A Complex Case of Cholestasis in a Patient with ABCB4 and ABCB11 Mutations

The low-phospholipid-associated cholelithiasis (LPAC) syndrome is a form of symptomatic cholelithiasis occurring in young adults, characterized by recurrence of symptoms after cholecystectomy and presence of hepatolithiasis. The case refers to a healthy 39-year-old Caucasian male who presented with abdominal pain and jaundice. His blood tests showed conjugated hyperbilirubinemia and elevated liver enzymes (total bilirubin 6.65 mg/dL, γ-glutamyltransferase 699 IU/L) and abdominal computed tomography revealed dilation of common bile duct and left intrahepatic ducts. Magnetic resonance cholangiopancreatography identified choledocholithiasis, retrieved by endoscopic retrograde cholangiopancreatography, after which there was a worsening of jaundice (total bilirubin 23 mg/dL), which persisted for several weeks, possibly due to ciprofloxacin toxicity. After an extensive workup including liver biopsy, the identification of two foci of hepatolithiasis on reevaluation abdominal ultrasound raised the hypothesis of LPAC syndrome and the patient was started on ursodeoxycholic acid, with remarkable improvement. Genetic testing identified the mutation c.1954A>G (p.Arg652Gly) in ABCB4 gene (homozygous) and c.1331T>C (p.Val444Ala) in ABCB11 gene (heterozygous). In conclusion, we describe the unique case of an adult male with choledocholithiasis, hepatolithiasis, and persistent conjugated hyperbilirubinemia after retrieval of stones, fulfilling the criteria for LPAC syndrome and with possible superimposed drug-induced liver injury, in whom ABCB4 and ABCB11 mutations were found, both of which had not been previously described in association with LPAC.info:eu-repo/semantics/publishedVersio

On fermion masses and mixing in a model with A4A_4 symmetry

In a recently proposed multi-Higgs extension of the standard model in which discrete symmetries, $A_4$ and $Z_3$ are imposed we show that, after accommodating the fermion masses and the mixing matrices in the charged currents, the mixing matrices in the neutral currents induced by neutral scalars are numerically obtained. However, the flavor changing neutral currents are under control mainly by mixing and/or mass suppressions in the neutral scalar sector.Comment: Version accepted for publication in International Journal of Modern Physics A. In this version we added a discussion on the charged lepton and neutrino masses. The title has been changed. Other minor changes do not modify the conclusion

The effects of corruption on earnings management

This study provides empirical evidence on the effects of corruption, as proxied by Transparency International’s Corruption Perception Index, on earnings management. It tests the hypothesis of positive association between the countries’ level of corruption and the level of earnings management using a sample of foreign firms with American Depositary Receipts (ADR) in the U.S. market. Findings indicate that corruption perception is related to higher incentives for firms to manipulate earnings in the case of emerging countries. Such results are not identified in developed countries.info:eu-repo/semantics/publishedVersio

The influence of moisture content variation on the withdrawal capacity of self-tapping screws

Due to high axial load-bearing capacity and economical application without pre-drilling, self-tapping screws are widely used in modern timber constructions nowadays. Their withdrawal behaviour, as one mechanism to be verified according to EN 1995-1-1 (2004), is discernibly influenced by the timber member and its moisture content. In case of increase of moisture content above 12 %, test results indicate a significant decrease in withdrawal capacity, which is actually not considered in design procedure. In our paper, we thus concentrate on these experimental studies, carried out in the frame of two research projects. Furthermore, we discuss two models developed for design procedure as well as for data assessment covering a large bandwidth of moisture content and compare them with results from previous investigations

Jarlskog-like invariants for theories with scalars and fermions

Within the framework of theories where both scalars and fermions are present, we develop a systematic prescription for the construction of CP-violating quantities that are invariant under basis transformations of those matter fields. In theories with Spontaneous Symmetry Breaking, the analysis involves the vevs' transformation properties under a scalar basis change, with a considerable simplification of the study of CP violation in the scalar sector. These techniques are then applied in detail to the two Higgs-doublet model with quarks. It is shown that there are new invariants involving scalar-fermion interactions, besides those already derived in previous analyses for the fermion-gauge and scalar-gauge sectors.Comment: 12 pages, Latex, no figure

The albumin-bilirubin score predicting the mortality of patients with decompensated cirrhosis.

info:eu-repo/semantics/publishedVersio

What about vaginal extraction of the kidney? results of an online survey

PURPOSE: We aimed to characterize surgeons opinion about the vaginal extraction of the kidney after transperitoneal laparoscopic nephrectomy. Matherial and Methods: A 9-item questionnaire was published online (Survey Monkey TM) and publicized via email to a multidisciplinary pool of surgeons in Portugal. Data was collected and statistical analysis was performed using IBM SPSS Statistics, Version 21.0. RESULTS: Three hundred and fifty nine inquiries were sent, 154 surgeons completed the questionnaires (response rate of 43.0%). Fifty five point eight percent of the participants would choose the transvaginal approach for themselves or for a close relative. The most stated arguments were a better cosmesis (29.0%) expectancy of lower post operative pain (26.0%) and lower rate of incisional hernias (23.0%). Defenders of the transabdominal procedure justified with an expectancy of lower complication rate (39%), namely impairment of sexual function and fertility (22%). The female gender and the familiarity with transvaginal surgery were the stronger predictors of the option for this approach (70.6% vs 48.5%; p=0,016 and 85.3% vs 46.6%; p <0.001 respectively). CONCLUSIONS: Contrasting with similar surveys published on transvaginal NOTES, the vaginal specimen extraction after conventional laparoscopic nephrectomy was fairly accepted by the inquired surgeons.info:eu-repo/semantics/publishedVersio

Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

PURPOSE: The aim of the this study was to determine the effect of intravitreal antivascular endothelial growth factor injections on intraocular pressure (IOP) and identify possible risk factors for the development of increased IOP. MATERIALS AND METHODS: This prospective study included a total of 106 eyes receiving intravitreal injection of bevacizumab as treatment for macular edema or active choroidal neovascularization. IOP was measured by Goldmann applanation tonometry immediately before the intravitreal injection and 5 min, 1 h and 15 days after the procedure. The records of the study patients were reviewed for age, gender, history of glaucoma, diabetes mellitus, phakic status, systemic and topical medication and number of previous injections. Subconjunctival reflux was registered. IOP elevation was defined as IOP ≥21 mm Hg and/or a change from baseline of ≥5 mm Hg recorded at least on two or more measurements on the same visit. RESULTS: Mean preoperative IOP was 15.31 ± 3.90 mm Hg and postoperative IOP values were 27.27 ± 11.87 mm Hg (after 5 min), 17.59 ± 6.24 mm Hg (after 1 h) and 16.86 ± 3.62 mm Hg (after 15 days). The IOP variation was statistically significant between pre- and postoperative measurements (p < 0.05). Subconjunctival reflux was recorded in 11.3%, and in this subgroup the IOP at 5 min and at 1 h was lower than preoperative IOP (p < 0.05). CONCLUSIONS: More than one third of the eyes achieved IOPs >30 mm Hg 5 min after injection. Subconjunctival reflux contributed to a lower mean postoperative IOP (p < 0.05). Considerations for the management include prophylactic IOP lowering with medical therapy and/or preinjection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to an as-needed injection protocol in patients suffering a marked IOP rise in previous injections. © 2015 S. Karger AG, Basel

Influence of moisture content and gaps on the withdrawal resistance of self tapping screws in CLT

Self-tapping screws (STS) have been proclaimed as the easiest solution for structural timber connections, in special for cross laminated timber (CLT) constructions. In order to understand deeply the composite model “CLT-STS”, an experimental campaign which comprised 270 withdrawal tests was carried out. Maximum withdrawal load capacity of self-tapping screws inserted in plane side of a three layered CLT panel was evaluated considering three main parameters: moisture levels of CLT (i), number of gaps (ii) and the width of gaps (iii). Regarding (i), connections were tested with CLT at 8%, 12% and 18% of moisture content. Concerning (ii) and (iii), different test configurations with 1, 2 and 3 gaps, with 0 or 4mm, were tested. The influences of moisture content and number of gaps were modeled. Further a correlation between test results and a prediction model developed by Uibel and Blaß (2007) has been proposed

Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

PURPOSE: The aim of the this study was to determine the effect of intravitreal antivascular endothelial growth factor injections on intraocular pressure (IOP) and identify possible risk factors for the development of increased IOP. MATERIALS AND METHODS: This prospective study included a total of 106 eyes receiving intravitreal injection of bevacizumab as treatment for macular edema or active choroidal neovascularization. IOP was measured by Goldmann applanation tonometry immediately before the intravitreal injection and 5 min, 1 h and 15 days after the procedure. The records of the study patients were reviewed for age, gender, history of glaucoma, diabetes mellitus, phakic status, systemic and topical medication and number of previous injections. Subconjunctival reflux was registered. IOP elevation was defined as IOP ≥21 mm Hg and/or a change from baseline of ≥5 mm Hg recorded at least on two or more measurements on the same visit. RESULTS: Mean preoperative IOP was 15.31 ± 3.90 mm Hg and postoperative IOP values were 27.27 ± 11.87 mm Hg (after 5 min), 17.59 ± 6.24 mm Hg (after 1 h) and 16.86 ± 3.62 mm Hg (after 15 days). The IOP variation was statistically significant between pre- and postoperative measurements (p < 0.05). Subconjunctival reflux was recorded in 11.3%, and in this subgroup the IOP at 5 min and at 1 h was lower than preoperative IOP (p < 0.05). CONCLUSIONS: More than one third of the eyes achieved IOPs >30 mm Hg 5 min after injection. Subconjunctival reflux contributed to a lower mean postoperative IOP (p < 0.05). Considerations for the management include prophylactic IOP lowering with medical therapy and/or preinjection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to an as-needed injection protocol in patients suffering a marked IOP rise in previous injections. © 2015 S. Karger AG, Basel