Acute-on-chronic liver failure (ACLF):the 'Kyoto Consensus'-steps from Asia

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies.</p

Acute-on-Chronic Liver Failure (ACLF): The ‘Kyoto Consensus’-Steps From Asia

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the APASL ACLF Research Consortium (AARC) was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the \u27Golden Therapeutic Window\u27, the \u27transplant window\u27, and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The \u27Kyoto APASL Consensus\u27 presented below carries the final recommendations along with the relevant background information and areas requiring future studies

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Hip disarticulation for non-salvageable primary malignant sarcoma of femur: What were the oncological &amp; functional outcomes?

Background: Currently, there is limited literature available on hip disarticulation for primary malignant bone tumours. The purpose of this retrospective study is to evaluate the demographic distribution, clinical behaviour, and oncological outcomes and functional outcomes following hip disarticulation in patients with lower extremity sarcoma. Aims and objectives: The current study's aims and objectives were to examine clinical behaviour, oncological outcome, prognostic variables, and quality of life in patients who underwent hip disarticulation for primary sarcoma of the femur. Material &amp; methods: This study includes a retrospective examination of patients with primary femoral sarcoma who had hip articulation between May 2015 and December 2018. Neoadjuvant chemotherapy was administered to all patients with osteosarcoma and Ewing's sarcoma per institutional policy. The R0 resection had been performed on each patient. There were 24 patients with primary femur sarcoma (16 men and 8 women). The patients' median age was 28.5 years (range 11 years–70 years). Results: Among 24 patients, 5 patients had distant metastasis at presentation. The computed median overall survival was 23.1 months (95 % CI:(14.76, 31.44)). Osteosarcoma, Ewing's sarcoma, and chondrosarcoma were the three most frequent cancers associated with hip disarticulation. During follow-up, thirteen patients (68.4 %) out of 19 patients suffered a recurrence. Disease-free survival was 16.97 months(95 % CI:(1.89, 32.04)). Metastatic disease at presentation was associated with a low overall survival rate. Both overall survival and disease-free survival were found to have strong positive correlation with pathological fracture at presentation. Quality of Life assessment of live patients shows reasonable ECOG and general health to maintain personal care. Conclusion: Hip disarticulation is a surgical option reserved for individuals with non-salvageable tumours around the knee and hip joint. Hip disarticulation is associated with a poor prognosis, a high recurrence rate, and a low long-term survival rate. To employ emerging technology to enhance the quality of life and prosthetic limb, more research and study must be done

Proceedings of International Conference on Women Researchers in Electronics and Computing

This proceeding contains articles on the various research ideas of the academic community and practitioners presented at the international conference, “Women Researchers in Electronics and Computing” (WREC’2021). WREC'21 was organized in online mode by Dr. B R Ambedkar National Institute of Technology, Jalandhar (Punjab), INDIA during 22 – 24 April 2021. This conference was conceptualized with an objective to encourage and motivate women engineers and scientists to excel in science and technology and to be the role models for young girls to follow in their footsteps. With a view to inspire women engineers, pioneer and successful women achievers in the domains of VLSI design, wireless sensor networks, communication, image/ signal processing, machine learning, and emerging technologies were identified from across the globe and invited to present their work and address the participants in this women oriented conference. Conference Title: International Conference on Women Researchers in Electronics and ComputingConference Acronym: WREC'21Conference Date: 22–24 April 2021Conference Location: Online (Virtual Mode)Conference Organizers: Department of Electronics and Communication Engineering, Dr. B. R. Ambedkar National Institute of Technology, Jalandhar, Punjab, INDI