A Novel Backward Stepwise Logistic Regression and Classification and Regression Tree Model to Predict 180-day Clinical Outcomes in Hepatitis B Virus-Acute-on-Chronic Liver Failure Patients

As the era of precision and personalized medicine is gaining exponential positive gain in the field of medicine, there is a positive shift towards a more evidence-based patient care approach for patients with hepatological diseases. One factor that is crucial in any physician’s decision-making efforts involves the application of novel innovative approaches that can enhance predicting survival outcome. Acute-on-chronic liver failure (ACLF) is a perfect example of how liver can rapidly deteriorate, and the hepatitis B virus (HBV) is one crucial culprit. Patients can experience organ failure that leads to their mortality, and in this article the authors clearly described the use of backward stepwise logistic regression (LR) and classification and regression tree (CART) analysis to derive two predictive models and then compared them with the model of end-stage liver disease (MELD) score for novel prognostic models of the 180-day outcome for patients with HBV-ACLF

An assessment of dynamic pressure in buried tanks subjected to seismic loadings

The seismic performance of storage tanks is a matter of special importance, extending beyond the economic value of the tanks and contents. This has led to attention of many researchers due to the seismic behavior of tanks buried in the soil. Because of the interaction between soil and structure during an earthquake, dynamic analysis of such structures is very important that must be considered. In this paper, according to the interaction effect of soils and structures, under the time history record, seismic behavior of concrete cubic buried tanks has been analyzed using the finite element software ABAQUS. In this process circular and cubic tanks have been studied and the impact of changes in parameters such as earthquake and quantity of water in tanks on pressure on tank's wall has been studied

Geriatric Hepatology: The Hepatic Diseases of the Elderly and Liver Transplant

Introduction: With the aging US population, chronic liver diseases are becoming more commonly diagnosed in the geriatric population. Advanced age leads to changes in liver blood flow, volume, morphology and normal physiology. This predisposes elderly patients to develop certain chronic liver diseases. Also, the clinical course and management differ in an older patient when compared to a younger patient. Some causes of chronic liver disease in the geriatric population include Hepatitis A, B, C, Non-Alcoholic Fatty liver disease, prolonged alcohol use and inflammation. Many chronic liver diseases are characterized by a slow, indolent course of progression with non-specific symptoms and thus may lead to diagnosis at a later age. The presence of an advanced liver disease, cirrhosis, and hepatocellular carcinoma are becoming more frequent in older patients and often the first clinical presentation. Aim: The aim of this study is to highlight hepatic diseases in the geriatric population to better understand the scope of the clinical management including liver transplantation. Method: PubMed, MEDLINE, EMBASE, and EMBASE classic were searched to research published articles, case reports, cross-sectional and case-control studies reporting regarding aging and the liver diseases. Result: Decreases in the functioning of the liver and other organs, as well as, alterations in immune functions should be taken into consideration in the management of the liver diseases. Aging has been shown to not only enhance vulnerability to acute liver injury but also increase the susceptibility of the fibrotic response. Aging has a significant impact on the risk and poor prognosis of various liver diseases including NAFLD, ALD, HCV, and liver transplantation. The diagnosis of advanced liver disease is important to make in the elderly population since many of the condition’s features are treatable and can lead to improved quality of life and, most importantly, decrease the likelihood of acute care hospitalization, which carries a high risk of nosocomial infections and therapeutic mishaps in the aged population. Conclusion: Geriatric patients show various changes in the liver, which play a role in the clinical characteristics of liver diseases in these patients. Geriatric patients with risk factors for hepatitis should be screened for liver disease, along with those that have a family history of liver diseases, or a history of long-term or heavy alcohol consumption. Age cannot be a single exclusion criterion from the liver transplantation, and an individualization strategy, which takes into consideration all risk factors of a recipient, needs to be considered. We suggest geriatric patients should be a candidate for liver transplant, and the healthcare team treating our elderly generation to collaborate for these patients for them to have a smoother transition both in pre-transplant phase and post-transplant phase

Management and treatment of hepatocellular carcinoma with immunotherapy: A review of current and future options

With mortality rates of liver cancer doubling in the last 20 years, this disease is on the rise and has become the fifth most common cancer in men and the seventh most common cancer in women. Hepatocellular carcinoma (HCC) represents approximately 90% of all primary liver cancers and is a major global health concern. Patients with HCC can be managed curatively with surgical resection or with liver transplantation, if they are diagnosed at an early stage. Unfortunately, most patients with HCC present with advanced stages of the disease and have underlying liver dysfunction, which allows only 15% of patients to be eligible for curative treatment. Several different treatment modalities are available, including locoregional therapy radiofrequency ablation, microwave ablation, percutaneous ethanol injection, trans-arterial chemoembolization, transarterial radio-embolization, cryoablation, radiation therapy, stereotactic radiotherapy, systemic chemotherapy, molecularly targeted therapies, and immunotherapy. Immunotherapy has recently become a promising method for inhibiting HCC tumor progression, recurrence, and metastasis. The term “Immunotherapy” is a catch-all, encompassing a wide range of applications and targets, including HCC vaccines, adoptive cell therapy, immune checkpoint inhibitors, and use of oncolytic viruses to treat HCC. Immunotherapy in HCC is a relatively safe option for treating patients with advanced disease in the USA who are either unable to receive or failed sorafenib/lenvatinib therapy and thus may offer an additional survival benefit for these patients. The purpose of this review is to elaborate on some of the most recent advancements in immunotherapy

Active tactile sensibility of three-unit implant-supported FPDs versus natural dentition

Splinting of the implants might improve the active tactile sensibility (ATS) of the pontic area due to cumulative effect of Osseo perception of two retainers; on the other hand, due to the lack of any supporting implant in the axis of occlusal force for the pontic area, ATS might be lower for this portion of FPDs. we evaluated the active tactile sensibility of natural teeth and three-unit implant-supported FPDs. The ATS of posterior 3-unit implant-supported FPD and contralateral teeth was measured in 50 patients, in a random order blinded to patients and assessor, carried out at two sessions. Based on the experimental range of 0 to 70 um, the sigmoid shape of psychometric curve was estimated to locate the 50% values as the ATS thresholds for each tooth or implant. Data were analyzed using unpaired t-tests. The ATS of the teeth and implants differed significantly and compared to teeth, implants exhibited significantly higher ATS thresholds in all the groups. The results of independent t-test showed the highest difference in the means of ATS between the pontic and the first molar tooth. Based on the equivalence testing approach, the 95% CIs indicated that the differences were clinically significant only in the Pontic/First Molar group. In multi-unit implant-supported prostheses the tactile perception of the prosthesis that are placed on fixtures is similar to the natural teeth. In pontic areas there are significant statistical and clinical differences, with much lower tactile sensibility in pontics compared to the natural teeth

Scrum for product innovation : a longitudinal embedded case study

This article describes the innovation processes used in a partnership between Add Latent Ltd., an asset integrity and maintenance management consulting services provider in the energy sector and University of Salford. The challenge faced by the company is to make their in-house expertise more readily available to a worldwide audience. A longitudinal embedded case study has been used to investigate how installable desktop software applications have been redesigned to create a new set of cloud hosted software services. The innovation team adapted an agile scrum process to include exploratory prototyping and manage the geographical distribution of the team members. A minimum viable product was developed that integrated functional elements of previous software tools into an end-to-end data collection, analysis and visualisation product called AimHi which uses a cloud-hosted web services approach. Field trials were conducted using the software at the Uniper, Isle of Grain power station in Kent, UK. Enhancements were made to the AimHi product which was adopted for use at the Uniper site. The product emerged from a Knwledge Transfer Partnership whci was evaluated on cmplettion by InnovateUK and awarded the highest possible “outstanding” grade. The article illustrates how the scrum software development method was tailored for a product innovation context. Extended periods of evaluation and reflection, prototyping and requirement refinement were combined with periods of incremental feature development using sprints. The AimHi product emerged from a technology transfer and innovation project that has successfully reconciled conflicting demands from customers, universities, partner companies and project staff members

Acute Upper Gastrointestinal Bleeding–Impact of Timing of Endoscopy on Patient Outcomes: Impact of Timing of Endoscopy on Patient Outcomes

Acute upper gastrointestinal bleeding (AUGIB) is one of the most common emergencies encountered by gastroenterologists across the world. Various medical and endoscopic therapies have evolved over time to improve patient outcomes. However, controversy still exists around the optimal time of endoscopy for patients with AUGIB. Recently, several studies have been published to answer this clinical question and we have reviewed one of these articles. On 13th October 2021, @Gijournal, we discussed the latest high-impact article published to answer this clinical question. We critically appraised, ‘’Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study’’ which was published in ‘Gut’ on Sep 21 by Cosmos L T Guo et al. This is a brief review of this article and subsequent discussion around it. This session was moderated by Shima Ghavimi, and experts were Cosmos L T Guo, Louis H S Lau, and Rashid N S Lui who were also authors of this paper