommended treatment for chronic hepatitis B virus (HBV) infection achieves only viral suppression whilst on therapy, but rarely hepatitis B surface antigen (HBsAg) loss. The ultimate therapeutic endpoint is the combination of HBsAg loss, inhibition of new hepatocyte infection, elimination of the covalently closed circular DNA (cccDNA) pool, and restoration of immune function in order to achieve virus control. This review concentrates on new antiviral drugs that target different stages of the HBV life cycle (direct acting antivirals) and others that enhance both innate and adaptive immunity against HBV (immunotherapy). Drugs that block HBV hepatocyte entry, compounds that silence or deplete the cccDNA pool, others that affect core assembly, agents that degrade RNase-H, interfering RNA molecules, and nucleic acid polymers are likely interventions in the viral life cycle. In the immunotherapy category, molecules that activate the innate immune response such as Toll-like-receptors, Retinoic acid Inducible Gene-1 (RIG-1) and stimulator of interferon genes (STING) agonists or checkpoint inhibitors, and modulation of the adaptive immunity by therapeutic vaccines, vector-based vaccines, or adoptive transfer of genetically-engineered T cells aim towards the restoration of T cell function. Future therapeutic trends would likely be a combination of one or more of the aforementioned drugs that target the viral life cycle and at least one immunomodulator