Interventions to improve sarcopenia in cirrhosis: A systematic review

BACKGROUND: Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis. Hence, it is imperative to study interventions which targets to improve sarcopenia in cirrhosis. AIM: To examine the relationship between interventions such nutritional supplementation, exercise, combined life style intervention, testosterone replacement and trans jugular intrahepatic portosystemic shunt (TIPS) to improve muscle mass in cirrhosis. METHODS: We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles (RCTs, clinical trial, comparative study) in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above. In the screening process, 154 full text articles were included in the review and 129 studies were excluded. RESULTS: We identified 24 studies that met review inclusion criteria. The studies were diverse in terms of the design, setting, interventions, and outcome measurements. We performed only qualitative synthesis of evidence due to heterogeneity amongst studies. Risk of bias was medium in most of the included studies and low quality of evidence showed improvement in the muscle mass, strength and physical function following aerobic exercise. 60% of the included studies on the nutritional intervention, 100% of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis. CONCLUSION: Although the quality of evidence is low, the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions. High quality randomized controlled trials needed to further strengthen these findings

All-optical header processing in a 42.6Gb/s optoelectronic firewall

A novel architecture to enable future network security systems to provide effective protection in the context of continued traffic growth and the need to minimise energy consumption is proposed. It makes use of an all-optical pre-filtering stage operating at the line rate under software control to distribute incoming packets to specialised electronic processors. An experimental system that integrates software controls and electronic interfaces with an all-optical pattern recognition system has demonstrated the key functions required by the new architecture. As an example, the ability to sort packets arriving in a 42.6Gb/s data stream according to their service type was shown experimentally

Fgf9 and Wnt4 Act as Antagonistic Signals to Regulate Mammalian Sex Determination

The genes encoding members of the wingless-related MMTV integration site (WNT) and fibroblast growth factor (FGF) families coordinate growth, morphogenesis, and differentiation in many fields of cells during development. In the mouse, Fgf9 and Wnt4 are expressed in gonads of both sexes prior to sex determination. Loss of Fgf9 leads to XY sex reversal, whereas loss of Wnt4 results in partial testis development in XX gonads. However, the relationship between these signals and the male sex-determining gene, Sry, was unknown. We show through gain- and loss-of-function experiments that fibroblast growth factor 9 (FGF9) and WNT4 act as opposing signals to regulate sex determination. In the mouse XY gonad, Sry normally initiates a feed-forward loop between Sox9 and Fgf9, which up-regulates Fgf9 and represses Wnt4 to establish the testis pathway. Surprisingly, loss of Wnt4 in XX gonads is sufficient to up-regulate Fgf9 and Sox9 in the absence of Sry. These data suggest that the fate of the gonad is controlled by antagonism between Fgf9 and Wnt4. The role of the male sex-determining switch— Sry in the case of mammals—is to tip the balance between these underlying patterning signals. In principle, sex determination in other vertebrates may operate through any switch that introduces an imbalance between these two signaling pathways

Preliminary Results from NEOWISE: An Enhancement to the Wide-field Infrared Survey Explorer for Solar System Science

The \emph{Wide-field Infrared Survey Explorer} has surveyed the entire sky at four infrared wavelengths with greatly improved sensitivity and spatial resolution compared to its predecessors, the \emph{Infrared Astronomical Satellite} and the \emph{Cosmic Background Explorer}. NASA's Planetary Science Division has funded an enhancement to the \WISE\ data processing system called "NEOWISE" that allows detection and archiving of moving objects found in the \WISE\ data. NEOWISE has mined the \WISE\ images for a wide array of small bodies in our Solar System, including Near-Earth Objects (NEOs), Main Belt asteroids, comets, Trojans, and Centaurs. By the end of survey operations in February 2011, NEOWISE identified over 157,000 asteroids, including more than 500 NEOs and $\sim$120 comets. The NEOWISE dataset will enable a panoply of new scientific investigations.Comment: ApJ accepte

Heme Degrading Protein HemS Is Involved in Oxidative Stress Response of Bartonella henselae

Bartonellae are hemotropic bacteria, agents of emerging zoonoses. These bacteria are heme auxotroph Alphaproteobacteria which must import heme for supporting their growth, as they cannot synthesize it. Therefore, Bartonella genome encodes for a complete heme uptake system allowing the transportation of this compound across the outer membrane, the periplasm and the inner membranes. Heme has been proposed to be used as an iron source for Bartonella since these bacteria do not synthesize a complete system required for iron Fe3+uptake. Similarly to other bacteria which use heme as an iron source, Bartonellae must transport this compound into the cytoplasm and degrade it to allow the release of iron from the tetrapyrrole ring. For Bartonella, the gene cluster devoted to the synthesis of the complete heme uptake system also contains a gene encoding for a polypeptide that shares homologies with heme trafficking or degrading enzymes. Using complementation of an E. coli mutant strain impaired in heme degradation, we demonstrated that HemS from Bartonella henselae expressed in E. coli allows the release of iron from heme. Purified HemS from B. henselae binds heme and can degrade it in the presence of a suitable electron donor, ascorbate or NADPH-cytochrome P450 reductase. Knocking down the expression of HemS in B. henselae reduces its ability to face H2O2 induced oxidative stress

Materials for Pharmaceutical Dosage Forms: Molecular Pharmaceutics and Controlled Release Drug Delivery Aspects

Controlled release delivery is available for many routes of administration and offers many advantages (as microparticles and nanoparticles) over immediate release delivery. These advantages include reduced dosing frequency, better therapeutic control, fewer side effects, and, consequently, these dosage forms are well accepted by patients. Advances in polymer material science, particle engineering design, manufacture, and nanotechnology have led the way to the introduction of several marketed controlled release products and several more are in pre-clinical and clinical development

Comment letters to the National Commission on Commission on Fraudulent Financial Reporting, 1987 (Treadway Commission) Vol. 1

https://egrove.olemiss.edu/aicpa_sop/1661/thumbnail.jp

Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults (Review)

Background: Fibromyalgia is a long-term medical condition that is characterised by long-lasting widespread pain throughout the body. TENS is a treatment that involves putting pulsed electrical currents across the surface of the skin using two or four electrodes. It is used to manage painful conditions. TENS is inexpensive, can be self-administered by people with fibromyalgia, and is not associated with any particular side effects. TENS reduces pain during movement so it may be useful in addition to other treatments to help people carry on their normal lives. Study characteristics: In January 2017, we found eight clinical studies that examined 315 people. We included TENS administered to produce a non-painful 'tingling' sensation at the site of pain either as a treatment alone or combined with exercise treatment. All studies used TENS in comparison with 'fake' (called placebo or sham) TENS, no treatment, or other treatments such as medicine or hydrotherapy (treatment in water). Key results: We did not find enough high-quality studies to allow us to come to any conclusions about the effectiveness of TENS for fibromyalgia pain. Even though seven studies concluded that TENS relieved pain associated with fibromyalgia, the studies were low quality and the findings for measures of pain were inconsistently reported. Studies did not measure most of our outcomes and it was not always clear what aspects of pain were being reported (e.g. present pain, remembered pain, pain severity, etc.). Only one small pilot study found that one 30-minute treatment of TENS reduced pain on movement during and immediately after treatment; however, there were too few participants observed and it is unknown whether this effect would be maintained over a longer course of TENS treatments. Overall, it is not possible to judge whether TENS reduces pain associated with fibromyalgia. There were no serious side events reported in any of the studies. Quality of the evidence: We rated the quality of the evidence from studies using four levels: very low, low, moderate, or high. Very low-quality evidence means that we are very uncertain about the results. High-quality evidence means that we are very confident in the results. The quality of the evidence was very low overall because of a lack of data

Transcutaneous Electrical Nerve Stimulation (TENS) for fibromyalgia in adults

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the analgesic efficacy and adverse events of TENS for fibromyalgia in adults. We will assess TENS on its own or added to usual care in comparisons with placebo (sham) TENS, usual care, or no treatment