Primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown aetiology characterised by inflammation and fibrosis of the biliary tree. The mean age at diagnosis is 40 years and men are affected twice as often as women. There is a reported annual incidence of PSC of 0.9–1.31/100,000 and point prevalence of 8.5–13.6/100,000. The onset of PSC is usually insidious and many patients are asymptomatic at diagnosis or have mild symptoms only such as fatigue, abdominal discomfort and pruritus In late stages, splenomegaly and jaundice may be a feature. In most, the disease progresses to cirrhosis and liver failure. Cholangiocarcinoma develops in 8–30% of patients. PSC is thought to be immune mediated and is often associated with inflammatory bowel disease, especially ulcerative colitis. The disease is diagnosed on typical cholangiographic and histological findings and after exclusion of secondary sclerosing cholangitis. Median survival has been estimated to be 12 years from diagnosis in symptomatic patients. Patients who are asymptomatic at diagnosis, the majority of whom will develop progressive disease, have a survival rate greater than 70% at 16 years after diagnosis. Liver transplantation remains the only effective therapeutic option for patients with end-stage liver disease from PSC, although high dose ursodeoxycholic acid may have a beneficial effect

Major shifts in species’ relative abundance in grassland mixtures alongside positive effects of species diversity in yield:A continental-scale experiment

Increased species diversity promotes ecosystem function; however, the dynamics of multi-species grassland systems over time and their role in sustaining higher yields generated by increased diversity are still poorly understood. We investigated the development of species’ relative abundances in grassland mixtures over 3 years to identify drivers of diversity change and their links to yield diversity effects.A continental-scale field experiment was conducted at 31 sites using 11 different four-species mixtures each sown at two seed abundances. The four species consisted of two grasses and two legumes, of which one was fast establishing and the other temporally persistent. We modelled the dynamics of the four-species mixtures, and tested associations with diversity effects on yield.We found that species’ dynamics were primarily driven by differences in the relative growth rates (RGRs) of competing species, and secondarily by density dependence and climate. The temporally persistent grass species typically had the highest RGRs and hence became dominant over time. Density dependence sometimes induced stabilising processes on the dominant species and inhibited shifts to monoculture. Legumes persisted at most sites at low or medium abundances and persistence was improved at sites with higher annual minimum temperature.Significant diversity effects were present at the majority of sites in all years and the strength of diversity effects was improved with higher legume abundance in the previous year. Observed diversity effects, when legumes had declined, may be due to (i) important effects of legumes even at low abundance, (ii) interaction between the two grass species or (iii) a store of N because of previous presence of legumes.Synthesis. Alongside major compositional changes driven by RGR differences, diversity effects were observed at most sites, albeit at reduced strength as legumes declined. This evidence strongly supports the sowing of multi-species mixtures that include legumes over the long-standing practice of sowing grass monocultures. Careful and strategic selection of the identity of the species used in mixtures is suggested to facilitate the maintenance of species diversity and especially persistence of legumes over time, and to preserve the strength of yield increases associated with diversity

New Variants and Age Shift to High Fatality Groups Contribute to Severe Successive Waves in the 2009 Influenza Pandemic in Taiwan

Past influenza pandemics have been characterized by the signature feature of multiple waves. However, the reasons for multiple waves in a pandemic are not understood. Successive waves in the 2009 influenza pandemic, with a sharp increase in hospitalized and fatal cases, occurred in Taiwan during the winter of 2010. In this study, we sought to discover possible contributors to the multiple waves in this influenza pandemic. We conducted a large-scale analysis of 4703 isolates in an unbiased manner to monitor the emergence, dominance and replacement of various variants. Based on the data from influenza surveillance and epidemic curves of each variant clade, we defined virologically and temporally distinct waves of the 2009 pandemic in Taiwan from May 2009 to April 2011 as waves 1 and 2, an interwave period and wave 3. Except for wave 3, each wave was dominated by one distinct variant. In wave 3, three variants emerged and co-circulated, and formed distinct phylogenetic clades, based on the hemagglutinin (HA) genes and other segments. The severity of influenza was represented as the case fatality ratio (CFR) in the hospitalized cases. The CFRs in waves 1 and 2, the interwave period and wave 3 were 6.4%, 5.1%, 15.2% and 9.8%, respectively. The results highlight the association of virus evolution and variable influenza severity. Further analysis revealed that the major affected groups were shifted in the waves to older individuals, who had higher age-specific CFRs. The successive pandemic waves create challenges for the strategic preparedness of health authorities and make the pandemic uncertain and variable. Our findings indicate that the emergence of new variants and age shift to high fatality groups might contribute potentially to the occurrence of successive severe pandemic waves and offer insights into the adjustment of national responses to mitigate influenza pandemics

Vertical rhizome disking to reduce Elymus repens (quackgrass) abundance in grass-clover leys

Elymus repens is a problematic perennial weed in annual crops, grasslands and leys. Rhizome fragmentation by vertical disking can potentially reduce E. repens abundance with minimal tillage, but data are lacking on its efficiency in forage production. In a two-year study (2017-2018, 2018-2019) conducted in two forage grassclover leys that were mostly weed-free except for large E. repens populations, this study examined effects on forage yield, botanical composition, and E. repens rhizome biomass of rhizome fragmentation at significant growth initiation in spring (early rhizome fragmentation, ERF) and/or when conditions allowed after the first forage cut (late rhizome fragmentation, LRF). Cold, wet springs and hard, dry soil in summer delayed treatment in both treatment years, to late spring (ERF) and late summer/early autumn (LRF). In the treatment year, ERF reduced first-cut forage yield by 44% compared with no rhizome fragmentation, while LRF decreased secondand third-cut yield by 24% and 53%, respectively. In the year after treatment, ERF increased total forage yield by on average 10%, while LRF had no effect. Over both years, combined forage yield was reduced by 11% by ERF and 4% by LRF. Both treatments reduced E. repens rhizome biomass, but inconsistently (ERF by 25% in one year only, LRF by 24% at one of two sites). ERF reduced E. repens incidence in forage by 10% in the treatment year, but had no effect in the following year. Thus, rhizome fragmentation by vertical disking can reduce E. repens abundance in grass-clover leys, but the effect is inconsistent and forage yield can be impaired, especially in swards with much E. repens. Moreover, disking is hampered by hard, dry soil conditions

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