The effects of vasopressin and its analogues on the liver and its disorders in the critically ill:

Purpose of review: Vasopressin and terlipressin, a long-acting V1a analogue, are increasingly used in intensive care. The main clinical indications are the treatment of patients with septic shock and of patients with cirrhosis, who develop variceal bleeding, the hepatorenal syndrome or both. In this review, we summarize the effects of these drugs on splanchnic hemodynamics and organ function.Recent findings: A recent systematic meta-analysis of randomized trials suggests that terlipressin may improve renal function in hepatorenal syndrome and thereby reduce mortality by 34%. Moreover, a recent study reported that association of terlipressin and albumin was more effective than terlipressin alone. In patients with variceal bleeding, the bleeding control is significantly improved by early administration of terlipressin. The place of vasopressin in the treatment of patients with septic shock is still discussed, but compared with norepinephrine, vasopressin showed at least an equal efficacy. Summary: The use of vasopressin and its synthetic analogues has shown beneficial effects in the management of patients with cirrhosis, especially in the context of variceal bleeding, the hepatorenal syndrome or both. In both cases, the use of terlipressin improved survival. Therefore, in these clinical indications, terlipressin is a part of recommendations. The role of vasopressin in patients with septic shock remains to be precisely evaluated

Reproductive capacity of the red cusk-eel genypterus chilensis (Guichenot, 1848) in captivity

Indexación: Scopus.This work was supported by the FONDEF Project D06I 1024 “Development of technologies for the production of red cusk-eel fingerlings (Genypterus chilensis)”.Genypterus chilensis is a marine fish of high gastronomic demand, whose capture has declined in recent years due to overfishing. In the development of the farming technology, high mortalities were obtained during egg incubation. The objective of this study is to contribute to the knowledge of fecundity and eggs viability of G. chilensis in captivity. The spawns of G. chilensis were analyzed over a period of 2 years and 3 months. The total fecundity was estimated by counting the masses and eggs produced monthly throughout the period. The results confirm that G. chilensis is a partial spawner, since a female may more than two masses of eggs per day, due to a large amount of mass spawned per season (621 average). The total production of masses of the Farming Centre during the period was 2,290; of these, only 7% (166) corresponding to 15,330,517 eggs were incubated. Because of its high fecundity, G. chilensis produces numerous masses of eggs, of which only a small percentage reaches incubation, as well as it occurs in other marine fish. © 2018, Escuela de Ciencias del Mar. All rights reserved.https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-560X201800020048

EXT-TAURUM P2T: an Extended Secure CAN-FD Architecture for Road Vehicles

The automobile industry is no longer relying on pure mechanical systems; instead, it benefits from advanced Electronic Control Units (ECUs) in order to provide new and complex functionalities in the effort to move toward fully connected cars. However, connected cars provide a dangerous playground for hackers. Vehicles are becoming increasingly vulnerable to cyber attacks as they come equipped with more connected features and control systems. This situation may expose strategic assets in the automotive value chain. In this scenario, the Controller Area Network (CAN) is the most widely used communication protocol in the automotive domain. However, this protocol lacks encryption and authentication. Consequently, any malicious/hijacked node can cause catastrophic accidents and financial loss. Starting from the analysis of the vulnerability connected to the CAN communication protocol in the automotive domain, this paper proposes EXT-TAURUM P2T a new low-cost secure CAN-FD architecture for the automotive domain implementing secure communication among ECUs, a novel key provisioning strategy, intelligent throughput management, and hardware signature mechanisms. The proposed architecture has been implemented, resorting to a commercial Multi-Protocol Vehicle Interface module, and the obtained results experimentally demonstrate the approach’s feasibility

TAURUM P2T: Advanced secure CAN-FD architecture for road vehicle

Interconnected devices are growing very fast in today's automotive market, providing new and complex features that cover very different domains. This vast and continuous requirement for new features brings to impact areas categorized as real-time safety-critical devices, opening the possibility to add potential vulnerabilities. By analyzing the security vulnerabilities within vehicle networks, this paper aims at proposing a new generation of a secure architecture based on Controller Area Network (CAN) called TAURUM P2T. This new architecture looks at mitigating the vulnerabilities found in the current network systems of road vehicles by introducing a low-cost and efficient solution based on the introduction of a Secure CAN network able to implement a novel key provisioning strategy. The proposed architecture has been implemented, resorting to a commercial Multi-Protocol Vehicle Interface module, and the obtained results experimentally demonstrate the approach's feasibility

Screening for significant chronic liver disease by using three simple ultrasound parameters

Objectives Chronic liver diseases remain asymptomatic for many years. Consequently, patients are diagnosed belatedly, when cirrhosis is unmasked by lifethreatening complications. We aimed to identify simple ultrasound parameters for the screening of patients with unknown significant chronic liver disease. Methods Three hundred and twenty seven patients with chronic liver disease, liver biopsy, and ultrasound examination were included in the derivation set. 283 consecutive patients referred for ultrasound examination were included in the validation set; those selected according to the ultrasound parameters identified in the derivation set were then referred for specialized consultation including non-invasive fibrosis tests and ultimately liver biopsy if liver fibrosis was suspected. Results In the derivation set, three ultrasound parameters were independent predictors of severe fibrosis: liver surface irregularity, spleen length (>110 mm), and demodulation of hepatic veins. The association of ≥2 of the three above parameters provided 49.1% sensitivity and 86.9% specificity. In the validation set, at ≥2 of the three parameters were present in 23 (8%) of the patients. Among these patients, 8 had liver fibrosis (F ≥ 1), 5 had significant fibrosis (F  ≥2) and two cirrhosis. Conclusion The generalized search of three simple ultrasound signs in patients referred for abdominal ultrasound examination may be an easy way to detect those with silent but significant chronic liver disease

Simple blood fibrosis tests reduce unnecessary referrals for specialized evaluations of liver fibrosis in NAFLD and ALD patients

BACKGROUND: Liver fibrosis evaluation is mandatory in non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) to decide the patient management. Patients with these diseases are usually under the care of non-liver specialists who refer them to specialized centers where the most accurate fibrosis tests are available. We aimed to evaluate whether simple blood fibrosis tests available to all physicians help to reduce the rate of unnecessary referral of NAFLD and ALD patients without advanced fibrosis. METHODS: NAFLD and/or ALD patients newly referred to our center for a non-invasive evaluation of liver fibrosis were retrospectively included. The FibroMeter (FM, combination of blood markers and Fibroscan results) was defined as the reference test for specialized evaluation of liver fibrosis. A FM result <0.384 indicated the absence of advanced fibrosis and thus an "unnecessary referral". RESULTS: 558 patients were included (NAFLD: 283, ALD: 156, mixed NAFLD+ALD: 119). FM was <0.384 (unnecessary referral) in 58.8% of patients. FIB4 was <1.30 in 45.2% and eLIFT <8 in 47.7% of the patients. 84.9% of patients with FIB4 <1.30 and 85.3% of patients with eLIFT <8 had also FM <0.384. Therefore, using FIB4 or eLIFT as first-line evaluation of liver fibrosis decreased by three-fold the rate of unnecessary referral. The negative predictive value of FIB4 and eLIFT was >80% whatever the underlying cause of chronic liver disease. CONCLUSION: The use of eLIFT by non-liver specialists for NAFLD and ALD patients can improve the relevance of referrals for specialized evaluation of liver fibrosis

The noninvasive diagnosis of esophageal varices and its application in clinical practice

Here, we review recent improvements made to different noninvasive tests used for the diagnosis of esophageal varices (EV) in the light of the recent Baveno VI recommendation and with an emphasis on clinical application. Like for fibrosis tests, these noninvasive EV tests can be classified as direct markers when they provide a visualization of EV (including all imaging procedures like endoscopy or radiology) and as indirect markers when they do not (blood markers or elastometry). Clinical descriptors expressed as percentages, especially the spared endoscopy rate and the missed high-risk esophageal varices (HREV) rate, are more eloquent in this setting than classical statistical descriptors like accuracy. Single biomarkers are insufficient, generally due to a missed HREV rate exceeding the acceptable limit of 5% indicated in the Baveno VI consensus. Thus, biomarker combinations are currently garnering the most interest. The Baveno VI recommendation states that in alcoholic and viral cirrhoses, screening endoscopy can be safely set aside for patients with liver stiffness<20kPa and platelets>150G/L. The Baveno rule\u27s mean missed HREV rate is<5% but its spared endoscopy rate is<20%. New combinations or stepwise algorithms show promise but must be validated. Going forward, the Baveno rule provides a simple noninvasive method to rule out HREV in clinical practice but the need for further research continues. The noninvasive diagnosis of HREV will be significantly improved by new, simple and affordable combinations

Cirrhosis Diagnosis and Liver Fibrosis Staging: Transient Elastometry Versus Cirrhosis Blood Test.

INTRODUCTION: Elastometry is more accurate than blood tests for cirrhosis diagnosis. However, blood tests were developed for significant fibrosis, with the exception of CirrhoMeter developed for cirrhosis. We compared the performance of Fibroscan and CirrhoMeter, and classic binary cirrhosis diagnosis versus new fibrosis staging for cirrhosis diagnosis. METHODS: The diagnostic population included 679 patients with hepatitis C and liver biopsy (Metavir staging and morphometry), Fibroscan, and CirrhoMeter. The prognostic population included 1110 patients with chronic liver disease and both tests. RESULTS: Binary diagnosis: AUROCs for cirrhosis were: Fibroscan: 0.905; CirrhoMeter: 0.857; and P=0.041. Accuracy (Youden cutoff) was: Fibroscan: 85.4%; CirrhoMeter: 79.2%; and P<0.001. Fibrosis classification provided 6 classes (F0/1, F1/2, F2±1, F3±1, F3/4, and F4). Accuracy was: Fibroscan: 88.2%; CirrhoMeter: 88.8%; and P=0.77. A simplified fibrosis classification comprised 3 categories: discrete (F1±1), moderate (F2±1), and severe (F3/4) fibrosis. Using this simplified classification, CirrhoMeter predicted survival better than Fibroscan (respectively, χ=37.9 and 19.7 by log-rank test), but both predicted it well (P<0.001 by log-rank test). Comparison: binary diagnosis versus fibrosis classification, respectively, overall accuracy: CirrhoMeter: 79.2% versus 88.8% (P<0.001); Fibroscan: 85.4% versus 88.2% (P=0.127); positive predictive value for cirrhosis by Fibroscan: Youden cutoff (11.1 kPa): 49.1% versus cutoffs of F3/4 (17.6 kPa): 67.6% and F4 classes (25.7 kPa): 82.4%. CONCLUSIONS: Fibroscan\u27s usual binary cutoffs for cirrhosis diagnosis are not sufficiently accurate. Fibrosis classification should be preferred over binary diagnosis. A cirrhosis-specific blood test markedly attenuates the accuracy deficit for cirrhosis diagnosis of usual blood tests versus transient elastometry, and may offer better prognostication